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Home , British protectorate, Maravi, Nyasaland

CHAPTER 1

INTRODUCTION

1.1 Geography, History and the Economy

Geography

Malawi is a landlocked country bordered to the north and northeast by the United Republic of , to the east, south and southwest by the People's Republic of and to the west by the Republic of . It is 901 kilometres long and ranges in width from 80 to 161 kilometres. The country has a total area of 118,484 square kilometres, of which 94,276 square kilometres is land area. Fifty-six percent of the land area is arable.

Malawi's most striking topographic feature is the Rift Valley which runs through the entire length of the country, passing through in the northem and central part of the country to the Shire Valley in the south. To the west and south of the lake are fertile plains and high mountain ranges whose main peaks range from 1,698 to 3,002 metres.

The country is divided into three administrative regions; Northern, Central and Southern. There are twenty-four districts, five in the Northern Region, nine in the Central Region and ten in the Southern Region. In each district there are Traditional Authorities (or chiefs) and the smallest administrative unit is the village. There are 43 Traditional Authorities in the Northcrn Region, 79 in the Central Region and 83 in the Southern Region.

Malawi experiences a tropical continental climate with some maritime influences. Rainfall and temperature are greatly influenced by the lake and altitude, which varies from 37 to 3,050 meters above sea level. From May to August, the climate is cool and dry. From September to November, average temperatures rise and the rainy season begins towards the end of this period. The rainy season extends to April or May.

History

Based on the examination of earliest human remains and stone-aged tools, people who are known as Abathwa, Akafula or Mwandionerakuti lived in Malawi since around 8000 BC. During the 9th Century AD, a group of people known by the name of Pule, Lenda or Katanga from the shores of Lake settled in Malawi. Between the 13th and 16th Century AD, Bantu speakers known as settled in central and southern Malawi. Those who eventually settled in central Malawi are known as Chewa while those who settled in southern Malawi are known as Mang'anja or Nyanja. The Tumbuka, , Ngonde, and Lambya eventually came to settle in northem Malawi. Later, during the 19th Century AD, the Ngoni, Yao, Lomwe and Sena settled in Malawi. It was also during this period that Europeans arrived in Malawi.

On 14th May 1891, the British declared the country a British under the name of District Protectorate which was then changed to British Central African Protectorate in 1893. Opposition to colonial adminstration culminated in the uprising led by John Chilembwe in 1915. In 1953 the Federation of and Nyasaland, which was also known as the Centred African Federation, was instituted comprising three countries, namely, (then ), Zambia (then ) and Malawi (then Nyasaland) despite protests from Africans in Malawi through the Nyasaland African Congress, which was a nationalist movement founded in 1944. On 3rd a state of emergency was declared by the colonial government and the Nyasaland African Congress, whose leaders were arrested and detained, became a banned party. In September 1959 the was formed and on 19th September 1959 the Malawi News was launched as the official organ of the Party.

On 15th August 1961 the first multiparty general election was held wherein four political parties contested. The Malawi Congress Party won all twenty seats on the lower roll plus two which it contested on the higher roll. As a result of the general election, the country formed an internal self-government. In April 1964 another general election was held wherein all candidates of the Malawi Congress Party were returned unopposed. On 6th Nyasaland became the independent state of Malawi under the monarchical constitution which was replaced by a republican constitution as of 6th July 1966 when Malawi bec~une a Republic and a one-party state. On 14th June 1993 a National Referendum was eonductcd which resulted in Malawi becoming a multiparty state.

The Economy

Malawi is predominantly an agricultural country. Agricultural produce accounts for 90 percent of Malawi's exports; , tea and cotton are the major export commodities. The country is largely self- sufficient in food.

The improved in 1991 over performance in the three preceding years. Real gross domestic product (GDP) grew at a rate of 7.8 percent in 1991 compared to growth of 4.8 percent, 4.1 percent and 3.3 percent recorded in 1990, 1989 and 1988, respectively. The agricultural and distribution sectors accounted for most of the increase in real GDP.

