Our proposed data collection, empirical analyses and policy intervention build on and complement an established longitudinal data collection effort: The Malawi Longitudinal Study of Families and Health (MLSFH). The MLSFH is one of very few long-standing, publicly available longitudinal cohort studies in a sub-Saharan African (SSA) context. It provides a rare record of more than a decade of demographic, socioeconomic and health conditions. Since 1998 it has regularly collected information on socioeconomic and demographic characteristics, health, sexual behaviors, risk perceptions and subjective expectations, social networks and social capital, intergenerational relations and family/household dynamics in seven survey rounds of up to 4,000 individuals.
The proposed data collection activities as part of this project build on the 2013 round of the MLSFH, which comprised a sample of 1,500 mature adults aged 45 and older. This baseline survey collected comprehensive information on health and wellbeing (including physical health, HIV/AIDS, cognitive function, mental health and anxiety, and biomarkers and functional performance tests), health behaviors, healthcare use, subjective expectations, and measures of work productivity as well as disability.
To study the impact of chronic disease for the evolution of health, healthcare use, work productivity, poverty and human capital investments, the requested funding will support the collection of six additional rounds of data following the 2013 baseline sample of 1,500 mature adults over time. Given the focus of the overall research project, the proposed data collection effort will couple the continuation of key longitudinal items with new survey modules specifically targeted toward the study of chronic disease and its consequences in terms of healthcare use and expenditures, treatment and—importantly—socioeconomic outcomes such as work disability, earnings, poverty and human capital investments. Specifically, the envisaged data collection will contain new or more detailed information on healthcare use and expenditures, medication use (medication inventory), health literacy and health expectations, visual assessments, blood pressure measurements, mental health and anxiety, chronic pain, time-use based measures of productivity and wellbeing
Research Team
Hans-Peter Kohler
Hans-Peter Kohler, Ph.D., is a social and economic demographer whose current research focuses on health, demography and social change in developing and developed countries. A key characteristic of his research is the attempt to integrate demographic, economic, sociological and biological approaches in empirical and theoretical models of health and demographic behaviors. In his prior work, he investigated the role of social and sexual networks for HIV risk perceptions and HIV infection risks, the causal effects of education on health, the consequences of learning one’s HIV status on risky behaviors, the interrelations between marriage and sexual relations in developing countries, the role of social interaction processes for fertility and AIDS-related behaviors, and the determinants and consequences of low fertility in developed countries.
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His research combines extensive knowledge about the determinants of health, fertility/mortality, HIV/AIDS, and related economic behaviors in developing and developed countries with considerable experience in sophisticated econometric and demographic analyses, including analyses with controls for endowment and unobserved determinants of individuals’ behaviors, models of population and disease dynamics, randomized designs and integration of social science and biomedical research methods.
He has extensive experience in the design and implementation of large-scale data collection in sub-Saharan contexts. He has been awarded the Clifford C. Clogg Award for Early Career Achievement by the Population Association of America for my interdisciplinary work on fertility and health, and have been honored with Otis Dudley Duncan Award for Outstanding Scholarship in Social Demography by the American Sociological Association. He has been a Fellow at the Center for Advanced Studies at the Norwegian Academy of Science, served as the president of the Society of Biodemography and Social Biology, and was engaged as lead-paper author in the Copenhagen Consensus Project to evaluate policies to prevent the sexual transmission of HIV (2011, with Behrman) and reduce population growth (2012). Kohler served as the Chair of Penn’s Ph.D. Program in Demography for many years, and continues to be the NICHD T32 Training Director for this program (successfully renewed in 2012). He has also been the PI of the NIH grant “Consequences of High Morbidity and Mortality in a Low-Income Country” (R01HD053781) that supported the Malawi Longitudinal Study of Families and Health (MLSFH).
Iliana Kohler
Iliana Kohler, Ph.D., is a population scientist and social demographer, with a background in both social and biomedical sciences. Her research focuses on global health issues and their social, economic and policy implications in different international contexts. Her primary research agenda is centered on health, health-related behaviors, mortality, aging and intergenerational transfers in an international context. Her most recent research focuses on aging in African poor high HIV-prevalence contexts, with a specific focus on the social and biological determinants and patterns of mental health and cognitive abilities. In her work, demography provides the overarching framework to understand the life-course determinants of aging, related intergenerational relations and transfers, the interactions between population dynamics and disease dynamics that are central to understanding current European and global demographic and health patterns.
