Karonga HDSS, Malawi

Transcription

1 50 Kilometres Karonga HDSS, Malawi Karonga DSS area Karonga DSS area Northern Province Malawi M A L A W I Northern Province M A L A W I Kilometers Karonga District is a rural area in northern Malawi, bordered by Lake Malawi on the east, the Songwe flood plain and river on the north (the boundary with Tanzania) and the Central African plateau and Nyika escarpment on the west and south The terrain is varied, with a flat coastal plain along the lake, rising to hills and the plateau (c m) to the west. The climate is appreciably wetter in the north than in the south of the District, which is reflected in differences in vegetation, agriculture and disease patterns (more filariasis and schistosomiasis in the north). The people are of Bantu origin and include several language groups, predominantly Tumbuka in the south and Nkhonde in the northern part of the District. The population has more than doubled during the period of the project, from approximately 110,000 in 1980 and approaching 280,000 today. There is good road access both to the south (Mzuzu, the capital of Malawi s northern region, is 2.5 hours away) and to the north (Mbeya in Tanzania, c. 3hours). Lilongwe, Malawi s capital and site of the nearest international airport, is 592 km and 6.5 hours away by road. The project s headquarters are located near Chilumba, a port-village on the lake in the southern part of Karonga District. Most staff are based there, though some are based in Karonga Boma and in Kaporo, in the north. The area of the Karonga CRS is located in the south of the district near the project headquarters in Chilumba between latitudes and S and longitudes and E and covers an area of approx. 150 km2. The CRS area is unambiguously defined by the lake-shore in the east and the Nyika National Park boundary in the west; the north and the south delineation follow village boundaries. The CRS population is predominantly rural and the economy is based upon subsistence agriculture and fish from the lake. In these rural areas homesteads are scattered, however the area includes 2 peri-urban settlements, a trading centre on the main road carrying goods from Tanzania to

2 Malawi (M1) and the port-village of Chilumba where the settlement structure is dense. Approximately 5,000 population live in these peri-urban centres. Population Characteristics: 2009 TOTAL MID-YEAR POPULATION 33,686 TOTAL LIVEBIRTHS DURING YEAR 1,348 MID-YEAR POPULATION AGED 1-4 5,122 POPULATION AT THE START OF THE YEAR 33,546 POPULATION AT THE END OF THE YEAR 34,040 Figure: Age sex distribution of the population in Karonga DSS Age-Sex Distribution of the Population in Karonga DSS Mid-Year Population Males Females

3 Demographic Characteristics Crude Birth Rate (CBR) Total Fertility Rate (TFR) Crude Death Rate (CDR) Neonatal Mortality Post-neonatal Mortality Infant Mortality Child Mortality (1-4 years) Under Five Mortality Rate of Natural Increase In-Migration Out-Migration Growth 40.2 per 1000 population 5.4 per woman 7.1 per 1000 population 24.5 per 1000 live births 17.8 per 1000 live births 42.3 per 1000 live births 5.1 per 1000 children aged 1-4 years 61.6 per 1000 live births 33.1 per 1000 population 78.1 per 1000 population 99.7 per 1000 population 0.3 per 100 population Priority Research Areas The programme combines detailed clinical and behavioural studies in individuals, with population-based epidemiological and demographic studies to: Understanding the impact of new vaccine introduction on child mortality Defining new methods for tuberculosis control through understanding transmission and pathogen characteristics. Monitor changes in HIV incidence and transmission of drug resistant virus, Assess changes in sexual behaviour and attitudes, Measure HIV-attributable mortality and morbidity Identify factors affecting ART adherence, Evaluate socio-economic and demographic impact, and provide estimates of future trends in the HIV epidemic, in order to identify target areas for future interventions Funders WELLCOME TRUST EUROPEAN UNION THE GATES FOUNDATION ESRC LEPRA Collaborators London School of Hygiene and Tropical Medicine Malawi National AIDS Commission

