Gender differentials in sexual initiation among adolescents in Zambia

The purpose of the present study was to assess gender differentials in factors influencing sexual initiation among adolescents in Zambia. Data employed in this study was derived from the 2013 Zambia Demographic Health Survey. Logistic regression analysis was used to identify gender differentials in sexual initiation by considering socio-economic variables. The data revealed that about 22 per cent of the female and 32.6 per cent of males reported having had sex by the age of 15 years old. About 49.5 per cent of the female and 54.9 per cent of the males reported having had sex by the age of 18 years old. Logistic regression analysis identified age, religion, residence, wealth status, working status, educational level, watching television and drinking alcohol as strong predictors of respondent’s likelihood of sexual initiation by the age of 15 years old. The study found that male youths who drank alcohol were 1.4 times more likely to be sexually active by the age of 15 years old compared to those who did not drink alcohol. Female youths who were working were 1.4 times more likely to report having had sex by the age of 15 years old and those who drank alcohol were 1.3 times more likely to report been sexually active by the age of 15 years old. This study is in agreement with other African and western based studies which have shown that socioeconomic and demographic variables have a significant influence on early sexual initiation among adolescents in Zambia. Interventions that seek to prevent HIV and AIDS and unwanted pregnancies among adolescents through regulation of sexual behaviour would need to seriously account for socio-demographic and economic influences.Keywords: Gender differentials, sexual initiation, youth, Zambi

Reasons for Non-use of Condoms in Eight Countries in Sub-Saharan Africa

Objective: To determine why sexually experienced males and females from multiple countries in sub-Saharan Africa do not use condoms.Methods: We used data from sample surveys conducted in eight countries in sub-Saharan Africa. Respondents were asked about their use of condoms and their reasons for not using a condom in last sex with a marital, a regular (non-marital) or a casual partner. Respondents' reasons for not using a condom are shown by type of partner and by gender. Results: Males and females most frequently reported trusting their partner as the main reason for not using a condom in last sex with a marital or a regular (non-marital) partner. This suggests that low personal risk perception is the most important reason for not using a condom with a marital or a regular partner. A dislike of condoms is the most frequently cited reason for not using a condom with a casual partner. Respondents rarely cited the price of condoms as a barrier to condom use. Lack of condom availability was also rarely cited as a reason for not using a condom, except to some degree by males in casual partnerships. The latter may be because of the unplanned nature of casual sex activity, rather than because condoms are not available. Conclusions: Behavior change campaigns encouraging sexually experienced people to accurately assess their personal risk of acquiring HIV should be complemented with marketing campaigns emphasizing the positive attributes of condoms

Pre-Schooling and Academic Performance of Lower Primary School Pupils in Rural Zambia

The primary objective of this study was to investigate the relationship between pre-schooling and the academic performance of pre-schooled lower primary school pupils in a rural Zambian setting of Zambezi district. The study also assessed the socio-economic status (SES) of parents, pupils’ sex, age and their academic performance. This study employed a quantitative cross sectional design and used Chi-square test of independence, Phi and Cramer’s V test, Independent sample t-test and Pearson correlation coefficient to analyze the data obtained. The results indicated that there was a relationship between pre-schooling and the performance of pre-schooled lower primary school pupils in literacy and numeracy. However, it was also shown that there was no relationship between the SES of parents, pupil’s sex age and academic performance of the pupils in literacy and numeracy. Based on the obtained results, the study recommended that the Ministry of Education should scale up the implementation of preschools in government schools. This may provide easy access to pre-school education especially in rural areas where pre-schools are very few.Keywords: Social Economic Status (SES), pre-schooling, academic performanc

