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Information on women's use of antenatal clinic (ANC) service, including malaria prevention and treatment during pregnancy, was collected during a national malaria knowledge, attitudes, and practices survey in Malawi. Among 1531 households, 809 (53%) included a woman who had carried a pregnancy past the second trimester within the past 5 years. Of these, 756 (93%) women reported at least one ANC visit during pregnancy (median = 4); 336 (42%) attended 5 or more times. Approximately half (51%) reported delivering in a hospital; 5% delivered in a clinic; 13% delivered at home with a trained birth attendant; and 28% delivered at home with only family attending. Women at increased risk for delivery complications (e.g. primigravidas and grand multigravidas) were no more likely to attend ANC or deliver in hospital than women without increased risk. The woman's level of education was the only significant predictor of initiating ANC care, continued ANC attendance, and delivery in hospital. In a setting where 43% of women pregnant within the past 5 years had received no formal education and 70% had completed less than 5 years, this survey identified a critical need for targeting health messages towards poorly educated women to ensure proper utilization of antenatal care services, including coverage with malaria prevention throughout pregnancy.

Household heads were questioned about household income and household expenditures on the treatment or prevention of malaria in a nationwide malaria knowledge, attitudes, and practices (KAP) survey conducted in Malawi in 1992. Very low income households with an average annual income of $68 constituted 52% of the sampled households. The primary income source for these households was farm production (92%), with the majority of goods produced consumed by the household and not available as discretionary income. Expenditure on malaria prevention varied with household income level. Only 4% of very low income households spent resources on malaria preventive measures compared to 16% of other households. In contrast, over 40% of all households, independent of income level, reported expenditures on malaria treatment. Almost half of the reported malaria cases sought treatment at a health facility at a cost of $0.21 per child case and $0.63 per adult case. The overall direct expenditure on treatment of malaria illness in household members was $19.13 per year (28% of annual income) among very low income households and $19.84 per year (2% of annual income) among low to high income households. The indirect cost of malaria, calculated on the basis of days of work lost, was $2.13 per year (3.1% of annual income) among very low income households and $20.61 per year (2.2% of annual income) among low to high income households. Very low income households carried a disproportionate share of the economic burden of malaria, with total direct and indirect cost of malaria among these households consuming 32% of annual household income compared to 4.2% among households in the low to high income categories.

A national knowledge, attitudes and practices (KAP) survey was conducted in March-April 1992 to examine malaria illness and the people's response to illness and malaria prevention. Fifty-one households in each of 30 randomly selected communities were sampled and information was recorded from 1,531 households and 7,025 individuals. The population is characterized by low income (average household and per capita income were US $490 and $122, respectively) and low education levels (among adult women, 45% had no formal education and only 3.9% completed more than 8 years of schooling). Characteristics of the population were similar to those found in the 1987 national census, suggesting that the survey population was representative of the larger population of Malawi. Children under 5 years of age made up 15.8% of the population and had the highest rates of fever illness; these children experienced an estimated 9.7 cases/year of fever illness consistent with malaria. Although adults reported fever less frequently, women of reproductive age experienced an estimated 6.9 episodes of fever annually. The burden of malaria morbidity in this population is extremely high and occurs in all age groups.

Caretakers of children (< 10 years of age) were questioned about management of pediatric malarial fever episodes in a nation-wide knowledge, attitudes, and practices survey conducted in Malawi. A total of 1,531 households in 30 randomly selected clusters of 51 households each were sampled and interviewed. Overall 557 caretakers reported a fever in their child in the previous 2 weeks; 43%-judged the illness as severe. Fifty-two percent of caretakers brought their febrile children to clinic. Clinic attendance was positively correlated with young age of the child (< 4 years), severe illness, and higher socioeconomic status. Seventy-four percent of clinic attenders gave their child an antimalarial; in contrast, only 42% of those not attending clinic gave an antimalarial. Optimal therapy (administration of an antimalarial promptly and at the proper dosage) was received by only 7% of febrile children. Children taken to clinic were twice as likely to receive optimal therapy as were non-attenders. Identification of critical points in the optimal therapy algorithm and characteristics of caretakers linked with sub-optimal therapy may help malaria control programs target specific groups and health education messages to improve treatment of malaria fever episodes.

In a double blind study, the Teesdale glass sandwich and Kato-Katz techniques were compared for the diagnosis of Schistosoma mansoni. From each of five stool specimens, six slide preparations were made by each method, and each slide was read independently by two readers. Examination of the differences in the number of eggs per slide by Analysis of Variance (ANOVA) showed no significant differences between methods, readers, or slides prepared from the same specimen at the 90% level of significance.

Prevalence data for schistosomiasis in Malawi, collected in recent years, indicated that the infection, especially Schistosoma mansoni is far more widespread than was previously thought. S. haematobium is highly prevalent in the south, while S. mansoni predominates on the Central Plateau. Both infections occur with moderate to high intensity along the lakeshore plain. Despite the high prevalence, reports of morbidity due to the infection are fewer than might be expected.