KARONGA HDSS, MALAWI

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Brief Description

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 leprosy, 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 250,000 today.

The area of the Karonga CRS (Continuous Registration System) 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. 135 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 approximately 33,000, 13% of the district population. The CRS population is predominantly rural and the economy is based upon subsistence agriculture and fish from the lake. Population density is about 245 persons/km2, however the area includes 2 peri-urban settlements, a truck stop and trading centre on the Trans-African Highway (M1) and the port-village of Chilumba where the settlement structure is dense. Approximately 5,000 populations live in these peri-urban centres.

The average household size is 5 and 7% of the 6,845 households in the HDSS are headed by polygamists. Only 3% of homes have electricity, 16% have piped water; the most common construction materials are burnt brick walls (59%), grass thatch roofs (57%) and mud flooring (76%). The main sources of household income are farming (43%), regular employment (15%), trading (11%), casual labour (9%) and fishing (7%). A radio is owned by 62% of households, 52% own a clock or a watch, 44% have a bicycle and 19% own cattle.

The HIV epidemic started in the early 1980s in Karonga and the prevalence is estimated to have stabilised around 13% in the adult population since the early 1990s, and is now thought to be in the order of 10% among adults.

Within the CRS, the crude birth rate is 44/1000, with a total fertility rate of 5.6. The crude death rate is 10/1000, with an infant mortality rate of 48/1000, U5 mortality rate of 80/1000 and adult mortality rate of 8.8/1000. The resulting population structure is: 19% are under 5 years old, 29% are aged 5-14, 48% are aged 15-64 and 4% are ≥65 years old.

Priority Research Areas

The programme combines detailed clinical and behavioural studies in individuals, with population-based epidemiological and demographic studies to:

·  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.

In addition, the programme will build upon our extensive data on HIV and tuberculosis trends and molecular epidemiology of tuberculosis to assess the direct and indirect effects of HIV and ART on tuberculosis incidence; and describe household transmission of the pneumonia bacteria, the pneumococcus.

Completed Key Projects (Up to 10)

Project Name / Funder / Grant Period
WT second programme concentrated upon three broad project areas: the initiation of a demographic surveillance system with emphasis on HIV-related studies, immunological studies comparing T cell memory and responses to BCG between infants and adults, and between Malawi and the UK; and expanded epidemiological studies of tuberculosis. / Wellcome Trust / Sep 2001– Aug 2006
This project assessed the need for antiretrovirals and the use of simplified HIV/AIDS case definitions in surveillance. / WHO SURVART initiative / July 2005 – Aug 2006
This project investigated access to antiretrovirals (ARVs) and analysed treatment outcomes in Karonga’s ARV rollout program. / Malawi National AIDS Commission / Aug 2005 – Aug 2006

Ongoing Key Projects (Up to 10)

Project Name / Funder / Grant Period
WT third programme. This forms the basis of our studies of the epidemiology of HIV, tuberculosis and pneumococcal disease as well as the core support to the demographic surveillance system. / The Wellcome Trust / Sep 2006- Aug 2011
Increasing prevention and treatment of TB through development of a rapid, sensitive, and affordable biological marker (genomic or proteomic ) for diagnosis of TB in HIV positive and negative populations / European Union / Jan 2007 – December 2010
Unintended childbearing and family welfare in rural Malawi. Dr Angela Baschieri. London School Hygiene & Trop Medicine. / ESRC(UK)/Hewlett / Aug 2008-Aug 2010
Polygamy and its contribution to HIV transmission. / The Wellcome Trust / Sep 2008 – March 2011
Resolving the Critical Challenges Now Facing the Global Programme to Eliminate Lymphatic Filariasis: RCT of modified dosing schedules for filarial control / The Task Force for Child Survival and Development, Inc / Sep 2008 – March 2011

Funders

·  WELLCOME TRUST

·  LEPRA

·  EUOPEAN UNION

·  THE GATES FOUNDATION

·  ESRC

Collaborators

·  London School of Hygiene and Tropical Medicine

·  Malawi National AIDS Commission

·  Malawi National TB programme

Key publications

1.  Jahn A, Floyd S, Crampin AC, Mwaungulu F, Mvula H, Munthali F, McGrath N, Mwafilaso J, Mwinuka V, Mangongo B, Fine PE, Zaba B, Glynn JR. Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. Lancet. 2008 10;371(9624):1603-11.

2.  Glynn JR, Crampin AC, Traore H, Chaguluka S, Mwafulirwa DT, Alghamdi S, Ngwira BM, Yates MD, Drobniewski FD, Fine PE. Determinants of cluster size in large, population-based molecularepidemiology study of tuberculosis, northern Malawi. Emerg Infect Dis. 2008 14(7):1060-6.

3.  Glynn JR, Crampin AC, Ngwira BM, Ndhlovu R, Mwanyongo O, Fine PE. Herpes simplex type 2 (HSV-2) trends in relation to the HIV epidemic in northern Malawi. Sex Transm Infect. 2008 Jun 4. [Epub ahead of print]

4.  Crampin AC, Jahn A, Kondowe M, Ngwira BM, Hemmings J, Glynn JR, Floyd S, Fine PE, Zaba B. Use of antenatal clinic surveillance to assess the effect of sexual behavior on HIV prevalence in young women in Karonga district, Malawi. J Acquir Immune Defic Syndr. 2008 Jun 1; 48(2):196-202.

5.  Crampin AC, Floyd S, Ngwira BM, Mwinuka V, Mwaungulu JN, Branson K, Fine PE, Glynn JR. Assessment and evaluation of contact as a risk factor for tuberculosis in ruralAfrica. Int J Tuberc Lung Dis. 2008 Jun; 12(6):612-8.

6.  Floyd S, Crampin AC, Glynn JR, Mwenebabu M, Mnkhondia S, Ngwira B, Zaba B, Fine PE. The long-term social and economic impact of HIV on the spouses of infected individuals in northern Malawi.Trop Med Int Health. 2008 13(4):520-31.

Minimum Dataset

No Dataset

Site Contact Details

Site Leader: Neil French

Karonga prevention Study

P.O.Box 46 Chilumba,

Malawi

+265 8 263001/2/3

Email:

Web site: http://www.lshtm.ac.uk/ideu/kps/