Zambia Demographic Health Survey Research Articles

Spatial analysis and associated factors of underweight, overweight and obesity among non-pregnant women of reproductive age in Zambia

Introduction: Malnutrition in women in reproductive age (WRA) is associated with distinct types of public health problems such as preterm birth, low birth weight, malnourished children, poor psychological health and high mortality. The study aimed at investigating the risk factors associated with underweight, overweight and obesity among WRA and map their spatial distribution. Methods: The study used the 2013/2014 Zambia Demographic Health Survey (ZDHS) data and survey proportional odds model was fitted to the data. Spatial effects were modeled using Quantum Geographic Information System (QGIS) version 2.18.1 to develop univariate choropleth maps. Results: 14,377 WRA were enrolled into the study. Overweight was more prevalent (15.87%) compared to underweight (10.22%) and obesity (6.47%). The findings revealed that a higher wealth index, age, having a car, using contraceptives, being married or divorced similarly increased the odds of being at or beyond a particular category of nutrition status. The spatial analysis also suggested Lusaka and Copperbelt were more prone to overweight and obesity, whereas Western had increased prevalence of underweight. Conclusion: Appropriate nutritional and economic programs are highly recommended in specific provinces of Zambia. Programs to curb overweight and obesity should be directed more to Lusaka and Copperbelt while underweight programs to Western province. Keywords: Underweight; overweight; obesity

Biomass Fuel use Prevalent in the Zambian Population: Observations from the Zambia Demographic Health Survey 2018

Abstract Background: Biomass fuels are used by half of the world’s population, and are often the only source of domestic energy. Markers of lower socioeconomic status were related to greater use of dirty-burning fuels. This study aimed to measure the prevalence and determinants of biomass fuel use in the Zambian population. Methodology: This cross-sectional study used secondary data from the Zambia Demographic Health Survey 2018. Descriptive statistics of individual characteristics, testing for associations using Pearson’s chi-square test, and univariate and multivariate binomial regressions were performed using Stata 13. Results: The prevalence of biomass fuel use was 91.7% (11,762), with the most notable usage observed among females (68.2%) residing in rural areas compared to males (63.4%). Factors indicating lower socioeconomic status, such as living in rural areas with a crude prevalence ratio of 1.13 (1.12-1.14) and cooking outdoors at 1.10 (1.09-1.10), were linked to the use of biomass fuels, while higher education served as a protective factor at 0.84 (0.83-0.85). Conclusion: This study showed that rural residence, cooking from outside, and educational attainment could be important determinants of the use of biomass fuels. Education appears to be an effective preventive factor in reducing the likelihood of biomass fuel use.

Socio-economic disparities and predictors of fertility among adolescents aged 15 to 19 in Zambia: Evidence from the Zambia Demographic and Health Survey (2018).

Globally, 12 million girls aged 15-19 give birth each year, and Africa hosts 19% of youth aged 15-24. In Zambia, 29% of adolescents experience childbirth, with variations by age. Projections suggest a continued rise in these trends by 2030. Zambia came up with Adolescent Health Strategic Plan 2011-2015 among the specific policies being advocated for was Adolescent-Friendly Health Services (ADFHS) in order to mitigate among others adolescent fertility. The study aims to investigate socio-economic disparities and predictors of fertility in Zambian adolescents aged 15 to 19. The study used a cross-sectional study design utilized the 2018 Zambia Demographic Health Survey (ZDHS). The variable of interest in this study is "total number of children ever born" among adolescents aged 15 to 19 years. The explanatory variables that were used in the study were demographic, socio-economic, behavioral and community level factors. The Rao-Scott Chi-square test was used to test for association between categorical variables. Determinants of adolescent fertility were identified through a multilevel ordinal logistic regression conducted at a significance level of 5%. Analysis in the study was carried out using Stata version 14.2. A total of 3,000 adolescents were involved in the study, revealing that 75.88% had not given birth, 21.14% had one child, and 2.98% had at least two children. The findings revealed that education played a protective role, with adjusted odds ratios (AOR) of 0.47 (95% CI, 0.23-0.97), 0.21 (95% CI, 0.10-0.47), and 0.03 (95% CI, 0.00-0.54) for primary, secondary, and tertiary education, respectively. On the other hand, certain factors were associated with an elevated risk of fertility. These included the age of adolescents, educational attainment, marital status, wealth index, contraceptive use, exposure to family planning (FP) messages, being educated about FP at health facilities, and age at first sexual encounter. Among contextual factors, only community age at first birth was identified as a predictor of fertility, AOR, 1.59 (95% CI, 1.01-2.52). The study highlights sociodemographic disparities in adolescent fertility, emphasizing the need for targeted sexual reproductive health policies. Education protects against having more than one child, while marital status significantly influences fertility, particularly for married adolescents. The research provides valuable insights into the complex factors shaping adolescent fertility in Zambia, offering guidance for interventions and policies to support this vulnerable demographic.

