Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study.

OBJECTIVES: To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head. SETTING: Households in Lusaka District, Zambia, 2004-2011. PARTICIPANTS: 43,064 household heads (88% female) who enumerated 123,807 adult household members aged between 15 and 60 years. PRIMARY OUTCOME: Premature adult mortality. RESULTS: The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing. CONCLUSIONS: To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services

A SOCIOLOGICAL ANALYSIS OF THE DETERMINANTS OF DIFFERENCES IN SOCIOECONOMIC ACHIEVEMENT PATTERNS OF HIGH SCHOOL AND COLLEGE GRADUATES IN ZAMBIA (SOCIAL, MOBILITY)

This research attempted to isolate the most salient causes of differences in the socioeconomic achievement patterns of College and high school graduates in Zambia. Patterns of intergenerational mobility (Chapter Three) reveal that upward mobility for both high school and college graduates was the norm; downward mobility, the exception. High rates of structural and exchange mobility suggested an increase in the availability of occupational opportunities and in the openness of the occupational structure. Intragenerational mobility among college graduates revealed a tendency towards job stability; mobility was generally upward. Chapter Four shows that colleges, to a greater degree than high schools, were selective of people from the higher socioeconomic strata of the general population. For college graduates, educational attainment and college quality were systematically related to socioeconomic background. For high school graduates, academic performance, school quality and occupational aspirations were not linked systematically to background. According to Chapter Six, college graduates favored formal job information channels--bonding, advertisements and institutional placement. Use of informal channels was greater for older graduates of higher quality colleges with degrees in humanities and social sciences. Multiple classification analysis (Chapters Five and Six) and path analysis (Chapter Seven) showed socioeconomic background to have the least effect on the graduates\u27 occupational attainment. First job and educational attainment (college graduates) and academic performance (high school graduates) had the greatest effect. Specialization and information channel for college graduates had no significant effect. Education was more important than previous job in the occupational attainment of younger college graduates; the opposite was true for older graduates. In conclusion, patterns of socioeconomic achievement, predicated on superior educational and academic performance paralleled those found in Western societies and other Third World countries. Father-to-offspring occupational inheritance was the exception not the rule. Future research on social mobility should focus on issues such as ethnic discrimination and nepotism which most graduates preceived to be barriers to upward mobility

A SOCIOLOGICAL ANALYSIS OF THE DETERMINANTS OF DIFFERENCES IN SOCIOECONOMIC ACHIEVEMENT PATTERNS OF HIGH SCHOOL AND COLLEGE GRADUATES IN ZAMBIA (SOCIAL, MOBILITY)

This research attempted to isolate the most salient causes of differences in the socioeconomic achievement patterns of College and high school graduates in Zambia. Patterns of intergenerational mobility (Chapter Three) reveal that upward mobility for both high school and college graduates was the norm; downward mobility, the exception. High rates of structural and exchange mobility suggested an increase in the availability of occupational opportunities and in the openness of the occupational structure. Intragenerational mobility among college graduates revealed a tendency towards job stability; mobility was generally upward. Chapter Four shows that colleges, to a greater degree than high schools, were selective of people from the higher socioeconomic strata of the general population. For college graduates, educational attainment and college quality were systematically related to socioeconomic background. For high school graduates, academic performance, school quality and occupational aspirations were not linked systematically to background. According to Chapter Six, college graduates favored formal job information channels--bonding, advertisements and institutional placement. Use of informal channels was greater for older graduates of higher quality colleges with degrees in humanities and social sciences. Multiple classification analysis (Chapters Five and Six) and path analysis (Chapter Seven) showed socioeconomic background to have the least effect on the graduates\u27 occupational attainment. First job and educational attainment (college graduates) and academic performance (high school graduates) had the greatest effect. Specialization and information channel for college graduates had no significant effect. Education was more important than previous job in the occupational attainment of younger college graduates; the opposite was true for older graduates. In conclusion, patterns of socioeconomic achievement, predicated on superior educational and academic performance paralleled those found in Western societies and other Third World countries. Father-to-offspring occupational inheritance was the exception not the rule. Future research on social mobility should focus on issues such as ethnic discrimination and nepotism which most graduates preceived to be barriers to upward mobility

Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

Abstract Background Child marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia. Methods Data came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013–14 and 2018. A pooled weighted sample of 9990 women aged 20–29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models. Results The prevalence of child marriage among women aged 20–29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26–0.49] and [aOR = 0.07, 95% CI = 0.03–0.18] and those whose age at first birth was (15–19 year) or (20–29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15–1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained. Conclusion Prevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information

Perceived ideal number of children among adolescent girls in sub-Saharan Africa: does exposure to family planning messages matter?

Abstract Background Even though evidence shows that fertility transition has begun almost everywhere in sub–Saharan Africa (SSA), the decline has been slower than in other parts of the world. Research shows that there is a positive relationship between fertility levels and fertility preference. Therefore, many countries in the region are implementing family planning education campaigns targeting at influencing reproductive behavior of women. Thus, this study aimed to examine the extent to which exposure to family planning communication influences fertility preferences of adolescent girls in SSA. Methods This study used data extracted from the most recent Demographic and Health Survey datasets for 28 countries in SSA. Analyses were conducted on a pooled sample of 87,950 female adolescents’ aged 15–19 years who were captured in respective country’s survey. Multivariable binary logistic regression model was fitted in Stata version 17 software to examine the association between exposure to family planning communication and fertility preference among adolescent girls in SSA. Results The average fertility preference among adolescent girls in SSA was 4.6 children (95% CI: 4.5, 4.7). Findings show that regardless of the country, adolescents who had exposure to family planning messages [aOR = 0.76, 95% CI = 0.72–0.80] were less likely to prefer 4 or more children. On average, fertility preference among adolescents who had exposure to family planning communication was (3.8 children compared to 4.5 children; p < 0.001) among those with no exposure. Furthermore, results show that married adolescents in SSA who had exposure to family planning message had a higher average preferred family size compared to those who were not married (4.8 versus 3.8; p < 0.001). Conclusion Exposure to family planning communication has shown the potential to influence adolescents’ fertility preference in sub-Saharan Africa. Adolescents with exposure to family planning messages preferred a small family size. Therefore, there is a need to scale-up family planning education programmes in order to reduce fertility further in SSA

Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001–2018)

Abstract Background Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia. Methods This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15–49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software. Results Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25–29 years and 30–34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies. Conclusions The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women’s age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies

Prevalence and factors associated with early childbearing in sub-saharan Africa: evidence from demographic and health surveys of 31 countries

Abstract Background Early childbearing remains a public health concern in sub-Saharan Africa (SSA) because it has substantial implications for women’s and children’s health and population control. However, little is known about recent changes in early childbearing in the region following the implementation of the Family Planning 2020 initiative (FP2020) national-level interventions. Thus, this study examined factors associated with early childbearing among women in SSA. Methods The study used data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2021. The analysis included a pooled sample of 54,671 parous young women aged 20–24 years. A multivariable binary logistic regression model was used to examine the association between early childbearing and individual and household-level factors. All analyses were weighted to account for complex survey design. Results The study shows that the mean prevalence of early childbearing was high in SSA at 39% (95% CI: 35, 43). Chad had the highest prevalence of early childbearing, 62% (95% CI: 60, 64) while Rwanda had the lowest prevalence of 13% (95% CI: 11, 15). Completing secondary school (aOR = 0.57; 95% CI: 0.52, 0.62) or attaining tertiary level education (aOR = 0.32; 95% CI: 0.22, 0.45), first sexual debut in the age range 15–24 years (aOR = 0.15; 95% CI: 0.14, 0.16) and desire for a small family size (aOR = 0.63; 95% CI: 0.58, 0.69) were associated with reduced odds of early childbearing among young women in SSA. Conclusion The study has established that the prevalence of early childbearing is high in SSA. Level of education, age at first sexual debut, household size, and desired family size are associated with early childbearing in SSA. Governments of SSA countries should enhance sexual and reproductive health interventions to change reproductive behaviour, particularly in adolescents and young women