This study used the 2013-2014 Zambia Demographic and Health Survey (ZDHS) data to examine, on one hand, the socio-demographic characteristics associated with intimate partner violence (IPV) and, on the other hand, the relationship between IPV and maternal health care (place of delivery and ANC visits) utilization. The findings indicate that women’s characteristics including marital status, household wealth, witnessing parental violence and attitudes justifying wife beating were significantly associated with reporting experience of IPV. Partner characteristics significantly associated with IPV were alcohol consumption and jealous behaviour. In this study, IPV was not found to be strongly associated with use of maternal health care. The study indicates that gender inequality and problematic cultural norms that privilege men with power over women still exist in Zambia, and thus IPV preventive strategies should incorporate means of toning down such norms to enhance the welfare of women.

BackgroundIn Western settings, the relationship between trauma history, posttraumatic stress disorder, substance use, and HIV risk behavior, is well established. Although female fish traders in Zambia are affected by HIV at rates estimated to be 4–14 times higher than the national prevalence, no studies have examined the co-occurring issues of trauma, substance use and HIV risk behavior among this vulnerable population. The current study examined: 1) trauma history, trauma symptoms and HIV risk behaviors and 2) the relationship between these co-occurring issues among female fish traders from the Kafue Flatlands in Zambia.MethodsTwenty individual semi-structured qualitative interviews and a focus group discussion (n = 12 participants) were conducted with female fish traders in the Kafue Flatlands of Zambia. Template analysis was used to examine the data.ResultsThe findings indicate that female fish traders in Zambia are at risk of multiple and ongoing traumatic events and daily stressors, severe mental health symptoms (including western conceptualizations of disorders such as anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief, as well as local idioms of distress), substance abuse, and HIV sexual risk behaviors. The results suggest a relationship between trauma and HIV sexual risk behavior in this population.ConclusionsThe indication of these co-occurring issues demonstrates the need for HIV prevention intervention efforts, which account for trauma, mobility, and psychosocial outcomes in order to reduce HIV sexual risk behavior among female fish traders in Zambia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-017-0369-z) contains supplementary material, which is available to authorized users.

Background The attainment of targets set for modern contraceptive use remains a challenge in sub-Saharan Africa. Rwanda, in its new Family Planning and Adolescent Sexual Reproductive Health/Family Planning (FP/ASRH) Strategic Plan 2018–2024 has set the attainment of a contraceptive prevalence rate (CPR) of 60% by 2024. To achieve this, identifying factors that enhance modern contraceptive use among sexually active women is critical. Methods We used three Rwanda Demographic Health Surveys (RDHS) datasets collected in 2010, 2015, and 2019/2020 in a multivariable decomposition analysis technique to describe trends and identify factors influencing change in modern contraceptive use among sexually active women aged 15–49 years. Results presented as coefficients and percentages took into consideration the complex survey design weighted using StataSE 17. Results Modern contraceptive use increased from 40% in 2010 to 52.4% in 2020 among sexually active women. About 23.7% of the overall percentage change in modern contraceptive use was attributable to women’s characteristics which included women’s education levels, number of living children, and being told about family planning at health facilities. Coefficients contributed 76.26% to the change in modern contraceptive use. This change was attributed to modern contraceptive use among young women between the age of 20–24 years, women’s education level, the number of living children, changes in family size, and being visited by community health workers. Conclusion Rwanda remains on course to archive its 2024 family planning targets. However, there is a need to enhance programs that target sexually active adolescents and young adults, and women from rural areas to sustain the gains made. Furthermore, continuous support of community health workers will be key in exceeding the set targets of modern contraceptive use among sexually active women in Rwanda.

Truck drivers are part of mobile populations which have been noted as a key population at risk of HIV in Zambia. This study was aimed at 1) determining Potentially Traumatic Events (PTEs), labor migrant-related stressors, psychosocial problems and HIV risk behaviors among truck drivers in Zambia and 2) examining the relationship between PTEs, migrant-related stressors, psychosocial outcomes and HIV sexual risk behavior among truck drivers in Zambia. We conducted fifteen semi-structured interviews with purposively sampled male truck drivers at trucking companies in Lusaka, Zambia. Findings indicate that truck drivers experience multiple stressors and potentially traumatic incidences, including delays and long waiting hours at borders, exposure to crime and violence, poverty, stress related to resisting temptation of sexual interactions with sex workers or migrant women, and job-related safety concerns. Multiple psychosocial problems such as intimate partner violence, loneliness, anxiety and depression-like symptoms were noted. Transactional sex, coupled with inconsistent condom use were identified as HIV sexual risk behaviors. Findings suggest the critical need to develop HIV prevention interventions which account for mobility, potentially traumatic events, psychosocial problems, and the extreme fear of HIV testing among this key population.