1.2 Population and Family Planning Policies and Programmes

The major source of demographic data Table 1.1 Selected demographic indices fi~r Malawi is the population census. Population censuses have been taken in Malawi during the years 1891, 1901, 1911, 1921, 1926, 1931, 1945, Census year 1956, 1966, 1977 and 1987. Additional popula- tion data have been collected through nationwide Index 1966 1977 1987 demographic and other related surveys. These are the Malawi Population Change Survey in Population I 4039583 55474611 7988507 1970-72, the Malawi Demographic Survey in Intercensal growth rate 2 - 2.9 3.2 Total area (sq. kin.) 118484 118484 118484 1982, the Malawi Labour Force Survey and the Land area (sq. kin.) 94079 94276 94276 Survey of Handicapped Persons in 1983, and the Density (pop./sq. kin.) 43 59 85 Family Formation Survey in 1984. Table 1.1 Percentage urban 5.0 8.5 10.7 Women of childbearing age provides some demographic indices for Malawi. as percentage of female population 47.6 45.1 44.2 The population of Malawi is growing at Sex ratio 90 93 94 Crude birth rate 48.3 41.2 a rate of around 3.2 percent per year based on Total fertility rate 7.6 7.63 the 1987 census, up from 2.9 percent in 1977 Crude death rate 25.0 14. I (this considers only natural or intrinsic growth Infant mortality rate 165 1513 and does not include refugee populations, esti- Life expectancy' mated at about 1 million persons in 1992). The Male 39.2 41 4 total Malawian population in the 1987 census Female 42 4 44.6 was enumerated at around 8 million persons, IDe facto population having roughly doubled since the 1966 census. 2Natural increase; excludes migration, refugees Given current growth rate estimates, the 1994 3Based on the 1984 Family Formation Survey population will reach approximately 10 million

2 persons. With a doubling of the size of Malawi's population over the last two decades has come a doubling of the population density from 43 to 85 persons per square kilometre during the period 1966 to 1987. By 1994, Malawi's population density will exceed 100 persons per square kilometre.

A national population policy for Malawi has been prepared. The policy aims at achieving lower population growth rates compatible with attainment of the country's social and economic objectives in addition to reducing morbidity and mortality among mothers and children. It aims at improving the status of mothers and children in all spheres of development as well as improving information, education and communication on the use of contraceptives and benefits of small family sizes. In the education sector, the policy will enhance the relevance of formal and informal education. The policy stresses the importance of the creation of employment and food self-sufficiency especially for pregnant and lactating mothers as well as children. Last but not least, the policy aims at improving the collection, analysis and dissemination of demographic, environment and employment data, by gender, and the utilisation of these data for social and economic planning.

A technical secretariat for the National Population Advisory Committee (NPAC) composed of all relevant ministries and non-government organisations (NGOs) was recently established in the Office of the President and Cabinet (OPC). The Secretariat's overall responsibility is to coordinate and monitor the implementation of population programmes and projects and to develop population guidelines for the country.

1.3 Health Priorities and Programmes

Health services in Malawi are provided by the Ministry of Health, the Ministry of Local Government and the NGOs, particularly mission organisations. The Ministry of Health is responsible for planning and developing health policies and for providing health care in all government hospitals. The Ministry of Local Govemment is in charge of health care delivery at the district level and below. NGOs provide services to both hospitals and smaller medical units.

In Malawi, the provision of curative services takes a large proportion of the total government funds allocated to the health sector. The lack of an effective outreach capacity in the system has been recognised by the Ministry of Health, and strategies for creating a community-based distribution system are being implemented despite a severe lack of trained medical personnel in the country. Currently, the government is developing a health policy with the goal of achieving health for all by the year 2(g30.

1.4 Objectives, Organisation, and Design of the Survey

Objectives

The Malawi Demographic and Health Survey (MDHS) was a national sample survey of women and men of reproductive age designed to provide, among other things, information on fertility, family planning, child survival, and health of mothers and children. Specifically, the main objectives of the survey were to:

Collect up-to-date information on fertility, infant and child mortality, and family planning

Collect information on health-related matters, including breastleeding, antenatal and maternity services, vaccinations, and childhood diseases and treatment

Assess the nutritional status of mothers and children

Collect information on knowledge and attitudes regarding AIDS • Collect information suitable for the estimation of mortality related to pregnancy and childbearing

Assess the availability of health and family planning services. Organisation

The MDHS was conducted by the National Statistical Office (NSO) from September to November 1992. Financial support for the survey was provided by the United States Agency for International Development (USAID) while technical assistance was provided by Macro International Inc. (Macro) of Columbia, Maryland (USA) through its contract with USAID. Survey Design

Based on the 1987 Malawi Population and Housing Census, the country is demarcated into 8,652 enumeration areas (EAs) of roughly equal population size. This sampling frame of census EAs was stratified by urban and rural areas within each of the three administrative regions, making six sampling strata in total. Within each sampling stratum, districts were geographically ordered, thereby providing additional implicit stratification.

The MDHS sample of households was selected in two stages. First, 225 EAs were selected from the 1987 census frame of EAs with probability proportional to population size. The distribution of selected sample points (EAs) is shown in the map of Malawi on page xx. The measure of EA size was based on the number of households enumerated during the 1987 census. NSO staff, after being trained in listing procedures and methods for updating maps, were sent to the selected EAs to list all households and produce maps which provided the orientation for later data collection teams in finding selected households. Households in refugee camps and institutional populations (army barracks, police camps, hospitals, etc.) were not listed. In the second stage, a systematic sample of households was selected from the above lists, with the sampling interval from each EA being proportional to its size based on the results of the household listing operation.

