Gender inequities in women's access to maternal health care utilisation in Zambia: a qualitative analysis.

BACKGROUND: The role of gender inequities in women's ability to access maternal health care has mainly been analysed from either women's or men's perspective only. In this article, we explore the role of gender inequities in maternal health care utilisation from both men's and women's perspectives. METHODS: Thirty-six interviews were conducted with reproductive age women (n = 24), and men whose wives/partners gave birth within the last three years prior to our study in Zambia (n = 12). Our study sought to improve understanding of the normative environment in which women and men make decisions on maternal health care utilisation in Zambia. RESULTS: We found that men and women had different expectations regarding their gender roles in maternal health care utilisation, which created inequities reinforced by societal norms and traditions. Men make most household decisions including those related to reproductive health and they often have the major say in access to maternal health services despite not having holistic maternal health information which creates challenges in maternal health care utilisation. CONCLUSION: The study highlights the need for maternal health care utilisation decisions to be made by both men and women and that men should be fully involved in maternal health care from pregnancy until after child birth. Further, there is urgent need for concerted and sustained efforts to change traditional norms that reinforce these inequities and affect maternal health care utilisation if Zambia is to meet Sustainable Development Goal-3.1.

How soon do single mothers have another child? A competing risk analysis of second premarital childbearing in sub-Saharan African countries.

BACKGROUND: A considerable number of previous studies have examined the trends, correlates, and consequences of premarital childbearing among adolescents and young women in Africa. However, very little is known about whether and how soon single mothers have another premarital birth in sub-Saharan African countries. This study examines the timing of a second premarital birth among single mothers and assesses how it may differ across key socio-demographic variables. METHODS: We pooled recent Demographic and Health Surveys from 25 sub-Saharan African countries to create a database of 57, 219 single mothers aged 15-49 years. Cumulative incidence graphs and Fine and Gray's competing risk models were used to delineate the timing of a second premarital birth and its socio-demographic correlates. RESULTS: More than one-third of single mothers in 16 countries have had a second premarital birth in their reproductive life. We also observed that more than 15% of the single mothers in Angola, Benin, the Republic of Chad, Liberia, Namibia, Nigeria, Sierra Leone, and Uganda, have had another premarital birth three years after the first. The incidence of a second premarital birth was significantly lower among women with secondary or higher education, compared to women with less than secondary education (p < 0.05) in most countries. Residence in an urban area compared to rural, was also significantly associated with a low incidence of second premarital birth in 10 countries (p < 0.05). CONCLUSIONS: Findings indicate a rapid progression to having a second premarital birth in some sub-Sahara African countries, particularly among socio-economically disadvantaged women. The findings suggest the need for tailored interventions for improving the quality of life of single mothers, to reduce the associated burden and consequences of having a premarital birth.

Variations in sex ratios estimated from census and survey data in Zambia, 1969-2014.

The sex ratio question has been an area of growing interest in population dynamics, especially in developing countries with respect to the issue of missing women, but few studies have examined this in sub-Saharan Africa. Both at birth and in the general population, sex ratios follow an expected demographic pattern in the absence of the interference of historical events affecting either males or females in a population. In Zambia, an unexpected demographic pattern of sex ratios is exhibited in census and survey data. This study used data from censuses and surveys conducted from 1969 to 2014 to examine variations in sex ratios in the Zambian population. It was found that sex ratio imbalances were largely due to data deficiencies due to age misreporting and under-enumeration. A consistent under-enumeration of young adult males in the 20-34 years age group was found. A systematic pattern of high sex ratios, above 100, for ages 40+ was found, represented by synthetic cohorts traceable from the 1969 census, progressing to the 2000 census and phased out in the 2010 census. Extremely high adult male mortality was found in 2010 in the 35-59 years age group, primarily attributable to HIV/AIDS. Understanding the demographic pattern of sex ratios in a population is relevant for policies to improve the quality of data collection systems, and socioeconomic development planning, for the young age group population, which is prone under-enumeration.

Adult mortality in sub-Saharan Africa: cross-sectional study of causes of death in Zambia.

