BackgroundAbout three in ten young women aged 15–19 have begun childbearing among the Zambian population, with adolescent pregnancy levels as high as 35% in rural areas. In 2009, Luapula reported 32.1% adolescent pregnancies. The study sought to investigate obstetric and perinatal outcomes among adolescents compared to mothers aged 20-24 years delivering at selected health facilities in Kawambwa and Mansa districts of Luapula.MethodsA retrospective analysis was carried out of all deliveries to mothers aged between 10 and 24 years for the period January 2012 to January 2013. A total of 2795 antenatal and delivery records were reviewed; 1291 adolescent mothers and 1504 mothers aged 20–24 years. Crude and adjusted odds ratios for the association between maternal age and adverse obstetric and perinatal outcomes were obtained using logistic regression models.ResultsThe mean age of the adolescent mothers was 17.5 years. Mothers younger than 20 years faced a higher risk for eclampsia, anaemia, haemorrhage, Cephalopelvic disproportion, prolonged labour and caesarean section. After adjustment for potential confounders, the association between maternal age and adverse obstetric and perinatal outcome diminished. Children born to mothers younger than 20 were at increased risk for low birth weight, pre-term delivery, low Apgar score and neonatal death; the risk for asphyxia, however, tended to increase with age.ConclusionThe findings demonstrate that adolescent pregnancy increases the risk of adverse obstetric and perinatal outcomes. High rates of adolescent pregnancies in Luapula province are likely as a result of the predominantly rural and poor population. Understanding the factors that contribute to the high levels of adolescent pregnancy in the region will be vital in addressing the situation and subsequently reducing the high obstetric and perinatal morbidity and mortality.

BackgroundHuman African Trypanosomiasis (HAT) is a neglected tropical disease affecting poor rural communities living in tsetse-infested regions of sub-Saharan Africa. In Zambia, sporadic cases of HAT have been reported mainly in the old foci along the tsetse-infested Luangwa river valley in north-eastern part of the country. In such places where malaria is the major endemic febrile disease, with possibilities of co-infections of HAT and malaria and where the levels of alertness to the presence of HAT among health care personnel (HCP) is low, there is a high chance of misdiagnosing HAT for malaria because of their similarities in clinical presentation. This study, conducted in Zambia’s tsetse-infested rural health centres (RHCs) of Chama and Mambwe districts, was designed to investigate the staffing levels, the HCP levels of alertness to the occurrence of HAT and their capacity to detect the disease.MethodsStructured questionnaires were used to collect information pertaining to HAT alertness and the capacity to detect the disease from 101 HCP in a cross sectional study of 23 RHCs drawn from Zambia’s Chama and Mambwe districts between April and July 2013. The data collected were analyzed using Stata/SE version 11.0.ResultsParticipants from both Chama and Mambwe district RHCs reported similar very low levels of qualified HCP and laboratory technicians, and that they had similar basic tools for HAT diagnosis. Although not statistically significant, respondents from Chama (~89 %) tended to be more aware about the occurrence of HAT compared to their Mambwe counterparts (~78 %). Whereas ~40 % of the HCP from Chama district (n = 52) claimed to have encountered at least one case of HAT, only ~4 % of their Mambwe counterparts (n = 49) had similar experiences (P = 0.000).ConclusionHealth care personnel in RHCs from Chama tended to be more alert to the occurrence of HAT than the HCP from Mambwe district. The extremely low levels of categorized HCP, general absence of functional laboratories, coupled with absence of national HAT surveillance and control programs, are among some of the serious challenges that Zambia’s Chama and Mambwe districts face to control/eliminate HAT.

Introduction: Unmet need for family planning among married women is still high in Africa. In the year 2018, one in every five married women in Zambia had an unmet need for family planning. Unmet need for family planning can increase the number of unintended pregnancies and abortions, both of which have the potential to increase the proportion of women of child bearing age who are at high risk of birth complications. Studies have shown that factors explaining unmet need for family planning vary significantly from country to country, depending on access and availability of family planning services for women. We conducted this study to understand the determinants of unmet need for family planning in Zambia. Knowledge of factors associated with unmet need for family planning can help governments and stakeholders to identify health strategies to reduce unwanted fertility and prevent maternal and child mortality.Methods: The study used datasets from the Zambia Demographic and Health Survey which was a representative cross-sectional survey conducted in 2018. Zambia conducted a Demographic and Health to capture health indicators which are used to measure progress of implementation of health sector interventions. We did analysis on a sample of 7, 597 married women aged 15-49 years. Chi-square test and multivariate logistic regression were used to analyse determinants of unmet need for family planning. Stata version 14.2 was used to analyse weighted data and survey commands were applied to account for the complex sample design. Results: Study findings have revealed that half of the married women were still not using contraception by 2018. Unmet need for family planning among married women is still a public health issue in Zambia. In multivariate regression analysis; age, parity, household wealth and exposure to media-based family planning messages were found to be significantly associated with unmet need for family planning among married women.Conclusion: There is need to enhance family planning policy and programming in the country in order to achieve desired health outcomes. Mass media campaigns and community-based outreach activities with special focus on the young women can achieve significant results in reducing unmet need for family planning. Further, there should be some deliberate interventions to conduct family planning talks during in health facilities targeting women who visit maternal and children care clinics.

