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Although child sexual abuse is a significant public health problem globally, its incidence, prevention, and management is less well described in resource-poor settings. In poorer settings prevention initiatives assume even more importance since resources for managing abused children are severely limited. This article examines the current status of policy and practice related to the prevention of child sexual abuse in Zimbabwe. It identifies implementation challenges and highlights opportunities that could be embraced to reduce CSA in Zimbabwe, based on evidence synthesized from recent work. Although Zimbabwe has a well-established legal and regulatory framework to protect children from child sexual abuse, implementation of existing policies is weak. Financial, human, and material resource constraints are frequently cited to explain limited prevention activity. Effective strategies for the prevention of child sexual abuse should focus on implementing existing legislation, targeting schoolchildren, and getting community involvement. A dedicated budget would help entrench these strategies, but gains can be achieved even in the absence of this.

Background: Interventions aimed at improving accessing of health care services, including HIV testing, remain a priority in global HIV eradication efforts. Grassroot Soccer Zimbabwe (GRSZ) is an adolescent health organisation that uses the popularity of soccer to promote healthy behaviours. We assessed HIV knowledge levels, risky behaviours and attitudes in school going adolescents and young adults who attended GRSZ programmes and determined if HIV knowledge levels were associated with increased levels of accessing of health care services by youths. Methods: This was a cross-sectional study carried out on 450 participants aged 13-30 years who attended at least one of the three programmes offered by GRSZ. Self-administered and self-reporting questionnaires were used to collect information on participants' demographics, knowledge on HIV and reproductive health, sources of information, access to HIV and reproductive health services and attitudes and risky behaviours. Results: A total of 392 (87.1%) responses were received. High HIV and reproductive health knowledge levels were recorded (77.7%) on our scale with females recording higher levels (81.1%) than males (71.1%). The majority of participants (72%) indicated willingness to abstain from risky behaviours such as use of drugs and attending youth sex parties. However about 33.3% of the participants who had sexual intercourse reported having condomless sex. There was marginal association between high HIV and reproductive health knowledge levels and accessing health care services in the past 24 months (p = 0.045). Conclusions: HIV and reproductive health knowledge levels were relatively high among adolescents and were associated with accessing health care services in the past 24 months. There however are some gaps associated with engaging in risky sexual behaviours such as condomless sex which could be addressed by using these findings to assist organizations working with adolescents, educators and policy makers in developing programmes that address adolescent sexual behaviours.

This study aimed to determine knowledge, attitudes and practices related to a HIV prevention of parent-to-child transmission (PPTCT) programme among pregnant women who book for antenatal care. The intention was to develop new strategies toward improving the acceptance rate of the programme, which had a low uptake despite its availability, accessibility and affordability. A descriptive survey was used and 33 randomly selected pregnant mothers participated in a structured interview. Data are presented in tables and accompanied by a research-article and analysis of the participants’ answers. The study revealed that pregnant women are exposed to information on PPTCT. Negative attitudes of the community, spouses/partners and some pregnant women toward the programme contribute to practices of risky behaviour. Interventions to improve acceptance of the PPTCT programme should target the pregnant mothers, their partners and the community at large during the design, implementation and evaluation stages.

Introduction Midwives attend intrapartum women of diverse ethnic backgrounds who each bring their cultural beliefs into the labor and delivery rooms. The International Confederation of Midwives has recommended providing culturally appropriate maternity care in its quest to increase skilled birth attendance and subsequently improve maternal and newborn health. Objective This study aimed to examine midwives’ cultural sensitivity during intrapartum care from women's perspectives, and how this relates to women's satisfaction with maternity care services. Methods A qualitative phenomenological design was employed. Two focus group discussions were conducted with 16 women who had delivered in the labor ward of the selected national referral maternity unit. An interpretive phenomenological approach was used to analyze the data. Results This study revealed ineffective midwife–woman collaboration that excludes the incorporation of women's cultural beliefs in the design of maternity care plans. Emotional, physical, and informational support in the care provided to women during labor and childbirth was found to be incompetent. This suggests that midwives are not sensitive to cultural norms and do not provide woman-centered intrapartum care. Conclusion Various factors implying midwives’ lack of cultural sensitivity in their provision of intrapartum care were identified. Resultantly, women's expectations of labor are not met and this could negatively affect future maternity care-seeking behaviors. This study's findings provide policy makers, midwifery program managers and implementers with better insights for developing targeted interventions to improve cultural sensitivity for the delivery of respectful maternity care. Identifying factors that affect the implementation of culture-sensitive care by midwives could guide the adjustments required in midwifery education and practice.

