Predictors of mortality in acute hospitalised COVID-19 pneumonia patients: A retrospective cohort study at two tertiary-level hospitals in Zambia.

BACKGROUND: The global COVID-19 pandemic has resulted in increased acute hospitalisations, a high demand for intensive care and high in-hospital mortality, placing a huge burden on healthcare systems. OBJECTIVES: To assess in-hospital mortality outcomes and associated factors in acute hospitalised COVID-19 pneumonia patients in Zambia. METHODS: We performed a retrospective cohort review of patients admitted to two tertiary-level hospitals in Zambia from 1 March 2020 to 28 February 2021. We examined the factors (demographic, clinical and laboratory) that were associated with in-hospital mortality using multivariate logistic analysis. Adjusted odds ratios with their 95% confidence intervals (CIs) are reported. RESULTS: Of 350 patients, 59.4% were aged ≥55 years and 52.6% were male. The commonest comorbidities were hypertension, diabetes mellitus (DM), HIV/AIDS and chronic kidney disease (49.6%, 28.5%, 22.0% and 8.1%, respectively). The overall in-hospital mortality rate was 42.6%, and mortality was significantly increased in patients aged ≥55 years (52.0% v. 48.0%) and in those with DM (52.1% v. 47.9%), cardiac disease (68.0% v. 32.0%), a Quick Sequential (Sepsis-Related) Organ Failure Assessment (q-SOFA) score ≥2 (75.4% v. 24.6%), and admission blood glucose levels ≥7.0 mmol/L (66.3% v. 33.7%). Compared with patients who survived, who spent a median (interquartile range) of 6 (3 - 10) days in hospital, the median time between admission and death in those who died was 2.5 (1 - 6) days. In multivariate logistic analysis, age ≥55 years, a q-SOFA score ≥2 and a random blood sugar level ≥7.0 mmol/L were predictors of in-hospital mortality, with adjusted odds ratios of 1.54 (95% CI 1.09 - 2.17), 2.17 (95% CI 1.40 - 3.38) and 1.65 (95% CI 1.18 - 2.30), respectively. Raised serum creatinine was not associated with in-hospital COVID-19 mortality after adjusting for other confounders. CONCLUSIONS: This study highlights that high in-hospital COVID-19 mortality was associated with a high q-SOFA score, hyperglycaemia on admission and older age. The study reinforces the need to invest in emergency healthcare services for optimal management of COVID-19 patients presenting with high q-SOFA scores in resource-limited countries.

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Re-assessing community-directed treatment: evidence from Mazabuka District, Zambia.

Cross-sectional surveys with carers, health workers, community drug distributors (CDDs) and neighbourhood health committees were conducted to identify factors associated with utilization of community-directed treatment (ComDT) of soil-transmitted helminths in children aged 12-59 months in Mazabuka district, Zambia. The surveys took place in December 2006 and December 2007. In addition child treatment records were reviewed. The factors that were found to be significantly associated (p < 0.05) with treatment of children by the CDDs were: (1) the perception of soil-transmitted helminth infections as having significant health importance, (2) the community-based decision to launch and subsequently implement ComDT, (3) the use of the door-to-door method of drug distribution, (4) CDDs being visited by a supervisor, (5) CDDs receiving assistance in mobilizing community members for treatment, (6) CDDs having access to a bicycle and (7) CDDs having received assistance in collecting drugs from the health centre. Despite the effectiveness of ComDT in raising treatment coverage there are factors in the implementation process that will still affect whether children and their carers utilize the ComDT approach. Identification and understanding of these factors is paramount to achieving the desired levels of utilization of such interventions.

Correlates of diarrhoea among children below the age of 5 years in Sudan.