OBJECTIVE: To describe the age-sex pattern and socio-economic differentials in causes of death among adults between the ages of 15 and 59 years in Zambia. METHODS: Using data from the 2010-2012 Zambia sample vital registration with verbal autopsy survey, we calculated the percentage share of causes of death, the age-/sex cause-specific death ratio and cause-eliminated life expectancy at age 15. RESULTS: HIV/AIDS was the leading cause of death across all socio-economic subgroups contributing 40.7% of total deaths during the study period. This was followed by deaths due to injury and accidents (11.2%). Cause-specific death ratios due to HIV/AIDS increased by age and peaked in the 35-39 age group and were higher among females than males. The second-leading cause of death was injuries and accidents for males and tuberculosis for females. The third-leading cause of death was cardiovascular diseases for females and tuberculosis for males. Cause of death patterns varied notably by socio-economic characteristics. Deaths attributable to non-communicable diseases were more evident in adults aged 45-59 years. Eliminating HIV/AIDS in Zambia as a cause of death could raise life expectancy at age 15 by 5.7 years for males and by 6.4 years for females. CONCLUSION: HIV/AIDS-related health programmes and interventions should be further supported and strengthened, as they would significantly contribute to the reduction in adult mortality in Zambia.

OBJECTIF: Décrire les profilsselon l'âge et le sexe, et les différences socioéconomiques dans les causes de décès chez les adultes âgés de 15 à 59 ans en Zambie. MÉTHODES: En utilisant les données de l'enregistrement de l'état civil d'un échantillon de la Zambie de 2010 à 2012 avec l'enquête sur l'autopsie verbale, nous avons calculé la part en pourcentage des causes de décès, le taux de mortalité selon l'âge et le sexe et l'espérance de vie éliminée à 15 ans. RÉSULTATS: Le VIH/SIDA était la principale cause de décès dans tous les sous-groupes socioéconomiques, contribuant à 40,7% du nombre total de décès au cours de la période de l'étude. Viennent ensuite les décès par blessures et accidents (11,2%). Les taux de mortalité par cause dus au VIH/SIDA ont augmenté avec l'âge et ont culminé dans le groupe d'âge des 35 à 39 ans et étaient plus élevés chez les femmes que chez les hommes. La deuxième cause de décès était les blessures et les accidents chez les femmes et la tuberculose chez les hommes. Latroisième cause de décès était les maladies cardiovasculaires chez les femmes et la tuberculose chez les hommes. Les causes de décès variaient notamment en fonction des caractéristiques socioéconomiques. Les décès imputables aux maladies non transmissibles étaient plus évidents chez les adultes âgés de 45 à 59 ans. L'élimination du VIH/SIDA en Zambie en tant que cause de décès pourrait augmenter l'espérance de vie à 15 ans de 5,77 ans pour les hommes et de 6,40 ans pour les femmes. CONCLUSION: Les programmes et interventions de santé liés au VIH/SIDA devraient être davantage soutenus et renforcés, car ils contribueraient de manière significative à la réduction de la mortalité des adultes en Zambie.

REGIONAL DIFFERENCES IN POSITIVE SEXUAL BEHAVIOUR AMONG YOUTH IN SUB-SAHARAN AFRICA.

The question of youth sexual behaviour has been widely debated, with researchers such as Berhan and Berhan (2015) arguing that young adults aged 15-24 are more likely to engage in risky behaviours. However, research has not adequately addressed the issue of positive sexual behaviours, in particular among young people in sub-Saharan Africa. Adapting the compensatory model of risk and resiliency theory, this study examined the determinants of positive sexual behaviours among youth in sub-Saharan Africa. Using recent data from Demographic and Health Surveys of sixteen countries representative of each African region (East, West, Southern and Central), it was hypothesized that positive sexual behaviours of youth (condom use at last sex and single sexual partnership) would be most strengthened by protective factors at the individual and family levels, and that these behaviours would differ by region due to regional variation in socio-cultural practices. Delayed age at sexual debut (first sex after the age of 15) was found to be the strongest protective factor for positive sexual behaviours among males and females in sub-Saharan Africa. Certain socioeconomic variables were found to be positively associated with positive sexual behaviours and the associations differed by gender.

Household structure, maternal characteristics and childhood mortality in rural sub-Saharan Africa.

