Sexual behaviour and risk compensation among single women of reproductive age using hormonal contraception in Zambia.

OBJECTIVE: Developing countries have seen an increase in the use of hormonal contraception due to its high efficacy in preventing pregnancy. Our study assessed risk compensation among single women of reproductive age using hormonal contraception. METHODS: The study used data from a nationally representative, cross-sectional sample of the 2018 Zambia Demographic and Health Survey (DHS). Study participants (N = 2151) were single, sexually active women aged 15-49 years, of whom 595 were using hormonal contraception. RESULTS: Hormonal contraception was used by 26% of participants, 81% of whom reported they had not used a condom every time they had sexual intercourse (p < .001). Sexually transmitted infections (STIs) were reported in 4% of hormonal contraceptive users, compared with 2% of non-hormonal contraceptive users (p = .036). The odds of condom use at each occurrence of sexual intercourse were lower for: hormonal contraceptive users (adjusted odds ratio [OR] 0.62; 95% confidence interval [CI] 0.48, 0.80); women aged 15-19 years (adjusted OR 0.62; 95% CI 0.36, 1.08) and 20-24 years (adjusted OR 0.56; 95% CI 0.33, 0.95); women with no education (adjusted OR 0.33; 95% CI 0.16, 0.69) and primary education (adjusted OR 0.62; 95% CI 0.42, 0.94); women in the low wealth quintile (adjusted OR 0.46; 95% CI 0.36, 0.61); and women who had one or more children (adjusted OR 0.59; 95% CI 0.45, 0.77). CONCLUSION: Lack of knowledge about hormonal contraception predisposes women to sexual risk behaviour. As hormonal contraception is very effective in preventing unwanted pregnancy, and condoms are effective in reducing the risk of STI transmission, the use of both (dual protection) should be encouraged.

Factors associated with intention to smoke cigarettes among never smoker school going adolescents in Zambia.

Background: Cigarette smoking intention is a strong predictor of cigarette smoking initiation. There is limited data on predictors of cigarette smoking intentions among adolescents in developing countries. Objective: To determine factors associated with cigarettes smoking intentions among never-smoked adolescents. Methods: The study utilized the Zambia 2011 Global Youth Tobacco Survey dataset on adolescents. Results: Being in grade nine compared to grade seven (AOR 0.43, 95%CI 0.23-0.82). Having a smoking father (AOR 2.38, 95%CI 1.25-453) mother (AOR 11.77, 95%CI 4.16-33.33), or both parents (AOR 7.05, 95%CI 2.91-17.10) showed significantly higher chance of having smoking intentions than having non-smoker parents. Also, having some (AOR 1.97, 95%CI 1.12-3.47), most (AOR 5.37, 95%CI 2.82-10.25), or all (AOR 3.75, 95%CI 1.64-8.56) smoker close friend was significantly associated with smoking intention compared to having none-smoker friends. Being around others who smoked in out-door places 1-2 days (AOR 2.16, 95%CI 1.19-3.93), 5-6 days (AOR 3.21, 95%CI 1.51-6.83) and 7 days/week (AOR 2.73, 95%CI 1.41-5.30) were also associated with one's intention to smoke cigarettes compared to not being around smokers in outdoor public places 7 days/week. Conclusion: Having smoking parents, smoking friends or around people who smoke in public places were associated with cigarette smoking intentions among adolescents.

Prevalence and Factors Associated with Tobacco Smoking in a National Representative Sample of Zambian Adults: Data from the 2017 STEPS - NCDs Survey.

