Summaryobjectives To examine factors affecting readiness for and acceptability of voluntary HIV counselling and testing (VCT).methods Participants in a population-based HIV survey conducted in an urban population in Zambia in 1996 were offered VCT. Although 29% of them expressed interest in being tested (readiness), only 4% of this group used the services (i.e. acceptability). When the survey was repeated 3 years later, VCT was designed differently to assess acceptability. At the cluster level the participants were randomly allocated to VCT either at the local clinic (similar to 1996, n ¼ 1102) or at an optional location (n ¼ 1343).results Readiness varied significantly by age group (47% in age group 20-24 years vs. 18% in age group 40-49 years). There were contrasts between young (15-24 years) and older age groups (25-49 years) regarding the main factors associated with readiness. Whereas self-perceived risk of being HIV infected was the only significant factor among the young, poor self-rated health and ever HIV tested were important factors among the older. The acceptability was 11.8% among the group allocated to VCT at the local clinic compared with 55.8% for the group allocated to an optional location (RR, 4.7).conclusions Perceived risk of HIV infection had a major influence on VCT readiness among young people, whereas declining general health status, as indicated by self-rated health, was most evident among those of older age. A strong effect of placement on acceptability of VCT was demonstrated, indicating this barrier to be important in explaining low demands for VCT in the past. Differences in perceptions of how confidentiality is handled at the two locations might be an important underlying factor.

BackgroundThe treatment guidelines for tuberculosis treatment under Directly Observed Treatment, Short-course (DOTS) have been a common strategy for TB treatment in Zambia. The study was carried out in Ndola, Zambia, to investigate factors contributing to treatment non-adherence and knowledge of TB transmission among patients on TB treatment, in order to design a community-based intervention, that would promote compliance.MethodsA household-based survey was conducted in six randomly selected catchment areas of Ndola, where 400 out of 736 patients receiving TB treatment within the six months period, were recruited through the District's Health Management Board (DHMB) clinics. All patients were interviewed using a pre-tested structured questionnaire, consisting of i. Socio-demographic characteristics ii. Socio-economic factors iii. Knowledge about TB transmission and prevention iv. Patterns in health seeking behaviour and v. TB treatment practices at household level.ResultsMost male TB patient respondents tended to be older and more educated than the female TB patient respondents. Overall, 29.8% of the patients stopped taking their medication. There were 39.1% of the females and 33.9% of the males, who reported that TB patients stopped taking their medication within the first 2 months of commencing treatment. Age, marital status and educational levels were not significantly associated with compliance. The major factors leading to non-compliance included patients beginning to feel better (45.1% and 38.6%), lack of knowledge on the benefits of completing a course (25.7%), running out of drugs at home (25.4%) and TB drugs too strong (20.1% and 20.2%). There was a significant difference [OR = 1.66, 95% CI 1.23, 2.26] in TB knowledge, with more males than females reporting sharing of cups as a means for TB transmission, after adjusting for age, marital status and educational levels. Significantly [p = 0.016] more patients who had resided in the study for less than two years (59%) were more likely to report mother to child transmission of TB, compared to 41.2% of those who had been in the area for more than 2 years.ConclusionThis study established that 29.8% of TB patients failed to comply with TB drug taking regimen once they started feeling better.