BACKGROUND: The Millennium Development Goals recognise child health and survival as an important socio-development issue. OBJECTIVES: To determine the correlates of diarrhoea among children aged below 5 years in north Sudan. METHODS: We conducted secondary data analysis of the Sudan Multiple Cluster Indicators Survey II. RESULTS: Altogether, 23,295 children were included in the survey. Half (50.0%) of the children were males, and 22.5% of them were of age less than one year. Boys were 3% (p=0.044) more likely to have diarrhoea compared to girls. Compared with the oldest age group (48-59 months), children less than 6 months of age and those aged 36-47 months had 25% and 18% lower prevalence of diarrhoea, respectively, while children aged 6-24 months and those aged 24-35 months had 1.5 fold and 1.17 fold higher prevalence of diarrhoea. Children in urban areas were 6% more likely to have diarrhoea. Children from households with 1 or 2 people per room were 8% less likely to have diarrhoea compared to children from households with more than 3 people per room. CONCLUSIONS: Diarrhoea was associated with child's age, gender, and social status. Our findings provide a useful baseline for interventions and comparisons with future studies.

District specific correlates for hypertension in Kaoma and Kasama rural districts of Zambia.

INTRODUCTION: Hypertension a major risk factor for cardiovascular disease and is the most widely recognized modifiable risk factor for this disease. There is little information on the prevalence and risk factors for hypertension in Zambia, and in particular in rural areas of the country. In order to contribute to the existing global literature on hypertension, particularly in rural Zambia, this study was conducted to determine the prevalence of hypertension and its correlates in two rural districts of Zambia, namely Kaoma and Kasama. METHODS: A cross-sectional study using a modified World Health Organization (WHO) global non communicable diseases (NCD) surveillance initiative NCD-STEPwise approach was used. Proportions were compared using the Yates' corrected χ2 test, and a result yielding a p-value of less than 5% was considered significant. Bivariate and multivariate logistic regression analyses were conducted. Factors that were significantly associated with the outcome in bivariate analyses were considered in a multivariate logistic regression analysis using a backward variable selection method. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were reported. RESULTS: In total, 895 participants from Kaoma and 1198 participants from Kasama took part in the surveys. Overall, 25.8% participants (27.5% male, 24.6% female; p=0.373) in Kaoma and 30.3% (31.3% male, 29.5% female; p=0.531) in Kasama were hypertensive. In Kaoma, age and BMI were independently associated with hypertension. Compared with participants aged 45 years or older, participants aged 25-34 years were 60% (AOR=0.40, 95% CI [0.21, 0.56]) less likely to be hypertensive. Participants with BMI <18.5 and 18.5-24.9 were 54% (AOR=0.46, 95% CI [0.30, 0.69]) and 31% (AOR=0.69, 95% CI [0.49, 0.98]) less likely to be hypertensive compared with participants with BMI ≥30. In Kasama, age, smoking and heart rate were significantly associated with hypertension in multivariate analysis. Participants 25-34 years were 49% (AOR=0.51, 95% CI [0.41, 0.65]) less likely to be hypertensive compared with participants 45 years or older. Compared with participants who were non-smokers, smokers were 21% (AOR=1.21, 95% CI [1.02, 1.45]) more likely to be hypertensive. Participants who had heart rate >90 beats/min were 59% (AOR=1.59, 95% CI [1.17, 2.16]) more likely to be hypertensive compared with participants who had heart rate 60-90 beats/min. CONCLUSIONS: The findings reveal that hypertension is prevalent among rural residents in Kaoma and Kasama, Zambia. The disease is highly associated with age, BMI, smoking and heart rate. Efficient preventive strategies are needed to halt the growing trend of non-communicable diseases through the control of risk factors highlighted in this study.

Prevalence and correlates of being bullied among in-school adolescents in Malawi: results from the 2009 Global School-Based Health Survey.