BACKGROUND: There has been a reduction in tobacco smoking worldwide except in developing countries. Africa has the lowest prevalence of tobacco use in the world, however, the rising trends amidst the WHO FCTC implementation are worrisome as it is likely to increase the tobacco public health impact in the next decade. The study investigated factors associated with tobacco smoking among adults in Zambia. METHODS: We used secondary data extracted from the 2017 STEPS - NCDs Survey. Logistic regression was used to obtain unadjusted (UOR) and adjusted odds ratios (AOR) at 95% confidence interval (CI). RESULTS: Of the 4,301 adults who participated, 11.0% were current tobacco smokers (25.7% men and 2.27% women). Of these 75.6% and 11.9% drunk alcohol and had mental health problems, respectively. In multivariable analysis, factors significantly associated with increased odds of current tobacco smoking were older age groups of 45-59 years (AOR = 1.69; 95% CI: 1.17-2.43, p = 0.005) and 60-69 years (AOR = 2.22; 95% CI: 1.25-3.93, p = 0.006), alcohol consumption (AOR = 5.93; 95% CI: 4.44-7.91, p < 0.001), mental health problems (AOR = 2.08; 95% CI: 1.34-3.22, p = 0.001). On the other hand, female gender (AOR = 0.07; 95% CI: 0.05-0.10, p < 0.001), being diabetic (AOR = 0.52; 95% CI: 0.15-0.46, p = 0.026), education attainment; primary, secondary, and higher education (AOR = 0.65; 95% CI: 0.47-0.91, p = 0.012, AOR = 0.40; 95% CI: 0.29-0.55, p < 0.001 and AOR = 0.26; 95% CI: 0.15-0.46, p < 0.001), respectively, had reduced odds of tobacco smoking. CONCLUSIONS: Our findings underscore the high prevalence of tobacco smoking particularly in uneducated males who consume alcohol and have mental health problems.  The mental health problems and alcohol consumption in this population need to be addressed in concert with smoking cessation strategies.

School tobacco-related curriculum and behavioral factors associated with cigarette smoking among school-going adolescents in Zambia: Results from the 2011 GYTS study.

INTRODUCTION: Tobacco smoking is a global public health concern. It has been projected that children and young people who are alive today in developing countries will bear the most burden of tobacco-related morbidity and mortality in the near future. This study investigated the school tobacco-related curriculum and behavioral factors associated with cigarette smoking among school-going adolescents. METHODS: We accessed secondary data in a public domain collected using a cross-sectional study design. Altogether, 3377 seventh to ninth grade students were selected by stratified two-stage cluster sampling. Data were collected using a Global Youth Tobacco Survey (GYTS) Core Questionnaire. Multivariate logistic regression models were used to determine associations of school tobacco-related curriculum and behavioral factors with current cigarette smoking status. Adjusted odds ratios and their 95% confidence intervals are reported. RESULTS: Of the 2611students included in the analysis, 6.8% (7.8% of males and 5.8% of females) reported smoking cigarettes. Slightly over half of the students were taught in schools about the effects of smoking (53.6%) and the dangers of smoking (64.1%). Adolescents who had friends who smoked were more likely to smoke compared to those who did not have friends who smoked. Adolescents whose parents smoked were more likely to smoke compared to those who did not have parents who smoked. Adolescents who were not taught at school about the dangers of smoking, or were not sure about it, were more likely to smoke compared to those who were taught (AOR=1.94; 95% CI: 1.28-2.94). CONCLUSIONS: Schools play an important role in shaping smoking behavior among school-going adolescents. Based on our findings, school programs aimed at reducing cigarette smoking among school-going adolescents may achieve greater impact by implementing anti-smoking interventions that involve parents and peers in smoking prevention activities, and have a robust tobacco school curriculum.

Prevalence and correlates of voluntary medical male circumcision adverse events among adult males in the Copperbelt Province of Zambia: A cross-sectional study.

BACKGROUND: Voluntary Medical Male Circumcision (VMMC) is a key intervention in HIV/AIDS. Improving VMMC program uptake in Zambia requires careful monitoring of adverse events (AE) to inform program quality and safety. We investigate the prevalence of VMMC AE and their associated factors among adult males in Ndola, Copperbelt Province, Zambia. METHODS: We performed a cross-sectional study using secondary clinical data collected in 2015 using two validated World Health Organisation/Ministry of Health reporting forms. We reviewed demographics and VMMC surgical details from 391 randomly sampled adult males aged ≥18 years at Ndola Teaching Hospital, a specialised VMMC fixed site in Zambia. Non-parametric tests (Fisher's exact test or Chi-square depending on assumptions being met) and logistic regression were conducted to determine the relationships between associated factors and VMMC AE. RESULTS: The overall VMMC AE prevalence was 3.1% (95% CI 1.60%- 5.30%) and most AEs occurred postoperatively. In decreasing order, the commonly reported VMMC AE included; bleeding (47.1%), swelling (29.4%), haematoma (17.6%), and delayed wound healing (5.9%). There was an inversely proportional relationship between VMMC volume (as measured by the number of surgeries conducted per VMMC provider) and AEs. Compared to the highest VMMC volume of 63.2% (247/391) as reference, as VMMC volume reduced to 35.0% (137/391) and then 1.8% (7/391), the likelihood of AEs increased by five times (aOR 5.08; 95% CI 1.33-19.49; p = 0.018) and then sixteen times (aOR 16.13; 95% CI 1.42-183.30; p = 0.025) respectively. CONCLUSIONS: Our study found a low prevalence of VMMC AEs in Ndola city, Copperbelt Province of Zambia guaranteeing the safety of the VMMC program. We recommend more surgically proficient staff to continue rendering this service. There is a need to explore other high priority national/regional areas of VMMC program safety/quality, such as adherence to follow-up visits.

