Here is a list of some of the other unique stand alone qualitative data projects that have occurred within the context of the MDICP/MLSFH project, click on the links below to read descriptions:
- Migration and Health in Malawi (MHM) Study
- Family Transfers Project
- Likoma Network Project
- Interviews with Elders in Balaka and Mchinji (Kaler)
- Revisiting J Clyde Mitchell’s 1946-48 Research (Kaler)
- Interviews with Community Based Distributors (Kaler)
- The Gender Context Study (Schatz)
- Timing of the Onset of Sexual Activity and Extramarital Partnerships (Tawfik)
- Verbal Autopsies (Doctor)
- Adolescent Attitudes and Sexuality Study (Poulin)
- The Malawi Childbearing Project (Yeatman)
- Couples and HIV Testing (Gaydosh)
- Children’s School Enrollment and HIV/AIDS in Rural Malawi: The Role of Parental Risk Perceptions (Grant)
- Working Outside of the Box: The Transformation of HIV Voluntary Counseling and Testing (VCT) by Health Workers in Rural Malawi (Angotti)
The Migration and Health in Malawi (MHM) Study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is often unresolved. To examine this issue, the MHM Study addresses key data limitations, such as the inability to measure important characteristics that affect both migration and health outcomes, and the lack of longitudinal data necessary to distinguish between the effect of migration on health and the selection of individuals of differing health status into migration streams. Current data are available for two waves of MHM, which took place in 2007 and 2012, and includes extensive information on migration history, socioeconomic and demographic characteristics, sexual behaviors, marriage, household/family structure, risk perceptions, social networks and social capital, intergenerational relations, HIV/AIDS and other dimensions of health. The MHM public use data can be requested by contacting the Principal Investigator (Philip Anglewicz, firstname.lastname@example.org).
The overall goal of the Family Transfers Project (FTP) was to examine inter- and intra-generational flows of resources (money and time) within the basic family support network and to measure the extent to which those support systems are sensitive to changes in health status among family members (i.e. between adult respondents and their parents, uncles and aunts, brothers and sisters, and children). The FTP sample was a randomly selected sub-sample of respondents who participated in the first wave (1998) of the Malawi Longitudinal Study of Families and Health (MLSFH). The FTP data and documentation are available for download.
The Likoma network study (LNS) investigates the sexual networks connecting the inhabitants of Likoma, a small island of Lake Malawi with high HIV prevalence. Whereas previous studies of sexual networks and HIV/AIDS in sub-Saharan countries have focused solely on the personal networks of a small number of respondents, the LNS attempts to document the sexual networks of the entire adult population of Likoma. To do so, it uses a unique sociocentric study design, in which all members of the local population are contacted for a survey interview and are asked to nominate their five most recent sexual partners. Using these data, quasi-complete `maps’ of the sexual networks connecting inhabitants of the island can be constructed. These maps allow investigation of the impact of networks on HIV epidemiology and can inform mathematical models of HIV prevention. In addition to data on sexual networks, the LNS data include information on the social networks (e.g. friendship), socioeconomic characteristics and HIV status of Likoma’s residents. Baseline data were collected in 2005–06. A first follow-up was conducted in 2007–08 and a second follow-up is planned for early 2013. A Cohort Profile for the LNS has been published in the International Journal of Epidemiology (DOI: 10.1093/ije/dyt001)
In 1999, in the context of the Let’s Chat interviews, Amy Kaler carried out interviews with 49 eldest members of households. The selection of the respondents was based on the same sample which was used for Let’s Chat, so her results are representative to the same extent that the Let’s Chat sample is. Each day, interviewers were sent out to shadow interviewers from the Let’s Chat project, with instructions to find the oldest person in the household where the Let’s Chat interviewer was interviewing. Interviews centered around the question “how is life nowadays different from life when you were a young person?”. Specific topics included: perceived changes in health status, in the prevalence of illness, in patterns of nuptiality, in norms of marriage and childbearing, in relationships between generations, and in the availability of consumer goods. Respondents were asked to explicitly compare themselves as young people just embarking on adulthood with what they saw of their children and grandchildren who are currently entering adulthood. These interviews were translated and transcribed in the field.
