14 research outputs found
Factors associated with the ability of adolescent girls and young women (AGYW) in sexual unions to negotiate for safer sex. An analysis of data from the 2018 Zambia Demographic and Health Survey (ZDHS)
No full textThe ability of AGYW to negotiate for safer sex is key in the fight against the Human Immunodeficiency Virus (HIV). We determined the prevalence of safer sex negotiation among AGYW in sexual unions aged 15–24 and its associated factors in Zambia. Of 1879 respondents, 78.0% (1466) had the ability to negotiate for safer sex (ANSS). While adjusting for other variables in the model, condom use at last sex with the most recent partner (AOR 4.08, 95% CI 1.74–9.60, p = 0.001), experiencing any sexual violence by husband or partner (AOR 1.74, 95% CI 1.17–2.59, p = 0.006), listening to the radio at least once a week (AOR 2.03, 95% CI 1.32–3.13, p = 0.001), secondary or higher education (AOR1.77, 95% CI 1.04–2.99, p = 0.034), being in the richest wealth quintile (AOR 2.70, 95% CI 1.30–5.60, p = 0.008), and living in Eastern Province (AOR 2.75, 95% CI 1.53–4.93 p = 0.001), Northwestern (AOR 2.31, 95% CI 1.15–4.65, p = 0.019) and Southern (AOR 3.11, 95% CI 1.58–6.09, p = 0.001) was associated with a significant increase in the odds of ANSS among AGYW aged 15–24 years in sexual unions. On the other hand, being in Muchinga province (AOR 0.48, 95% CI 0.28–0.81, p = 0.006) decreased the odds of ANSS. In conclusion, safer sex negotiation is crucial in combating HIV; hence, tailor-made interventions that promote condom use, frequency of listening to health programmes on the radio, education, and wealth acquisition should be implemented to build and sustain safer sex negotiation, particularly among AGYW in sexual unions.publishedVersio
Interventions for Keeping Adolescent Girls in School in Low- and Middle-Income Countries: A Scoping Review
No full textBackground: Adolescent girls dropping out of school may lead to gender inequality, high illiteracy levels, single motherhood, unemployment, and many more undesirable outcomes that inhabit human capital development for girls. It is therefore important to put measures in place to support adolescent girls to stay in school. The objectives of the scoping review were to identify and describe the types of studies conducted to assess interventions for keeping adolescent girls in school and to describe these interventions in low- and middle-income countries.
Methods and Results: A comprehensive search was done in Epistemonikos, Social Science Citation index, Embase, OVID Medline, the Campbell Collaboration Library, and CENTRAL in March 2020. The search yielded 3,295 studies of which 18 studies were eligible for inclusion. All the 18 included studies were primary studies, and 12 out of these were randomized controlled studies. The other study designs of included studies were mixed-methods longitudinal design, random evaluation, cross section, etc. The interventions in the included studies were categorized as follows: provision of funding, school-based interventions for learners, community-based interventions, and education systems intervention. Provision of school fees, and other school supplies have shown evidence of reducing school dropouts, increasing enrolments and school attendance, while interventions like hygiene promotion and water treatment in a study done in Kenya found no significant evidence to support the observed effect on school attendance.
Conclusion: The scoping review found that several primary studies have been done on interventions to keep adolescent girls in school. However, there is need for more research to be done. Therefore, the authors propose to conduct a systematic review on the effect of provision of sanitary towels to adolescent girls on school retention in low- and middle-income countries.publishedVersio
Effects of interventions for preventing road traffic crashes: an overview of systematic reviews
No full textBackground
Road traffic crashes (RTCs) are among the eight-leading causes of death globally. Strategies and policies have been put in place by many countries to reduce RTCs and to prevent RTCs and related injuries/deaths.
Methods
In this review, we searched the following databases Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Web of Science, and LILACS for reviews matching our inclusion criteria between periods January 1950 and March 2020. We did not apply language or publication restrictions in the searches. We, however, excluded reviews that focused primarily on injury prevention and reviews that looked at crashes not involving a motor vehicle.
Results
We identified 35 systematic reviews matching our inclusion criteria and most of the reviews (33/35) included studies strictly from high-income countries. Most reviews were published before 2015, with only 5 published between 2015 and 2020. Methodological quality varied between reviews. Most reviews focused on enforcement intervention. There was strong evidence that random breath testing, selective breath testing, and sobriety checkpoints were effective in reducing alcohol-related crashes and associated fatal and nonfatal injuries. Other reviews found that sobriety checkpoints reduced the number of crashes by 17% [CI: (− 20, − 14)]. Road safety campaigns were found to reduce the numbers of RTCs by 9% [CI: (− 11, − 8%)]. Mass media campaigns indicated some median decrease in crashes across all studies and all levels of crash severity was 10% (IQR: 6 to 14%). Converting intersections to roundabouts was associated with a reduction of 30 to 50% in the number of RTCs resulting in injury and property damage. Electronic stability control measure was found to reduce single-vehicle crashes by − 49% [95% CI: (− 55, − 42%)]. No evidence was found to indicate that post-license driver education is effective in preventing road traffic injuries or crashes.