Consumption of Energy Drinks and Their Effects on Sleep Quality among Students at the Copperbelt University School of Medicine in Zambia.

Background. Good sleep quality is cardinal to good health, and research has shown that it plays a fundamental role in immunity, learning, metabolism, and other biological functions. Energy drink consumption is a popular practice among college students in the United States. There has been little research done on the consumption of energy drinks and its effects in Zambian universities. The main objective was to determine the effects of energy drinks on sleep quality among students at the Copperbelt University School of Medicine. A self-administered questionnaire was administered to 195 undergraduate students at the Copperbelt University School of Medicine in their second- and third-year of study. Energy drink consumption and sleep quality were assessed by univariate, bivariate, and multivariate analyses. 157 students were enrolled into the study. The prevalence of energy drink consumption was 27.4% among participants. Studying for an exam was the most common reason for drinking energy drinks (83.7% of energy drink users). The majority of participants were found to be have poor sleep quality (59.6%). There was a statistically significant association between energy drink consumption and poor sleep quality (p value < 0.01). The findings of our study show that energy drink consumption is not a common practice in the Zambian university setting as the prevalence was 27.4%. Furthermore, the prevalence of poor sleep quality among Zambian university students is high and is significantly associated with energy drink consumption, and there is a need to better understand the patterns of energy drink use as well as their effects on various aspects of health including sleep quality in the Zambian setting. Further research should assess the knowledge of nonmedical students on the effects of energy drinks.

Spatial distribution and correlates of smoking in Zambia.

OBJECTIVE: The objective of the paper was to investigate the spatial distribution and correlates of tobacco smoking in various regions of Zambia. METHODS: This paper adopts a cross-sectional study design. The study used data from the 2013/2014 Zambia Demographic Health Survey which is a nationwide health survey conducted in all the 10 provinces. A random sample of men and women from 15 920 households was successfully selected and interviewed. All women aged 15-49 and men aged 15-59 who were either permanent residents of the households or visitors present in the households on the night before the survey were eligible to be interviewed. RESULTS: The results show that 8.2% and 11% of Zambians in urban and rural areas smoke, respectively. In urban areas, the risk of being a cigarette smoker was 2.31 (CI: 1.69 to 3.16) and 2.03 (CI: 1.36 to 3.02) times higher for the divorced and separated. However, the risk of being a cigarette smoker was lower for those with some formal education. In rural areas, the risk of being a cigarette smoker was lower for the married (relative risk ratios (RRR): 0.69, CI: 0.55 to 0.86) and those with a formal education. Nevertheless, in rural areas, the risk of being a pipe and other smoker was higher for those who were self-employed (RRR: 8.46, CI: 2.95 to 24.20) and with an occupation (RRR: 2.37, CI: 1.39 to 4.02) but was lower among women. CONCLUSION: Tobacco smoking varies between and within regions as well as provinces. Therefore, interventions to curb smoking should target specific demographic, socioeconomic and cultural factors and how they are spatially distributed.

Acceptance of Cervical Cancer Screening and its Correlates Among Women of a Peri-Urban High-Density Residential Area in Ndola, Zambia.

