Mortality in Sub-Saharan Africa: What is Killing Adults Aged 15-59 Years in Zambia? VID Working Paper 04/2019

The question of cause-of-death remains of interest among demographers, epidemiologists and public health researchers. Adults in the age group 15-59 years play a significant role in the socio-economic development of a country. However, in most of sub-Saharan African countries, the coverage and accuracy of data on adult mortality has been deficient compared to that of under-five (age group 0-4) mortality. As a result, little research exists on causes-of-death in this age group in most of sub-Saharan Africa and adult mortality remains a health burden for many countries in this part of Africa. Using the 2010-2012 Zambia Sample Vital Registration with Verbal Autopsy (SAVVY) survey data and computing age-sex and cause-specific death rates and ratios as well as constructing cause-deleted life tables, this study examined the causes-of-death among adults in age group 15-59 years. The study found that HIV/AIDS was the major leading cause-of-death across all demographic and socioeconomic background characteristics of the deceased adults. HIV/AIDS deaths increased by age and peaked in age group 35-39 and were higher among females than males. Injuries and accidents were the second leading cause-of-death among males while among females it was tuberculosis. Injuries and accidents were more prevalent in age group 15-35, the highly educated and the never married. Diseases of the circulatory system were the third leading cause-of-death among female decedents while tuberculosis was the third leading cause of death among males. Malaria was the fourth leading cause-of-death for both males and females. Adult deaths attributable to non-communicable diseases were more evident in older ages 45-59. Eliminating HIV/AIDS as a cause of death would have the most impact in reducing adult mortality in Zambia and contribute significantly to the number of additional years of life gained compared to eliminating the other causes-of-death. Therefore, health programmes and interventions on HIV/AIDS should be further supported and strengthened as they would significantly contribute to the reduction of adult mortality in Zambia in line with sustainable development goals (SDGs)

Inter-provincial migration effect on youth risk behaviors in South Africa: A multilevel analysis of contextual- and individual-level factors

Background: This study compared the participation of inter-provincial migrant and non-migrant South African youths in risk behaviors (RBs), and investigated the contextual and individual factors that influenced their participation in RBs. Method: Data was from the National Income Dynamics Study (NIDS), wave 3 of 2014 which was a survey of individuals and households living in the nine provinces of South Africa. A total of 5590 young people aged 15–24 years were used for this study. Smoking of cigarettes and drinking of alcohol were used as the two outcome variables of risk behaviors. Data analysis was with univariate, bivariate, and multilevel logistic regression techniques. Results: While 12.67% of the youths were smokers, 26.70% were drinkers. In addition, more of the non-migrants were engaged in smoking and drinking compared to migrants. With the exception of self-rated physical health and marital status, the results showed significant differences in smoking and drinking among migrants and non-migrants in other contextual and individual variables. Province of residence and living in urban areas significantly increased the odds of smoking and drinking among the migrants and non-migrants. Other contextual factors that increased the odds of drinking and smoking in the study area were poor mental health status, and good self-rated health of non-migrants (1.42; p < 0.05), and migrants (1.40; p < 0.05). Conclusion: Intervention measures/strategies should include provision of counseling centers, improvement in the education of the youth and increased media reportage on the dangers of participation in these risk behaviors

Contraceptive awareness among men in Bangladesh

Objective: A considerable gap exists between contraceptive awareness and use. Traditional approaches to measuring awareness are inadequate to properly understand the linkages between awareness and use. The objective of this study was to examine the degree of men's modern contraceptive awareness in Bangladesh and the associated determinants and further testing of a hypothesis that current contraceptive use confers a high degree of method awareness.Methods: This study used the couple data set from the Bangladesh Demographic and Health Survey (1999–2000). A two-level, multinomial logistic regression was used with the degree of contraceptive awareness as the dependent variable. The degree of awareness was measured by the reported number of modern contraceptive methods known among men aged 15–59 years. Men's responses on method awareness were classified according to those reported spontaneously and probed.Results: Nearly 100% of the study participants reported having heard of at least one method and about half reported awareness of at least eight different methods of contraception. Multinomial logistic regression analyses showed that older and educated men were more likely to have reported a high degree of awareness. The findings confirmed our hypothesis that current contraceptive use is likely to confer a high degree of modern method awareness among men (p&lt;0.001), after controlling for other important characteristics.Conclusions: Men who had a low degree of contraceptive awareness seem not properly informed of the wide range of contraceptive options. It is imperative that family planning intervention strategies in Bangladesh should focus on the degree and functional knowledge of contraceptive methods to improve the uptake of especially male-based modern methods