Family Domestic Violence: Impact on Children in Lusaka, Zambia

Aim: To explore the experiences of children exposed to domestic violence in Lusaka District, Zambia. Study Design: A qualitative exploratory approach was adopted for this study. Place and Duration of the Study: The study took place in Lusaka district over a period of 8 months. The study population included domestic violence survivor children and their parents. The study sample consisted of fifty-two participants divided into thirty children (boys and girls), sixteen parents or guardians, and six key informants. Data was collected using detailed interviews with children and key informants, while focus group discussions were conducted with the parents or guardians. Results: The findings of the study revealed that children were exposed to different forms of domestic violence including physical abuse, emotional (verbal) abuse, and economic abuse. The children were both witnesses and victims of domestic violence. The study also revealed that exposure to violence had negative effects on the children such as physical injury, fear and anxiety, loss of confidence and self-esteem, academic under performance, guilt and shame, and poor relationships with peers and parents. Conclusion and Recommendations: Domestic violence is still prevalent in Lusaka District and has negative long-term effects on children who witness it and are victimised by it. Interventions are necessary to address the size, nature, and complexity of the problem. It is recommended that professionals who have regular contact with families and children, including teachers, child care workers, health and mental health care providers, law enforcement officers, child welfare workers, and court officials should receive ongoing training on domestic violence and its impact on children, and necessary interventions to combat it

Bride Price (Lobola) and Gender-based Violence among Married Women in Lusaka

Background: This study investigated the influence of lobola, a payment made for marriage, on gender-based violence among married women in Lusaka’s Kamanga compound. Specifically, the study sought to establish how married women and men perceived lobola in relation to gender-based violence in marriage. Method: The study used the qualitative research method. Participants in the study included eighteen married women and men. In addition, in-depth interviews using a semi-structured interview guide were conducted with five key informants. Results: The findings from the study suggest that paying lobola translated into buying a wife and as such, a wife became a husband’s property. Lobola gave the man or husband powers to treat his wife as he wished, including subjecting her to sexual and other forms of abuse. This seems to take away a wife’s rights to make decisions on matters that affected her own life such as being restricted in her movements, in choosing what to wear, and depriving her of a claim over her children among others. Conclusion: The study recommends that the Ministries of Justice and Gender and the Local Government should look deeply into the issue of paying lobola and correct the practice by deterring or reprimanding those who do adhere to its significance. Civil society should also lobby government to enact appropriate laws and policies to deal with patriarchy and help married women to enjoy their rights as human beings

Dating Violence Experienced by Students at the University of Zambia

Dating violence is a complex problem determined by multiple factors. Poverty, cultural and social environmental factors are a major contributor to the gender based violence. The aim of this study was to examine the nature and extent of dating violence experienced by students at the University of Zambia. Eighteen students (nine males and nine females) aged fifteen to thirty years were recruited from the University of Zambia hostels. In-depth interviews with semi-structured interviews were used for data collection. This study has found that various forms of dating violence exists at the University of Zambia. The study further found risk factors that were associated with dating violence such as consumption of alcohol and/or use of entertaining substances, as well as being involved in aggressive activities such as fighting or insulting; other factors included; poverty, experiencing of inter-parental violence and prior experience with violence. The psychological and emotional implications were that some students became depressed and stressed, insecure, ideated suicide, feared sex, distrusted people and were worried and uneasy. Under physiological and health outcomes, some students contracted STDs and HIV, body injuries, became pregnant, and others lost or terminated their pregnancy. Furthermore, social implications were that some students became aggressive, went into self-isolation, and began living recklessly. Physical abuse, verbal abuse, sexual abuse and psychological or emotional abuse where the most common types of dating abuse found at the University of Zambia. Conclusively, In addition to awareness against gender based violence, youth friendly corners should be considered during the treatment of gender based violence in universities

Trends in all-cause mortality during the scale-up of an antiretroviral therapy programme: a cross-sectional study in Lusaka, Zambia.