This report describes the findings of a preliminary investigation of women who sought treatment for abortion from the Gynecological Emergency Ward at the University Teaching Hospital (UTH) in Lusaka, Zambia. Barriers to obtaining legal abortions are identified and the harsh experiences of women seeking treatment for complications of illegally induced abortion are discussed. The data contribute to an understanding of the intensity of abortion for Zambian women and draw attention to the value of small-scale, qualitative research on women's reproductive health care needs. It is suggested that a study be planned at UTH to determine how health care delivery can be improved for women who seek abortion.

BackgroundIn 2013, Zambia accepted the immediate operationalization of Option B+, a policy used to try and eliminate mother to child transmission. This policy requires all HIV-positive pregnant and breastfeeding women to initiate antiretroviral treatment for life regardless of CD4 count. However, not all HIV positive women accept treatment for life. This study aimed to investigate acceptability of lifelong ART (Option B+) among HIV positive women receiving antenatal and postnatal services at the university teaching hospital and Lusaka urban city clinics.MethodsThis was a cross sectional study conducted in November, 2016 to March 2017. The study population comprised of HIV positive women in their reproductive age (15–49 years). A Structured questionnaire was used to collect data in a face to face interview with the participants. Data was entered in EpiData version 3.1 and analysed using Stata version 13. Multivariate logistic regression analysis was performed to determine predictors of acceptability.ResultsOverall, 427 women participated in this study. Their mean age was 30 years. Of the 427, over half (54%) had inadequate knowledge and about 30% of the women in the study still experience stigma and discrimination.63.2% of the women had good attitude towards Option B+ and overall, the majority (77.8%) were willing to accept antiretroviral therapy for life. Multivariate analysis showed that only women with good attitude were 9.4 times more likely to accept Option B+ than those with a bad attitude [OR: 9.4: 95%CI, 5.8–15.2)].ConclusionThis study showed that in general, women accepted initiation of Option B+. However, there is still a gap in the level of knowledge of Option B+ as well as stigma and discrimination in some communities, hence there is need to intensify programs that are aimed at educating the community on the importance of ART for life, combat stigma and discrimination and consequently promote acceptability of Option B+.

BackgroundUnder-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators. Displaced population in camps provide a basis for under-five mortality surveillance because detailed registration databases have been developed. Additionally, health data routinely collected on mortality allowed for a review of mortality trends and identification of correlating factors to under-five mortality. Literature suggests a number of factors that influence child mortality including biological, socio-econimic and environmental factors. However, while progress in reducing mortality is evident disparities in under-five mortality trends have been observed.MethodsThe study examined differential levels and trends of under-five mortality with correlating factors in Meheba refugee camp in Zambia which is presently in its post emergency phase. The retrospective cross-sectional study reviewed the ProGres and Health Information System (HIS) databases under-five mortality data for a seven (7) year period (2008–2014) and included all children aged less than five years in each year of review. STATA 12 (including Ordinary Least Squares Regression) and Microsoft Excel 2010 where used for data analysis and computation of findings.ResultsMalaria and respiratory infections accounted for 81 % of under-five deaths while cases of Diarrhoea were responsible for 10 % of reported mortalities. Seventy five percent (75 %) of all mortalities were reported in children aged less than 1 year (<1 year). While no significant variations in mortality were noted as a result of time, increased frequency of visits to health centre significantly (P < 0.05) reduced mortalities in children by 3/1000 in each year.ConclusionIn addition to improving health infrastructure and reducing distances to health facilities, the study also recommends sensitization programmes targeted at ensuring accessibility to health care services for children under-5 years. The study found that increased health centre visitations were associated with reduction in under-five mortality and encourages initiatives targeted at sensitizing communities to seek health care. Furthermore, collaboration between the health systems, community and Non Governmental Organisations (NGOs) is key in addressing higher infant mortality observed. It is envisaged that this will contribute to the reduction in mortality cases and will compliment already existing strategies.

BackgroundThe high burden of cervical cancer in Zambia prompted the Ministry of Health and partners to develop the cervical cancer prevention program in Zambia (CCPPZ) in 2006. Despite this intervention more women continue to die from the disease and there is little understanding of factors that may be linked with abnormal cervical lesions in the general population. We therefore examined if educational attainment is associated with abnormal cervical lesions among Zambian women aged 15 to 49 years.MethodsThis study used data from the cervical cancer prevention program in Zambia, where a total of 14,294 women aged 15 to 49 years were screened for cervical cancer at nine health facilities between October 2013 and September 2014. The data represents women from six provinces of Zambia, namely Southern, Central, Copperbelt, Luapula, North-western and Eastern provinces. Step-wise logistic regression analysis using the Statistical Package for the Social Sciences (SPSS) version 21 was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CIs) for educational attainment with presence of abnormal cervical lesions as outcome. Multiple imputation was further used to obtain the imputed stabilized estimates for educational attainment.ResultsThe prevalence of abnormal cervical lesions, using the Visual Inspection with Acetic-acid (VIA) test was 10.7% (n = 1523). Educational attainment was inversely associated with abnormal cervical lesions (AOR = 0.75; 95% CI:0.70–0.81, AOR = 0.74; 95% CI:0.68–0.81 and AOR = 0.46; 95% CI:0.41–0.51) among women with primary, secondary and tertiary education, respectively, compared to those with no formal education.ConclusionWe find reduced likelihood of abnormal cervical lesions in educated women, suggesting a differential imbalance with women who have no formal education. These findings may be a reflection of inequalities associated with access to cervical cancer screening, making the service inadequately accessible for lower educated groups. This might also indicate serious limitations in awareness efforts instituted in the formative phases of the program. These findings underline the prevailing need for urgent concerted efforts in repackaging cervical cancer awareness programs targeting women with low or no formal education in whom the risk may be even higher.

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