Disclosure to HIV-seropositive children in rural Zambia.

BACKGROUND: Care of children living with HIV comprises various issues, some considered challenging. One of the challenging areas is the serostatus disclosure to HIV-positive children. This study describes the current situation of HIV disclosure among rural children in Zambia and examines the socio-demographic factors promoting disclosure. METHODS: We used a mixed method approach applying both quantitative and qualitative methods to obtain comprehensive picture of HIV serostatus disclosure for children. Data were collected in Mumbwa district, Zambia (2010-2012), included 57 clinical records of children older than 5 years old. We examined children's age, gender, and cohabitation status with their parents, caregivers' level of education and income, and the relation between children and caregivers. Logistic regression model was applied to examine associations between disclosure and socio-demographic characteristics. Semi-structured interviews with 50 caregivers and 22 HIV-positive children were conducted to qualitatively investigate attitude towards disclosure and support needed. RESULTS: Full disclosure was completed in 17 out of 57 (29.8%) patients. Median ages of patients in disclosed group and non-disclosed group were 10 and 9, respectively (IQR 8.0-13.0, 7.0-11.25). In univariate analyses, older age and male gender has positive relation to the completion of serostatus disclosure. In logistic regression models, cohabitation status with patients' mothers showed positive correlation to the completion of serostatus disclosure. In the interviews with caregivers, all caregivers said that disclosure of serostatus is a necessary process and good for their children, while actual serostatus disclosure rate was low. CONCLUSION: Serostatus disclosure to HIV-seropositive children is not prevalent in Rural Zambia. Although further researches would be desirable, increased support to caregivers would be beneficial.

Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients.

BACKGROUND: Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia. METHODS: This is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence. RESULTS: Of 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%). CONCLUSIONS: The treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after starting ART.

Hypertension, its correlates and differences in access to healthcare services by gender among rural Zambian residents: a cross-sectional study.

OBJECTIVES: To examine the prevalence of hypertension and access to related healthcare services among rural residents of Mumbwa district in Zambia. DESIGN: Cross-sectional study with probability cluster sampling. SETTING: Rural Zambia. PARTICIPANTS: We recruited 690 residents from Mumbwa district aged 25-64 years who had been living in the study area for ≥6 months and had adopted the lifestyle of the study area. Pregnant women and women who had given birth in the past 6 months were excluded. The data collection-questionnaire survey and anthropometric and biological measurements-was conducted between May and July 2016. RESULTS: In the overall sample, 39.7% and 33.5% of the men and women had hypertension (systolic blood pressure (BP)≥140 or diastolic BP ≥90 mm Hg), respectively. Among the participants without a previous diagnosis of hypertension, 30.3% presented with hypertension at the time of measurement. In the multivariable analysis, alcohol intake and urban residence in men, and older age group, higher education and body mass index ≥25 kg/m2 in women were significantly associated with hypertension. Among the 21.8% who never had their BP measured, 83.8% were men; among these men, older age (adjusted OR (AOR), 0.43; 95% CI 0.25 to 0.73) and HIV positive status (AOR, 0.37; 95% CI 0.14 to 0.97) were negatively associated, while current smoker status (AOR, 2.09; 95% CI 1.19 to 3.66) was positively associated with the lack of BP measurements. CONCLUSION: We found that hypertension is prevalent in the target rural area. However, many were not aware of their hypertension status and many never had their BP measured, indicating a serious gap in cardiovascular disease prevention services in Zambia. There is an urgent need for health promotion and screening for hypertension, especially in the primary health services of rural Zambia. Issues related to healthcare accessibility in men require particular attention.

Social factors affecting ART adherence in rural settings in Zambia.