Trends and Inequalities in Maternal and Newborn Health Services for Unplanned Settlements of Lusaka City, Zambia.

Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka's settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka's unplanned settlements.

Determinant of stunting among children under-five years: A nationwide study in Zambia

Background: Stunting cases among children represent one of the most serious issues in human development. Zambia, in particular, has a higher number of stunting cases in Africa.Objective: The purpose of this research was to analyze the prevalence and determinant of stunting among children under-five years in Zambia. Methods: This study utilized data from the 2018 Zambia Demographic Health Survey (ZDHS), with a total of 1,710 surveys selected. We observed variables related to mothers, children, and the environment to assess stunting. Chi-Square and Binary Logistic Regression were used for data analysis.Results: A total of 22,16% children under five years in Zambia had a stunting. We found that factors such as low birth weight (<2500 grams) (OR = 3.24; 95% CI = 2.163-4.869), mothers with no education (OR = 1.80; 95% CI = 0.681-4.760), those with the poorest wealth index (OR = 2.30; 95% CI = 1.341-3.943), intervals between previous children less than 24 months (OR = 1.58; 95% CI = 1.107-2.270), and breastfeeding for more than 6 months (OR = 4.499; 95% CI = 3.179-6.67) were associated with a higher likelihood of stunting in Zambia.Conclusions: Our study demonstrates that stunting is associated with family and household factors, as well as breastfeeding practices. Policymakers should consider implementing structured policies to address stunting, particularly for expectant mothers, as a long-term solution.

Factors Influencing Adherence to Pulmonary Tuberculosis Treatment among Adult Patients at St Francis’ Hospital-Katete, Zambia

Background: Pulmonary tuberculosis (PTB) is a contagious bacterial infection of the lungs caused by mycobacterium tuberculosis, also known as tubercle bacilli. The symptoms of PTB can appear gradually and vary in severity. Malnutrition, Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDs), age (young and old), diabetes mellitus, substance abuse, low socioeconomic status, malignancies, and or overcrowding are some of the common risk factors for PTB. According to the Zambia Demographic Health Survey (ZDHS, 2021), Zambia’s prevalence rate of PTB stood at 455 cases per 100,000 population. The World Health Organization (WHO) has recommended Direct Observation of Treatment (DOT) by a trained supervisor (WHO, 2019). However, implementing DOT in Zambia is challenging for both the patient and healthcare provider as it has been observed that a daily visit to a health facility for the first two months by PTB patients was very difficult for a range of reasons which included severe illness at the initiation of treatment, distance too far for walking, and high transportation costs. Objective: The study aimed at determining Factors Influencing Adherence to Pulmonary Tuberculosis Treatment among Adult PTB Patients at St Francis’ Hospital-Katete, Zambia. Methods and materials: Data was collected using a questionnaire and the study sample was one hundred (100) Adult PTB patients, who were selected by simple random sampling method. A quantitative descriptive cross-sectional study design was used. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21. Chi-square test was used to determine the relationship between independent and dependent variables. Conclusion: The study revealed a significant association between ‘level of information and knowledge, individual motivational support, behavioural skill’ and ‘Adult PTB patients’ adherence to PTB treatment’. Level of Information and knowledge (p-value 0.001), Individual .........

Going deeper with health equity measurement: how much more can surveys reveal about inequalities in health intervention coverage and mortality in Zambia?

BackgroundAlthough 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.MethodsUsing 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.ResultsInequalities 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.ConclusionsMulti-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

BackgroundZambia 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.MethodsUsing 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.ResultsThe 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.ConclusionZambia’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.

A cross-sectional study of women’s autonomy and modern contraception use in Zambia

BackgroundModern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women’s autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women’s autonomy and modern contraception use among partnered women in Zambia.MethodsThis cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women’s autonomy using three indices: women’s participation in decision-making, women’s attitude towards wife-beating and women’s household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR).ResultsThe mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women’s autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048–1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013–1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091–1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105–1.766) and age, 15–24 (AOR = 1.266, P value = 0.007, 95% CI 1.182–2.113,) and 25–34 (AOR = 1.163, P value = 0.002, 95% CI 1.052–1.273).ConclusionThis study argues that increasing women’s assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women’s autonomy, which in turn would support gender equality and reproductive health.