Based on her archival work in Oxford in April 2000, in 2001 Amy Kaler conducted some interviews with elders in Machinga to follow up on themes which emerged from data collected by J. Clyde Mitchel, who was a prominent member of the Rhodes Livingstone Institute (Lusaka) group of social anthropologists/sociologists involved in central African field research in the 1940s. He spent two years doing village surveys, conducting interviews with heads of households, and observing settings such as customary courts and weddings in an area of southern Malawi which incorporates Machinga and Kalembo, the sites of the former Malawi Diffusion and Ideational Change Project, now the Malawi Longitudinal Study of Families and Health (MLSFH). Amy Kaler used Mitchell’s published and unpublished notes and data, deposited at the Rhodes House Library in Oxford University, to learn about continuities and changes across generations.
In 2001 I interviewed the first cadre community-based family planning distributors (CBDs) in Balaka about the challenges of introducing new methods of contraception to the area, the ways in which the CBDs interpreted or defined these methods for their prospective clients, and how they perceived these new technologies to affect preexisting local social dynamics. The purpose of these interviews was to provide comparative information for my own interviews with Zimbabwean CBDs in 1997 and Watkins et al.’s interview with Kenyan CBDs in 1996.
In 2000, funded by a Mellon grant to the Population Studies Center at the University of Pennsylvania and partially supported by the Watkins and Behrman Social Networks NIH grant, Enid Schatz fielded the Gender Context Study (GCS). The GCS included repeated semi-structured interviews with 50 couples in rural Malawi about gender dynamics in the household. The interviews covered issues of marriage, divorce, polygyny, family planning and HIV/AIDS. This study built on the pilot study Schatz conducted in 1999 (funded by a Mellon grant to the Population Studies Center at the University of Pennsylvania), and grew out of questions that were unanswerable with the quantitative data collected by the former Malawi Diffusion and Ideational Change Project, now the Malawi Longitudinal Study of Families and Health (MLSFH), in 1998. Enid Schatz spent six weeks in the field in 1999 (two weeks in each of three sites) for the pilot study, and two months in the field in 2000 (one month in each the northern and southern sites) for the GSC. On both occasions, while in the field, she trained and worked closely with local interviewers who conducted the interviews, as well as translated and transcribed them. These interviewers also became key informants who helped better understand the local culture in each site. In addition to interviewing and speaking with her key informants, she spent time as a participant observer watching and learning about local behavior. The pilot study included interviews with 6 MDICP-1 couples in each of the three sites. In 2000, the GCS respondents included the 12 couples interviewed in 1999 in Balaka and Rumphi, plus an additional 19 couples in each of the two sites, for a total of 50 women and 41 men in the two regions (25 couples in Balaka/Southern, and 25 couples in Rumphi/Northern) who had been interviewed in the MDICP-1 household survey. In both studies, the sample was stratified in that it selected couples from various family arrangements (polygynous/monogamous, matrilineal/patrilineal, matrilocal/patrilocal) and ages.
Dissertation: Soap, Sweetness, and Revenge: Patterns of Sexual Onset and Partnerships Amidst AIDS in Rural Southern Malawi. 2003. PhD Dissertation, Bloomberg School of Public Health, Johns Hopkins University.
