Explore the vast range of titles available.

Understanding the national burden and epidemiological profile of childhood malnutrition is central to achieving both national and global health priorities. However, national estimates of malnutrition often conceal large geographical disparities. This study examined the prevalence of childhood malnutrition across provinces in Zambia, changes over time, and identified factors associated with the changes. We analyzed data from the 2013/4 and 2018 Zambia demographic and health surveys (ZDHS) to examine the spatial heterogeneity and mesoscale correlates of the dual burden of malnutrition in children in Zambia. Maps illustrating the provincial variation of childhood malnutrition were constructed. Socio-demographic and clinical factors associated with childhood malnutrition in 2013 and 2018 were assessed independently using a multivariate logistic model. Between 2013/4 and 2018, the average prevalence of stunting decreased from 40.1% (95% CI: 39.2-40.9) to 34.6% (95% CI:33.6-35.5), wasting decreased from 6.0% (95% CI: 5.6-6.5) to 4.2% (95% CI: 3.8-4.7), underweight decreased from 14.8% (95% CI: 14.1-15.4) to 11.8% (95% CI: 11.2-12.5) and overweight decreased from 5.7% (95% CI: 5.3-6.2) to 5.2% (95% CI: 4.8-5.7). High variability in the prevalence of childhood malnutrition across the provinces were observed. Specifically, stunting and underweight in Northern and Luapula provinces were observed in 2013/14, whereas Lusaka province had a higher degree of variability over the two survey periods. The study points to key sub-populations at greater risk and provinces where malnutrition was prevalent in Zambia. Overall, these results have important implications for nutrition policy and program efforts to reduce the double burden of malnutrition in Zambia.

Contraception is an important public health initiative for addressing maternal health outcomes associated with unplanned pregnancies, unsafe abortions and maternal deaths. Although contraceptive use has been on the rise globally, the observed increases in sub-Saharan Africa (SSA) are sub-optimal and vary among countries. In Zambia, drivers of contraceptive use transition are not well documented. Thus, this study examined the drivers of contraceptive use change among sexually active women in Zambia between 1992 and 2018. Data came from the six Zambia Demographic and Health Surveys conducted between 1992 and 2018. A sample of 44,762 fecund sexually active women aged 15-49 years was analysed using multivariable Blinder Oaxaca decomposition regression analysis. Analysis took into account the complex survey design. Results were presented using adjusted coefficients, their 95% confidence intervals, and percentages. The prevalence of contraceptive use among sexually active women increased significantly by 30.8 percentage points from 14.2% (95% CI: 12.8, 15.6) to 45.0% (95% CI: 43.6, 46.4) during the period 1992 to 2018. The major share of the increase happened during the period 1992-1996 (10.2%) while the least increase occurred between 2013 and 2018 (0.2%). Overall, about 15% of the increase in the prevalence of contraceptive use was attributable to changes in the compositional characteristics of women. On the other hand, 85% of the increase was due to change in contraceptive behaviour of sexually active women. Changes in women's compositional characteristics such as secondary education (5.84%), fertility preference (5.63%), number of living children (3.30%) and experience of child mortality (7.68%) were associated with the increase in contraceptive use prevalence. Change in contraceptive behaviour of sexually active women contributed largely to the observed increase in contraceptive use prevalence in Zambia. Increase in the proportion of women attaining secondary education, decrease in the percentage of women who want large families and improvement in child survival were the major compositional factors driving the rise in contraceptive use. The findings imply that increasing investment in education sector and enhancing existing family planning programmes has the potential to further improve contraceptive use prevalence in Zambia.

Background Violence against women and girls is a major public health issue, a violation of human rights, and is linked to a number of harmful effects on one’s physical, mental, sexual, and reproductive health. Studies conducted in other parts of sub-Saharan Africa (SSA) suggest that there is an association between contextual factors and experience of intimate partner violence. However, in Zambia, this association is not well documented. Thus, this study was conducted to examine how individual and community-level characteristics influence spousal violence against women in Zambia. Methods Data from the most recent Zambia Demographic and Health Survey conducted in 2018 was used. A sample of 7,358 ever-married women aged 15–49 years was used in the analysis. Two level multilevel binary logistic regression models were employed to examine the association between individual and contextual-level factors and experience of spousal violence. Results The prevalence of spousal physical violence against women in Zambia was 21.1% [95% CI, 19.8, 22.5]. Women aged 15–19 [aOR = 2.36, 95% CI = 1.34–4.14] and 20–24 [aOR = 2.11, 95% CI = 1.38–3.22], who did not own mobile phone [aOR = 1.36, 95% CI = 1.10–1.69], and had low decision making autonomy [aOR = 1.24, 95% CI = 1.01–1.54] were more likely experience spousal physical violence. Furthermore, communities which had a low proportion of women with decision making power [aOR = 1.66, 95% CI = 1.26–2.19] were more likely experience spousal physical violence. Additionally, women whose partners’ drank alcohol [aOR = 2.81, 95% CI = 2.30–3.45] and those whose partners exhibited jealous behaviour [aOR = 2.38, 95% CI = 1.88–3.21] were more likely to experience spousal physical violence. Conclusion Both individual and community-level factors influenced spousal physical violence in Zambia. Integrating community level factors when designing interventions to address gender-based would be key to reduce women’s vulnerability to gender based violence in the country. There is need to re-evaluate and re-strategize current strategies being implemented to address gender based violence in the country to make them context specific.