With many countries experiencing high prevalence rates of HIV scaling up ART, it is vital to assess quality assurance in health facilities accredited to provide these HIV and AIDS-related services. Reviewed literature indicates that there are limited studies in Zambia on the capacity of accredited health care facilities to provide effective HIV/AIDS related services. Using data from a large ethnographic qualitative study in a resource poor rural setting in Zambia, this paper assesses quality assurance in health facilities to providing HIV/AIDS services in a remote rural setting. Findings show that although HIV and AIDS related services were available at the remote rural health facility of Chivuna, the services provided did not meet the WHO minimum guidelines/standards on the provision of such services. Therefore, there is need for such facilities to be adequately equipped in all the departments of ART delivery so as to ensure effective delivery of these services and universal access.

Childhood stunting in its moderate and severe forms is a major global problem and an important indicator of child health. Rwanda has made progress in reducing the prevalence of stunting. However, the burden of stunting and its geographical disparities have precipitated the need to investigate its spatial clusters and attributable factors. Here, we assessed the determinants of under-5 stunting and mapped its prevalence to identify areas where interventions can be directed. Using three combined rounds of the nationally representative Rwanda Demographic and Health Surveys of 2010, 2015 and 2020, we employed the Blinder-Oaxaca decomposition analysis and the hotspot and cluster analyses to quantify the contributions of key determinants of stunting. Overall, there was a 7.9% and 10.3% points reduction in moderate stunting among urban and rural areas, respectively, and a 2.8% and 8.3% points reduction in severe stunting in urban and rural areas, respectively. Child age, wealth index, maternal education and the number of antenatal care visits were key determinants for the reduction of moderate and severe stunting. Over time, persistent statistically significant hotspots for moderate and severe stunting were observed in Northern and Western parts of the country.There is a need for an adaptive scaling approach when implementing national nutritional interventions by targeting high-burden regions. Stunting hotspots in Western and Northern provinces underscore the need for coordinated subnational initiatives and strategies such as empowering the rural poor, enhancing antenatal health care, and improving maternal health and education levels to sustain the gains made in reducing childhood stunting.

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For the past two decades, HIV and AIDS pandemic has been one of the most challenging problems faced by humanity globally with the sub Saharan region being the most affected. Within the region, Zambia is one of the countries worst hit by the HIV and AIDS pandemic. Since 2005, the government has been providing ART free of charge in all public heath institutions. To ensure access to life-saving drugs, VCT, which is the entry point to ART Uptake, has been stepped up by providing free testing services and increasing the number of both static and mobile free testing services throughout the country. However, available literature shows that despite the efforts aimed at increasing access to testing, very few Zambians have taken up testing. Methodology: Drawing on data from a wider ethnographic study conducted in a remote Zambian rural setting on the factors influencing VCT and adherence to ART, this paper focuses on the barriers that limited people's access to VCT services within the context of the health care system. Results: The study findings reveal and hence confirm that VCT services which were crucial for ART uptake were wide spread in a rural setting like Chivuna. However, the study found out that access and utilization of these services was not guaranteed. This was due to a number of bottlenecks within the health system itself. Among these were: lack of confidentiality among staff, inadequate training, low staffing levels, non-availability of equipment and inadequate nutritional support. This was compounded by other factors such as the challenge of travelling great distances to the nearest VCT and having to raise money for transport, securing money for food for one to use when away from home to attend VCT services in a distant place, lack of financial resources and the poor road network. Conclusion: The study has shown a level of association between health system-related factors and people's uptake of VCT services. In this regard, it is important for stakeholders to redress barriers in the health delivery system so as to enhance early HIV testing in order to enable entry into the continuum of care for people found HIV positive. This has the potential to contribute to reduced morbidity, reduced mortality and reduced transmission of new HIV infection cases.