Abstract #358  -  The impact of HIV/AIDS on household dynamics and household welfare in rural Malawi
Authors:   Presenting Author:   Ms Sian Floyd - London School of Hygiene & Tropical Medicine
Additional Authors:  Dr Angela Baschieri, Ms Aulive Msoma, Mr Albert Dube, Dr Andreas Jahn, Dr Neil French, Dr Judith Glynn,
Aim: To describe household dynamics and changes in household welfare over a period of 4-5 years, from 2002/4 to 2007/8, in a rural area of Karonga district, northern Malawi. During this period, HIV prevalence was stable at around 14%, and two-thirds of deaths among individuals aged 15-59 years old were attributable to AIDS. The main focus of the analysis is to quantify the effect of young (age 15-49)adult mortality on household composition and welfare.
Method / Issue: Assessment of the impact of HIV/AIDS illness and death on household welfare is complicated by the fact that household composition changes over time, and also that some of the changes in household composition are themselves a response to HIV/AIDS death(s). Possible changes over time are that one or more individuals die, join, leave, or are born into the household. These changes may have positive, neutral, or negative effects on overall household welfare. A household may also “dissolve”, with all members dispersing to either form new households or join existing households. A demographic surveillance system (DSS) was established with a baseline census conducted over 2 years from mid-2002 to mid-2004, in the south of Karonga district. The total population at this time was around 30000, with a median household size of 5. During the baseline census, all households were enumerated and a full listing of all household members was made. A household was defined as a group of people living together who recognize the same household head. Sufficient identifying information was collected so that all individuals can be traced over time. Similarly, whole households can be traced over time, whether they stay in the same location or move. Socio-economic data on 3 welfare indicators were collected: housing quality (roof, walls, floor; water source and sanitation), household assets (a list of 10 items), and household sources of income. For sources of income, all sources were identified and then ranked in terms of relative importance. From the time each household was enrolled in the baseline census, information on births and deaths has been collected monthly, information on in- and out-migrations updated once a year, and verbal autopsies have been conducted for all deaths. During 2007/8, a follow-up socio-economic survey of all households was conducted, including all the questions on household welfare that were part of the 2002-4 baseline census.
Results / Comments: We first assess changes in household composition between 2002/4 and 2007/8, summarizing this using a typology based on the age, sex, and generational structure of households and using a matrix to show all possible transitions. Second, we summarize change over time in terms of the number and sequence of individuals who join, leave, are born into, or die from, the household. Observed sequences are then grouped for further analysis, possibly using an “optimal matching technique”. Third, we quantify the impact of HIV/AIDS death(s) on each of the 3 indicators of household welfare, allowing for changes in household composition.
Discussion: From the results of the analyses described above, we will quantify the nature and magnitude of the impact of HIV/AIDS on household dynamics and welfare, and consider the policy implications of our findings.
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