BACKGROUND: Physical and emotional violence against adolescents is a neglected, but growing problem globally. Violence against adolescents negatively affects the victim in terms of physical health, school attendance and performance and social adjustment. The literature on the prevalence and associated factors of bullying against adolescents is sparse in southern Africa outside South Africa. Such data are even sparser for Malawi. The current study was conducted to estimate the prevalence of self-reported bullying and its personal and social correlates. METHODS: A secondary analysis of the Malawi School-Based Student Health Survey (2009) was done. Descriptive analyses were done to describe the sample and estimate the prevalence of reporting history of bullying in the past 30 days preceding the survey. Logistic regression analysis was done to assess the association between several factors and being a victim of bullying. Crude and adjusted odds ratios are reported. RESULTS: A total of 2,264 in-school adolescents participated in the Malawi School-Based Student Health Survey of 2009. Just under half (44.5%) reported having been bullied in the previous month to the survey (44.1% among boys versus 44.9% among girls). Compared to adolescents of age 16 years or older, those who were 12 years old or younger and those who were 14 years of age were more likely to be bullied (AOR=1.54; 95% CI [1.41, 1.76]) and OR=1.26; 95% CI [1.21, 1.31]) respectively. The other risk factors that were identified in the analysis were loneliness (AOR = 2.23; 95% CI [2.20, 2.27]), and being worried (AOR = 2.80; 95% CI [2.76, 2.85[). Adolescents who had no close friends were 14% (AOR = 1.14; 95% CI [1.11-1.17]) more likely to be reporting bullied compared to adolescents who reported having close friends. Adolescents who smoked cigarettes were more than three times more likely to reporting be bullied compared to non-smokers (AOR=3.97; 955 CI [3.83, 4.10]), while those who drank alcohol were more than twice as likely to be bullied as adolescents who did not take alcohol (AOR=2.26; 95% CI [2.16, 2.35]). CONCLUSION: Malawian in-school adolescents report a high prevalence of having been bullied. Traditional associated factors such alcohol and smoking as well as emotional correlates (loneliness, worry) were associated with being a victim of bullying. School officials and health workers caring for adolescents should be sensitized to the frequent occurrence of bullying and to its correlates and consequences.

Socio-demographic factors associated with treatment against soil-transmitted helminth infections in children aged 12-59 months using the health facility approach alone or combined with a community-directed approach in a rural area of Zambia.

A health facility-based (HF) approach to delivering anthelminthic drugs to children aged 12-59 months in Zambia was compared with an approach where community-directed treatment (ComDT) was added to the HF approach (HF+ComDT). This paper reports on the socio-demographic factors associated with treatment coverage in the HF+ComDT and HF areas after 18 months of implementation. Data were collected by interviewing 288 and 378 caretakers of children aged 12-59 months in the HF+ComDT and HF areas, respectively. Bivariate and multivariate logistic regression analyses were used for data analysis. Statistically significant predictors of a child being treated were: a child coming from the HF+ComDT area, being 12-36 months old, the family having lived in the area for >20 years, coming from a household with only one under-five child and living ≤3 km from the health facility. It is concluded that socio-demographic factors are of public health relevance and affect treatment coverage in both the HF+ComDT and the HF approaches. The implementation and strengthening of interventions like ComDT that bring treatment closer to households will enable more children to have access to treatment.

Exposure to occupational health hazards among Zambian workers.

BACKGROUND: Data on occupational safety and health in Southern Africa are scant. Hence the negative impact of poor working conditions is unknown and the scientific basis for interventions and policy formulation is lacking. AIMS: To determine the prevalence of, and factors associated with, exposure to occupational health hazards in Zambia. METHODS: We used data collected in the 2009 National Labour Force Survey. Unadjusted and adjusted odds ratios and their 95% confidence intervals were used to measure magnitudes of associations. RESULTS: Exposure to occupational hazards among the 64 119 respondents (response rate = 78%) included vibration from hand tools or machinery (3%), temperatures that make one perspire even when not working (4%), low temperatures whether indoors or outdoors (4%), smoke, fume, powder or dust inhalation (13%), pesticides (3%), noise so loud that voice had to be raised to talk to people (4%), chemical handling or skin contact (3%) and exposure to heavy object lifting, frequent bending of the back or rapid movement of limbs causing body pain (30%). In multivariate analysis, exposure to occupational health hazards was associated with older age, male sex, low educational level, being married/cohabiting and not being self-employed. CONCLUSIONS: Results from this study indicate that Zambian workers are exposed to a broad range of occupational health hazards. This could be useful for the formulation of a multi-sector approach aimed at the prevention and control of hazard exposure.

