27 research outputs found

    Factors associated with late antenatal care attendance in selected rural and urban communities of the copperbelt province of Zambia

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    Background: Despite antenatal care services being provided free of charge or sometimes at a minimal cost in Zambia, only 19% of women attend antenatal care by their fourth month of pregnancy, as recommended by World Health Organization (WHO). An estimated 21% of pregnant women in urban and 18% in rural districts make their first ANC visit by 4th months of pregnancy. A number of factors have been found to contribute to late initiation of Antenatal care among pregnant women and these may vary between rural and urban areas. Therefore, a study aimed at examining factors associated with late ANC attendance amongst pregnant women in selected communities of the Copperbelt Province was conducted.Methodology: A cross- sectional study using a semistructured questionnaire was conducted in selected health facilities of Mpongwe and Ndola districts. A total number of 613 women attending antenatal clinic, distributed evenly between Mpongwe rural district (51% (307/613) and Ndola urban district (49% (306/613) were included in the study. Data from the completed questionnaires was entered using Epi InfoTM 3.5.1 and finally analyzed with SPSS version 16.0.Results: The prevalence of late ANC attendance was 72.0 % (n=221) and 68.6% (n=210) in rural and urban districts respectively. However, the difference between two districts was not statistically significant [OR 0.851 (95% CI=0.6, 1.2), p=0.363]. In the rural district, nulliporous women were 59% (AOR 0.411, 95% CI 0.238, 0.758) less likely to initiate ANC late compared to multiparous women, while the proportion the urban was 48% (AOR 0.518, 95% CI 0.316, 0.848). Inadequate knowledge about ANC resulted into 2.2 times high odds for late ANC attendance (AOR 2.205, 95% CI 1.021, and 4.759) than women who had adequate knowledge in urban district. Women who fell pregnant unintentionally had a higher odds of starting ANC late in both rural [4.2 times (AOR 4.258, 95% CI 1.631, 11.119)] and urban [3.1 times (AOR 3.103, 95% CI 1.261, 7.641)] respectively. The perception of no benefits derived from commencement of ANC early was associated with 4 times (AOR 3.983, 95% CI 1.365, 11.627) likelihood of late attendance in the urban district. Compared to lack of privacy at health institutions, pregnant women in rural were 3.4 times (AOR 3.377, 95% CI 1.180, and 9.660) more likely to initiate ANC late because of long distance to health facilities. Compared to misconceptions on ANC, pregnant women in rural areas were 2.2 times (AOR 2.211 95% CI 1.049, 4.660) more likely to start ANC late because of community norm(less value attached to ANC); while in urban late ANC attendance was 2.9 times (AOR 2.899, 95% CI 1.372, 6.083) higher due to cultural beliefs than misconceptions.Conclusion: Late antenatal care attendance remains high in both rural and urban districts indicating the need for intensified and more focused utilization of resources aimed at increasing sensitization of the importance of early attendance for high risk groups, such as women with unplanned pregnancies, inadequate knowledge about ANC, cultural beliefs and women who are multiporous

    ‘Mankind owes to the child the best that it has to give’: Prison conditions and the health situation and rights of circumstantial children incarcerated in Sub Saharan African prisons.

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    Background: In recent times, sub-Saharan African (SSA) prisons have seen a substantial increase in women prisoners, including those incarcerated with children. Methods: A scoping review mapped what is currently known about the health situation and unique rights violations of children incarcerated with their mothers in SSA prisons. A systematic search collected and reviewed all available and relevant published and grey literature (2000-2018). Following application of exclusion measures, 64 records remained, which represented 27 of the 49 SSA countries. These records were charted and thematically analysed. Results: Four main themes were generated as follows: 1) the prison physical environment; 2) food availability, adequacy and quality; 3) provision of basic necessities and 4) availability and accessibility of health services for incarcerated children. Conclusions: The review highlights the grave situation of children incarcerated with their mothers in SSA prisons, underpinned by the lack of basic necessities, inadequate hygiene, sanitation and safe drinking water, exposure to diseases in overcrowded cells, inadequate nutrition, lack of provision of clothing and bedding, and difficulties accessing paediatric care. Reported paediatric morbidity and mortality associated with such prison conditions is deeply concerning and contrary to international mandates for the rights of the child, right to health and standards of care

    Factors Affecting Utilization of Skilled Birth Attendants by Women in Northern Zambia

