Malawi

Malawi is a landlocked country located in southeastern Africa. A long, narrow country within the Great Rift Valley, it is home to Lake Nyasa (also known as Lake Malawi), the third largest lake in Africa. Slightly smaller in size than the state of Pennsylvania, it is dwarfed by neighboring Tanzania, Mozambique, and Zambia. Beyond its physical beauty, Malawi is a country in crisis, with most of its people facing poverty, malnutrition, and above all, the horrifying repercussions of the AIDS epidemic.

The population is approximately 13 million, with an annual growth rate of 2.38 percent. This comes from natural increase: the birth rate is 41.13 per 1,000 people, the death rate 19.33 per 1,000 people. Although only 15 percent of the people live in urban areas, Malawi is nevertheless one of the more crowded countries in southern Africa, with 109 people per square kilometer.

Few countries have been as ravaged by AIDS as Malawi, and any discussion of the nation's health has to begin there. Over 16 percent of Malawi's population is now infected with human immunodeficiency virus (HIV)/AIDS—perhaps 1 million people in all, with upward of 100,000 already dead from the virus. AIDS is the primary cause in 70 percent of all hospital deaths. In the past two years, the number of patients receiving antiretroviral medications has expanded from 4,000 to 46,000, still just a fraction of those who need them.

The impact on life expectancy is staggering: At birth, the average Malawian, male or female, can anticipate living only to the age of 42. Healthy life expectancy is just 35 years. Infant mortality is 113 deaths per 1,000 live births; 175 out of every 1,000 die between the ages of 1 and 5 years. At least 500,000 children have lost one or both parents to the virus. Between 1995 and 2005, maternal mortality jumped from 580 deaths per 100,000 live births to 1,800 deaths per 100,000 live births—a fatality rate second only to Sierra Leone.

Malawi is an agricultural nation, with 90 percent of the workforce involved in farming an economy based on the export of tobacco, tea, coffee, and sugar. However, working-aged people are those most likely to suffer from AIDS, leaving a limited amount of young people to perform such manual labor. Today, [Page 1055]Malawi has the lowest Gross Domestic Product in the world. Per capita income is $170 a year, and 42 percent of the population live on less than $1 a day.

A weakened workforce and a prolonged period of drought has hurt Malawi's ability to feed itself. Even before AIDS, the Malawian diet was nutrient poor. Staple crops are millet, maize, and sorghum, with two-thirds of the animal protein coming from fish. In 2005, Malawian president Bingu wa Mutharika declared a food emergency in all 28 districts of the country, and the United States Agency for International Development (USAID) estimated that 5.1 million people would require food rations to get them through until the 2006 harvest.

Malnutrition alone reduces the body's ability to fight off opportunistic infections by about 50 percent, but this is not the only problem facing Malawians. Sanitation is another critical factor in public health. About 67 percent of the people have access to clean drinking water, and only 46 percent have sanitary facilities. This increases the risk of water- and vector-borne illnesses such as diarrhea, typhoid, hepatitis A, and malaria. There are regional outbreaks of plague and sporadic outbreaks of schistosomiasis. The rate of acute respiratory illness is also high. Tuberculosis (TB) has risen along with the AIDS epidemic, with 501 people out of every 100,000 positive for TB.

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