MLSFH Research News


Health Seeking Behavior During an Epidemic

Pessimistic survival expectations are widespread in countries affected for decades by high disease burdens and repeated epidemics. A new MLSFH study published in PNAS shows that providing individuals in these contexts with accurate information about population survival risk can help improve health-seeking behaviors. Multiple pathways contribute to these treatment effects, including an increased engagement with the healthcare system and belief that biomedical treatments are effective. Importantly, these MLSFH findings suggest that health information interventions focused on survival perceptions can be useful in promoting health behavior and participation in the formal healthcare system, even during health crises—such as the COVID-19 pandemic—that are unanticipated at the time of the intervention.

Purcell et al. (2024). PNAS,

Sexual Behaviors and Mortality Risk Information

In sub-Saharan African countries affected by HIV, individuals are often overly pessimistic about their own survival. A new Economic Journal paper evaluates the impacts of the 2017 MLSFH Benknow Health Information Intervention that provided individuals aged 45+ with accurate information about their mortality risks.  Importantly, Benknow reduced risky sexual behaviors: it increased sexual abstinence, reduced the propensity of having multiple sex partners and increased marriage among treated individuals. MLSFH expectations data also provide insights into the why sexual behaviors changed: treated individuals have an increased subjective transmission risk associated with multiple partners, driven by an increase in the perceived HIV prevalence of potential partners. Overall, this paper highlights that expectations of population mortality risks are an important and modifiable determinant of health behaviors.

Ciancio et al. (2024). Economic Journal,

Penn News features the MLSFH research on Aging in Malawi, including our Malawi visitors to Penn: Victor Mwapasa, Kaz Kulizewa and Kondani Katundu. “Aging in high-income countries has been studied for many years, and it’s a big and prominent and important research agenda, and we know a lot about this. Aging in poor countries is really understudied,” Penn News writes, and referring to the MLSFH project on Adversity, Aging and ADRD Risk, the article states: "A new $10 million grant from the National Institutes of Health’s National Institute on Aging, the largest single grant the Malawi Longitudinal Study of Families and Health (MLSFH) has received, is funding cutting-edge research to fill a gap in understanding about aging in low-income countries."

Penn News, January 23, 2024

An update of the MLSFH website was long overdue. Our new website is now live (Jan '24) will provide a new home for the MLSFH with comprehensive information about the project, as well as the MLSFH team, research and publications. Please be patient while we are still adding some project documentation to the new site, and please send us MLSFH research news updates to be featured on or @MLSFHresearch

Learning HIV status may lead to higher mortality

Providing personal health information allows individuals to take action to improve their health. If treatment is not available, however, being informed about having a life-threatening disease could lead to feelings of despair or fatalistic behaviors resulting in negative health outcomes. MLSFH reseaerch documents this possibility utilizing a 2004 MLSFH experiment that randomized incentives to learn HIV testing results. At the time, anti-retroviral treatment (ART) was not yet available in the MLSFH study regions. Six years after the experiment, receiving an HIV+ diagnosis reduced survival rates by 23% points. This effect persists after 15 years. HIV+ persons who learned they were HIV+ engaged in more risky health behaviors, have greater anxiety and a higher discount rate. Analyses do not find effects of receiving an HIV- diagnosis on survival.

Population Center Working Paper (PSC/PARC), 2024-102

Resilience, Accelerated Aging and Persistently Poor Health

Individuals age at vastly different rates resulting in significant within-population heterogeneity in health and aging outcomes. This diversity in health and aging trajectories has rarely been investigated among low-income aging populations that have experienced substantial hardships throughout their lifecourses. Utilizing 2006-2019 data, MLSFH ANALYSES identified three distinct lifecourse health trajectories: (1) comparatively good initial mental and physical health that persisted throughout the lifecourse (“resilient aging”), (2) relatively good initial mental and physical health that started to deteriorate during mid-adulthood (“accelerated aging”), and (3) poor initial mental and physical health that further declined over the lifecourse (“aging with persistently poor health”). For both physical and mental health, men were found to more likely enjoy resilient aging than women.

Cung Hoang, Iliana Kohler, et al. (2023). Population and Development Review,

A First for the MLSFH: DBS on their way to DNA Methylation Profiling!

The MLSFH team pilot tested in Nov '23 the collection of dried blood spots (DBS) from respondents aged 45+ for subsequent DNA methylation (DNAm) profiling and whole gnome sequencing as part of the MLSFH project on Adversity, Aging and ADRD Risk among the Global Poor: A Biosocial Lifecourse Approach

Team is celebrating a successful pilot, and having successfully shipped the DBS off to the Kobor Lab at UBC. More DBS to come in 2024, ultimately yielding epigenetic clocks and novel biological age measures for MLSFH respondents aged 45+ to allow for biosocial studies of aging, cognition and ADRD.

More info about this project...

Cognition and Cognitive Changes in Malawi

Cognition and its age-related changes remain vastly understudied in low-income countries (LICs), despite evidence suggesting that cognitive decline among aging low-income populations is a rapidly increasing disease burden often occurring at younger ages as compared to high-income countries.

Analyses of 2012-17 MLSFH data on cognition show that women have lower levels of cognition than men, a pattern in stark contrast to findings in higher-income contexts. Schooling and socioeconomic status increase the probability of having consistently high performance during the cognitive assessment. Cognitive decline accelerates with age and is detectable already at mid-adult ages (45-55 years). Yet, despite lower levels of cognitive function observed among women, the pace of decline with age is similar for both genders.

