Adverse Childhood Experiences: Prevalence and Association With Adolescent Health in Malawi

  • Rachel Kidman
    Address correspondence to: Rachel Kidman, PhD, Program in Public Health and Department of Family, Population and Preventive Medicine, HSC Level 3, Room 79, State University of New York at Stony Brook, Stony Brook NY 11794.
    Program in Public Health, State University of New York at Stony Brook, Stony Brook, New York

    Department of Family, Population and Preventive Medicine, State University of New York at Stony Brook, Stony Brook, New York
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  • Luciane R. Piccolo
    Department of Pediatrics, New York University School of Medicine, New York, New York
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  • Hans-Peter Kohler
    Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania

    Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Published:December 04, 2019DOI:


      Childhood adversity is robustly associated with poor health across the life course. However, very few studies have examined the prevalence and implications of adverse childhood experiences in low- and middle-income countries. The objective of this study is to measure adverse childhood experiences among adolescents in Malawi and examine the association with mental and physical health outcomes.


      From 2017 to 2018, baseline data were collected among adolescents aged 10–16 years (n=2,089). Respondents were interviewed in their local language at their homes. Respondents completed questions on childhood adversity (Adverse Childhood Experiences-International Questionnaire), self-rated health, mortality expectations, and mental health (Beck Depression Inventory and Post-Traumatic Stress Disorder Scale). Stunting, obesity, and grip strength were measured. Analyses were conducted in 2018. Frequencies described the prevalence of adverse childhood experiences, and adjusted multivariate models examined whether cumulative adversity predicts current health.


      Adolescents reported a high burden of adversity (i.e., 5 lifetime adverse childhood experiences on average). Adolescents who scored in the top adverse childhood experiences quintile were more likely to report depression (OR=3.11, 95% CI=2.10, 4.60), post-traumatic stress disorder (OR=4.19, 95% CI=2.43, 7.23), worse self-rated health (OR=3.72, 95% CI=2.03, 6.81), and a higher expected likelihood of dying in the next 5 years (RR=5.02, 95% CI=2.15, 7.88) compared with those in the bottom quintile. However, adverse childhood experiences did not demonstrate a graded relationship with obesity, stunting, or grip strength.


      These patterns are quite consistent with evidence from high-income countries and suggest that primary prevention of adverse childhood experiences should be a priority to ensure lifelong health in low-resources settings.
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