4 Malawi National TB programme Publications: Most recent 1. Glynn, JR; Kayuni, N; Banda, E; Parrott, F; Floyd, S; Francis-Chizororo, M; Nkhata, M; Tanton, C; Hemmings, J; Molesworth, A; Crampin, AC; French, N Assessing the validity of sexual behaviour reports in a whole population survey in rural Malawi. PLoS One , e Glynn JR, Kayuni N, Floyd S, Banda E, Francis-Chizororo M, Tanton C, Molesworth A, Hemmings J, Crampin AC, French N. Age at menarche, schooling, and sexual debut in northern Malawi. PLoS One (12):e Floyd S, Molesworth A, Dube A, Banda E, Jahn A, Mwafulirwa C, Ngwira B, Branson K, Crampin AC, Zaba B, Glynn JR, French N. Population-level reduction in adult mortality after extension of free anti-retroviral therapy provision into rural areas in northern Malawi. PLoS One ;5(10):e Mallard K, McNerney R, Crampin AC, Houben R, Ndlovu R, Munthali L, Warren RM, French N, Glynn JR Molecular detection of mixed infections of Mycobacterium tuberculosis in sputum samples from patients in Karonga District, Malawi J Clin Micro (12): Epub 2010 Oct Molesworth A, Ndhlovu R,, Banda E, Saul J, Ngwira B, Glynn JR, Crampin AC, French N. High accuracy of home-based community rapid HIV testing in rural Malawi. JAIDS in press Bansode V, Travers S, Drebert Z, Crampin A, GlynnJ, French N, MacCormack G. Drug resistance mutations in drug naïve HIV-1 subtype C infected individuals from rural Malawi AIDS Research and Human Retroviruses in press Houben RM, Glynn JR, Mallard K, Sichali L, Malema S, Fine PE, French N, Crampin AC. Human immunodeficiency virus increases the risk of tuberculosis due to recent re-infection in individuals with latent infection. Int J Tuberc Lung Dis Jul;14(7): PubMed PMID: Crampin AC, Mwaungulu JN, Mwaungulu FD, Mwafulirwa DT, Munthali K, Floyd S, Fine PE, Glynn JR. Recurrent TB: relapse or reinfection? The effect of HIV in a general population cohort in Malawi. AIDS Jan 28;24(3): PubMed PMID: Thye T, Vannberg FO, Wong SH, Owusu-Dabo E, Osei I, Gyapong J, Sirugo G, Sisay-Joof F, Enimil A, Chinbuah MA, Floyd S, Warndorff DK, Sichali L, Malema S, Crampin AC, Ngwira B, Teo YY, Small K, Rockett K, Kwiatkowski D, Fine PE, Hill PC, Newport M, Lienhardt C, Adegbola RA, Corrah T, Ziegler A; African TB Genetics Consortium; The Wellcome Trust Case Control Consortium, Morris AP, Meyer CG, Horstmann RD, Hill AV. Genome-wide association analyses identifies a susceptibility locus for tuberculosis on chromosome 18q11.2. Nat Genet Sep;42(9): PubMed PMID: Jahn A, Floyd S, McGrath N, Crampin AC, Kachiwanda L, Mwinuka V, Zaba B, Fine PE, Glynn JR. Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata. PLoS One Jun 28;5(6):e PubMed PMID: Khor CC, Vannberg FO, Chapman SJ, Guo H, Wong SH, Walley AJ, Vukcevic D, Rautanen A, Mills TC, Chang KC, Kam KM, Crampin AC, Ngwira B, Leung CC, Tam CM, Chan CY, Sung JJ, Yew WW, Toh KY, Tay SK, Kwiatkowski D, Lienhardt C, Hien TT, Day NP, Peshu N, Marsh K, Maitland K, Scott JA, Williams TN, Berkley JA, Floyd S, Tang NL, Fine PE, Goh DL, Hill AV. CISH

5 and susceptibility to infectious diseases. N Engl J Med Jun 3;362(22): PubMed PMID: