Factors influencing utilization of Natural Family Planning among Child Bearing Women in Chilonga Northern Province Zambia

Objectives: The study sought to determine factors influencing utilization of Natural Family Planning (NFP) among child bearing women in Chilonga Catchment area. The literature review was mainly obtained from studies conducted globally, regionally and Zambia inclusively. Literature review revealed that information concerning the use of NFP method in Zambia is poor.Methods: A cross sectional study was done in five health posts of Chilonga Catchment area between July to November 2010. Systemic random sampling was used with a sampling interval of 1: 5. Mothers coming for under five and antenatal clinics were interviewed. A total of 425 questionnaires were issued. Of these 411 were successfully utilized which gave a dropout rate of 3%.Teachers trained in NFP method were purposively selected into the study for Focus Group Discussions (FGD) that is 10 per FGD. Total number of teachers selected were 20. Data was collected using a structured interview schedule comprising of open ended and closed ended questions .The study sought to answer the research question: What are the factors influencing utilization or non-utilization of NFP among child bearing women in Chilonga? The study was analysed using SPSS version 17.0 and content analysis. Chi-square was used to determine the association of between categorical variables. The findings have been presented using frequency tables and cross tabulations.Results: The majority (74%) of the respondents had heard of NFP method, though 26% had never heard of it. However, of the total, 58.4% did not know any method of NFP. Ever-used NFP was 50.4%, Current use of family planning (FP) was 38.4 % and most of the respondents (67.9 %) were in favour of NFP. Contraceptive pills were the commonest method in use 27.0% followed by NFP 23.6 %. There was no significant association between FP use and desired number of children (÷2 = 9.530; p > 0.023). There was also no significant association between FP use and education status (÷2 = 0.263; p > 0.005).Conclusion: The majority of the respondents (72.8%) wanted to have more than 4-10 children. This means they did not know what impact large families will have on the poverty stricken households. There is some ignorance about NFP methods. They are more used to artificial harmful methods of Family Planning. Therefore, there is need to intensify Health Education in this area.Keywords: Abstinence, Couple, Determinants, Family Planning (FP), Fertility, Fertile period, Intraspousal communication, Knowledge, Utilizatio

Factors associated with non-participation in a research: Observations from community engagement experiences in a home based VCT randomized controlled trial in Monze

Participation in research is crucial for success of research. It has been widely argued to be an important factor in interpreting research and implementation of the findings. In this study, factors associated with non-participation in the home based RCT VCT study in rural communities in Monze were explored.Methodology: Qualitative approaches using ethnographic methods that included observation and contextualization were employed. Triangulation was achieved using observation, in-depth interviews and focus group discussion (FGDs). Purposive sampling was used to select participants for the 8 FGDs (stratified by sex) in which each FGD consisted of 6-12 respondents. In-depth interviews were conducted with 20 key informants that were aged between 25-50 years. Data collected was transcribed replacing all identifiers with coded labels. Thematic content analysis employing iterative approaches and word processing guided the analysis. In addition for the in-depth interviews, systematic textual analysis was used to highlight quotes that support or refute identified themes.Results: Overall there were 20 in-depth interviews, 4 observations per village were conducted and 8 focus group discussions. Majority of the respondents from the FGDs were male (56.3%) aged between 25-49 years. Superstition and mistrust of the research assistants was cited consistently as a key reason for non-participation in the home based VCT RCT baseline survey by majority (97.8%) of the respondents. Many of the respondents described fears about the drawing of blood to test for HIV. Most of the key informants (15/20) cited mistrust to be the main reason of non-participation. The other factors that were identified included lack of understanding the study and benefits of participating, failure to respect culture and tradition, fear of violence by an intimate partner following HIV testing and disclosure of results, poor timing and prior negative engagements with the community.Conclusion: The findings of this study show that mistrust, superstition and lack of understanding of the study benefits were core factors associated with non participation in health research. This may underscore the need for setting specific and appropriate community engagement processes

A case study of government innovative programmes for increasing access to qualified health personnel in selected rural districts of Zambia

Objective: To document the experiences and lessons learnt from implementing innovative programmes that aim at increasing access to qualified health workers in Gwembe and Chibombo districts by Ministry of Health and participation of health workers.Methods: Qualitative analysis of the participation and satisfaction rates in retention and recruitment incentives for health workers in Gwembe and Chibombo Districts was conducted. Further document review of the current strategies implemented by the government was conducted with regards to them addressing the problems identified by the health workers based on a criterion that was developed. The study used primary and secondary data.Results: The findings indicated that there was high desire by the health workers to leave their current rural job postings and this was mainly due to issues related to their living and working conditions rather than the participation or satisfaction in the existing retention andrecruitment schemes. There was substantial turnover in the health workforces in both districts over the five-year period from 2005-2009, with annual losses ranging from 2 percent to 16 percent of the professional health workforce in each district. These losses were dues to death, retirement and redirection. Overall, there was also very little evidence and the quality of much of what existed was weak hence the difficult to ascertain if these interventions were contributing to an increase in access to qualified health workers in rural areas.Conclusion: To retain staff in the rural areas remains a challenge because of the high desire to leave exhibited by health workers. Bundled interventions therefore coupled with strong national leadership, governance and information systemsare key in ensuring skilled, motivated and supported health workers at the right place and time. In addition, a strong monitoring and evaluation system should be establised to provide evidence and lessons to ascertain which interventions are or are not working and inform further policy decisions on health workforce

The influence of social constructs of hegemonic masculinity and sexual behaviour on acceptability of vaginal microbicides in Zambia

Vaginal microbicides are heralded as a woman’s HIV prevention method. This ethnographic study, conducted in a trial setting in Zambia, explored how the social construction of masculinity and sexual behaviour influenced the acceptability of vaginal microbicides from the man’s perspective. The data was generated from 18 In-depth Interviews (IDIs), and 8 Focus Group Discussions (FGDs). The data was analysed thematically. The study found that hegemonic masculinity influenced the use of gel use among women in multiple ways: decision to initiate gel use, autonomous use of the gel and consistent use of the gel. Men were seen as heads of households and decision makers who approved their partners’ intentions to initiate gel use. Autonomous gel use by women was not supported because it challenged men’s position in sexual matters and at family level. The socially accepted notion that men engaged in multiple sexual relationships also influenced women’s decision to use the gel. Sustained gel use depended on the perceived effect of the gel on men’s sexual desires, sexual performance, fertility, and sexual behaviour. This study suggests that acceptability of microbicides partially lies within the realm of men, with use constrained and dictated by cultural constructs and practice of masculinity and gender

Perceptions and Beliefs of University and College Students Towards Male Circumcision in Lusaka

Background: Data from a range of observational epidemiological studies, conducted since the mid 1980s, showed that circumcised men have a lower prevalence of HIV than those who are uncircumcised. Furthermore recent randomized controlled trials conducted in Uganda, Kenya and South Africa have presented a myriad of data pointing to a 60 – 70% protection against HIV transmission. This evidence supports the notion that there are substantial health benefits from scaling-up male circumcision in Zambia,  due to the country's high HIV prevalence and low rates of male  circumcision.Study Objective: To gain insights into the perceptions and beliefs about Male circumcision among University and college students in Lusaka,  Zambia. The study was purely qualitative, was conducted with an iterative approach.Results: Manifest content of the study findings suggests that there is a remarkable and consistent trend in the way that Medical Male Circumcision is perceived amongst college and university student. They present virtuallyuniversal knowledge about the procedure, its practice, where it should be conducted, the facts about circumcision and what the prevailing untruths are about the procedure. The female respondents approve of male circumcision for males of all ages. They were quite conservative in their speech where to express themselves adequately they would have to be coerced for example, into explicitly referring to the male sex organ as a penis.Conclusions: The results from this particular study suggest that most young male adults are willing to go for circumcision and for the correct reasons as stipulated in the clearing house on “Basic facts about  Circumcision”. In their opinion the main aspect which may limit scale upof circumcision would be lack of services as near to the prospective clients as possible and lack of sufficient information about male circumcision in various sections of society. The female students have grasped the opportunity and have become partners in their counterpart's health seeking behavior. They are aware that there are indirect benefits for them when their male partners have undergone circumcisio

Exploring the challenges faced by informal home based palliative (HBP) caregivers in Ndola District, Zambia

In order to explore informal Home-based palliative caregivers’ challenging experiences, this study gives an overview of the need of Home-based palliative caregivers in communities. Dialogs using In-depth interviews (IDI’s) with twenty-five (25) purposively and conveniently selected respondents aged 18 years and over were conducted. They were not professional caregivers but volunteers from within the community attached to health facilities in Ndola. Discussions on global, Africa and Zambian’ situations, and Ndola in particular were included. The findings, using thematic analysis, were lack of supporting resources, inadequate coordination, lack of training, undesirable working conditions and unreliable transport network. The study will facilitate formulation of guiding principles and policies for palliative care practices through recommendations based on results from this study to improve and sustain palliative care services

A mixed methods and triangulation model for increasing the accuracy of adherence and sexual behaviour data: the Microbicides Development Programme.