Performance of Machine Learning Classifiers in Classifying Stunting among Under-Five Children in Zambia.

Stunting is a global public health issue. We sought to train and evaluate machine learning (ML) classification algorithms on the Zambia Demographic Health Survey (ZDHS) dataset to predict stunting among children under the age of five in Zambia. We applied Logistic regression (LR), Random Forest (RF), SV classification (SVC), XG Boost (XgB) and Naïve Bayes (NB) algorithms to predict the probability of stunting among children under five years of age, on the 2018 ZDHS dataset. We calibrated predicted probabilities and plotted the calibration curves to compare model performance. We computed accuracy, recall, precision and F1 for each machine learning algorithm. About 2327 (34.2%) children were stunted. Thirteen of fifty-eight features were selected for inclusion in the model using random forest. Calibrating the predicted probabilities improved the performance of machine learning algorithms when evaluated using calibration curves. RF was the most accurate algorithm, with an accuracy score of 79% in the testing and 61.6% in the training data while Naïve Bayesian was the worst performing algorithm for predicting stunting among children under five in Zambia using the 2018 ZDHS dataset. ML models aids quick diagnosis of stunting and the timely development of interventions aimed at preventing stunting.

The association between food groups and childhood anemia in Zambia, based on the analysis of Zambia Demographic and Health Survey 2018.

High prevalence of anemia among children has been an important public health concern globally. In Zambia, the prevalence of anemia among children aged 6-59 months was 58%. Previous studies have suggested that feeding a variety of food prevents anemia. However, it is not yet determined if out of several food groups available locally, some foods have played crucial roles in anemia among young children. The objective of this study was to find out the food groups that were associated with childhood anemia among Zambian children aged 6-59 months. We have obtained the individual- level data related to health and nutrition of the Zambia Demographic Health Survey (ZDHS) 2018 with permission. Children’s feeding, demographic, and household information were analyzed using logistic regression models. Children who consumed food made from grains (AOR:1.2; 95%CI: 1.01-1.46; p=0.044) and cheese or food made from milk (AOR:2.7; 95%CI: 1.19-6.00; p=0.018) showed relatively higher prevalence of anemia than those who did not. Additionally, malnutrition, mother’s anemia and education, and area of living were also significantly associated with prevalence of anemia. Most common food in Zambia is food made from grain. Grain consists of phytic acids which can prevent iron absorption. This is a potential reason for the highlevel anemia among children. Dephytinization strategies should be considered through further studies.

Association between socioeconomic status and fertility among adolescents aged 15 to 19: an analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)

BackgroundAdolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings, which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections, unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contributes to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility.MethodsSecondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n = 3666).ResultsOverall, 23.1% of adolescents had given birth at least once in the 5 years leading to the survey (n = 3666, 99.4% response), and 49.8% were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR 6–10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (aOR = 2.4, 95% CI: 1.5, 3.7, p < 0.001). Although odds of giving birth were much higher among rural-based married adolescents (aOR = 8.0, 95% CI: 5.4, 11.9, p < 0.001) compared to urban married adolescents (aOR = 5.5, 95% CI: 8.3, 16.0, p < 0.001), and these relationships both statistically significant, higher educational attainment (aOR = 0.7, 95% CI: 0.6, 0.8 p < 0.001) and abortion (aOR = 0.3, 95% CI: 0.1, 0.8, p = 0.020) reduced these odds, particularly for rural-based adolescents.ConclusionDespite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address sexual and reproductive health needs of urban-based adolescents with a lower socioeconomic status.

Tobacco smoking prevalent in Zambian males: Observations from the Zambia Demographic Health Survey 2013-2014