Parity and maternal education are associated with low birth weight in Malawi.

BACKGROUND: The consequences of low birth weight (LBW) include death and long-term health sequelae. Limited attention has been made towards the study of socio-demographic factors that may be associated with LBW in Malawi. OBJECTIVES: To assess factors that may be associated with LBW. METHODS: We used secondary data on the 2006 Malawi Multiple Indicator Cluster Survey (MICS). Logistic regression analyses were conducted. RESULTS: A total of 26,259 females in the age group 15-49 years participated in the survey, and of these, 5024 had children who were reported to have been weighed at birth. Most (60.5%) of the respondents were in the 20-29 years age group. In multivariate analysis, the odds of LBW delivery were lower for women in higher wealth quintiles and those who had some education. Women who previously had a child were less likely to deliver a LBW baby. CONCLUSION: The higher odds of delivering a LBW baby among women with no education, and lower wealth status may suggest that there is need to tailor pre-natal care based interventions on social status. This may involve creating education level-specific health messages.

Alcohol use among school-going adolescents in Harare, Zimbabwe: results from the 2003 Global School-Based Health Survey.

Data from the Global School-Based Health Survey (2003) were analysed to estimate the proportions of relevant socio-demographic and behavioural characteristics. Of the 1997 students who participated in the survey, 15.6% (17.1% males and 14.0% females) reported alcohol consumption. Factors associated with consumption of alcohol use were being worried, bullied, smoking cigarettes, truant, and lack of parental supervision. Students who were never worried were 49% (AOR=0.51 [95% CI (0.36, 0.72)]) less likely to consume alcohol compared to students who were most of the time or always worried. Similarly, students who were never bullied were 42% (AOR=0.57 [95% CI (0.42, 0.77)]) less likely to take alcohol compared to students who were bullied at least six times in the previous one month to the survey. Compared to students who smoked cigarettes, non-smokers were 71% (AOR=0.29 [95% CI (0.21, 0.41)]) less likely to consume alcohol. Compared to students who always received parental supervision, students who rarely received parental supervision were more likely (AOR=1.85 [95% CI (1.19, 2.90)] to consume alcohol, and those students who sometimes received parental supervision were less likely (AOR=0.70 [95% CI (0.50, 0.98)] to consume alcohol. There is a need to implement public health interventions with special attention to the determinants of alcohol consumption in this age group.

Alcohol Use among School-Going Adolescents in Harare; Zimbabwe: Results from the 2003 Global School-Based Health Survey

Data from the Global School-Based Health Survey (2003) were analysed to estimate the proportions of relevant socio-demographic and behavioural characteristics. Of the 1997 students who participated in the survey; 15.6(17.1males and 14.0females) reported alcohol consumption. Factors associated with consumption of alcohol use were being worried; bullied; smoking cigarettes; truant; and lack of parental supervision. Students who were never worried were 49(AOR=0.51 [95CI (0.36; 0.72)]) less likely to consume alcohol compared to students who were most of the time or always worried. Similarly; students who were never bullied were 42(AOR=0.57 [95CI (0.42; 0.77)]) less likely to take alcohol compared to students who were bullied at least six times in the previous one month to the survey. Compared to students who smoked cigarettes; non-smokers were 71(AOR=0.29 [95CI (0.21; 0.41)]) less likely to consume alcohol. Compared to students who always received parental supervision; students who rarely received parental supervision were more likely (AOR=1.85 [95CI (1.19; 2.90)] to consume alcohol; and those students who sometimes received parental supervision were less likely (AOR=0.70 [95CI (0.50; 0.98)] to consume alcohol. There is a need to implement public health interventions with special attention to the determinants of alcohol consumption in this age group