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    Background: World Health Organization (WHO) strongly advocates for 'skilled care at every delivery' to reduce the global burden of 536,000 maternal deaths, 3 million still births and 3.7 million newborn deaths each year. Improving delivery care is an essential element of attaining improved maternal and child health. In the more developed countries, skilled attendance at delivery is about 99.5% where as that of Africa is 46.5% (WHO, 2008) and Zambia was at 47% in 2008 (2007 ZDHS) below the WHO target of 85% in 2010 (WHO, 2005). More than half of Zambian births (52%) occur at home. Kasama district has low institutional deliveries with more than half (56%) of pregnant women delivering at home without the assistance of a skilled attendant (Kasama District Health Action Plan, 2010). The number of deliveries conducted by skilled birth attendants in Kasama is lower than the national figures. This underscores the need to investigate factors responsible for low use of skilled attendants at birth. The main purpose of the study was to identify factors affecting utilization of skilled attendants at birth by pregnant women in Kasama district in order to help contribute to the reduction of maternal and child complications.Methodology: The study was conducted in Kasama district in Northern Province of Zambia. The study used the triangulation approach method to collect data which included one semi structured interview schedule which was administered to 340 eligible women (170 cases and 170 controls) who had children aged six months and below and those who may have lost a child during or after delivery in the first two quarter of 2011 accessing various health services at three selected health centres under study namely Lukupa, Chisanga and Location. This was done to ensure that the reasons for the loss of a child during or after delivery which could yield useful information about the care given during labour and after delivery were captured. In this study, the exposure of interest was skilled delivery and therefore the exposed were women who were delivered by unskilled birth attendants while the unexposed were those who were delivered by skilled birth attendants. Mothers who were delivered by skilled birth attendants were controls while those who were delivered by unskilled birth attendants were cases. Three clinics with delivery facilities were conveniently selected from the 31 government health centres in Kasama. The estimated number of pregnancies (5.4%) and deliveries (5.2%) for each clinic was considered in order to correctly identify clinics with the lowest deliveries. Three focus group discussions were also conducted one at each selected health centre. The health centre staff, TBAs and women of child bearing age (15-49 years) in the catchment areas participated in the focus group discussions. Women to be included in the focus group discussions were purposely selected. In order to ensure that the findings were valid, statistical significant was set at p<0.05.Results: One of the most interesting findings of this study was that the consultation of the services of TBAs by pregnant women did not affect their utilization of the skilled delivery services and most TBAs are educating women on HIV/AIDs. Therefore, it did not matter whether a woman consulted the services of TBAs for them to use the services of skilled attendants at birth. However, the study found that majority of the cases 131(77.1%) had a problem with male midwives attending to women during delivery compared to the controls 115(67.7%). Respondents who were not comfortable with male midwives attending to women during labour/delivery were 1.271 [OR (95%CI) = 1.271 (1.029, 1.570)] more likely to be delivered by unskilled birth attendants than those who were comfortable about it as they believe that it is against their tradition for a man other than their husbands to see their nakedness. The study also found that majority of the pregnant women take traditional herbs during pregnancy to quicken labour and prevent obstructed labour as they belief that most of the men end up having extra marital affairs when their wives are pregnant and this puts the pregnant women at risk of obstructed labour. The study discovered that majority of the cases 46(27.1%) took the traditional herbs in their last pregnancy compared to the controls 14(8.2%). Respondents who took the traditional herbs on their last pregnancy were 1.717 [OR (95% CI) = 1.717 (1.407, 2.096)] more likely to be delivered by unskilled birth attendants than those who did not take the traditional herbs. The study also found out that the knowledge levels of women on danger signs of pregnancy, labour and puerperium was alarmingly lower than expected. Majority of the women could not identify most of the danger signs of pregnancy, labour and puerperium Sixty seven point seven percent of the cases and 52.9% of the controls perceived dizziness as not being dangerous during pregnancy while majority of the controls 99(58.2%) and cases 93(54.7%) perceived fitting as not being dangerous during pregnancy. These are danger signs of pregnancy which should be known by every pregnant woman.Conclusion: The study found out that women are shunning delivering in health facilities by skilled attendants because of the presence of male midwives at the health facilities, use of traditional herbs to quicken labour and low levels of knowledge of danger signs of pregnancy, labour and puerperium. These factors and deficiencies need urgent attention for the district to reduce maternal and child suffering. Addressing these factors and deficiencies will not only contribute towards achievement of millennium development goals (MDGs) but also to the overall improvement of maternal and child health. The presence of TBAs in the communities did not affect the women's utilization of skilled attendants at delivery