INTRODUCTION: The household dynamics of childhood mortality in rural areas of sub-Saharan Africa is less researched despite the fact that mortality rates are almost two times that of urban settings. This study aimed to investigate the influence of household structure on childhood mortality while controlling for household and maternal characteristics in rural sub-Saharan Africa. METHODS: Eight countries with recent demographic and health survey data not earlier than the year 2010 were selected, two from each sub-region of sub-Saharan Africa. The outcome variables were risk of infant and child death while the main independent variables included sex of household head and household structure. Descriptive statistics were generated for all variables. Mortality rates disaggregated by sex of household head and household structure were estimated using the Kaplan-Meier method. Cox proportional hazard regression models were fitted to investigate the relationship between the outcome and explanatory variables in each country. RESULTS: The percentage of children living in female-headed households (FHHs) ranged from 5.2% in Burkina Faso to 49.1% in Namibia while those living in extended family households ranged from 27.4% in Rwanda to 59.9% in Namibia. Multivariate hazard regression showed that, in the majority of the countries, there was no significant relationship between living in FHHs and childhood mortality, but the direction and magnitude of effect varied across countries. A significant negative effect of FHHs on infant mortality was observed in Burkina Faso (HR=1.64, 95% confidence interval (CI): 1.09-2.48) and Zambia (HR=1.49, 95%CI: 1.02-2.17). Likewise, children in extended family households had a higher risk of child mortality in Burkina Faso (HR=1.33, 95%CI: 1.04-1.69) and Zambia (HR=1.59, 95%CI: 1.02-2.49). There was not much difference in the effect of FHHs between infancy (0-11 months) and childhood (12-59 months) in the other countries. The pooled adjusted hazard ratio (HR) showed that the risk of death in childhood was 23% higher in extended family households (HR=1.23, 95%CI: 1.09-1.39) than in nuclear family households. CONCLUSIONS: In rural sub-Saharan Africa, children in FHHs do not have significantly higher infant and child mortality. Also, there was no difference in infant mortality between nuclear and extended family households but the latter constitute a higher risk for child mortality.

Decomposition of age- and cause-specific adult mortality contributions to the gender gap in life expectancy from census and survey data in Zambia.

In the context of high adult mortality and an immense impact on the health burden of Zambia, a decomposition analysis of age- and cause-specific mortality in age group 15-59 was performed to determine the contributions to the gap in life expectancy at birth between males and females. Previous studies on decomposition have examined income groups, ethnicity, and regional differences' contributions to gaps in life expectancy, but not the adult mortality age group 15-59. These studies focus on developed countries and few on developing countries. Arriaga's decomposition method was applied to 2010 census and 2010-2012 sample vital registration with verbal autopsy survey (SAVVY) data to decompose contributions of age- and cause-specific adult mortality to the gap in life expectancy at birth between males and females. The decomposition analysis revealed that mortality was higher among males than females and concentrated in age groups 20-49. Age- and cause-specific adult mortality contributed positively, 50% of the years to the gap in life expectancy at birth between males and females. Major cause-specific mortality contributors to the gap in life expectancy were infectious and parasitic diseases (1.17 years, 26.3%), accidents and injuries (0.54 years, 12.2%), suicide and violence (0.30 years, 6.8%). Female HIV mortality offset male mortality. Neoplasms deaths among females contributed negatively to the gap in life expectancy (-0.22 years, -5.4%). Accidents, injuries, suicide, and violence are emerging major causes of death in age group 20-49 in Zambia which health policy and programmes should target.

Adult mortality in sub-Saharan Africa using 2001-2009 census data: does estimation method matter?

Adult mortality is an important development and public health issue that continues to attract the attention of demographers and public health researchers. Controversies exist about the accurate level of adult mortality in sub-Saharan Africa (SSA), due to different data sources and errors in data collection. To address this shortcoming, methods have been developed to accurately estimate levels of adult mortality. Using three different methods (orphanhood, widowhood, and siblinghood) of indirect estimation and the direct siblinghood method of adult mortality, we examined the levels of adult mortality in 10 countries in SSA using 2001-2009 census and survey data. Results from the different methods vary. Estimates from the orphanhood data show that adult mortality rates for males are in decline in South Africa and West African countries, whilst there is an increase in adult mortality in the East African countries, for the period examined. The widowhood estimates were the lowest and reveal a marked increase in female adult mortality rates compared to male. A notable difference was observed in adult mortality estimates derived from the direct and indirect siblinghood methods. The method of estimation, therefore, matters in establishing the level of adult mortality in SSA.

Adult mortality in sub-saharan Africa, Zambia: Where do adults die?

Place of death remains an issue of growing interest and debate among scholars as an indicator of quality of end-of-life care in developed countries. In sub-Saharan Africa, however, variations in place of death may suggest inequalities in access to and the utilization of health care services that should be addressed by public health interventions. Limited research exists on factors associated with place of death in sub-Saharan Africa. The study examines factors associated with the place of death among Zambian adults aged 15-59 years using the 2010-2012 sample vital registration with verbal autopsy survey (SAVVY) data, descriptive statistics and multivariate logistic regression analysis. Results show that more than half of the adult deaths occurred in a health facility and two-fifths died at home. Higher educational attainment, urban versus rural residence, and being of female gender were significant predictors of the place of death. Improvement in educational attainment and investment in rural health facilities and the health care system as a whole may improve access and utilization of health services among adults.