University Students' Perspective of Sexual Harassment: a Case Study of the University of Zambia

Objectives: To determine if sexual harassment was a problem at the University of Zambia (UNZA); to explore UNZA student's perception on the nature of sexual harassment; and determine student's knowledge and understanding about sexual harassment. Design: A cross-sectional study across UNZA. Main outcomes: Occurrence of sexual harassment at UNZA; knowledge; perception and understanding of sexual harassment. Measure: A self-administered questionnaire was developed for the purpose of the study and piloted. The questionnaire included items on perceptions and understanding of sexual harassment; the nature of the environment at UNZA; frequency of the occurrence of sexual harassment; direct experiences and observations of sexual harassment; and formal and informal reporting of sexual harassment. Results: This study found that sexual harassment was a problem at the University of Zambia (UNZA) and female students were more likely to be affected. There was no gender difference on the knowledge about sexual harassment (p=0.27) but there was a significant gender difference in the perception of sexual harassment occurring at UNZA (?2 = 86.51; df= 1; p0.001); there were significantly more female students who perceived a lot of sexual harassment to be occurring at UNZA. More female students also perceived that students were likely to harass other students (p0.01) and students were likely to harass lecturers (p0.001). Conclusion: The problem of sexual harassment at UNZA should not be underestimated; among our recommendation is to formulate a policy on sexual harassment at UNZA

Higher Prevalence Rates of Smoking in Rural than Urban Areas among School-Going Adolescents in the Lusaka Province; Zambia

Objectives: The objective of the study was to compare prevalence rates of smoking in school-going adolescents among urban; peri-urban; and rural districts. Design: Secondary analysis of the Zambia Global Youth Tobacco Survey (GTYS) data of 2007. Main outcome measure: Tobacco smoking status. Results: Totals of 2378 adolescents in Lusaka urban; 1 7 5 6 in Ka f u e p e r-u r ba n ; a nd 1 38 6 i n Chongwe/Luangwa rural districts were enrolled into the study. Smoking rates were 10.5in urban; 11.1in peri-urban; and 13.5in rural districts. After adjusting for age; sex; grade; parental and best friend smoking status; and knowing that smoking is harmful to health; compared to adolescents in L u s a k a u r b a n d i s t r i c t ; a d o l e s c e n t s i n Chongwe/Luangwa rural districts were 17(AOR=1.17; 95CI [1.10; 1.23]) more likely to smoke cigarettes. No significant difference in smoking rates was observed between adolescents in urban and peri-urban districts. Conclusions: The prevalence rate of smoking among adolescents was higher in rural than urban district. Antismoking interventions should be more targeted to adolescents in rural than urban areas

Socio-demographic characteristics and sexual health related attitudes and practices of men having sex with men in central and southern Malawi.

An exploratory study of men having sex with men (MSM) was conducted in central and southern Malawi in order to understand their socio-demographic characteristics, sexual behaviours, and perceptions about confidentiality and stigma. A total of 97 men participated in the study of whom 84 (86.6%) were in the age group 17-32 years. The majority, 73 (75.3%) of MSM had never married, 26 (32.5%) reported not always using condoms during sexual intercourse, and 23 (23.7%) had ever received money or gifts in exchange of sex. Only 17 (17.5%) of the participants reported being exposed to HIV prevention messages targeted at MSM. Fear of sexual orientation disclosure and discrimination were reported by 27 (30.7%) of MSM. Many of the study participants reported that HIV intervention programmes are not accessible to them. In conclusion, HIV intervention programmes may not be reaching out to the majority of MSM. We suggest an exploration of the feasibility of HIV prevention interventions targeting MSM in this country where the practice is illegal.

Prevalence and correlates of cigarette smoking among adolescents in Malawi: results from the Global Youth Tobacco Survey 2005.