BACKGROUND: Zambia has one of the highest cervical cancer incidence and mortality rates in the world. Cervical cancer screening leads to reduction in the incidence of invasive disease. The objectives of the study were to determine the level of acceptance of cervical cancer screening and its correlates among women of a peri-urban high-density residential area in Ndola, Zambia. METHODS: A cross sectional study was conducted. With a population size of 12,000 women in reproductive age and using an expected frequency of 50 + 5% and at 95% confidence interval, the required sample size was 372. A stratified sampling method was used to select participants. Independent factors that were associated with the outcome were established using multi-variate logistic regression. Adjusted odds ratios and their 95% confidence intervals are reported. RESULTS: In total, 355 out of 372 questionnaires were administered, achieving a response rate of 95.4%. Out of 355 participants, 9 (2.5%) had ever been screened for cervical cancer. In bivariate analyses, factors associated with screened were knowledge of body part affected, screening as a prevention tool, whether cervical cancer was curable in its early stages or not, awareness of cervical cancer screening, knowledge on frequency of screening and cervical cancer screening causing harm. However, in multivariate analysis, participants who knew that cervical cancer screening prevented cervical cancer were 3.58 (95% CI [1.49, 8.64]) times more likely to have been screened than those who did not have the knowledge. Participants who knew that cervical cancer is curable were 2.76 (95% CI [1.92, 8.31]) times more likely to have been screened than those who did not have the knowledge. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: The uptake of screening was low. Interventions should be designed to increase uptake of screening for cervical cancer by considering factors that have been identified in the current study that are independently associated with cervical cancer screening among this population.

Risk assessment for yellow Fever in Western and north-Western provinces of zambia.

BACKGROUND: North-Western and Western provinces of Zambia were reclassified as low-risk areas for yellow fever (YF). However, the current potential for YF transmission in these areas is unclear. AIMS: To determine the current potential risk of YF infection. SETTING AND DESIGN: A cross sectional study was conducted in North-Western and Western provinces of Zambia. MATERIALS AND METHODS: Samples were tested for both YF virus-specific IgG and IgM antibodies by the ELISA and YF virus confirmation was done using Plaque Reduction Neutralization Test. The samples were also tested for IgG and IgM antibodies against other flaviviruses. RESULTS: Out of the 3625 respondents who participated in the survey, 46.7% were males and 9.4% were aged less than 5 years. Overall, 58.1% of the participants slept under an impregnated insecticide-treated net and 20.6% reported indoor residual spraying of insecticides. A total of 616 (17.0%) samples were presumptive YF positive. The prevalence for YF was 0.3% for long-term infection and 0.2% for recent YF infection. None of the YF confirmed cases had received YF vaccine. Prevalence rates for other flaviviruses were 149 (4.1%) for Dengue, 370 (10.2%) for West Nile and 217 (6.0%) for Zika. CONCLUSION: There is evidence of past and recent infection of YF in both provinces. Hence, they are at a low risk for YF infection. Yellow fever vaccination should be included in the EPI program in the two provinces and strengthen surveillance with laboratory confirmation.

Prevalence and correlates of obesity among Lusaka residents, Zambia: a population-based survey.

BACKGROUND: Non-communicable lifestyle diseases are a growing public health concern globally. Obesity is a risk factor for premature mortality from cardiovascular diseases and diabetes as well as all-cause mortality. The objective of the study was to estimate the prevalence and associated factors for obesity among Zambian adults in Lusaka district. METHODS: A community-based study was done among adults in Zambia. Descriptive and co-relational analyses were conducted to estimate the prevalence of being obese as well as identify associated factors. RESULTS: A total of 1,928 individuals participated in the survey, of which 33.0% were males. About half of the participants were aged 25-34 years (53.2%), and about two-thirds had attended at least secondary level of education (63.9%). Overall, 14.2% of the participants (5.1% of males, and 18.6% of females) were obese. Significant factors associated with obesity were sex, age, education, cigarette smoking and blood pressure. Male participants were 55% (AOR = 0.45; 95% CI [0.29, 0.69]) less likely to be obese compared to female participants. Compared to participants who were of age 45 years or older, participants of age 25-34 years were 61% (AOR = 0.39 (95% CI [0.23, 0.67]) less likely to be obese. Compared to participants who attained college or university level of education, participants who had no formal education were 63% (AOR = 0.37; 95% CI [0.15, 0.91]) less likely to be obese; and participants who had attained secondary level of education were 2.22 (95% CI [1.21, 4.07]) times more likely to be obese. Participants who smoked cigarettes were 67% (AOR = 0.33; 95% CI [0.12, 0.95]) less likely to be obese compared to participants who did not smoke cigarettes. Compared to participants who had severe hypertension, participants who had moderate hypertension were 3.46 (95% CI [1.34, 8.95]) times more likely to be obese. CONCLUSIONS: The findings from this study indicate that Zambian women are more at risk of being obese. Prevention and control measures are needed to address high prevalence and gender inequalities in risks for non-communicable diseases in Zambia. Such measures should include policies that support gender specific approaches for the promotion of health behavior changes.