Surviving the Epidemic: Families and Well-Being, Malawi 1998?2020 Project Summary: Across Eastern and Southern Africa (ESA), a remarkable cohort is reaching middle and older ages: those who have survived the AIDS epidemic. Some were infected with HIV, but everybody in this co- hort was affected by HIV. Nobody could escape an epidemic that was devastating for both its health and social implications, and one that struck hard in a region also dealing with poverty, famines, and basic uncertainties of life. Were the survivors of this cohort just lucky? What promoted survival and resilience in such a terrible context, and what in?uenced health and well-being among the survivors and their families? How is present demographic change, health, well-being and economic development in ESA shaped by the experience of the epi- demic and by the strategies used to survive the epidemic? These and related questions about ?Surviving the Epidemic? (STE) will be studied by exploiting an unusually rich data source: the Malawi Longitudinal Study of Families and Health (MLSFH) cohort, 1998?2020. The motivation to expand, publicly-release and analyze the MLSFH until 2020 is multifold: (a) The MLSFH 1998?2020 will provide a unique opportunity to investigate questions about STE, an opportunity not available from other ESA data. (b) The MLSFH 1998?2020 will also be exceptional in allowing researchers to understand how the epidemic and the strategies for STE employed by individuals and families continue to shape the epidemiological and demographic transitions in ESA. (c) The end of the epidemic will almost certainly not mark the end of global health crises (an example at the time of this submission is the considerable concern about Zika in the Americas), and we need to better understand the mech- anisms of how low-income country citizens cope with such crises. The Speci?c Aims for the MLSFH 1998-2020 therefore include:
Aim 1 : Collect and publicly-release new MLSFH data from 2016?20 for (a) surviving MLSFH respondents and their families, (b) children of surviving and deceased respondents, and (c) migrants, with an expected N(surveyed) 6,300 plus data on 1,200 deceased respondents. The topics to be covered include well- being, mortality & morbidity, family & household dynamics, social capital & networks, physical & mental health, household production & consumption, and intergenerational relations.
Aim 2 : Using the MLSFH 1998?2020 and diverse methodological approaches for longitudinal data ranging from ethnographic methods to econometric structural equation modeling, analyze the determinants of STE by identifying the factors, social contexts and individual/household behaviors in?uencing survival, resilience, and well-being among MLSFH respondents, their children, and other family members.
Aim 3 : Analyze the consequences and lasting imprints of STE on (a) physical/mental health and non-communicable diseases among surviving adults and children of survivors and non-survivors, (b) fertility, investments in children and human capital in families differentially affected by the epidemic and STE, (c) migration and remittances, and (d) coping capabilities for new shocks and crises.

Public Health Relevance

Future global health crises are certain, and a better understanding of how low- income country citizens cope with such crises, how policies and programs can enhance these strategies, and how past crises affect current behaviors and health outcomes is essential for improving health in poor countries with weak health systems. To investigate these issues, the cohort of the Malawi Longitudinal Study of Families and Health (MLSFH) from 1998?2020 will be studied to learn: what predicted survival, and which factors in?uenced resilience, well-being and current health and demographic behaviors among the cohort of individuals (and their families) who survived the AIDS epidemic and are now reaching middle to old age in Eastern and Southern Africa?

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
Project #
Application #
Study Section
Social Sciences and Population Studies B Study Section (SSPB)
Program Officer
King, Rosalind B
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
Schools of Arts and Sciences
United States
Zip Code
Anglewicz, Philip; VanLandingham, Mark; Manda-Taylor, Lucinda et al. (2018) Health Selection, Migration, and HIV Infection in Malawi. Demography 55:979-1007
Payne, Collin F; Kohler, Iliana V; Bandawe, Chiwoza et al. (2018) Cognition, Health, and Well-Being in a Rural Sub-Saharan African Population. Eur J Popul 34:637-662
Kohler, Iliana V; Payne, Collin F; Bandawe, Chiwoza et al. (2017) The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context. Demography 54:1529-1558