The purpose of this study was to assess the factors that influence ART adherence arising in rural settings in Zambia. A survey was conducted with face-to-face interviews using a semi-structured questionnaire and written informed consent was obtained at ART sites in Mumbwa District in rural Zambia. The questionnaire included items such as the socio-demographic characteristics of respondents, support for adherence, ways to remember when to take ARVs at scheduled times, and the current status of adherence. Valid responses were obtained from 518 research participants. The mean age of the respondents was 38.3 years and the average treatment period was 12.5 months. More than half of the respondents (51%) were farmers, about half (49%) did not own a watch, and 10% of them used the position of the sun to remember when to take ARVs. Sixteen percent of respondents experienced fear of stigma resulting from taking ARVs at work or home, and 10% felt pressured to share ARVs with someone. Eighty-eight percent of the participants reported that they had never missed ARVs in the past four days. Multivariable logistic regression analysis identified age (38 years old or less, odds ratio (OR) = 2.5, 95% confidence interval (CI): 1.3-4.8, p=0.005), "remembering when to take ARVs based on the position of the sun" (OR = 3.3, 95% CI: 1.3-8.8, p=0.016), and "feeling pressured to share ARVs with someone" (OR = 4.4, 95% CI: 1.6-12.0, p=0.004) as independent factors for low adherence. As ART services expand to rural areas, program implementers should pay more attention to more specific factors arising in rural settings since they may differ from those in urban settings.

Expansion of antiretroviral treatment to rural health centre level by a mobile service in Mumbwa district, Zambia.

PROBLEM: Despite the Government's effort to expand services to district level, it is still hard for people living with HIV to access antiretroviral treatment (ART) in rural Zambia. Strong demands for expanding ART services at the rural health centre level face challenges of resource shortages. APPROACH: The Mumbwa district health management team introduced mobile ART services using human resources and technical support from district hospitals, and community involvement at four rural health centres in the first quarter of 2007. This paper discusses the uptake of the mobile ART services in rural Mumbwa. LOCAL SETTING: Mumbwa is a rural district with an area of 23 000 km² and a population of 167 000. Before the introduction of mobile services, ART services were provided only at Mumbwa District Hospital. RELEVANT CHANGES: The mobile services improved accessibility to ART, especially for clients in better functional status, i.e. still able to work. In addition, these mobile services may reduce the number of cases "lost to follow-up". This might be due to the closer involvement of the community and the better support offered by these services to rural clients. LESSONS LEARNT: These mobile ART services helped expand services to rural health facilities where resources are limited, bringing them as close as possible to where clients live.

Dietary habits, body image, and health service access related to cardiovascular diseases in rural Zambia: A qualitative study.

BACKGROUND: Cardiovascular diseases are among the leading causes of mortality and morbidity in sub-Saharan Africa, including Zambia, where cardiovascular diseases account for 8% of the mortality rates. Despite an increasing number of cardiovascular disease-related studies in Zambia, qualitative studies exploring how cardiovascular diseases and their risk factors are understood in the socioeconomic and cultural contexts are still few. This study, therefore, aimed to analyze the beliefs, perceptions, and behaviors related to cardiovascular diseases and their risk factors among the local residents of Zambia. METHODS: This qualitative study was conducted from August to September 2014 among healthy residents aged 40 years and above in a rural community in Mumbwa District. We investigated the beliefs, perceptions, and behaviors related to cardiovascular diseases and their potential risk factors in the sociocultural context of Zambia by conducting in-depth interviews and focus group interviews. Audio-recorded interviews were transcribed and analyzed using thematic analysis with investigator triangulation. RESULTS: We conducted 34 in-depth interviews and 6 focus group interviews with 27 males and 40 females. Most participants were aware of the prevalence of cardiovascular diseases around them and correctly identified hypertension, excessive salt, sugar, and cooking oil intakes, poor quality cooking oil, consumption of meat or vegetables contaminated with chemicals, obesity, stress ["thinking too much"], lack of physical exercise, and heredity as potential risk factors of cardiovascular diseases, while smoking and alcohol were mentioned by only a few participants. However, they claimed that many of these risk factors were difficult to avoid due to ingrained taste preferences for high salt and sugar, increasingly busy lives that force them to use cooking oil to reduce preparation time, cultural preference for big body size or fatness, especially for women, stigmatized body image attached to HIV, stressful life or life events related to poverty, and financial barriers to affording quality foods and healthcare services. Limited health screening opportunities and the negative impact of HIV-related stigma on health-seeking behavior also emerged as important risk factors for cardiovascular diseases. CONCLUSIONS: This study revealed that participants are relatively well aware of cardiovascular diseases and their risk factors. However, they engage in high-risk health behaviors, due to ingrained taste preferences, limited knowledge, and unavoidable socioeconomic and cultural circumstances. Results suggest that prevention interventions addressing cardiovascular diseases in rural Zambia should target gaps in knowledge and socioeconomic and cultural barriers.

Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia.

BACKGROUND: Sub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context. METHODS: In this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25-64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) ≥25 kg/m2 and underestimation of body weight were assessed using multiple logistic regression. RESULTS: Of the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI ≥25 kg/m2. In multivariate analyses, female gender, age 45-64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c ≥5.7% were significantly associated with BMI ≥25 kg/m2. Among participants with BMI ≥25 kg/m2, 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45-64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m2 and BMI≥25 kg/m2, respectively; "looks attractive" and "fear of being perceived as HIV-positive" were the main reasons. CONCLUSION: In rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI ≥25 kg/m2 underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia.

Proton NMR Study of Oxo-Bridged Dimanganese(III) Complexes: Solution State Structures and an Isotropic Shift/Magnetic Exchange Correlation.

The (1)H NMR spectra of a series of manganese-oxo aggregates have been examined, and a characteristic signature was found for each complex. For the dimanganese(III,III) complexes [Mn(2)O(OAc)(2)(HB(pz)(3))(2)], [Mn(2)O(OAc)(2)(tacn)(2)](2+), [Mn(2)O(OAc)(2)(H(2)O)(2)(bpy)(2)](2+), and [Mn(2)O(OAc)(2)(bpta)(2)](2+) (HB(pz)(3) = hydrotris(pyrazol-1-yl)borate; tacn = 1,4,7-triazacyclononane; bpy = 2,2'-bipyridine, and bpta = N,N-bis(2-pyridylmethyl)-tert-butylamine), the (1)H NMR spectra reveal a resonance associated with acetate, found downfield between 58 and 80 ppm, and a generally well resolved set of terminal ligand resonances which can be divided into two classes: those resonances associated with pyridyl or pyrazolyl ring protons and those of methylene groups. A number of the pyridine ring resonances have been unambiguously assigned by the examination of methyl-substituted derivatives. Data for these derivatives also support a coordination geometry-dependent pathway for spin delocalization. Moreover, interpretation of the (1)H NMR spectra leads to the conclusion that the solution-state structures of all members of the series are the same as the reported solid-state structures. A strong linear correlation between the magnetic coupling constant (J) and the isotropic shift of the acetate resonance was observed within this series of {Mn(2)O(OAc)(2)}(2+) core complexes. Furthermore, comparisons of the acetate proton isotropic shift ratio (DeltaH(Mn)/DeltaH(Fe)) to the ratio of the squared effective magnetic moments &mgr;(eff)(2)(Mn)/ &mgr;(eff)(2)(Fe) for complexes with the {M(2)O(OAc)(2)}(2+) core (where M = Mn(3+) or Fe(3+)) revealed excellent agreement (within 10%) between these two quantities.

Tuning tetranuclear manganese-oxo core electronic properties: adamantane-shaped complexes synthesized by ligand exchange.