Background Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia. Methods This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15–49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software. Results Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25–29 years and 30–34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies. Conclusions The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women’s age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies.

Background Intimate partner violence (IPV) is linked to adverse mental health outcomes. Despite its widespread prevalence and devastating consequences, the mental health impacts of IPV remain understudied in Mozambique. We examined the association between IPV and mental health outcomes among ever-married women in Mozambique. Methods This study adopted a cross-sectional design based on the most recent Mozambique Demographic and Health Survey (MDHS) conducted in 2022-23. The sample comprised of 3,957 ever-married women aged between 15 and 49 years. The outcome variable for our study is mental health outcomes specifically focusing on depressive and anxiety symptoms. The main independent variable is IPV, focusing on three forms: physical, sexual and emotional violence each measured as a binary variable (yes/no). A multivariate analysis using binary logistic regression was performed between IPV and mental health outcomes while controlling for other independent variables. Adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (95% CI) were reported. All analyses were weighted to account for complex survey design. Results The prevalence of depressive symptoms was 11.5% (95% CI: 9.7–13.5) while that of anxiety symptoms was 29.9% (95% CI: 27.5–32.4). Ever-married women who experienced physical violence had significantly higher odds of depressive symptoms (aOR = 1.52, 95% CI: 1.01–2.30). Emotional violence was significantly associated with both depressive symptoms (aOR = 3.10; 95% CI: 2.08–4.61) and anxiety symptoms (aOR = 1.60; 95% CI: 1.22–2.11). Conclusion The findings highlight the need to integrate mental health services into IPV prevention and response programmes in Mozambique. Incorporating routine mental health screening within IPV services could enable early identification and timely support for victims.

Background Child marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia. Methods Data came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013–14 and 2018. A pooled weighted sample of 9990 women aged 20–29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models. Results The prevalence of child marriage among women aged 20–29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26–0.49] and [aOR = 0.07, 95% CI = 0.03–0.18] and those whose age at first birth was (15–19 year) or (20–29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15–1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained. Conclusion Prevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.

Background In sub-Saharan Africa, HIV and AIDS remain a major public health concern among adolescents and young men. HIV testing is the first critical step for linking infected individuals to HIV treatment and prevention. However, HIV-testing uptake among sexually active young men remains low in the region. This study was conducted to assess the HIV testing rates among unmarried young men in sub-Saharan Africa. Methods Using data from the most recent country Demographic and Health Surveys (DHS) conducted between January 1, 2015, and December 31, 2020, in 18 sub-Saharan African countries, an Inverse Heterogeneity model (IVhet) using MetaXL software was used to estimate country, regional and sub-regional pooled estimates of HIV testing uptake among sexually active unmarried young men in sub-Saharan Africa. Furthermore, multivariable binary logistic regression was conducted to examine the factors associated with HIV testing uptake among unmarried young men. Results The overall pooled prevalence estimate of HIV testing uptake among sexually active unmarried young men in sub-Saharan Africa was 33.0% (95% CI: 21–45, I2 = 99%, p <0.001). There was variation in the prevalence across countries ranging from 7% (95% CI: 5–9) in Guinea to 77% (95% CI: 74–80) in Cameroon. Central Africa had the highest prevalence of HIV testing among unmarried young men, at 47% (95% CI:0–100) while West Africa had the lowest prevalence at 11% (95% CI:2–23). Results further show that young men aged 15–19 (aOR = 0.59, 95% CI 0.52–0.66) were less likely to test for HIV. Young men who spent 8 to 12 years in school (aOR = 3.26 95% CI 2.21–4.79) or 13 years and above (aOR = 3.56 95% CI 2.35–5.37) had increased odds of undertaking an HIV test. Conclusion The prevalence of HIV testing among sexually active unmarried young men remains low in sub-Saharan Africa. Therefore, the results suggest that health policymakers should consider re-evaluating the current HIV prevention policies and programmes with the view of redesigning the present HIV testing campaigns to enhance the uptake among young people.