Iliana Kohler, Fabrice Kämpfen et al. (2023). Journal of Alzheimer's Disease,

MLSFH joins SSA HCAP Network

Penn Population Aging Research Center (PARC), in coordination with the Harmonized Cognitive Assessment Protocol (HCAP) Network and the National Institute on Aging (NIA), organized in October 2023 a workshop at the University of Pennsylvania to initiate the Sub-Saharan Africa (SSA) HCAP Network to promote research on cognition and ADRD in SSA.

MLSFH is glad to be part of this important SSA HCAP initiative!

Nyasaland FAmine: Lasting Effects of Cardiovascular health

An influential literature on the Barker's hypothesis (or the Developmental Origins of Health and Disease, DOHaD) has documented that poor conditions in utero lead to higher risk of hypertension, diabetes, stroke and heart disease in middle age in middle- and high-income contexts. One of the main explanations is that periods of high calorie intake after birth are inconsistent with the adaptations that the fetus makes to prepare for a poor resources environment (thrifty phenotype hypothesis). MLSFH research documents that individuals exposed in utero to a substantial famine in 1949, have lower levels of blood pressure and blood sugar and less symptoms associated with stroke over half a century later. These findings may be explained by a prolonged period of malnutrition following the famine in contrast to most of the contexts studied in the previous literature.

Ciancio et al (2023). Demography.

Childhood Adversity and Adolescent Intimate Partner Violence

Adverse childhood experiences (ACEs)—including child maltreatment, witnessing violence, and household dysfunction—have been robustly associated with poor health in later life. Among MLSFH adolescents (MLSFH ACE Cohort), the cumulative ACEs score is associated with emotional IPV victimization for boys and sexual IPV victimization for girls. The ACEs score demonstrated a significant association with perpetration for girls only. By using longitudinal data, MLSFH data allow to more rigorously demonstrate the critical role of childhood adversity in shaping later IPV behavior. Given the burden that adolescents already carry, this research highlights the need for secondary interventions that can help interrupt the pathway from adversity to IPV. It also calls for an increased collaboration between those working to address violence against children and violence against women.

Rachel Kidman et al (2023). Journal of Interpersonal Violence.

MLSFH meets National Health Sciences Research Committee

Providing key findings and their policy implications to stake holders in Malawi is a critical part of the MLSFH mission. In March '23, the MLSFH team hosted the National Health Sciences Research Committee (NHSRC) chair and additional the NHSRC members to provide updates about current and future MLSFH research. 

Thank you, NHSRC, for your ongoing support of the MLSFH!

A Celebration with Representatives of MLSFH Study Communities

25 Years of MLSFH: The MLSFH celebrated in March '23 this great milestone with representatives of the MLSFH study communities and local stake holders.

It was rewarding to share MLSFH findings with the individuals and communities who have volunteered their time, effort and personal insights for our research. Most importantly, the team was proud to learn how the MLSFH has made a difference for participants, their families and communities, and for local staff  working on the MLSFH. 

Zikomo and thank you to our study communities for supporting the MLSFH for a quarter century. The MLSFH is proud to be a part of your lives!

Outside, while the team was meeting in Blantyre, Cyclone Freddy unfortunately caused widespread destruction and despair across southern Malawi. The MLSFH study communities were (relatively) spared.

The future of health research in Malawi

A workshop convened by Penn, the MLSFH team, the University College Dublin, and the Malawi Young Researchers Forum  brought together stakeholders to discuss the African nation’s use of technology in health care and the double burden of non-communicable and infectious diseases. Recognizing that the disease burden was evolving beyond malaria and other infectious diseases, which had been the traditional focus, the 2012 Malawi National Health Research Agenda (NHRA) suggested a research pivot to put greater emphasis on non-communicable diseases, mental health, and trauma and rehabilitation. MLSFH research is providing critical insights to help achieve the goals of preventing non-communicable diseases and reducing their impacts of the livelihoods and well-being of individuals in Malawi.

Penn News, Feb 2023

HIV positivity awareness and Risky Sexual behavioR

Awareness of one's HIV status has been shown to impact risky sexual behaviors such as inconsistent condom use and multiple sexual partners. Risky sexual behaviors are a major driver for HIV transmission in Sub-Saharan Africa (SSA). MLSFH data combined with marginal structural model allow estimation of the causal effect of HIV status awareness on condom use, multiple sexual partners and marital stability. Results show that awareness of HIV positivity was associated with increased condom use. Only among women was it associated with multiple sexual partners. These findings reinforce the need to up-scale interventions that promote HIV testing, awareness of HIV status, and prevention of HIV transmission.

Halima Twabi, Samuel Manda et al (2023). Biostatistics & Epidemiology.

2022: Back after Covid-19!

While MLSFH data collections continued throughout the Covid-19 pandemic, initially with a 2020 phone survey and then in 2021 with in-person surveys for MLSFH ACE Round 2 and the MLSFH sibling enrollment, the US-based MLSFH team could not join due to travel restrictions. 

This fortunately changed in 2022, and it was great to be back in the field with the local MLSFH team for the MLSFH M12 Surviving an Epidemic data collection. Nothing can replace spending time in the Warm Heart of Africa with the MLSFH team!