In these households, all women age 15-49 years were eligible lot interview. Further, a one-in-tln'ce systematic subsample of households was drawn, within which both eligible men age 20-54 years and women age 15-49 years were interviewed.

Because the objective of the survey was to produce region-level and urban/rural estimates of some indicators, an oversample of households in the Northern Region and in urban areas was necessary. Thus the MDHS sample is not self-weighting at the national level, but it is self-weighting within each ol the six region/urban-rural strata.

Four types of questionnaires were used: the Household Questionnaire, the Individual Female Questionnaire, the Individual Male Questionnaire, and the Health Services Awfilability Questionnaire. The contents of these questionnaires were based on the DHS Model B Questionnaire, which is designed for use in countries with a low level of contraceptive use. Modification of the questionnaires was undertaken by NSO in consultation with the Ministry of Health and Macro. The questionnaires were pretested in April 1992. Approximately 250 interviews were conducted over a two-week period, and further adjustments to the questionnaires were made based on lessons drawn fi'om the interviews and analysis of the data.

4 The Household Questionnaire was used to list all the usual members and visitors of selected households. A household is defined as one that consists of one or more persons, related or unrelated, who make common provisions for food, or who regularly take all their food from the same pot or same grainstore (Nkhokwe), or who pool their incomes for the purpose of purchasing food. Persons in a household may live in one or more dwelling units. Information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women who were eligible for individual interview, namely, those age 15-49 years.

For those women who were either absent or could not be interviewed during the first visit, a minimum of three visits were made before recording nonresponse. Women were interviewed with the individual female questionnaire. In the course of administering the household questionnaire, eligible men, namely, those age 20-54 were also identified. The individual male questionnaire was administered to all men age 20-54 living in every third household in the selected sample. The male questionnaire collected much of the same information found in the female questionnaire, but was considerably shorter because it did not contain questions on reproductive history, and maternal and child health.

During the household listing operation (i.e., before the main survey), one Health Services Availability Questionnaire was completed in each of the 225 MDHS sample points. Leaders in the community provided information that allowed an assessment of the availability of health and family planning services to persons living in the respective localities.

A three-week training course for the main survey was held in July and August of 1992. A total of 80 field staff was trained. The training course consisted of instruction in general interviewing techniques, field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children, mock interviews between participants in the classroom, and practice interviews in areas outside MDHS sample points. Only trainees who performed satisfactorily in the training programme were selected for fieldwork. Team leaders were NSO staff who had previously participated in the MDHS pretest.

1.5 Data Collection and Data Table 1.2 Results of the household mad indivldua[ interviews Processing Number of households, number of interviews, and response The fieldwork for the MDHS was car- rates, Malawi 1992 ried out by ten interviewing teams, each con- ResuLt Urban Rural Malawl sisting of one team leader, one field editor, five female interviewers, one male interviewer and Households sampled 1413 4398 5811 one driver. Additionally, senior NSO staff co- Households occupied 1360 4036 5396 ordinated and supervised fieldwork activities. Households interviewed 1339 3984 5323 Data collection began 1 September and was HOUSEIIOLD RESPONSE completed on 10 November 1992. RATE 98 5 98.7 98.6 Eligible women 1359 3661 51120 Table 1.2 shows the results of house- Eligible women interviewed 1316 3533 4849 hold and individual interviews for the urban and ELIGIIILE WOMEN rural sample and for Malawi as a whole. A more RESPONSE RATE 96.8 96 5 96.6 detailed presentation of interview results by re- Eligible men 416 872 1288 gion and urban-rural residence is given in Eligible men lnlerviewed 364 787 1151 Appendix A. A total of 5,811 households was selected in the MDHS sample, of which 5,396 ELIGIBLE MEN RESPONSE RATE 87.5 903 89.4 were currently occupied. Of the 5,396 occupied households, 5,323 were interviewed, yiclding a household response rate of 98.6 percent. Rural and urban response rates at the household level did not differ significantly.

Within the interviewed households, 5020 eligible women (15-49 years) were identified of which 4849 were interviewed, yielding an individual female response rate of 96.6 percent. In the one-in-three subsample of households, 1,288 eligible men were identified, of which 1,151 were successfully interviewed (89.4 percent response). The principal mason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. The lower response rate among men than women was due to more frequent and longer-term absence of men. The refusal rate in the MDHS was extremely low (0.1 percent).

Response rates were marginally better in rural areas than in urban areas in the male survey (rural, 90.3 percent; urban, 87.5 percent), but nearly the same in the female survey (rural, 96.5 percent; urban, 96.8 percent).

Completed questionnaires were retumed to NSO for data processing. The processing operation consisted of office editing, coding of open-ended questions, data entry and editing of errors found by the computer programs. Data entry, editing, and analysis were accomplished on personal computers, using a software program called ISSA (Integrated System for Survey Analysis). Data processing started on 14 September 1992 and was completed on 21 January 1993.

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