Background: Tobacco smoking is one of the biggest public health threats causing poverty, several illnesses and death. Previous studies found that the lower the education, the higher the risk of smoking. This study assessed the association between education attainment and smoking among participants of the Zambia Demographic Health Survey 2013-2014.Methodology: This was a population-based crosssectional study. Secondary data was extracted from existing Zambia Demographic Health Survey 2013-2014 data sets, from ten provinces in comparison with different variables to constitute a resultant data set which this study used. All successfully interviewed male and female participants who answered the question, “Do you currently smoke cigarettes?” or “Do you currently smoke or use any other type of tobacco?” were included. The data extraction form was used to extract values of dependent and independent variables and imported into statistical analysis tool Stata version 13. Descriptive statistics of individual characteristics, testing for associations using the Pearson's Chi Square test and logistic regression were performed.Results: Overall there were 14773 men and 16411women with mean age of 15-19. Smoking prevalence was 9.9% overall and 20.4% in men, but 0.5% in women. The incidence of tobacco smoking is steadily increasing with increase in age among both men and women. There was a significant increase in the incidence of smoking between 20-24 and 25-29 particularly in male smokers. Higher socioeconomic status seems to have a protective effect, consequently smoking remains highest among poor individuals and lowest among the rich. Higher education groups had a decreased likelihood to smoke with an odds ratio of 0.5 overall, 0.2 in men and 0.1 in women.Conclusions: We report high and unchanging prevalence of smoking predominantly concentrated in rural adult populations with lower education attainment. This suggests past health promotion efforts that targeted whole population may not have been relevant to the most affected groups. This therefore calls for reshaping health promotion messages to target specific populations and settingswith highest burden. Furthermore, this calls for additional explorative studies in order to examine reasons for smoking in lower educated groups including exploring how what has worked in reducing smoking in higher educated groups could be extrapolated to most affected low educated and rural populations

Tobacco smoking prevalent in Zambian males: Observations from the Zambia Demographic Health Survey 2013-2014.

Introduction: Tobacco smoking is one of the biggest public health threats causing poverty, several illnesses and death. Previous studies found that the lower the education, the higher the risk of smoking. This study assessed the association between education attainment and smoking among participants of the Zambia Demographic Health Survey 2013-2014. Methodology: This was a population-based cross-sectional study. Secondary data was extracted from existing Zambia Demographic Health Survey 2013- 2014 data sets, from ten provinces in comparison with different variables to constitute a resultant data set which this study used. All successfully interviewed male and female participants who answered the question, “Do you currently smoke cigarettes?” or “Do you currently smoke or use any other type of tobacco?” were included. The data extraction form was used to extract values of dependent and independent variables and imported into statistical analysis tool Stata version 13. Descriptive statistics of individual characteristics, testing for associations using the Pearson’s Chi Square test and logistic regression were performed. Results: Overall there were 14773 men and 16411women with mean age of 15-19. Smoking prevalence was 9.9% overall and 20.4% in men, but 0.5% in women. The incidence of tobacco smoking is steadily increasing with increase in age among both men and women. There was a significant increase in the incidence of smoking between 20-24 and 25-29 particularly in male smokers. Higher socioeconomic status seems to have a protective effect, consequently smoking remains highest among poor individuals and lowest among the rich. Higher education groups had a decreased likelihood to smoke with an odds ratio of 0.5 overall, 0.2 in men and 0.1 in women. Conclusions: We report high and unchanging prevalence of smoking predominantly concentrated in rural adult populations with lower education attainment. This suggests past health promotion efforts that targeted whole population may not have been relevant to the most affected groups. This therefore calls for reshaping health promotion messages to target specific populations and settings with highest burden. Furthermore, this calls for additional explorative studies in order to examine reasons for smoking in lower educated groups including exploring how what has worked in reducing smoking in higher educated groups could be extrapolated to most affected low educated and rural populations.&#x0D;

Factors Affecting Women’s Autonomy in Household Decision-Making among Married Women in Zambia

The main aim of the study was to examine factors that affect women’s household decision-making among married women in Zambia. This paper utilizes secondary data from the 2013 Zambia Demographic Health Survey (ZDHS). Logistic regression analysis was used to identify various factors associated with factors that affect women’s autonomy in household decision-making among married women in Zambia. The findings of the study show that married women in Zambia are more likely to participate in decision-making that involved purchases of daily household needs (86%) followed by decision making that involved visits to her family or relatives (75%) and decisions about her own health care (74%). About 66per cent of the respondents reported having participated in household major purposes. Some socio-demographic variables only influenced women in some domains and not all. For instance, age only influenced decision-making on household goods and visits to family. Rich wealthy status, living in urban areas, higher levels of education and justification of wife-beating were influential to healthcare decision-making among women. Zambian programmes and policy initiatives should develop a clear policy foundation that should be crucial to empower women to take part in decision-making processes in the household. Moreover, enhancing their access to and control over economic resources and enabling them to establish and realise their rights are also essential means to empower women to be more autonomous in decision-making.