Background: The collection of accurate data on adherence and sexual behaviour is crucial in microbicide (and other HIV-related) research. In the absence of a "gold standard" the collection of such data relies largely on participant self-reporting. After reviewing available methods, this paper describes a mixed method/triangulation model for generating more accurate data on adherence and sexual behaviour in a multi-centre vaginal microbicide clinical trial. In a companion paper some of the results from this model are presented [1].Methodology/Principal Findings: Data were collected from a random subsample of 725 women (7.7% of the trial population) using structured interviews, coital diaries, in-depth interviews, counting returned gel applicators, focus group discussions, and ethnography. The core of the model was a customised, semi-structured in-depth interview. There were two levels of triangulation: first, discrepancies between data from the questionnaires, diaries, in-depth interviews and applicator returns were identified, discussed with participants and, to a large extent, resolved; second, results from individual participants were related to more general data emerging from the focus group discussions and ethnography. A democratic and equitable collaboration between clinical trialists and qualitative social scientists facilitated the success of the model, as did the preparatory studies preceding the trial. The process revealed some of the underlying assumptions and routinised practices in "clinical trial culture" that are potentially detrimental to the collection of accurate data, as well as some of the shortcomings of large qualitative studies, and pointed to some potential solutions.Conclusions/Significance: The integration of qualitative social science and the use of mixed methods and triangulation in clinical trials are feasible, and can reveal (and resolve) inaccuracies in data on adherence and sensitive behaviours, as well as illuminating aspects of "trial culture" that may also affect data accuracy

Beyond interviews and focus groups: a framework for integrating innovative qualitative methods into randomised controlled trials of complex public health interventions

Background Randomised controlled trials (RCTs) are widely used for establishing evidence of the effectiveness of interventions, yet public health interventions are often complex, posing specific challenges for RCTs. Although there is increasing recognition that qualitative methods can and should be integrated into RCTs, few frameworks and practical guidance highlight which qualitative methods should be integrated and for what purposes. As a result, qualitative methods are often poorly or haphazardly integrated into existing trials, and researchers rely heavily on interviews and focus group discussions. To improve current practice, we propose a framework for innovative qualitative research methods that can help address the challenges of RCTs for complex public health interventions. Methods We used a stepped approach to develop a practical framework for researchers. This consisted of (1) a systematic review of the innovative qualitative methods mentioned in the health literature, (2) in-depth interviews with 23 academics from different methodological backgrounds working on RCTs of public health interventions in 11 different countries, and (3) a framework development and group consensus-building process. Results The findings are presented in accordance with the CONSORT (Consolidated Standards of Reporting Trials) Statement categories for ease of use. We identify the main challenges of RCTs for public health interventions alongside each of the CONSORT categories, and potential innovative qualitative methods that overcome each challenge are listed as part of a Framework for the Integration of Innovative Qualitative Methods into RCTs of Complex Health Interventions. Innovative qualitative methods described in the interviews include rapid ethnographic appraisals, document analysis, diary methods, interactive voice responses and short message service, community mapping, spiral walks, pair interviews and visual participatory analysis. Conclusions The findings of this study point to the usefulness of observational and participatory methods for trials of complex public health interventions, offering a novel contribution to the broader literature about the need for mixed methods approaches. Integrating a diverse toolkit of qualitative methods can enable appropriate adjustments to the intervention or process (or both) of data collection during RCTs, which in turn can create more sustainable and effective interventions. However, such integration will require a cultural shift towards the adoption of method-neutral research approaches, transdisciplinary collaborations, and publishing regimes

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Young marriage, parenthood and divorce in Zambia

Zambian law prohibits marriage under 21 but the practise, driven by circumstance, stubbornly persists, albeit increasingly as informal cohabitations which are inseparable from pregnancy and parenthood. For many adolescents, who lack the experience, emotional maturity and financial resources to cope, they are a complex and challenging experience, rarely investigated until now. New research, published today as part of Young Lives' and Child Frontiers multi country Young Marriage and Parenthood Study (YMAPS), documents the experiences of young Zambians who are married or cohabiting before the age of 18 and of many who became parents in their teens. It exposes the challenges they face as they navigate these adult roles and responsibilities