    Characteristics of Child Sexual Abuse in Zambia

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    Child Sexual Abuse (CSA)is a problem in many countries in the world including Zambia. The effects of CSA are both physical (genital trauma, contraction of infections, pregnancy, etc) and psychosocial (emotional dysregulation, bed wetting, regression of milestones, relational problems, poor self-esteem and other psychiatric diagnosis such as depression, eating disorders, substance misuse disorders, dissociative anxiety disorders, anxiety disorders, posttraumatic stress disorder (PTSD), etc). As a result of its effects, CSA is a psychiatric emergency. However, little data exists in subsaharan Africa). Knowing the characteristics of CSA in our setting, aids early identification and intervention.Objective: To describe the characteristics of child sexual abuse (CSA) among sexually abused children from the CSA centre at University Teaching Hospital (UTH).Design: Cross-sectional study based on information from CSA centre records of children aged 4 to 15 years.Main Outcomes: There were 192 participants in the study with only 3 boys. Teenagers constituted almost 50% of the study population with median age = 13, mean age = 11. Ninety eight percent of the referrals were from the Police. All the abusers were maleswith neighbours, boyfriends and non-relative adults constituting over 50% of the abusers in the study. Penile penetration was the main feature of the abuse with only one in twenty abusers being reported to have used condoms. Physical Force was the main mode of engagement used on the children.Conclusions: Most of the sexual abuse involves unprotected penetrative sex. The police should be included in planned care for CSA victims

    Mothers' Perception of Infant Feeding Counselling in The Context of Prevention of Mother-to-child Transmission of HIV in Lusaka, Zambia

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    Background: The aim of infant-feeding counselling is to facilitate informed decision on method of feeding in the context of prevention of mother-to-child transmission of HIV. However, HIV-positive mothers are faced with uncertainty on how best to feed their infants. The question we asked for this research was: how does the information provided in counselling on HIV and infant-feeding assist mothers in making decisions for safer feeding practices for their infants?Methods: This sub-study was part of the larger study conducted on: HIV and infant feeding; choices and decision outcomes in the context of PMTCT among HIVpositive mothers in Zambia. Data were collected through key-informant interviews with health care workers (HCWs) and individual interviews with 30 HIV-positive mothers. Data were collected from January to September 2014. The interviews were digitally recorded and transcribed verbatim. The QRS NVivo 10 version was used for data coding and analysis.Results: The role of health care workers in PMTCT was to provide information on infant feeding and facilitate informed decision on feeding HIV-exposed infants. Concerning the decision on infant feeding, mothers reported that they chose to practice exclusive breastfeeding because it was an optimal choice for their exposed infants. However, there appeared to be other factors that influenced the decision on how to feed HIVexposed infants: maternal instinct to protect the baby from getting infected with HIV; the perception that a breastfed baby is health; and the cost of formula. Potentially, mothers may have risked to practice mixed feeding due to: late initiation of breastfeeding in respect of cultural norms; the belief that the baby can just stop breastfeeding on its own; and pressure from family and community to practice mixed feeding.Conclusion: While EBF is now recommended for HIVexposed infants, challenges remain on how to promote EBF and tailor information on infant feeding counselling and assist mothers make an informed decision in settings where formula feeding would not be recommended. Therefore, quality and objective infant feeding counselling should be practiced by HCWs to enhance safer feeding practices.Keywords: Exclusive breastfeeding, Formula feeding, Infant feeding counselling, Health promotion, Informed decision, Lusaka, Zambia

    High Prevalence of Low Birth Weight Babies Born to Pregnant Women Referred to a District Hospital in Rural Zambia

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    This is the accepted manuscript version of the work published in its final form as Buser, J. M., Boyd, C. J., Moyer, C. A., Zulu, D., Ngoma-Hazemba, A., Jones, A. D., & Lori, J. R. (2021). High Prevalence of Low Birth Weight Babies Born to Pregnant Women Referred to a District Hospital in Rural Zambia. Maternal and Child Health Journal, 25(8), 1182-1186. https://doi.org/10.1007/s10995-021-03190-8 Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing [email protected]
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