Verbal abuse during childbirth constitutes a violation of women's human rights and indicates poor maternal health care. The aim of the study was to investigate experiences and drivers of verbal abuse among women in Ndola and Kitwe health facilities. The study adopted a cross-sectional survey. Qualitative and quantitative data using questionnaires and focus group interviews were employed. The study was done in the Ndola and Kitwe districts of Zambia. The target population were women attending postnatal services who had a live birth within 28 days of delivery. Twenty clinics were randomly selected and a total of 306 women were recruited using convenient sampling. Eleven percent of the study population experienced verbal abuse during intrapartum care. A 1-year increase in age reduced the odds of experiencing verbal abuse (Adjusted Odds Ratio [AOR] 0.89, 95% CI: 0.80-0.99). Women who consumed alcohol more frequently experienced verbal abuse than women who never consumed alcohol (adjusted odds ratio [AOR] 5.91, 99% CI 2.12-16.51), and women with bleached skin color more often experienced verbal abuse than women with natural skin tone (AOR = 3.95, 95% CI 1.13-13.83).
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.
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