Introduction: The GRSZ projects were aimed at bridging the gap between adolescents’ unwanted social behaviours and societal norms and values fashioned by the breakdown of family and society cultural practices, as a measure to militate against the spread of HIV/AIDS amongst adolescents, adolescent unwanted pregnancy and gender-based violence using soccer as a medium of learning. The program deliberately circumvented involvement of Secondary School Teacher during planning and implementation hoping to have a clean intervention strategy without the encumbrances and confounders possibly introduced by the societal authority figure. However, a for continuity and adaptation of the program into the school curriculum as a behaviour change catalyst, the Secondary School Teacher is pivotal. The evaluation sought to delineate the views and roles of this cadre as determinants and guidelines towards the successful translating of GRSZ experimental work into the real-life school environment. Methods: In-depth interviews were conducted by trained and qualified interviewers who formed the team of evaluators at various selected school during the teacher’s working hours. A pre-prepared interview guide constructed and reviewed by the panel of evaluators as well as the Medical Research Council of Zimbabwe was used to conduct the guided interview. The researchers brought the interview guides to selected schools where appointments had been made prior by the Key Researcher. The interviews were held on the same day other surveys at the school. A total of 11 (five females and six males) Secondary Schools Teachers with more had in-depth interviews carried out after which saturation was reached. Results: The majority of adolescents (62.2%) reported the teacher as their source of information on HIV and reproductive health and the mother followed a close second at 57.7% reflecting possibly contact hours as the factor. Teachers corroborated this information showing high eagerness to be involved in the GRSZ at the earliest given opportunity. Both males and females did agree that they were the closest role models and gave varied reasons as to why their influences were not adequate in shaping the life skills of adolescents under their watch. It was clear that teacher embraced and endorsed the GRSZ program expansion and their involvement in future cohorts. Conclusion and Recommendations: Teachers had high anticipation of involvement and showed dismay at not having been involved in the initial phases of the program where their contributions were most likely to have had a high impact through their possible engagement with the community to cement the gains of the program. They recommended that lifelong learning on HIV/AIDS prevention, unwanted pregnancies and gender-based violence need to be incorporated into all areas of learning at school and beyond. Expanding the program to other schools in Zimbabwe beyond Bulawayo was seen as an overdue process.

Background: Cervical cancer is the second most common cancer among women worldwide and is a leading cause of death in developing countries, with 80% of those affected dying from the disease. In Zimbabwe, it accounts for 33.5% of all cancers affecting women. Cervical cancer can be reduced significantly through implementation of effective screening programmes; although such programmes often suffer from resource constraints. Aim: To determine the uptake of cervical cancer screening among women attending Gwanda Provincial Hospital which uses the visual inspection with acetic acid and cervicography (VIAC) method. Methodology: The study sample consisted of 203 sexually active women aged 18 years and above. Data collection employed a researcher administered questionnaire which yielded a response rate of 96.7%. Results: Of the 203 participants, only 18.7% had been screened, with 14.3% having accessed VIAC screening. However, 62.2% of the participants had heard of cervical cancer, and 74.4% had heard of the VIAC programme. Screening was lowest among multiparous women and increased as the number of children decreased (P=0.03). Uptake of screening was also significantly associated with residential area (P=0.03). The strongest predictor of screening was prior knowledge of cervical cancer (P<0.001). Lack of adequate knowledge on cervical cancer and the VIAC screening programme were found to be the greatest barrier to the uptake of screening. Conclusions: Uptake of screening among women was low despite a high awareness of cervical cancer and the VIAC programme.

The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report3ie accepted the final version of this report, Voluntary medical male circumcision uptake through soccer in Zimbabwe, in November 2015 as partial fulfilment of requirements under grant TW3.09, issued under Thematic Window 3. The content has been copy edited and formatted for publication by 3ie. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its Board of Commissioners. Any errors and omissions are also the sole responsibility of the authors. Authors' affiliations listed in the title page are those that were in effect at the time the report was accepted. Any comments or queries should be directed to corresponding author Jeff DeCelles at j.decelles@grassrootsoccer.org. SummaryMake The Cut Plus (MTC+) is a short, sport-based intervention, delivered by Grassroot Soccer, that aims to increase demand for male circumcision among adolescent male students (aged 15 to 19 years) in secondary schools in Bulawayo, Zimbabwe. MTC+ consists of a 60-minute soccer-themed educational session led by a trained 'coach', who was circumcised; information, education, and communication material on male circumcision; referrals and phone-based follow-up to interested participants conducted by the coaches; and soccer-based incentives to participants who completed VMMC. This study's objective was to determine if the MTC+ intervention could substantially and significantly increase demand for VMMC in secondary schools and whether the intervention is an effective, innovative and scalable solution to increasing uptake of VMMC. The study was constructed as a cluster-randomised trial to assess the effectiveness of MTC+. Twenty-six schools in Bulawayo were randomised to receive MTC+ at the start of a four-month trial (intervention) or at the end (control). VMMC uptake over four months was measured via cross-linkage of the trial participant database (n=1,226 male participants aged 14 to 20 years; median age 16.2) and clinic registers of Bulawayo's two free VMMC clinics (n=5,713) from 7 March to 6 July 2014, using eight identifying variables. The trial had more than 80 per cent power to detect an absolute difference of 5 percentage points in VMMC uptake.A process evaluation was conducted to explore perceptions of VMMC, perceptions and...