This report presents findings from the Malawi 2005 antenatal clinic (ANC) sentinel surveillance and results of the National HIV Prevalence Estimates and Projections workshop.
The primary objective of ANC sentinel surveillance was to provide data on the occurrence and distribution of HIV infection among women attending antenatal clinics. HIV sentinel surveillance data are not representative of the general population. However, sentinel surveillance data have been used as input to develop estimates of HIV prevalence in the general population.
The 2005 ANC sentinel surveillance was carried out in nineteen sites distributed across all three regions of the country, as it has been since 1994. A total of 8,953 pregnant women were captured in the survey from 1st August 2005 through end September 2005. Over 80% of the women sampled were less than 30 years of age and about 60% aged less than 25 years. The age pattern of the women recruited in the survey is very similar to the previous surveys done since 1998.
The overall HIV prevalence for all antenatal attendees in 2005, was 16.9%. The median HIV prevalence in 2005 was 15.0%, and has declined from 2003 (17.0 %), 2001 (16.9%) and in 1999 (22.8%). Median prevalence is a better figure to compare to previous years since it is not affected by changes in site sample size, and is less effected by extreme site results.
Site-specific HIV prevalence ranged from 6.3% at Thonje Health Centre, a rural site in the central region to 27.0% at Limbe Health Centre, an urban site in the southern region of the country. HIV prevalence in the southern region (21.7%) remains higher than in the northern (14.0%) and central (14.3%) regions. Overall HIV prevalence in the urban (20.4%) areas continued to be high and significantly different from semi urban (17.0%) and rural areas (13.0%)
HIV prevalence was significantly higher among women with post secondary school education (33.3%) as compared to women with no education (17.9%) and those reporting to have gone up to std 1-5 (16.1%) and std 6-8 (15.4%).
Overall syphilis prevalence was 1.9%. Prevalence of syphilis ranged from 0% in Gawanani, Kasina Thonje and Mzuzu Health Centres to 10.8% in Nsanje.
There was a direct relationship between age and syphilis infection from 15 to 44 years of age. Syphilis prevalence rates among women by age group were as follows; 15-19 (1.1%), 20-24(1.5%) 25-29 (2.3%) 30-34 (2.7%) 35-39 (3.8) and 40-44 (5.1%). The observed syphilis prevalence rates across regions are not statistically different. However, syphilis prevalence in the southern region (2.4%) remains higher than the central (1.8%) and northern (1.6%) regions. Overall, there appears to be a decline in syphilis prevalence over the years.
There was a general association between HIV and syphilis infection in the study sample. This result shows that syphilis and HIV were not occurring independently.
The 2005 sentinel surveillance survey results have been used to estimate national HIV prevalence in Malawi using internationally recommended methods; antenatal clinic data and the modeling computer software Estimation and Projection Package (EPP) and Spectrum.
The estimated HIV/AIDS prevalence in adults (15 to 49 years) in Malawi in 2005 is 14.0%, with a range from 12% to 17% giving a total of 790,000 infected adults. The analysis indicates that levels of HIV infection in the adult population of Malawi have remained constant for the last nine years. The prevalence estimate was 21.6% in urban areas and 12.1% in rural areas
The stable prevalence at 12 to 17 percent does not mean the HIV/AIDS problem has gone away. Every year at least 86,592 people are dying from AIDS and as many as 96,552 new infections occur. . The stable high prevalence could be attributed to high incidence in the younger age groups, especially adolescents (15-19 years).
Infection levels are above 10 percent in all sentinel sites except three rural sites in the Central Region. HIV prevalence is very high, 23.1 - 27 percent, in Blantyre, Mulanje and Nsanje.
The total number of people infected with HIV is estimated to be between 780,000 and 1,120,000 people in 2005. This figure includes 69,000 – 100,000 children under the age of 15 who are infected. One-third of those infected live in urban areas and two-thirds in rural areas.
A total of 187,336 people living with HIV and AIDS (PLWHA) were in need of antiretroviral therapy (ART) in 2005 and it was projected that by the end of 2010, a total of 233,675 PLWHA would be in need of ART. The estimates and projections for AIDS cases and deaths, adults and children needing ART are based on the assumptions that ART coverage will increase to 50% and prevention of mother to child transmission (PMTCT) coverage will increase to 433,000 pregnant women by 2010.