Zimbabwe Demographic Health Survey Research Articles

Determinants of under-five mortality in Zimbabwe: Evidence from the 2015–2016 Zimbabwe demographic Health Survey data

BackgroundChild mortality is an important measure of a population’s health status. It is included in the third sustainable development goal that aims to improve global health by reducing under-five mortality to at least as low as 25 per 1000 live births by 2030. The study determines the factors associated with under-five child mortality in Zimbabwe. MethodsCross-sectional secondary data from the 2015 Zimbabwe Demographic Health Survey (ZDHS) were analyzed. The sample included 5,806 women aged 15–49 years of reproductive age. The Chi-square test was used to analyze the association between child death and independent variables. We identified the individual and contextual factors associated with child deaths in Zimbabwe using the Cox proportional hazard model. ResultsThe risks of under-five mortality were highest among children of first birth order (adjusted hazard ratio (aHR) ​= ​2.37, P ​= ​0.04), multiple births (aHR ​= ​2.37, P= 0.04), mothers with primary or less maternal education (aHR ​= ​1, Ref), mothers below 18 years old (aHR ​= ​1, Ref), apostolic mothers (aHR ​= ​2.90, P= 0.002), mothers who do not use contraceptives (aHR ​= ​2.20, P ​< ​0.001), formerly married women (aHR ​= ​6.42, P= 0.005), women with 5 or more children (aHR ​= ​15.84, P ​< ​0.001), women who read newspapers less than once a week (aHR ​= ​1.75, P= 0.13), and households that use high-polluting fuels (aHR ​= ​1.92, P= 0.023). ConclusionThis study establishes that child health, maternal, socioeconomic, household, and ecological factors are important determinants of under-five mortality in Zimbabwe. Understanding these determinants is crucial for designing effective interventions and policies to reduce child mortality rates. This requires comprehensive approaches such as improving access to healthcare, education, and basic sanitation facilities; prioritizing nutrition; providing clean water; enhancing poverty reduction and immunization; and promoting breastfeeding and social empowerment, with a particular focus on vulnerable populations and marginalized communities.

Maternal selenium deficiency was positively associated with the risk of selenium deficiency in children aged 6-59 months in rural Zimbabwe.

There is growing evidence showing the existence of selenium (Se) deficiency among women and children in sub-Saharan Africa. Unfortunately, the key drivers of Se deficiency are not clearly understood. This study assessed the determinants of Se deficiency among children aged 6-59 months and Women of Reproductive Age (WRA), in Zimbabwe. This cross-sectional biomarker study was conducted in selected districts in rural Zimbabwe (Murewa, Shamva, and Mutasa). Children aged 6-59 months (n = 683) and WRA (n = 683), were selected using a systematic random sampling approach. Venous blood samples were collected, processed, and stored according to World Health Organization (WHO) guidelines. Plasma selenium concentration was measured using inductively coupled plasma-mass spectrometry (ICP-MS). Anthropometric indices were assessed and classified based on WHO standards. Demographic characteristics were adapted from the Zimbabwe Demographic Health Survey standard questionnaire. Multiple logistic regression analysis showed that children whose mothers were Se deficient were 4 times more likely to be Se deficient compared to those whose mothers were Se adequate (OR = 4.25; 95% CI; 1.55-11.67; p = 0.005). Girl children were 3 times more likely to be Se deficient compared to boys (OR = 2.84; 95% CI; 1.08-7.51; p = 0.035). Women producing maize for consumption were 0.5 times more likely to be Se deficient than non-producers (OR = 0.47; 95% CI; 0.25-0.90; p = 0.022). The risk of Se depletion in children was amplified by maternal deficiency. Therefore, initiation of maternal multiple micronutrient supplementation from preconception through lactation is beneficial to both children and women.

Estimating HIV incidence over a decade in Zimbabwe: A comparison of the catalytic and Farrington models.

