Introduction

The Malawi Longitudinal Study of Families and Health (MLSFH) is one of a very few long-standing longitudinal cohort studies in a poor sub-Saharan African (SSA) context. The MLSFH cohorts were selected to represent the rural population of Malawi, where the vast majority of Malawians live in conditions that are similar to those in the rural areas of other countries with high HIV prevalence: health conditions are poor, health facilities and schools are over-burdened and under-staffed, standards of living are low and nutritional needs of adults, children and the elderly are often not met. With major data collection rounds in 1998, 2001, 2004, 2006, 2008, 2010, and 2012 for up to 4,000 individuals, as well as ancillary surveys and qualitative studies, the MLSFH has been a premier dataset for research on health, family dynamics, social networks, and HIV infection risks in a rural SSA context. Providing public-use data on the socioeconomic context, demographics and health of individuals and their families in Malawi over more than a decade, the MLSFH has been the basis of more than 150 publications and working papers submitted for publication. Importantly, the MLSFH has also informed health policy discussions in Malawi and elsewhere in SSA. A MLSFH Cohort Profile summarizes key findings of the MLSFH, and provides detailed additional information about the MLSFH study design.

The MLSFH (1998–2012) is a collaboration of the University of Pennsylvania with the College of Medicine and the Demography Unit, Chancellor College, both at the University of Malawi. It subsumes earlier research under the Malawi Diffusion and Ideational Change Project (MDICP, 1998–2004), which focused on the influence of social networks on the adoption of family planning and on AIDS-related attitudes and behaviors. Subsequently (2006–2012) the goals of the MLSFH expanded. Overall, the MLSFH has (1) provided a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world’s poorest countries through the collection of longitudinal cohort data, and (2) analyzed these data to investigate the multiple influences that contribute to HIV risks in sexual partnerships, the variety of ways in which people manage risk within and outside of marriage and other sexual relationships, the possible effects of HIV prevention policies and programs, and the mechanisms through which poor rural individuals, families, households, and communities cope with the impacts of high morbidity and mortality that are often—but not always—related to HIV/AIDS. The data collection and research conducted by MLSFH was approved by the IRB at the University of Pennsylvania and, in Malawi, by the College of Medicine Research Ethics Committee (COMREC) or the National Health Sciences Research Committee (NHSRC).

The first wave of the MLSFH was funded by the Rockefeller Foundation. Subsequent funding has been provided by the NICHD (grants R01 HD053781, R01 HD/MH041713, R01 HD37276, R01 HD044228, R21 HD050652, R03 HD058976, R21 HD071471), and has been supported by pilot grants from the Population Studies Center (PSC), Population Aging Research Center (PARC), the Boettner Center for Pensions and Retirement Security, the Institute on Aging, and the Center for AIDS Research (CFAR), all at the University of Pennsylvania and supported among other sources by NIH grants NICHD R24 HD044964, NIA P30 AG12836, NIAID AI 045008. The project also received funding from the University of Pennsylvania Research Foundation.