In April of 2008, The Medical College of Wisconsin, the University of Wisconsin-Milwaukee and CARE USA received a five-year grant from the National Institute of Child Health and Human Development to study the relationship between HIV vulnerability and changes in economic environment and food security in rural Malawi, a country in sub-Saharan Africa with a high prevalence of HIV infection, poverty, and child malnutrition.

This project is a partnership between the University of Wisconsin-Milwaukee College of Nursing, Center for Global Health Equity, the University of Wisconsin Joseph J. Zilber School of Public Health, CARE USA and CARE Malawi. CARE is one of the world's largest private international humanitarian and economic development organizations that currently operates in 70 countries with a mission of eradicating poverty and addressing health, education, food security and economic development globally. Other internationally recognized academic institutions have faculty who are consultants for this study, including the University of Pennsylvania, The London School of Economics and The University of Malawi.

The project was originally known as Tiphunzitsane or "working together" in the Chichewa language, one of the local languages in Malawi. It was recently renamed to SAGE4Health to reflect key goals: Savings, Agriculture, Governance and Empowerment.

Project Site

The project site is located in the Kasungu District in Central Malawi. The population of the Kasungu District is 627,467, with 4.1% of persons between the ages of 15 and 49 who are HIV positive. The study intervention areas for this project include Kaomba, Mwase, and Njombwa, and the study control areas include Kawamba, Lukwa, Chaima.


Project Design

The SAGE4Health Project multidisciplinary research team is conducting three related studies:

  1. A quasi-experimental non-equivalent control group longitudinal study of the mechanisms, processes, and magnitude of impact of a large multi-level development and food security intervention, as implemented by CARE Malawi with European Commission funding, on HIV vulnerability and economic outcomes including food security. The development program includes intensive farmer training and support on sustainable and diversified agricultural practices, community-based microfinance training, and strategies to strengthen local governance, among other coordinated elements. The project will examine effects at the individual and community levels over a four-year follow-up period.    
  2. The research team will statistically test pathways between socioeconomic changes, food security, and HIV-related outcomes.    
  3. Qualitative end-of-program evaluation will be conducted to understand the mechanisms of impact of the program.

These studies will help to improve the specific development program under examination and contribute to a body of scientific knowledge regarding public health effects of sophisticated multi-level development programs being implemented globally.

What SAGE4Health Measures

Questionnaire Modules

Respondent Characteristics

  1. Household socio-demographic characteristics    
  2. Household economic status/livelihood strategies
  3. Housing and assets    
  4. Use of assets for emergencies    
  5. Income and expenses    
  6. Household dietary diversity    
  7. Household food security    
  8. Household’s poverty perceptions    
  9. Access to services    
  10. Sustainable agriculture practices    
  11. Personal health    
  12. Illness occurrence and healthcare seeking    
  13. Childbirth experiences    
  14. Family planning    
  15. Chronic illnesses    
  16. Self-reported STD infections    
  17. HIV/AIDS perception of risks, stigma and testing    
  18. Male circumcision    
  19. HIV risk activities    
  20. Gender power    
  21. Community cohesion    
  22. Anthropometric measurements