Linda Tawfik conducted dissertation research on sexual partnerships in villages of the MDICP sample in Balaka District. The primary questions addressed by her research is the patterns in age of sexual onset and in sexual partnerships in rural Malawi in the context of the AIDS pandemic. A feasibility study was conducted in 1999, which included mapping, 22 key informant and informant interviews, and 60 free-listing exercises covering local classifications of types of diseases, types of male sexual partnerships, types of female sexual partnerships, ways to select partners and reasons for extramarital partnerships. In 2000, Tawfik conducted case studies: 145 three-part, in-depth interviews with 80 women respondents stratified by four cohorts (15-19, 20-24, 25-29, 30-34), randomly selected within cohort, and 65 husbands. The three parts of the case studies consisted of 1) life history interviews 2) a network component in which respondents were asked about the extramarital relationships of members of their social network and 3) an event history matrix that included age at sexual onset, reasons for partnerships, type of unions, marriage, sequence and selection of sexual partners, risk behaviors and AIDS risk-reduction strategies. The women respondents were randomly selected from respondents in MDICP-1; 15 of the husbands surveyed in the 1998 MDICP had either divorced, migrated, died, or were away during the fieldwork period in 2000. Data collection also included participant observation of initiation, marriage and funeral ceremonies. The interviews were transcribed and translated in the field. The project was supported by a grant from the Mellon Foundation to the Department of Population Dynamics, Bloomberg School of Public Health, Johns Hopkins University.
During the MDICP-2 survey fieldwork, Henry Doctor organized and supervised the collection of verbal autopsies for those MDICP-1 respondents who had subsequently died. Doctor developed a questionnaire, and trained the MDICP-2 interviewers in its use. When the interviewers found that a respondent had died, they administered the verbal autopsy questionnaire. Over the three years between MDICP-1 and MDICP-2,104 adults died, of whom there are verbal autopsies for 92 of them. Quantitative data for these 92 respondents are available for download in STATA format (the ID numbers of these respondents can be linked with the corresponding records for the MDICP-1). In addition to filling out the questionnaire, the interviewer sometimes wrote more detailed comments on the questionnaire. Two papers have been written using these data: Doctor and Weinreb (2002) and Doctor (2002).
Over the course of several months in 2004, Michelle Poulin designed and implemented the Adolescent Attitudes and Sexuality Study in rural Malawi. Her goal was to gather information about the lived experiences of young Malawians on the cusp of marriage and adulthood, during an era when a young person’s sense of their own mortality is sharpened given the AIDS epidemic in the country. The research project was funded from several sources, including the Department of Sociology at Boston University, the MDICP, and an NSF Dissertation Fellowship (#SES-0503350). Data collection for the study consisted of in-depth interviews with a sample of adolescents and young adults (N=141), aged 15-24, drawn randomly from the larger MDICP survey sample. A total of ten local interviewers conducted in-depth, conversational-style interviews, in three local languages, in two of the three MDICP study sites: Balaka in the South and Rumphi in the North. The decision about which topics to include in the in-depth interviews was largely, although not entirely, based upon narratives that arose from a period of pilot work in preparation for the Adolescent Study.
The resultant data from the study’s 141 interviews contain extensive information on the following six topics: (1) sexual decision-making (e.g. condom use, frequency of sex, and personal motivations behind these behaviors), as well as questions about friends’ beliefs and behaviors; (2) gift/money transfers in premarital partnerships; (3) social and sexual norms of adolescents and young adults; (4) choices regarding schooling; (5) conversational topics among friends; and (6) marital hopes and expectations. These data have been invaluable in providing new insights to understandings of how to interpret MDICP survey data, as well as to yielding detailed information about the sexual and social relations of Malawian adolescents and young adults more broadly. To view a selection of interviews from the Adolescent Attitudes and Sexuality Study.
Conducted from October to November 2006, The Malawi Childbearing Project was the qualitative component of Sara Yeatman’s dissertation research, funded through NSF-Doctoral Dissertation Improvement Grant (SES-0623543) and the University of Texas Liberal Arts Graduate Research Grant. In total, 48 interviews of MDICP respondents were conducted, over-sampling HIV positive individuals, along with 10 interviews with women at the PMTCT clinic at Mchinji District Hospital. The interviews focused on respondents’ fertility preferences, perception of the relationship between HIV and childbearing, network discussions about this relationship, specific HIV testing experience and its influence on subsequent childbearing intentions and behavior, and stories from the community about people who were HIV positive and either had many children or decided to have no more children. Additional topics included: the role of caring for extended family in fertility preferences, abortion, and infertility.