The majority of adults who smoke cigarettes initiated the habit when they were adolescents or young adults. While rates of smoking and associated factors are known among 13-15 year olds in Malawi, correlates of cigarette smoking among adolescents in a national representative sample in Malawi have not been studied. We, therefore, carried out this study to estimate the prevalence of current smoking and determine its correlates in a nationally representative sample of in-school adolescents in Malawi. An analysis of the Malawi Global Youth Tobacco Survey (GYTS) 2005 was conducted. Using logistic regression analysis, we estimated the association between current cigarette smoking and potential explanatory variables. Overall, 2.5% of adolescents (3.2% among males, and 1.8% among females) were current cigarette smokers. Smoking among parents was 9.6% with no significant difference between males and females (10.3% versus 10.1%). Stronger associations with smoking were observed for friends smoking status (AOR=3.07, 95%CI 2.99, 3.16), receiving pocket money (AOR=3.06, 95%CI 2.98, 3.14), and perception that smoking increases body weight (AOR=2.98, 95%CI 2.81, 3.16). Students who thought that cigarette smoking is harmful to health were 56% (AOR=0.44, 95%CI 0.43, 0.45) less likely to smoke than students who thought otherwise. Despite being the world's second leading grower of tobacco, the prevalence of cigarette smoking among adolescent is lower than has been reported elsewhere.

Prevalence and correlates of condom use at last sexual intercourse among in-school adolescents in urban areas of Uganda.

OBJECTIVES: Correct and consistent condom use remains an important public health intervention against the spread of Human Immunodeficiency Virus and other sexually transmitted infections. There is paucity of information on sexual behaviour of in-school adolescents in Uganda. We, therefore, used secondary data of the Uganda Global School-based Health Survey (UGSHS) conducted in 2003 to determine the prevalence and correlates of condom use at last sexual intercourse in urban areas of Uganda. METHODS: A two-stage cluster sampling technique was used to obtain a representative sample. Altogether 1709 students participated in the survey in urban areas of whom 179 (14.9% of males, and 7.9% of females) had sexual intercourse within 12 months before the survey. RESULTS: Overall 77.3% (79.7% of male, and 72.3% of female) adolescents used a condom at last sexual intercourse. Adolescents who drank alcohol and used drugs were 64% (OR = 1.64, 95% CI 1.54, 1.75) and 68%, (OR = 1.68, 95% CI 1.56, 1.81) more likely to have used a condom, respectively. Meanwhile, adolescents who ever got drunk, and who reported to ever had 2 or more sex partners were 55% (OR = 0.45, 95% CI 0.42, 0.48) and 35% (OR = 0.65, 95% CI 0.62, 0.68) less likely to have used a condom compared to those who had never got drunk, and who ever had 1 sex partner, respectively. Finally, adolescents who reported receiving no parental supervision were 45% (OR = 0.55, 95% CI 0.53, 0.58) less likely to have used a condom compared to those who reported receiving parental supervision. CONCLUSIONS: Parental supervision may be effective in promoting condom use among adolescents. Furthermore, drinking alcohol was associated with condom use probably due to peer pressure and easy access of condoms in drinking places as condoms are not actively promoted in schools. There is need for further research on how in-school adolescents could access condoms.

Prevalence and determinants of adolescent cigarette smoking in Mongolia.

INTRODUCTION: Cigarette smoking is the single most important risk factor for non-communicable chronic medical conditions. Estimating the prevalence of cigarette smoking and its determinants will aid in the design, implementation and evaluation of public health interventions. This study was conducted to estimate the prevalence and determinants of smoking among school-going adolescents in Mongolia. METHODS: A cross-sectional study using standardised methodology was conducted among school-going adolescents in 2003 in Mongolia. RESULTS: 4,105 adolescents (mean age 14.1 years, standard deviation 0.8 year) participated in the study. Approximately 55 percent were females, 30.4 percent of the study population was 15 years old, 63.5 percent had never smoked and 93.2 percent perceived tobacco as harmful. About 58 percent had parents, and 52 percent had friends, who were smokers. The prevalence of current cigarette smoking was 9.2 percent; 15.4 percent among males versus 4.4 percent among females. Cigarette smoking was associated with the male gender, parental and peer influence and having spending power. The perception that smoking was harmful to health was associated with lower odds of smoking. CONCLUSION: Cigarette smoking is prevalent among school-going adolescents in Mongolia. There is a need to implement public health interventions, with special attention to the determinants of smoking in this age group.