Fabrice Kämpfen
Swiss Team member
Fabrice Kämpfen is a broadly trained health economist with research interests focused on innovative topics in health economics, population health and aging. An important innovation of his research has been the expansion of aging research beyond well-studied high-income countries, with a novel focus on low-and middle-income contexts. Fabrice is currently a lecturer at the School of Economics in University College Dublin in Ireland.
Publications
Peer reviewed
2025
Ciancio, A., Kämpfen, F., Kohler, H.-P. & Thornton, R. (2025). Surviving Bad News: Health Information without Treatment Options. American Economic Review: Insights, Forthcoming. https://www.aeaweb.org/articles?id=10.1257/aeri.20240058&from=f
2024
Banda, S., Kohler, I. V., Kohler, H. P., & Chichlowska, S. C. (2024). Health-related quality of life and its predictors among hypertensive adults 45 years and older in rural Malawi: a population-based study. Malawi Medical Journal, 36(2), 97-106. https://doi.org/10.4314/mmj.v36i2.6
Purcell, H., Kohler, I. V., Ciancio, A., Mwera, J., Delavande, A., Mwapasa, V., & Kohler, H. (2024). Mortality risk information and health-seeking behavior during an epidemic. Proceedings of the National Academy of Sciences, 121(28). https://doi.org/10.1073/pnas.2315677121
Ciancio, A., Delavande, A., Kohler, H.-P, & Kohler, I. V. (2024). Mortality Risk Information, Survival Expectations and Sexual Behaviours. The Economic Journal, 134(660), 1431–1464. https://doi.org/10.1093/ej/uead116
Myroniuk,T. W., Kohler, H.-P, Mwapasa, V., Mwera, J., & Kohler, I. V. (2024). Surprising Gendered Age Differences in Rural Malawians’ Early COVID-19 Pandemic Prevention Efforts. The Journals of Gerontology: Series B, 79(5), gbae031. https://doi.org/10.1093/geronb/gbae031
2023
Ciancio, A., Behrman, J., Kämpfen, F., Kohler, I. V., Maurer, J., Mwapasa, V., & Kohler, H.-P. (2023). Barker’s Hypothesis Among the Global Poor: Positive Long-Term Cardiovascular Effects of in Utero Famine Exposure. Demography, 60(6), 1747–1766. https://doi.org/10.1215/00703370-11052790
Hoang, C. T., Kohler, I. V., Amin, V., Behrman, J. R., & Kohler, H.-P. (2023). Resilience, Accelerated Aging, and Persistently Poor Health: Diverse Trajectories of Health in Malawi. Population Development and Review, 49(4), 771–800. https://doi.org/10.1111/padr.12590
Scheve, A., Bandawe, C., Kohler, H.-P., & Kohler, I. V. (2023). Mental health and life-course shocks in a low-income country: Evidence from Malawi. SSM – Population Health, 19, 101098. https://doi.org/10.1016/j.ssmph.2022.101098
Kohler, I. V., Bandawe, C., Kämpfen, F., & Kohler, H.-P. (2023). Cognition and Cognitive Changes in a Low-Income Sub-Saharan African Aging Population. Journal of Alzheimer’s Disease, 95(1), 195-212. https://doi.org/10.3233/JAD-230271
2022
Kämpfen, F., Zahra, F., Kohler, H. -P., & Kidman, R. (2022). The effects of negative economic shocks at birth on adolescents’ cognitive outcomes and educational attainment in Malawi. SSM – Population Health, 18, 101085. https://doi.org/10.1016/j.ssmph.2022.101085
Kohler, I. V., Kämpfen, F., Ciancio, A., Mwera, J., Mwapasa, V., & Kohler, H.-P. (2022). Curtailing Covid-19 on a dollar-a-day in Malawi: Role of community leadership for shaping public health and economic responses to the pandemic. World Development, 151, 105753. https://doi.org/10.1016/j.worlddev.2021.105753
Kohler, I. V., Ciancio, A., Kämpfen, F., Kohler, H.-P., Mwapasa, V., Chilima, B., Vinkhumbo, S., Mwera, J., & Maurer, J. (2022). Pain Is Widespread and Predicts Poor Mental Health Among Older Adults in Rural Malawi. Innovation in Aging, 6(3). https://doi.org/10.1093/geroni/igac008
Kohler, I. V., Sudharsanan, N., Bandawe, C., & Kohler, H.-P. (2022). Aging and Hypertension among the Global Poor: Panel Data Evidence from Malawi. PLOS Global Public Health, 2(6), e0000600. https://doi.org/10.1371/journal.pgph.0000600
2021
Ciancio, A., Kämpfen, F., Kohler, H.-P., & Kohler, I. V. (2021). Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa. Journal of Health Economics, 75, 102388. https://doi.org/10.1016/j.jhealeco.2020.102388
2020
Kämpfen F, Kohler, I. V., Bountogo M, Mera J, Kohler, H. -P, Maurer J (2020). Using grip strength to compute physical health-adjusted old age dependency ratios. SSM – Population Health, 11, 100579. https://doi.org/10.1016/j.ssmph.2020.100579.
