Population Council Research that makes a difference

Malawi Schooling and Adolescent Study

This six-round longitudinal study aims to identify critical aspects of school quality that put adolescents who face the dual challenges of poverty and HIV/AIDS on a safer, healthier, and more productive path to adulthood. Our research seeks to uncover those aspects of schooling that will lead to more protective behaviors and lower HIV risk among young men and women.

In April 2010, the Population Council received a grant from the National Institute of Child Health and Human Development (NICHD) to expand the longitudinal study of adolescents in Malawi and extend the observation period for an additional four years beginning in 2010, making possible the accumulation of comprehensive data for adolescents as they age from 14–16 to 20–22 years old. These added rounds ensure the observation of our sample as they make the transition from adolescence to early adulthood, with all the concomitant life events that generally occur during those years.

The study completed its fourth round of data collection between June and August 2010. Adolescents from the original sample aged 14–16 years old in the beginning of 2007 were 17–19 at the start of 2010. The data-collection effort was very successful in capturing the original 2,650 study adolescents: 88% of those interviewed in Round 1 were re-interviewed in Round 4.

In addition to capturing information on adolescent transitions since 2007, such as school dropout, sexual initiation, marriage, and first birth, the study introduced biomarker collection in Round 4 to measure the prevalence and incidence of HIV and herpes simplex 2 (HSV-2) among our sample. The Council will explore the mechanisms linking school quality and educational outcomes to sexual behavior and the acquisition of HIV and HSV-2.  Given that incidence of infection increases significantly during the late teens and early twenties, yearly rounds of testing will be conducted to capture both incidence and prevalence of these STIs among our study cohort. 

In accordance with Ministry of Health guidelines, we conducted serial testing for HIV: The first test used was Determine™. If the test was positive, the counselor proceeded with a second test using Uni-Gold™. If the second test was positive, the participant was confirmed positive. If the second test was negative, a third test, SD BIOLINE HIV 1/2 3.0, was used as a tiebreaker.  Unreliable and unexpected test results using dried blood spots (DBS) for HSV-2 testing in another NICHD project (Grant #R01HD047764) in Uganda resulted in the realization mid-2010, that DBS must be validated for HSV-2 testing with Kalon before we could use DBS in our Malawi protocol. Given the timing of our Malawi fieldwork we quickly modified the HSV-2 testing procedure to test with serum instead of DBS. We also discovered that because HSV-2 testing had never been validated in Malawi, we needed to externally validate our test procedure, which we did successfully undertake with Contract Laboratory Services in Johannesburg.

The life-event cards depicting transitions to adulthood  introduced in Round 3 were repeated in Round 4, with the addition of two more events: pregnancy and childbirth. Participants were asked to place in order a set of life-event cards, and were asked about the age at each transition (see Round 3 details for more information).

In Round 4, qualitative in-depth interviews that explore gender attitudes, power in intimate relationships, and girls' agency were added to our fieldwork. The aim was to examine how these vary, their intersections with sexual behavior and with schooling, and how they may contribute to sexual risk. We selected 30 male and 30 female respondents, purposefully sampling to ensure that respondents included both in- and out-of-school youth, and youth living in both more- and less-remote settings. 

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