Pig production has increased significantly in the Eastern and Southern Africa (ESA) region during the past decade, especially in rural, resource-poor, smallholder communities. Concurrent with the increase in smallholder pig keeping and pork consumption, there have been increasing reports of porcine cysticercosis in the ESA region. This article reviews the findings concerning the presence and impact of porcine cysticercosis in seven of the ESA countries. Most of the reported findings are based on surveys utilising lingual palpation and post-mortem examination, however, some also used serological assays. In Tanzania, community-based studies on porcine cysticercosis indicate a prevalence of 17.4% in the northern highlands district of Mbulu and a prevalence range of 5.1 Á/16.9% in the southern highlands. In Kenya recent surveys in the southwestern part of the country where smallholder pig keeping is popular indicate that 10 Á/14% of pigs are positive for cysticercosis by lingual examination. Uganda has the most pigs in Eastern Africa, most of which are kept under smallholder conditions. Preliminary surveys in 1998 and 1999 at slaughterhouses in Kampala indicated a prevalence of porcine cysticercosis between 0.12 and 1.2%, however, a rural survey in northern Uganda in 1999 indicated 34 Á/45% of pigs slaughtered in selected villages were infected. Additionally, a new survey of 297 pigs slaughtered in Kampala in 2002 indicated that pigs from the central region of the country were negative for cysticercosis while 33.7% of the pigs coming from the rural Lira district in the north were positive. Interestingly, 8 piglet foetuses removed from an infected slaughtered sow coming from Lira district were all found to harbour cysts of T. solium providing evidence of congenital transmission of porcine cysticercosis. In Mozambique, abattoir records indicate that porcine cysticercosis is present in all provinces of the country. A serological survey on pigs in rural Tete Province found 15% of pigs positive. In Zimbabwe, a retrospective study in official abattoirs around the country from 1994 to 2001 reported a mean prevalence of 0.34% which is in contrast to a post-mortem survey in 1999, which showed that the prevalence of porcine cysticercosis in rural west Zimbabwe where smallholder pig keeping is popular was 28.6%. In Zambia, abattoir records reported porcine cysticercosis in six of the nine provinces. Routine meat inspection of 1316 pigs at a slaughter slab in Lusaka showed that 20.6% of the pigs had cysticercosis whereas serological testing of 874 pigs at the same abattoir indicated that 56.6% were found to have circulating antigens of Taenia solium . Field surveys based on lingual palpation in Southern and Eastern Provinces of Zambia revealed prevalences of 8.2 Á/28.4 and 5.2%, respectively. South Africa has the largest number of pigs in Southern Africa and cysticercosis has been recognised as a problem in the country for many decades. There is strong evidence supporting the high prevalence of neurocysticercosis infect...

BackgroundIntimate partner violence (IPV), defined as actual or threatened physical, sexual, psychological, and emotional abuse by current or former partners is a global public health concern. The prevalence and determinants of intimate partner violence (IPV) against pregnant women has not been described in Rwanda. A study was conducted to identify variables associated with IPV among Rwandan pregnant women.MethodsA convenient sample of 600 pregnant women attending antenatal clinics were administered a questionnaire which included items on demographics, HIV status, IPV, and alcohol use by the male partner. Mean age and proportions of IPV in different groups were assessed. Odds of IPV were estimated using logistic regression analysis.ResultsOf the 600 respondents, 35.1% reported IPV in the last 12 months. HIV+ pregnant women had higher rates of all forms of IVP violence than HIV- pregnant women: pulling hair (44.3% vs. 20.3%), slapping (32.0% vs. 15.3%), kicking with fists (36.3% vs. 19.7%), throwing to the ground and kicking with feet (23.3% vs. 12.7%), and burning with hot liquid (4.1% vs. 3.5%). HIV positive participants were more than twice likely to report physical IPV than those who were HIV negative (OR = 2.38; 95% CI [1.59, 3.57]). Other factors positively associated with physical IPV included sexual abuse before the age of 14 years (OR = 2.69; 95% CI [1.69, 4.29]), having an alcohol drinking male partner (OR = 4.10; 95% CI [2.48, 6.77] for occasional drinkers and OR = 3.37; 95% CI [2.05, 5.54] for heavy drinkers), and having a male partner with other sexual partners (OR = 1.53; 95% CI [1.15, 2.20]. Education was negatively associated with lifetime IPV.ConclusionWe have reported on prevalence of IPV violence among pregnant women attending antenatal care in Rwanda, Central Africa. We advocate that screening for IPV be an integral part of HIV and AIDS care, as well as routine antenatal care. Services for battered women should also be made available.

