Health in Malawi

There has been a shift in causes of mortality in many countries over the years. This can be as result of different factors like improved health interventions and access to health care, improved economic and social status and improved knowledge. This has resulted into a shift in the global burden of disease. According to the Institute for Health Metrics and Evalution (IHME)(www.healthdata.org) the top ten causes of death in Malawi are[4]:

1. HIV/AIDS (18.17%)
2. Respiratory infections and tuberculosis (12.96%)
3. Cardiovascular diseases (11.6%)
4. Maternal and neonatal disorders (9.36%)
5. Neoplasms (7.8%)
6. Enteric infections (6.27%)
7. Neglected tropical diseases and malaria (5.76%)
8. Digestive diseases (4.34%)
9. Other infectious diseases (4.29%)
10. Other non-communicable disease (3.99%).[5]
    

    Causes of death in Malawi

As of 2018 the estimated average life expectancy at birth in Malawi is at 64 years, with females having a slightly higher life expectancy at 67 years than males at 61.4 years.[6]

In 2014 Malawi had a total fertility rate of 5.26 children born/woman.[7]

There is a high degree of risk for major infectious diseases, including bacterial and protozoal diarrhea, hepatitis A, typhoid fever, malaria, plague, schistosomiasis and rabies.[8]

In 2013 Malawi had a HIV/AIDS adult prevalence rate of 11%.[7] In 2013 there were 920,000 people living with HIV/AIDS, and 51,000 AIDS related deaths.[7] Data indicate that 8.8% of women and men aged 15-49 have HIV and the prevalence is higher among women than men (10.8% versus 6.4%).[9].

Due to the vast scope of the HIV/AIDS epidemic, many Malawian men believe that HIV contraction and death from AIDS are inevitable.[10] Older men in particular often claim that the HIV/AIDS epidemic is a punishment issued by God or other supernatural forces.[10] Other men refer to their own irresponsible sexual behaviors when explaining why they believe that death from AIDS is inevitable.[10]

AIDS orphans in Malawi

These men sometimes claim that unprotected sex is natural (and therefore necessary and good) when justifying their lack of condom use during sex with extramarital partners.[10] Finally, some men identify as HIV-positive without having undergone testing for HIV, preferring to believe that they have already been infected so they can avoid adopting undesirable preventative measures such as condom use or strict fidelity.[10] Because of these fatalistic beliefs, many men continue engaging in extramarital sexual relations despite the prevalence of HIV/AIDS in Malawi.[11]

However, despite these widespread feelings of fatalism, some men believe that they can avoid HIV contraction by modifying their personal behaviors.[10] Men who decide to change their behaviors to reduce their risk of infection are unlikely to use condoms consistently, particularly during marital intercourse; instead, they usually continue engaging in extramarital sexual relations, but alter the ways in which they choose their sexual partners.[10]

For example, before selecting extramarital sexual partners, men sometimes survey their peers to determine whether their potential partners are likely to have exposed themselves to the virus.[12] Men who choose their sexual partners based on external appearances and peer recommendations often believe that women who violate traditional gender norms by, for example, wearing modern clothing are more likely to carry HIV, while young girls, who are perceived as sexually inexperienced, are considered "pure".[10] Because of this perception, many people are concerned that schoolchildren in Malawi, particularly girls, are becoming exposed to the virus through sexual harassment or abuse by their instructors.[13]

It is estimated that there are more than 14% cases of tuberculosis infections worldwide in year with 9 million new cases and nearly 1.7 deaths. In 2014 the incidence of tuberculosis was 227 per 100,000 people in Malawi. The good news is that the incidence is declining by 1.5% each, however the transmission still remains high[14].

The disease continues to be a major public health problem in sub-Saharan Africa region in which Malawi is found. It is estimated that in 2017 the disease caused 403,000 deaths in this region, of which, 61% were children below the age of five.[15] Malaria was the leading cause of death in under five children in 2013 in Malawi accounting for 22% of all under five mortality[16]. Malaria affects numerous aspects of social and economic life in Malawi. High malaria prevalence affects fertility, savings and investment rates, crop choices, schooling and migration decisions.[17] There are a wide variety of cost-effective approaches to reduce the burden of malaria. Some current intervention tactics include case management, the use of insecticide-treated bed nets, indoor residual spraying, and environmental vector control measures such as larvaciding (controlling mosquitoes at the larval stage through the use of chemicals) and filling and draining of breeding sites.[18] Each of these interventions has proven to have a high value of health gains achieved per dollar.[17] More specifically, mosquito nets are one of the most effective and widely used approaches. They are most effective in that they require a minimal amount of resource input and result in a large decrease in the prevalence of Malaria.[19]

In their article titled "The Economic and Social Burden of Malaria", Pia Malaney and Jeffrey Sachs present an argument for the prominent social theory regarding the intimate relationship between disease prevalence and poverty. They state that where malaria prospers most, human societies have prospered least.[17] In Poor Economics authors Banerjee and Duflo explain how poor healthcare contributes to the poverty trap.[20] That is, inadequacies of Malawi's healthcare lead to an increased prevalence of disease and other health issues, which, in turn, results in increased poverty incidence.[19]

A comparison of income in malarious and non-malarious countries indicates that average GDP (adjusted to give purchasing power parity (PPP)) in malarious countries in 1995 was US$1,526, compared with US$8,268 in countries without intensive malaria – more than a fivefold difference.[21] According to Jaimeson, effective intervention at the level of healthcare provision will have the greatest rate of return in the form of improved health.[22]

Maternal health has improved in Malawi due to a number of factors. There has been improvement made in proportion of births attended by skilled professionel. The proportion has increased from 54.8% in 1992 to 87.4% in 2014. [23]. In addition to that, the maternal mortality is on the decrease though at a slower rate. Since 1990 the maternal mortality ratio has decreased from 1100 deaths per 100,000 people to 510 deaths per 100,000 people in 2013[24]. Improved access to sexual and reproductive health services has also contributed to the improvements in maternal health. Knowledge and of family planning is almost universal in Malawi with 98% of women and nearly 100% of men age 15-49 knowing at least one method of contraception.[25] Child health has also improved in Malawi. According to the Demographic Health Survey (DHS) report, the number of children dying before reaching their fifth birthday has declined, from 234 deaths per 1000 live births in 1992 to 63 deaths per 1000 live births in 2015-16.[26]. Child health is an important area to focus our efforts to better the health status because children are the most vulnerable group (especially those below the age of five), and most importantly it is their right to survive and live better lives.[27]. In Malawi, the child mortality rate is very high although there has been a decline over the years, from 234 deaths per 1000 live births in 1992 to 63 deaths per 1000 live births in 2015. In addition, the neonatal mortality has went down to 27 deaths per 1000 live birth in 2004.[28]

The shift in the burden of disease has led to non-communicable diseases (NCDs) becoming the leading cause of death globally, most of these deaths are due to cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Mortality from many NCDs is on the rise worldwide, with a disproportionately larger burden in low-middle income countries (LMICs), where almost 3/4 of deaths globally occur from these causes. As of 2016 NCDs are estimated to account for 31.7% of deaths in Malawi, and the numbers are on the rise in countries throughout sub-Saharan Africa.[29]

The CIA World Fact Book's "country comparison to the world" ranking indicates how Malawi's health indicators compare to other countries in the world. Since the first case of HIV/AIDS in Malawi in 1985, HIV/AIDS has drastically affected Malawi's health indicators. Malawi's rankings:[7]