A series of adamantane-shaped [Mn4O6]4+ aggregates has been prepared. Ligand substitution reactions of [Mn4O6(bpea)4](ClO4)4 (1) with tridentate amine and iminodicarboxylate ligands in acetonitrile affords derivative clusters [Mn4O6(tacn)4](ClO4)4 (4), [Mn4O6(bpea)2(dien)2](ClO4)4)(5), [Mn4O6(Medien)4](ClO4)4 (6), [Mn4O6(tach)4](ClO4)4 (7), [Mn4O6(bpea)2(me-ida)2] (8), [Mn4O6(bpea)2(bz-ida)2] (9), [Mn4O6(bpea)2((t)bu-ida)2] (10), and [Mn4O6(bpea)2((c)pent-ida)2] (11) generally on the order of 10 min with retention of core nuclearity and oxidation state. Of these complexes, only 4 had been synthesized previously. Characterization of two members of this series by X-ray crystallography reveals that compound 7 crystallizes as [Mn4O6(tach)4](ClO4)4 x 3CH3CN x 4.5H2O in the cubic space group Fmm and compound 11 crystallizes as [Mn4O6(bpea)2((c)pent-ida)2].7MeOH in the monoclinic space group C2/c. The unique substitution chemistry of 1 with iminodicarboxylate ligands afforded asymmetrically ligated complexes 8-11, the mixed ligand nature of which is most likely unachievable using self-assembly synthetic methods. A special feature of the iminodicarboxylate ligand complexes 8-11 is the substantial site differentiation of the oxo bridges of the [Mn4O6]4+ cores. While there are four site-differentiated oxo bridges in 8, the solution structural symmetry of 8H+ reveals essentially a single protonation isomer, in contrast to the observation of two protonation isomers for 1H+, one for each of the site-differentiated oxo bridges in 1. Magnetic susceptibility measurements on 4, 7, 8, and 9 indicate that each complex is overall ferromagnetically coupled, and variable-field magnetization data for 7 and 9 are consistent with an S = 6 ground state. Electrochemical analysis demonstrates that ligand substitution of bpea affords accessibility to the Mn(V)(Mn(IV))3 oxidation state.

FTIR spectra and normal-mode analysis of a tetranuclear manganese adamantane-like complex in two electrochemically prepared oxidation states: relevance to the oxygen-evolving complex of photosystem II.

The IR spectra and normal-mode analysis of the adamantane-like compound [Mn(4)O(6)(bpea)(4)](n+) (bpea = N,N-bis(2-pyridylmethyl)ethylamine) in two oxidation states, Mn(IV)(4) and Mn(III)Mn(IV)(3), that are relevant to the oxygen-evolving complex of photosystem II are presented. Mn-O vibrational modes are identified with isotopic exchange, (16)O-->(18)O, of the mono-micro-oxo bridging atoms in the complex. IR spectra of the Mn(III)Mn(IV)(3) species are obtained by electrochemical reduction of the Mn(IV)(4) species using a spectroelectrochemical cell, based on attenuated total reflection [Visser, H.; et al. Anal. Chem. 2001, 73, 4374-4378]. A novel method of subtraction is used to reduce background contributions from solvent and ligand modes, and the difference and double-difference spectra are used in identifying Mn-O bridging modes that are sensitive to oxidation state change. Two strong IR bands are observed for the Mn(IV)(4) species at 745 and 707 cm(-1), and a weaker band is observed at 510 cm(-1). Upon reduction, the Mn(III)Mn(IV)(3) species exhibits two strong IR bands at 745 and 680 cm(-1), and several weaker bands are observed in the 510-425 cm(-1) range. A normal-mode analysis is performed to assign all the relevant bridging modes in the oxidized Mn(IV)(4) and reduced Mn(III)Mn(IV)(3) species. The calculated force constants for the Mn(IV)(4) species are f(r)(IV)= 3.15 mdyn/A, f(rOr) = 0.55 mdyn/A, and f(rMnr) = 0.20 mdyn/A. The force constants for the Mn(III)Mn(IV)(3) species are f(r)(IV)= 3.10 mdyn/A, f(r)(III)= 2.45 mdyn/A, f(rOr) = 0.40 mdyn/A, and f(rMnr) = 0.15 mdyn/A. This study provides insights for the identification of Mn-O modes in the IR spectra of the photosynthetic oxygen-evolving complex during its catalytic cycle.