BackgroundAppropriate feeding practices are of fundamental importance for the survival, growth, development and health of infants and young children. The aim of the present study was to collect baseline information on current infant and young child feeding practices, attitudes and knowledge in Mazabuka, Zambia, using a qualitative approach.MethodsThe study was conducted in Mazabuka, 130 km south of Lusaka in Zambia in January and February in 2005. Nine focus group discussions with mothers and a total of 18 in-depth interviews with fathers, grandmothers, health staff and traditional birth attendants were performed in both rural and urban areas.ResultsBreastfeeding was reported to be universal, the use of pre-lacteal feeds appeared to be low, colostrum was rarely discarded, and attitudes to and knowledge about exclusive breastfeeding were generally good. However, few practised exclusive breastfeeding. The barriers revealed were: (1) the perception of insufficient milk, (2) the fear of dying or becoming too sick to be able to breastfeed, (3) convention, (4) the perception of 'bad milk' and (5) lack of knowledge on the subject. The health staff and traditional birth attendants were the most important actors in transmitting knowledge about infant feeding to the mothers. Both categories appeared to have updated knowledge on child health and were well respected in the society. Fathers and grandmothers tended to be less knowledgeable on novel subjects such as exclusive breastfeeding and often showed a negative attitude towards it. At the same time they had considerable authority over mothers and children and infant feeding decisions. The rural population was in general less educated and more prone to conventional non-exclusive feeding practices.ConclusionThe message that exclusive breastfeeding (EBF) is beneficial for child health had reached the health workers and was taught to mothers. However, conventions and expectations from family members in this Zambian community were important barriers in preventing the message of EBF from being translated into practice. The deep-rooted beliefs that prohibit EBF need to be addressed in projects and campaigns promoting EBF.

Background: HIV and AIDS are significant and growing public health concerns in southern Africa. The majority of countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men.

BackgroundInterpersonal physical violence is an important global public health concern that has received limited attention in the developing world. There is in particular a paucity of data regarding physical violence and its socio-demographic correlates among in-school adolescents in Namibia.MethodsWe analysed cross-sectional data from the Namibia Global School-Based Health Survey (GSHS) conducted in 2004. We aimed to estimate the prevalence and socio-demographic correlates of physical fighting within the last 12 months. We obtained frequencies of socio-demographic attributes. We also assessed the association between self-reported history of having engaging in a physical fight and a selected list of independent variables using logistic regression analysis.ResultsOf the 6283 respondents, 50.6% (55.2% males and 46.2% females) reported having been in a physical fight in the past 12 months. Males were more likely to have been in a physical fight than females (OR = 1.71, 95% CI (1.44, 2.05)). Smoking, drinking alcohol, using drugs and bullying victimization were positively associated with fighting (OR = 1.91, 95% CI (1.49, 2.45); OR = 1.48, 95% CI (1.21, 1.81); OR = 1.55, 95% CI (1.22, 1.81); and OR = 3.12, 95% CI (2.62, 3.72), respectively). Parental supervision was negatively associated with physical fighting (OR = 0.82, 95% CI (0.69, 0.98)). Both male and female substance users (cigarette smoking, alcohol and drug use) were more likely to engage in physical fighting than non-substance users (OR = 3.53, 95% CI (2.60, 4.81) for males and OR = 11.01, 95% CI (7.25, 16.73) for females). Parental supervision was negatively associated with physical fighting (OR = 0.85, 95% CI (0.72, 0.99)).ConclusionPrevalence of physical fighting within the last 12 months was comparable to estimates obtained in European countries. We also found clustering of problem behaviours or experiences among adolescents who reported having engaged in physical violence in the past 12 months. There is a need to bring adolescent violent behaviour to the fore of the public health agenda in Namibia.

Background: Mental health is a neglected area of health research and practice in most of subSaharan African countries where the largest burden of morbidity is from infectious diseases. This even occurs despite the fact that some mental health problems may arise from infectious diseases.