Assessing the Validity of Sexual Behaviour Reports in a Whole Population Survey in Rural Malawi

Background: Sexual behaviour surveys are widely used, but under-reporting of particular risk behaviours is common, especially by women. Surveys in whole populations provide an unusual opportunity to understand the extent and nature of such under-reporting.Methods: All consenting individuals aged between 15 and 59 within a demographic surveillance site in northern Malawi were interviewed about their sexual behaviour. Validity of responses was assessed by analysis of probing questions; by comparison of results with in-depth interviews and with Herpes simplex type-2 (HSV-2) seropositivity; by comparing reports to same sex and opposite sex interviewers; and by quantifying the partnerships within the local community reported by men and by women, adjusted for response rates.Results: 6,796 women and 5,253 men (83% and 72% of those eligible) consented and took part in sexual behaviour interviews. Probing questions and HSV-2 antibody tests in those who denied sexual activity identified under-reporting for both men and women. Reports varied little by sex or age of the interviewer. The number of marital partnerships reported was comparable for men and women, but men reported about 4 times as many non-marital partnerships. The discrepancy in reporting of non-marital partnerships was most marked for married women (men reported about 7 times as many non-marital partnerships with married women as were reported by married women themselves), but was only apparent in younger married women.Conclusions: We have shown that the under-reporting of non-marital partnerships by women was strongly age-dependent. The extent of under-reporting of sexual activity by young men was surprisingly high. The results emphasise the importance of triangulation, including biomarkers, and the advantages of considering a whole population

Household water treatment uptake during a public health response to a large Typhoid Fever outbreak in Harare, Zimbabwe

Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011–April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75% of households were aware of chlorine solution and 85% received chlorine tablets, only 18% had reportedly treated stored water and had the recommended protective level of free chlorine residuals. Water treatment was more common among households that reported water treatment before the outbreak, and those that received free tablets during the outbreak (P < 0.01), but was not associated with chlorine solution awareness or use before the outbreak (P > 0.05). Outbreak response did not build on pre-existing prevention programs.The U.S. Centers for Disease Control and Prevention Division of Global Disease Detection and Emergency Response, the U.S. Agency for International Development’s Office of U.S. Foreign Disaster Assistance, the United Nations Children’s Fund-Zimbabwe, Welthungerhilfe- Zimbabwe, and Population Services International-Zimbabwe.http://www.ajtmh.orgam201

Age at Menarche, Schooling, and Sexual Debut in Northern Malawi

Background: Age at sexual debut is a key behavioural indicator used in HIV behavioural surveillance. Early age at menarche may precipitate early sex through perceived readiness for sex, or through school drop-out, but this is rarely studied. We investigated trends and circumstances of sexual debut in relation to schooling and age at menarche.Methods and Findings: A cross-sectional sexual behaviour survey was conducted on all individuals age 15-59 within a demographic surveillance site in Karonga District, Malawi. Time trends were assessed using birth cohorts. Survival analysis was used to estimate the median age at menarche, sexual debut and first marriage. The 25(th) centile was used to define "early" sex, and analyses of risk factors for early sex were restricted to those who had reached that age, and were done using logistic regression. Of the 8232 women and 7338 men resident in the area, 88% and 78%, respectively, were seen, and, 94% and 92% of these were interviewed. The median reported age at first sex was 17.5 for women and 18.8 for men. For women, ages at menarche, sexual debut and first marriage did not differ by birth cohort. For men, age at sexual debut and first marriage decreased slightly in later birth cohorts. For both men and women increased schooling was associated with later sexual debut and a longer delay between sexual debut and first marriage, but the associations were stronger for women. Earlier age at menarche was strongly associated with earlier sexual debut and marriage and lower schooling levels. In women early sexual debut (= 16 (OR 0.04, 95%CI 0.02-0.05) compared to those with menarche at = 16. The association between age at menarche and schooling was partly explained by age at sexual debut. The association between age at menarche and early sex was not altered by adjusting for schooling.Conclusions: Women with early menarche start sex and marry early, leading to school drop-out. It is important to find ways to support those who reach menarche early to access the same opportunities as other young women

Evaluación del uso del preservativo femenino promovido desde un programa de educación para la salud: un enfoque cualitativo

El trabajo aquí recogido se aborda desde un estudio de caso, a través del enfoque cualitativo, mediante la técnica del grupo de discusión con la participación de 9 grupos, conformados por un total de 83 estudiantes universitarios del noroeste de España, con edades entre 19 y 42 años. Los objetivos principales de este trabajo son conocer la satisfacción de los y las participantes con el uso del preservativo femenino, así como las ventajas y obstáculos encontrados en su utilización que ha sido promovida a través de un programa de promoción de la salud. Como resultados y conclusiones destacar que las mujeres enfatizan en mayor medida que los varones la satisfacción y ventajas obtenidas con la utilización del método. Como puntos fuertes sobre el uso del preservativo femenino los y las participantes destacan la alta resistencia a la rotura y entre las debilidades apuntan los problemas ligados a su colocación y estética. El estudio sobre el uso del preservativo femenino revela la necesidad de continuar desarrollando intervenciones de formación encaminadas a la promoción de este método, sin excluir el empleo de otros, así como de reforzar la incorporación de estrategias educativas que permitan avanzar en la eliminación de estereotipos de género.This study is concerned with the promotion of the female condom. It is a qualitative study that was carried out by means of discussion groups, with the participation of nine groups. The study's sample was formed by 83 university students aged 19-42 years, from Galicia (Spain). The main objective of this study is to know the degree of satisfaction of the participants, and the advantages/drawbacks of using the female condom, which was promoted by a health programme. With regard to the conclusions of the study, it should be pointed out that the female participants focused more on the advantages of using the female condom, whereas the male participants primaly emphasised its drawbacks. The main point mentioned in favour of the female condom was its resistance to breakage, and its insertion and appearance were the most common complaints. The evaluation of the use of the female condom reveals the need to continue developing health programmes aimed at its promotion, without ruling out the utilization of other methods, and also to reinforce the incorporation of educational strategies which foster the elimination of gender stereotypes