Determinants of unmet need for family planning among married women in Zambia.

Unmet need for family planning remains a major family planning problem in most countries around the world. It presents serious consequences for the women, their families and society at large. This study was undertaken to establish the factors that affect total unmet needs for family planning and its components in Zambia. This study used the 2013/14 Zambia Demographic Health Survey (ZDHS) dataset focusing on currently married women aged 15 to 49. Data analysis took the form of descriptive, binary logistic and multinomial logistic regressions. The study shows that, although there has been a substantial increase in the use of contraceptives, combined unmet need for family planning has only decreased slightly over time, and currently stand at 21%, made up of 14% limiters and 7% spacers. Various factors were identified as determinants of unmet need for spacing, limiting or total unmet need for family planning. These included age, partner’s level of education, contraceptive side effects, husband opposition to contraceptives and number of living children. To enhance utilization, policy should not be blind to the respective factors that influence combined unmet needs for spacing and limiting.

Perceived Risk of Contracting HIV and AIDS among Sexually Active Unmarried Young People in Zambia

The paper explored gender differences in factors affecting perceived risk of contracting HIV and AIDS among sexually active unmarried young people in Zambia. The data used was from the Zambia Demographic Health Survey (2013-2014), logistic regression analysis was used to identify the gender differences in perceived risk of acquiring HIV and AIDS. The study revealed that 61% of females and 64.4% of males reported low perceived risk of contracting HIV and 16.5% of females and 16.6% of males reported having a high risk of getting HIV/AIDS. Logistic regression analysis also identified wealth index, exposure to media, having had STDs in the last 12 months, consistent use of condoms with all partners and drinking alcohol as strong predictors of respondent’s likelihood of low risk perception of contracting HIV and AIDS. The analysis further indicated that females who used condoms consistently with all partners were 1.2 times more likely to report being at low risk of contracting HIV and AIDS. This suggests that interventions that seek to reduce the rate of HIV infection may need to focus on increasing risk perception among young people as a protective factor.

Perceptions of Risk of Contracting HIV among Married Men and Women in Zambia

&#x0D; This study explored the perceived risk of contracting HIV among the currently married men and women in Zambia. The analysis was carried out on data from the latest Zambia Demographic Health Survey (2014). Results indicated that 48% of the currently married women, and 61% of the currently married men reported low perceived risk for contracting HIV. The results also indicate that age, place of residence, wealth status, having had sex with three or more partners for the last 12 months, drinking alcohol and condom use were associated with high risk perception of contracting HIV for men. Women who had three or more sexual partners during the last 12 months were 1.5 times more likely to perceive high risk for contracting HIV than those who had less than three partners. Among the males, those who had sex with three or more sexual partners were 1.7 times more likely to perceive being at high risk for contracting HIV than those who had sex with less than three partners. Respondents from the higher socio-economic group were 1.3 times more likely to report low risk of contracting HIV as compared to those from middle and lower socio-economic group. These findings suggest that behaviour change campaigns encouraging married men and women to accurately assess their personal risk of contracting HIV should be complemented with targeted awareness messages emphasizing the positive attributes of using condom.

Determinants of HIV-risk sexual behaviors among Zambian adolescents: The role of gendered power

Sub-Saharan African adolescents account for a disproportionate share of the global HIV infection rates with adolescent females carrying the heavy burden. Vulnerability to negative sexual health outcomes have been attributed to varying life contexts and power differentials influencing adolescent sexual behaviors. Using social dominance theory and the four bases of gendered power, this study examines the relationship between gender based power and adolescent HIV-risk sexual behavior. Data was derived from the 2013‐14 Zambia Demographic Health Survey (ZDHS). We utilize gender stratified multivariate logistic regression to determine whether the four bases of gendered power are predictive of condom use and multiple sexual partnering among sexually active adolescents (N = 1908), ages 15–19. Findings highlight the significant effects of sexual abuse, resource constraints (low levels of education, condom access, poverty) and gender-unequal beliefs and values on the odds of adolescent HIV-risk sexual behavior. We found gender variant effects of these factors on sexual behavior. For males, beliefs in gender-unequal norms acted as a barrier to condom use. Among females, having no education facilitated multiple sexual partnering. Implications for policy and practice are provided.

Spatial distribution and correlates of smoking in Zambia

ObjectiveThe objective of the paper was to investigate the spatial distribution and correlates of tobacco smoking in various regions of Zambia.MethodsThis paper adopts a cross-sectional study design. The study used...