Karonga HDSS, Malawi

KarongaKaronga DSSDSS areaarea

Northern Province

Malawi Northern Province M A L A W I

000 505050 100100100 M A L A W I 000 252525 505050 KilometresKilometresKilometres KilometersKilometersKilometers

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. 2600 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 10.38° and 10.50°S and longitudes 34.08° and 34.27°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 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

95-99 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

3000 2500 2000 1500 1000 500 500 1000 1500 2000 2500 3000 Mid-Year Population

Males Females

Demographic Characteristics

Crude Birth Rate (CBR) 40.2 per 1000 population Total Fertility Rate (TFR) 5.4 per woman Crude Death Rate (CDR) 7.1 per 1000 population Neonatal Mortality 24.5 per 1000 live births Post-neonatal Mortality 17.8 per 1000 live births Infant Mortality 42.3 per 1000 live births Child Mortality (1-4 years) 5.1 per 1000 children aged 1-4 years Under Five Mortality 61.6 per 1000 live births Rate of Natural Increase 33.1 per 1000 population In-Migration 78.1 per 1000 population Out-Migration 99.7 per 1000 population Growth 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  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 2011 6, e228400 2. 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. 2010 5(12):e15334. 3. 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. 2010 ;5(10):e13499. 4. 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 2010 48(12):4512-8. Epub 2010 Oct 20. 5. 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 2010

6. 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 2010.

7. 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. 2010 Jul;14(7):909-15. PubMed PMID: 20550777.

8. 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. 2010 Jan 28;24(3):417-26. PubMed PMID: 20042847

9. 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. 2010 Sep;42(9):739-741. PubMed PMID: 20694014.

10. 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. 2010 Jun 28;5(6):e11320. PubMed PMID: 20596521.

11. 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 and susceptibility to infectious diseases. N Engl J Med. 2010 Jun 3;362(22):2092-101. PubMed PMID: 20484391.