Demographic and Health Survey 1992

The 1992 Malawi Demographic and Health Survey (MDHS) was a nationally representative sample survey designed to provide information on levels and trends in fertility, early childhood mortality and morbidity, family planning knowledge and use, and maternal and child health. The survey was implemented by the National Statistical Office during September to November 1992. In 5323 households, 4849 women age 15-49 years and 1151 men age 20-54 years were interviewed.

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.

MAIN FINDINGS

The findings indicate that fertility in Malawi has been declining over the last decade; at current levels a woman will give birth to an average of 6.7 children during her lifetime. Fertility in rural areas is 6.9 children per woman compared to 5.5 children in urban areas. Fertility is higher in the Central Region (7.4 children per woman) than in the Northem Region (6.7) or Southern Region (6.2). Over the last decade, the average age at which a woman first gives birth has risen slightly over the last decade from 18.3 to 18.9 years. Still, over one third of women currently under 20 years of age have either already given birlh to at least one child or are currently pregnant.

Although 58 percent of currently married women would like to have another child, only 19 percent want one within the next two years. Thirty-seven percent would prefer to walt two or more years. Nearly one quarter of married women want no more children than they already have. Thus, a majority of women (61 percent) want either to delay their next birth or end childbearing altogether. This represents the proportion of women who are potentially in need of family planning. Women reported an average ideal family size of 5.7 children (i.e., wanted fertility), one child less than the actual fertility level measured in the survey--further evidence of the need for family planning methods.

Knowledge of contraceptive methods is high among all age groups and socioeconomic strata of women and men. Most women and men also know of a source to obtain a contraceptive method, although this varies by the type of method. The contraceptive pill is the most commonly cited method known by women; men are most familiar with condoms. Despite widespread knowledge of family planning, current use of contraception remains quite low. Only 7 percent of currently married women were using a modem method and another 6 percent were using a traditional method of family planning at the time of the survey. This does, however, represent an increase in the contraceptive prevalence rate (modem methods) from about 1 percent estimated from data collected in the 1984 Family Formation Survey. The modem methods most commonly used by women are the pill (2.2 percent), female sterilisation (1.7 percent), condoms (1.7 percent), and injections (1.5 percent). Men reported higher rates of contraceptive use (13 percent use of modem methods) than women. However, when comparing method-specific use rates, nearly all of the difference in use between men and women is explained by much higher condom use among men.

Early childhood mortality remains high in Malawi; the under-five mortality rate currently stands at 234 deaths per 1000 live births. The infant mortality rate was estimated at 134 per 10130 live births. This means that nearly one in seven children dies before his first birthday, and nearly one in four children does not reach his fifth birthday. The probability of child death is linked to several factors, most strikingly, low levels of maternal education and short intervals between births. Children of uneducated women are twice as likely to die in the first five years of life as children of women with a secondary education. Similarly, the probablity of under-five mortality for children with a previous birth interval of less than 2 years is two times greater than for children with a birth interval of 4 or more years. Children living in rural areas have a higher rate ofunder-fwe mortality than urban children, and children in the Central Region have higher mortality than their counterparts in the Northem and Southem Regions. Data were collected that allow estimation ofmatemalmortality. It is estimated that for every 100,000 live births, 620 women die due to causes related to pregnancy and childbearing.

The height and weight of children under five years old and their mothers were collected in the survey. The results show that nearly one half of children under age five are stunted, i.e., too short for their age; about half of these are severely stunted. By age 3, two-thirds of children are stunted. As with childhood mortality, chronic undernutrition is more common in rural areas and among children of uneducated women.

The duration of breastfeeding is relatively long in Malawi (median length, 21 months), but supplemental liquids and foods are introduced at an early age. By age 2-3 months, 76 percent of children are already receiving supplements.

Mothers were asked to report on recent episodes of illness among their young children. The results indicate that children age 6-23 months are the most vulnerable to fever, acute respiratory infection (ARI), and diarrhea. Over half of the children in this age group were reported to have had a fever, about 40 percent had a bout with diarrhea, and 20 percent had symptoms indicating ARI in the two-week period before the survey. Less than half of recently sick children had been taken to a health facility for treatment. Sixty-three percent of children with diarrhea were given rehydration therapy, using either prepackaged rehydration salts or a home-based preparation. However, one quarter of children with diarrhea received less fluid than normal during the illness, and for 17 percent of children still being breastfed, breastfeeding of the sick child was reduced.

Use of basic, preventive maternal and child health services is generally high. For 90 percent of recent births, mothers had received antenatal care from a trained medical person, most commonly a nurse or trained midwife. For 86 percent of births, mothers had received at least one dose of tetanus toxoid during pregnancy. Over half of recent births were delivered in a health facility.

Child vaccination coverage is high; 82 percent of children age 12-23 months had received the full complement of recommended vaccines, 67 percent by exact age 12 months. BCG coverage and first dose coverage for DPT and polio vaccine were 97 percent. However, 9 percent of children age 12-23 months who received the first doses of DPT and polio vaccine failed to eventually receive the recommended third doses.

Information was collected on knowledge and attitudes regarding AIDS. General knowledge of AIDS is nearly universal in Malawi; 98 percent of men and 95 percent of women said they had heard of AIDS. Further, the vast majority of men and women know that the disease is transmitted through sexual intercourse. Men tended to know more different ways of disease transmission than women, and were more likely to mention condom use as a means to prevent spread of AIDS. Women, especially those living in rural areas, are more likely to hold misconceptions about modes of disease transmission. Thirty percent of rural women believe that AIDS can not be prevented.