Kohler, I. V., Bandawe, C., Ciancio, A., Kämpfen, F., Payne, C. F., Mwera, J., Mkandawire, James., Kohler, H. -P. (2020). Cohort profile: the mature adults cohort of the Malawi longitudinal study of families and health (MLSFH-MAC). BMJ open, 10(10), e038232–e038232. https://doi.org/10.1136/bmjopen-2020-038232
2019
Payne, C. F., Pesando, L. M., & Kohler, H. -P. (2019). Private Intergenerational Transfers, Family Structure, and Health in a sub‐Saharan African Context. Population and Development Review, 45(1), 41–80. https://doi.org/10.1111/padr.12225
Kidman, R., Smith, D. A., Piccolo, L.R., & Kohler, H.-P. (2019). Psychometric evaluation of the Adverse Childhood Experience International Questionnaire (ACE-IQ) in Malawian adolescents. Child abuse and neglect, 92, 139–145. https://doi.org/10.1016/j.chiabu.2019.03.015
Myroniuk,T. W., & Payne, C. F. (2019) The Longitudinal Dynamics of Household Composition and Wealth in Rural Malawi. Journal of Comparative Family Studies, 50(3), 242-260. https://doi.org/10.3138/jcfs.50.3.003
2018
2017
Kohler, I. V., Payne, C. F., Bandawe, C., & Kohler, H.-P. (2017). The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context. Demography, 54(4), 1529–1558. https://doi.org/10.1007/s13524-017-0596-9
Payne, C. F., Kohler, I. V., Chiwoza Bandawe, Lawler, K., & Kohler, H.-P. (2017). Cognition, Health, and Well-Being in a Rural Sub-Saharan African Population. European Journal of Population, 34(4), 637–662. https://doi.org/10.1007/s10680-017-9445-1
Non-Peer reviewed
Purcell, H., Kohler, I. V., Ciancio, A., Mwera, J., Delavande, A., Mwapasa, V., & Kohler, H.-P., (2024) Changing Perceptions of Survival Risk Increased COVID Vaccination 5 Years Later [Research Paper] https://ldi.upenn.edu/our-work/research-updates/correcting-pessimistic-mortality-beliefs-may-reduce-vaccine-hesitancy-malawi-study-shows/
Ciancio, A., Kämpfen, F., Kohler, H.-P., & Thornton, R. (2024) Surviving Bad News: Health Information without Treatment Options [Working Paper] https://www.aging.upenn.edu/node/86999
Kohler, I. V., Kämpfen, F., Mphamba, P., Katundu, K., Chirwa, G., & Namaganda, R. (2023) Disability and access to assistive technology in Malawi [Policy Brief] https://r4d-ncd.org/wp-content/uploads/2023/06/policy2-2.pdf
Owens, N., Kohler, I. V., Kämpfen, F., Katundu, K., Chirwa, G., Mphamba, P., & Somerville, C. (2023) Strategies to address challenges associated with the increasing burden of NCDs in Malawi [Policy Brief]. https://r4d-ncd.org/wp-content/uploads/2023/06/policy1-2.pdf
Ciancio, A., Kämpfen, F., Kohler, H.-P., & Kohler, I. V. (2021) Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa [Research Brief]. https://r4d-ncd.org/wp-content/uploads/2021/02/penn-ldi-parc-brief-health-screening-for-emerging-disease-burdens-among-the-global-poor-2.pdf
Kohler, I. V., Kämpfen, F., Mphamba, P., Katundu, K., Chirwa, G., & Ajuwon, A.J. (2021) Use of technology to improve delivery and quality of health care services in Malawi [Policy Brief]. https://r4d-ncd.org/wp-content/uploads/2023/06/policy3-3.pdf
Agarwal, N., Kohler,H.-P., & Mani.,S. (2020). “Path Dependence in Disability.” University of Pennsylvania Population Center Working Paper (PSC/PARC), 2020-57.[Working Paper] https://repository.upenn.edu/psc_publications/57.
MLSFH (2017) MLSFH SANE-Newsletter https://www.mlsfhresearch.org/projects/sane-newsletter
PROJECT FUNDED BY
Inclusive social protection for chronic health problems 