Conclusion
There were many systematic reviews of varying quality available which included studies that were conducted in high-income settings. The overview has found that behavioural based interventions are very effective in reducing RTCs.publishedVersio
Additional file 1 of Effects of interventions for preventing road traffic crashes: an overview of systematic reviews
No full textAdditional file 1: Table 1. Methodological quality of systematic reviews
Additional file 2 of Effects of interventions for preventing road traffic crashes: an overview of systematic reviews
No full textAdditional file 2: Table 3. Description of included systematic reviews in the overview: Enforcement category
Additional file 3 of Effects of interventions for preventing road traffic crashes: an overview of systematic reviews
No full textAdditional file 3: Table 11. Search Strategy-Overview of systematic reviews
Going deeper with health equity measurement: how much more can surveys reveal about inequalities in health intervention coverage and mortality in Zambia?
No full textAbstract
Background
Although Zambia has achieved notable improvements in reproductive, maternal, newborn and child health (RMNCH), continued efforts to address gaps are essential to reach the Sustainable Development Goals by 2030. Research to better uncover who is being most left behind with poor health outcomes is crucial. This study aimed to understand how much more demographic health surveys can reveal about Zambia’s progress in reducing inequalities in under-five mortality rates and RMNCH intervention coverage.
Methods
Using four nationally-representative Zambia Demographic Health Surveys (2001/2, 2007, 2013/14, 2018), we estimated under-five mortality rates (U5MR) and RMNCH composite coverage indices (CCI) comparing wealth quintiles, urban‐rural residence and provinces. We further used multi-tier measures including wealth deciles and double disaggregation between wealth and region (urban residence, then provinces). These were summarised using slope indices of inequality, weighted mean differences from overall mean, Theil and concentration indices.
Results
Inequalities in RMNCH coverage and under-five mortality narrowed between wealth groups, residence and provinces over time, but in different ways. Comparing measures of inequalities over time, disaggregation with multiple socio-economic and geographic stratifiers was often valuable and provided additional insights compared to conventional measures. Wealth quintiles were sufficient in revealing mortality inequalities compared to deciles, but comparing CCI by deciles provided more nuance by showing that the poorest 10% were left behind by 2018. Examining wealth in only urban areas helped reveal closing gaps in under-five mortality and CCI between the poorest and richest quintiles. Though challenged by lower precision, wealth gaps appeared to close in every province for both mortality and CCI. Still, inequalities remained higher in provinces with worse outcomes.
Conclusions
Multi-tier equity measures provided similarly plausible and precise estimates as conventional measures for most comparisons, except mortality among some wealth deciles, and wealth tertiles by province. This suggests that related research could readily use these multi-tier measures to gain deeper insights on inequality patterns for both health coverage and impact indicators, given sufficient samples. Future household survey analyses using fit-for-purpose equity measures are needed to uncover intersecting inequalities and target efforts towards effective coverage that will leave no woman or child behind in Zambia and beyond
How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study
No full textBackground
Zambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000.
Methods
Using nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020.
Results
The under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban–rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels.
Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers.
Conclusion
Zambia’s major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets
Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia
No full textAbstract Background Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia. Methods Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action. Results The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members. Conclusion This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens)
The effects of decentralisation on patient and service outcomes : a case of the 2018 decentralisation of multidrug-resistant tuberculosis in Zambia
No full textIntroduction: The Zambian government decentralised tuberculosis control programs by transferring responsibility for the care and treatment of multidrug-resistant tuberculosis (MDR-TB) patients from a two-national hospital model to provincial hospitals and other lower-level healthcare structures. Limited evidence exists on the effects of decentralisation on the quality of TB care provided through public sector decentralisation. In this paper, we explored the impact of decentralising MDR-TB on patient and service outcomes. Methods: This study used a mixed-methods approach. Quantitative data were collected through a survey of 244 MDR-TB patients, while qualitative data was collected through interviews with TB coordinators, healthcare providers, patients, and caregivers. Participants were drawn from health facilities and the Ministry of Health. Quantitative data was analysed in STATA version 16.0, while thematic analysis was used for the qualitative data. Results: Decentralisation has improved patient care and management by increasing access to essential commodities such as medication and diagnostic testing. It has led to more equitable distribution of MDR-TB healthcare services and resources across different population groups, regardless of social, economic, or demographic factors. Furthermore, the quality of life for MDR-TB patients has improved, with better adherence to medication resulting from increased family support. Due to decentralisation, tailored community and patient-centred services have been integrated resulting in reduced congestion at facilities. The study also identified challenges, including heavy workload for healthcare staff, fragmented coordination of supervisory responsibilities, and confusion over roles in patient management, which negatively impacted the decentralisation process. Conclusion: The decentralisation of MDR TB services offers significant benefits but is not a guaranteed solution, as poor planning or implementation can lead to challenges in service delivery