OBJECTIVE: To follow the trends in all-cause mortality in Lusaka, Zambia, during the scale-up of a national programme of antiretroviral therapy (ART). METHODS: Between November 2004 and September 2011, we conducted 12 survey rounds as part of a cross-sectional study in Lusaka, with independent sampling in each round. In each survey, we asked the heads of 3600 households to state the number of deaths in their households in the previous 12 months and the number of orphans aged less than 16 years in their households and investigated the heads' knowledge, attitudes and practices related to human immunodeficiency virus (HIV). FINDINGS: The number of deaths we recorded - per 100 person-years - in each survey ranged from 0.92 (95% confidence interval, CI: 0.78-1.09) in September 2011, to 1.94 (95% CI: 1.60-2.35) in March 2007. We found that mortality decreased only modestly each year (mortality rate ratio: 0.98; 95% CI: 0.95-1.00; P = 0.093). The proportion of households with orphans under the age of 16 years decreased from 17% in 2004 to 7% in 2011. The proportions of respondents who had ever been tested for HIV, had a comprehensive knowledge of HIV, knew where to obtain free ART and reported that a non-pregnant household member was receiving ART gradually increased. CONCLUSION: The expansion of ART services in Lusaka was not associated with a reduction in all-cause mortality. Coverage, patient adherence and retention may all have to be increased if ART is to have a robust and lasting impact at population level in Lusaka

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

The impact of a hybrid social marketing intervention on inequities in access, ownership and use of insecticide-treated nets

BACKGROUND: An ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Social marketing techniques were used for product and message development. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at $2.5 per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs. METHODS: A post-test only quasi-experimental study design was used to compare intervention and comparison districts. A total of 2,986 respondents were interviewed. Survey respondents were grouped into four socio-economic (SES) categories: low, medium-low, medium and high. Knowledge, access, ownership and use indicators are compared. Concentration index scores are calculated. Interactions between intervention status and SES help determine how different SES groups benefited from the intervention. RESULTS: Although overall use of nets remained relatively low, post-test data show that knowledge, access, ownership and use of mosquito nets was higher in intervention districts. A decline in SES inequity in access to nets occurred in intervention districts, resulting from a disproportionately greater increase in access among the low SES group. Declines in SES inequities in net ownership and use of nets were associated with the intervention. The largest increases in net ownership and use occurred among medium and high SES categories. CONCLUSION: Increasing access to nets among the poorest respondents in rural areas may not lead to increases in net use unless the price of nets is no longer a barrier to their purchase

Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection

Abstract Background Women who are newly diagnosed with HIV infection during pregnancy may not be ready to immediately initiate lifelong antiretroviral therapy (ART; called Option B +) as is recommended. Lack of “readiness” drives early disengagement from care and undermines prevention of HIV transmission to infants. Several studies have shown high early attrition of women initiating ART in pregnancy. Although poor ART uptake and adherence have been attributed to various factors including stigma, disclosure issues and structural issues, there is no standard way of determining which pregnant woman will face challenges and therefore need additional support. We developed and validated a novel ART readiness tool in Lusaka, Zambia. Methods The aim of this study was to develop and validate a tool that could be used to assess how ready a newly diagnosed pregnant woman living with HIV would be to initiate ART on the day of diagnosis. Using a mixed method design, we conducted this study in three public-setting health facilities in Lusaka, Zambia. Informed by qualitative research and literature review, we identified 27 candidate items. We assessed content validity using expert and target population judgment approaches. We administered the 27-item questionnaire to 454 newly diagnosed pregnant women living with HIV, who were enrolled into a randomized trial (trials number NCT02459678). We performed item reduction analysis and used Cronbach’s alpha coefficient of 0.70 as threshold for reliability. Results A total of 454 pregnant women living with HIV enrolled in the study between March 2017 and December 2017; 452 had complete data for analysis. The correlation coefficient between the 27 items on the completed ART readiness scale ranged from 0.31 to 0.70 while item discrimination index ranged from -0.01 to 2.38. Sixteen items were selected for the final scale, representing three domains, which we classified as “internalized and anticipated HIV stigma”, “partner support” and “anticipated structural barriers”. Conclusion We developed and validated a tool that could be used to assess readiness of newly diagnosed women living with HIV to initiate ART. This ART readiness tool could allow clinics to tailor limited resources to pregnant women living with HIV needing additional support to initiate and remain on ART