Prevalence and correlates of current cigarette smoking among adolescents in East Timor-Leste.

OBJECTIVES: To determine the prevalence and correlates for current cigarette smoking. DESIGN: Secondary analysis of the East Timor-Leste Global Youth Tobacco Survey conducted in 2006. SETTING: Public and private schools registered with the Ministry of Education. PARTICIPANTS: A two-stage cluster sample of 1790 students in Grades 7 to 9. Schools were selected with probability proportional to enrolment size, and classes were randomly selected in each school. All students in selected classes were eligible to participate in the survey. The school and student response rates were 96.0% and 84.5%, respectively. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: Out of 1790 adolescents, 52.1% were of ages less than 15 years, 51.8% were males, 42.8% reported having some pocket money in a month, and 72.7% had at least a parent who was a smoker. Prevalence of current cigarette smoking was 40.3%. Current smokers also reported having bought cigarettes from peddlers (32.4%), someone bought for them (16.7%), got from someone older (13.7%), borrowed (13.3%), and stole (3.4%). Males were more likely to be smokers than females (59.0% versus 19.3%). Factors positively associated with current smoking were: parental smoking; closest friend smoking; amount of pocket money; and exposure to anti-tobacco messages. CONCLUSIONS: East Timor has one of the highest prevalence of cigarette smoking among adolescents. The fact that exposure to anti-tobacco messages was associated with being a smoker may be evidence suggesting that anti-tobacco messages, especially from tobacco-related industry, may have unintended consequences.

Factors associated with secular trends in mortality attributed to measles in Gweru, Zimbabwe, in 1967-89.

A retrospective study conducted in Gweru, Zimbabwe, investigated the trend and its associated factors in measles mortality between 1967 and 1989. Measles and malnutrition surveillance data were analysed in SPSS version 8.0 using the Forward Stepwise Linear Regression method. Measles case fatality rates ranged from zero to 48.2% (median: 4.2, Q(1) = 1.2, Q(3) = 12.9) and they significantly linearly declined [slope = -1.686; 95% confidence interval (CI) -2.327, -1.044; R(2) = 59%]. Rates of mortality among complicated measles cases (slope = 0.546, 95% CI = 0.133-0.345) and rates of mortality from malnutrition among children aged <5 years (slope = 0.459, 95% CI = 0.031-0.099) independently predicted (R(2) = 87%) measles case fatality rates. It was concluded that decline in rates of mortality among complicated measles cases, probably due to good management of such cases, and decline in rates of malnutrition among children aged <5 years may have contributed to the decline in measles case fatality rates.

Gender differences in university students' HIV/AIDS-related knowledge and sexual behaviours in Malawi: a pilot study

A cross-sectional study was conducted among first-year university students in Malawi to determine distributions of HIV/AIDSrelated knowledge; and sexual behaviours. A total of 314 (199 male and 115 female) students were eligible to participate; and of these 221 (70.4) participated in the survey. Generally; levels of HIV/AIDS-related knowledge were similar between sexes. Overall; 68.9of students of both sexes felt that they knew enough about HIV/AIDS. Altogether; 83.3of students reported that they knew where to access HIV testing on campus; but only 19.0reported that they knew their HIV status. Some 60.3of students who had never been tested intended to have an HIV test. A history of having ever been tested was not associated with sex. Most (68.4) students felt that they were not at risk of acquiring HIV infection. Overall; 66.8of students knew where to get a condom on campus; and 38.7stated that they knew exactly how to use it. About half (52.6) of the students used a condom at last vaginal sexual intercourse. Having multiple sex partners in the last 12 months was reported by 40.4of students