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

Growing up without parents: socialisation and gender relations in orphaned-child-headed households in rural Zimbabwe.

The most distressing consequences of the HIV/AIDS pandemic's impact on children has been the development of child-headed households (CHHs). Child 'only' households challenge notions of the ideal home, family, and 'normal' childhood, as well as undermining international attempts to institute children's rights. The development of these households raises practical questions about how the children will cope without parental guidance during their childhood and how this experience will affect their adulthood. Drawing on ethnographic research with five child heads and their siblings, this article explores how orphaned children living in 'child only' households organise themselves in terms of household domestic and paid work roles, explores the socialisation of children by children and the negotiation of teenage girls' movement. Further, it examines whether the orphaned children are in some way attempting to 'mimic' previously existing family/household gender relations after parental death. The study showed that all members in the CHHs irrespective of age and gender are an integral part of household labour including food production. Although there is masculinisation of domestic chores in boys 'only' households, roles are distributed by age. On the other hand, households with a gender mix tended to follow traditional gender norms. Conflict often arose when boys controlled teenage girls' movement and sexuality. There is a need for further research on CHHs to better understand orphans' experiences, and to inform policy interventions

The formation, constitution and social dynamics of orphaned child headed households in rural Zimbabwe in the era of HIV/AIDS pandemic

This thesis focuses on children who have lost both parents and are currently living on their own as child headed households (CHHs) in a rural community in Zimbabwe. Children heading households and taking care of siblings is a very “un-childlike” behaviour yet these are growing phenomena. Through an exploration of how CHHs are constituted and evolve the thesis aims to examine whether local constructions of childhood are being (re) conceptualised as a result of Zimbabwe’s escalating HIV/AIDS crisis. In particular it examines whether the socialisation of children within ‘child only’ units is leading to social transformation and/or whether children are in some way attempting to mimic ‘normal’ family/gender relations. It also looks at CHH’s interactions with adults and explores how these affect survival strategies, socialisation and conceptualisations of childhood. This thesis draws on an intensive ethnographic research project with five CHHs and their siblings in a rural community in Zimbabwe. Participant observation, narratives, drama, essays, focus groups, conversations and participatory techniques were employed to gain an in-depth insight into household evolution, the socialisation of family members, gender roles and survival strategies. The thesis shows that while children living in CHHs are vulnerable, they exhibited considerable competence and capabilities to sustain themselves. However, state and non-governmental organisations’ definition of childhood and orphanhood on the other hand, and cultural and local understanding of childhood and orphanhood produce new conceptual struggles of childhood that impacts negatively on the CHHs’ integration into society and their capacity to function fully. The ambivalent position of orphaned children in CHHs needs to be addressed if CHHs are to be recognised as an alternative orphan care arrangement

The formation, constitution and social dynamics of orphaned child headed households in rural Zimbabwe in the era of HIV/AIDS pandemic

This thesis focuses on children who have lost both parents and are currently living on their own as child headed households (CHHs) in a rural community in Zimbabwe. Children heading households and taking care of siblings is a very “un-childlike” behaviour yet these are growing phenomena. Through an exploration of how CHHs are constituted and evolve the thesis aims to examine whether local constructions of childhood are being (re) conceptualised as a result of Zimbabwe’s escalating HIV/AIDS crisis. In particular it examines whether the socialisation of children within ‘child only’ units is leading to social transformation and/or whether children are in some way attempting to mimic ‘normal’ family/gender relations. It also looks at CHH’s interactions with adults and explores how these affect survival strategies, socialisation and conceptualisations of childhood. This thesis draws on an intensive ethnographic research project with five CHHs and their siblings in a rural community in Zimbabwe. Participant observation, narratives, drama, essays, focus groups, conversations and participatory techniques were employed to gain an in-depth insight into household evolution, the socialisation of family members, gender roles and survival strategies. The thesis shows that while children living in CHHs are vulnerable, they exhibited considerable competence and capabilities to sustain themselves. However, state and non-governmental organisations’ definition of childhood and orphanhood on the other hand, and cultural and local understanding of childhood and orphanhood produce new conceptual struggles of childhood that impacts negatively on the CHHs’ integration into society and their capacity to function fully. The ambivalent position of orphaned children in CHHs needs to be addressed if CHHs are to be recognised as an alternative orphan care arrangement.EThOS - Electronic Theses Online ServiceUniversity of St AndrewsRussell TrustGBUnited Kingdo

The Female Condom: Acceptability and Perception among Rural Women in Zimbabwe

This study was conducted to generate data for developing an action plan for accessing the female condom through primary health care centres in Zimbabwe. It used both quantitative and qualitative methods to gather information from sexually active women and men on the perception and acceptability of the female condom among users in rural areas of Zimbabwe. The findings show that very few women had used the female condom prior to the survey. Several women (93%) liked the condom especially young women aged 20-39 years (83%), compared to older women aged 40 years and above (11%). Both women and men liked the dual role of contraception and protection against STIs including HIV/AIDS played by the female condom. Most women (98%) felt that it is important for women to have their own condom. However, both men and women pointed out that it will be difficult to introduce the female condom in married situations due to the stigma associated with condoms in general. Over 80% of women said they will have to seek permission from their partners to use the female condom. Women had problems with inserting the condom and were concerned with lubrication, size and appearance, and how to dispose of used condom. Regarding cost, 77% felt that the female condom is too expensive given that the male condom can be obtained free from health centres. The cost of the female condom could hinder its continued use and would encourage women, especially commercial sex workers, to re-use it. Respondents still require more information relating to side effects (45%), effectiveness in STIs prevention including HIV/AIDS (44%), proper use (43%) and cost (32%). (Afr J Reprod Health 2003; 7 [3]: 101-116

The Impact of Family Planning on Women's Lives: Findings from the Women's Studies Project in Mali and Zimbabwe

This paper reports on the findings of the Women's Studies Project, a five-year research effort conducted by Family Health International and designed to study the impact of family planning on women's lives. Twenty-six field studies were conducted in ten countries, including the sub-Sahara countries of Mali and Zimbabwe. In Mali, researchers looked at the experiences of first-time contraceptive users and factors that influence decisions to continue or discontinue methods, including spousal approval. In Zimbabwe, studies focused on family planning as a factor in women's participation in the country's economic development process. Researchers concluded that daftly planning is one of many strategies women can use to exercise autonomy in their lives. However, negative consequences of contraceptive use, such as community disapproval or husband's opposition may discourage women from taking control of their fertility. (Afr J Reprod Health 1999:3 [1]: 27-38) Key Words: Family planning, women's lives, Mali, Zimbabw