BackgroundUnderstanding a woman’s future contraceptive needs and enhancing her chances of putting those needs into action depend heavily on her intentions to use contraceptive methods. However, there is little information about global perspectives of intention to utilise contraceptives among fecund sexually active women.ObjectivesThis study examines the patterns and determinants of contraception intention of fecund sexually active women.MethodsThe most recent Demographic and Health Surveys (DHS) from 59 countries were used for secondary data analysis. The DHSs applied a cross-sectional survey design to collect data from women between the ages of 15 and 49. The study comprises a sample of 697,590 fecund sexually active women in the reproductive ages. The desire to utilise contraceptive methods was examined using a multivariable binary logistic regression analysis. All analyses were weighted to allow for a complex survey design.ResultsA pooled prevalence of intention to utilise contraception was 42.8% (95% CI: 42.5, 43.1) at the global level. Eastern and Southern Europe had the lowest prevalence, 17.3% (95% CI: 16.4, 18.2), and the highest prevalence was observed in countries from Latin America and the Caribbean, 68.0% (95% CI: 67.5, 69.9). Attaining secondary-level education (adjusted odds ratio (aOR) = 1.68; 95% CI: 1.62–1.72) or higher (aOR = 1.71; 95% CI: 1.63–1.80), working (aOR = 1.21; 95% CI: 1.18–1.24), experience of a pregnancy loss (aOR = 1.06; 95% CI: 1.03–1.09), or being exposed to media family planning messages (aOR = 1.51; 95% CI: 1.48–1.55) were factors associated with an increased likelihood of intent to use contraceptives.ConclusionsThe study has established that contraceptive use intention was low in many developing countries. Education, age, employment status, fertility preference, and exposure to family planning messages influenced contraceptive use intention. Health policy-makers ought to consider these factors when designing sexual and reproductive health strategies in developing countries.

Background Closing the gap of unmet needs for family planning (FP) in sub-Saharan Africa remains critical in improving maternal and child health outcomes. Determining the prevalence of unmet needs for family planning among married women in the reproductive age is vital for designing effective sexual reproductive health interventions and programmes. Here, we use nationally representative data drawn from sub-Saharan countries to estimate and examine heterogeneity of unmet needs for family planning among currently married women of reproductive age. Methods This study used secondary data from Demographic and Health Surveys (DHS) conducted between January 1, 1995 to December 31, 2020 from 37 countries in sub-Saharan African. An Inverse Heterogeneity model (IVhet) in MetaXL application was used to estimate country and sub-regional level pooled estimates and confidence intervals of unmet needs for FP in SSA. Results The overall prevalence of unmet need for family planning among married women of reproductive age in the sub-region for the period under study was 22.9% (95% CI: 20.9–25.0). The prevalence varied across countries from 10% (95% CI: 10–11%) in Zimbabwe to 38% (95% CI: 35–40) and 38 (95% CI: 37–39) (I2 = 99.8% and p -value < 0.0001) in Sao Tome and Principe and Angola, respectively. Unmet needs due to limiting ranged from 6%; (95% CI: 3–9) in Central Africa to 9%; (95% CI: 8–11) in East Africa. On the other hand, the prevalence of unmet needs due to spacing was highest in Central Africa (Prev: 18; 95% CI: 16–21) and lowest in Southern Africa (Prev: 12%; 95% CI: 8–16). Our study indicates that there was no publication bias because the Luis Furuya-Kanamori index (0.79) was within the symmetry range of -1 and + 1. Conclusion The prevalence of unmet need for FP remains high in sub-Saharan Africa suggesting the need for health policymakers to consider re-evaluating the current SRH policies and programmes with the view of redesigning the present successful strategies to address the problem.

Unequal access to health services has long been a challenge for the People of Concern (PoC) before the COVID-19 pandemic. Still, the emergence of the COVID-19 pandemic widened existing inequalities in access to health services. Using a multivariate binary logistic regression model, we analyzed 2020 United Nations High Commissioner for Refugees (UNHCR) data on forcibly displaced populations to examine barriers, facilitators, and access to health services before and during COVID-19 among PoC in Nigeria. Access to health services was higher among women (82.63%; 74.57%) than among men (81.99%; 71.34%) before and during the COVID-19 pandemic, respectively. The adjusted odds ratios indicated that facilitators of access to health services were the same before and during the pandemic. Being a Cameroonian (AOR = 2.33; 95% CI [1.14–4.76]), fear of contracting COVID-19 (AOR = 1.59; 95% CI [1.37–1.85]), and being a host (AOR = 2.13; 95% CI [1.06–4.27]) increased the likelihood of accessing health services only during the pandemic. Being a man (AOR = 0.74; 95% CI [0.63–0.86]), a refugee returnee (AOR = 0.31; 95% CI [0.11–0.83]), and lack of competent personnel (AOR = 0.74; 95% CI [0.58–0.95]) reduced the likelihood of accessing health services only before the pandemic. The study shows that policies that empower PoC must be a significant focus to achieve optimum access to healthcare services, especially during outbreaks and other health emergencies.