These interviews were conducted alongside MDICP-4 in 2006. This wave of data collection saw the introduction of door-to-door rapid blood tests for HIV. We conducted 45 in-depth interviews in Mchinji with married couples who had been approached for VCT. Ideally I would have liked to include equal numbers of different types of couples, such as couples who refused VCT, those who were couple counseled, concordant positive and concordant negative couples, and discordant couples. However, the lower prevalence in this region resulted in a limited pool of HIV-positive individuals and this over-sampling of HIV-positive individuals was not possible. When the sample was drawn, 422 individuals had been approached for VCT, and only 1 couple was found to be concordant positive and only 7 couples were found to be discordant.
The qualitative sample included 25 couples. Of these 25 couples, 21 complete couple interviews were conducted, where both the husband and wife were interviewed; 3 individual interviews were conducted when the other spouse could not be located after several visits; and 1 couple was away at the hospital for several weeks. No one refused to be interviewed. Of the 21 complete couples, 5 had at least one partner who had refused VCT. Of the remaining 16 that were tested, 1 couple was concordant positive, 10 were concordant negative, and 5 were discordant. In an effort to examine the differences or similarities between couple VCT and individual VCT, of the 16 couples who participated in VCT, 9 were individually tested and counseled, and 7 were couple tested and counseled.
The semi-structured interviews were conducted in Chichewa, the native language of most Malawians living in Mchinji District. Interviewers were conducted by trained local interviewers and were tape recorded; subsequently, a few days following the interview the interviewer simultaneously translated and transcribed the interviews into English. There were 2 interviewers, 1 female and 1 male, who individually interviewed the wife and husband, respectively. Between two and four weeks following the VCT component of the study, the respondents in the qualitative sample were approached at their homes for participation in the qualitative study. Interviews ranged between thirty and seventy-five minutes, most running around forty-five minutes. Interviewers loosely followed an interview guide that covered five major themes: social networks, response to in-home rapid-testing, reasons for consent/refusal, projected behavioral change, and partner roles.
This project was supported by the Ruth Marcus Kanter Undergraduate Research Award at the University of Pennsylvania. A small set of transcripts have been anonymized and are available for downloading below. The full set of transcripts will be anonymized and made available to the public shortly.
Qualitative interviews were collected from 60 adults aged 25-50 who were the parent of at least one child aged 6 to 18 years old at the time of the 2006 MDICP. The respondents were randomly sampled from MDICP respondents who had completed the 2006 survey. All interviews were collected in Chichewa, the local language, by trained interviewers who also translated and transcribed the interviews in the field. The average interview lasted for 40 minutes. Interviewers were instructed to ask parents about (1) the educational history for each child in the household (e.g. current school enrollment status, age at school entry, grade progression, age and grade at school exit), (2) how they decided the amount of education each child should receive, (3) their own health expectations, and (4) the health expectations that they had for their families. The interviews vary in the extent to which each of these themes was explored. In order to avoid the possibility of leading questions, the interviewers were not told that I was interested in whether risk perceptions of HIV/AIDS were considered by parents as part of the education decision-making process. However, a substantial number of respondents made the connection spontaneously during the course of the interview. These qualitative data cast light on how parents think about the HIV epidemic and future health uncertainty. They provide insight into how uncertainty about the future and perceptions about risk may factor in to the statistical associations found in the models discussed above. Furthermore, they help us understand the value that parents place on education in rural Malawi.
From May-July 2007, Nicole Angotti conducted 25 semi-structured interviews with VCT counselors in health facilities throughout two rural districts in the central region of Malawi. The facilities include government district hospitals, private Catholic mission hospitals, military hospitals, and free-standing testing clinics. The purpose of these interviews is to understand HIV Voluntary Counseling and Testing as a dynamic social practice — as opposed to a set of rules — that transformed in the encounters between VCT counselors and their clients. With particular consideration for some of the core tenets of VCT (such as informed consent and confidentiality), the interviews consider how VCT counselors understand the dilemmas they face in their jobs, and the myriad ways in which they innovate to resolve them. These data will support Nicole Angotti’s dissertation research on the evolution of the Western public health model of VCT, and was funded through the University of Texas Liberal Arts Graduate Research Fellowship.