Over the years, numerous modelling studies have been proposed to estimate HIV incidence. As a result, this study aimed to evaluate two alternative methods for predicting HIV incidence in Zimbabwe between 2005 and 2015. We estimated HIV incidence from seroprevalence data using the catalytic and Farrington-2-parameter models. Data were obtained from 2005-06, 2010-11, and 2015 Zimbabwe Demographic Health Survey (ZDHS). These models were validated at the micro and macro-level using community-based cohort incidence and empirical estimates from UNAIDS EPP/SPECTRUM, respectively. The HIV incidence for the catalytic model was 0.32% (CI: 0.28%, 0.36%), 0.36% (CI: 0.33%, 0.39%), and 0.28% (CI: 0.26%, 0.30%), for the years 2005-06, 2010-11, and 2015, respectively. The HIV incidence for the Farrington model was 0.21% (CI: 0.16%, 0.26%), 0.22% (CI: 0.20%, 0.25%), and 0.19% (CI: 0.16%, 0.22%), for the years 2005-06, 2010-11, and 2015, respectively. According to these findings, the catalytic model estimated a higher HIV incidence rate than the Farrington model. Compared to cohort estimates, the estimates were within the observed 95% confidence interval, with 88% and 75% agreement for the catalytic and Farrington models, respectively. The limits of agreement observed in the Bland-Altman plot were narrow for all plots, indicating that our model estimates were comparable to cohort estimates. Compared to UNAIDS estimates, the catalytic model predicted a progressive increase in HIV incidence for males throughout all survey years. Without a doubt, HIV incidence declined with each subsequent survey year for all models. To improve programmatic and policy decisions in the national HIV response, we recommend the triangulation of multiple methods for incidence estimation and interpretation of results. Multiple estimating approaches should be considered to reduce uncertainty in the estimations from various models.

Estimating age specific prevalence and force of infection in Zimbabwe using combined cross-sectional surveys from 2005 to 2015.

Age structured sexual mixing patterns have been noted to be associated with HIV prevalence and force of infection. Therefore, this study aimed to estimate the age dependent HIV force of infection using survey cross-sectional data from Zimbabwe. We fit generalized additive models namely; linear, semi-parametric, non-parametric and non-proportional hazards models. Using the 2005-06, 2010-11 and 2015 Zimbabwe Demographic Health Surveys data. The Akaike Information Criteria was used to select the best model. The best model was then used to estimate the age dependent HIV prevalence and force-of-infection. Based on birth year cohort-specific prevalence, the female HIV prevalence reaches the highest peak at around 29 years of age, then declines thereafter. Males have a lower cohort specific prevalence between 15 and 30 years than females. Male cohort-specific prevalence slightly decreases between the ages of 33 and 39, then peaks around the age of 40. The cohort-specific FOI is greater in females than in males throughout all age categories. In addition, the cohort-specific HIV FOI peaked at ages 22 and 40 for females and males, respectively. The observed 18-year age difference between the HIV FOI peaks of males and females. Our model was appealing because we did not assume that the FOI is stationary over time; however, we used serological survey data to distinguish the FOI's age-and-time effect. The cohort-specific FOI peaked 18 years earlier in females than males, indicative of age-mixing patterns. We recommend interventions that target younger females so as to reduce HIV transmission rates.

Modern contraceptive use among women of reproductive age in Zimbabwe: analysis of 1999–2015 Zimbabwe Demographic Health Survey

Introduction Modern contraception use is the fundamental fulfilment of women’s rights to choose when and how many children to have. The study explored predictors of modern contraceptive use among women in Zimbabwe. Method Data from the 1999, 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Survey (ZDHS) was used in a secondary analysis that involved 5474 women of reproductive age. The outcome measure was modern contraceptive use as reported by women. Multiple logistic regression was done to determine the predictors of modern contraceptive use. Results The trend showed that since 1999 to 2015 there has been a steadily increase in modern contraceptive use from 54.9% to 72.9%. The use of contraceptives was lower among age 40 to 49 years (aOR = 0.49, p = 0.001)], other religion (aOR = 0.34, p = 0.005), induced abortion (aOR = 0.70; p ≤ 0.001), desire for having children within 2 years (aOR = 0.21; p ≤ 0.001) and polygamy (aOR = 0.43; p ≤ 0.001). The odds of contraceptives used was higher among richer wealth index (aOR = 1.45, p = 0.017), partners with higher education (aOR = 2.00, p = 0.029)], parity 1–2 (aOR = 15.53; p ≤ 0.001), 3–4 (aOR = 19.60; p ≤ 0.001), 5 or more (aOR = 17.50; p ≤ 0.001)] and media exposure (aOR = 1.79; p = 0.003). Conclusions The study asserts that women’s financial status, partners educational level, and media exposure might be important in promoting the use of modern contraceptives among women in a union in Zimbabwe and other low-income and middle-income countries.

Investigating the associations between intimate partner violence and nutritional status of women in Zimbabwe.

Intimate partner violence (IPV) against women and poor nutritional status are growing health problems in low and middle-income countries (LMICs). Moreover, violence against women has been shown to be associated with poor nutrition. This study investigated the relationship between IPV and nutritional status (i.e., underweight, overweight, and obesity) among women of reproductive age (15-49 years) in Zimbabwe. Pooled data from the 2005/2006, 2010/2011, and 2015 Zimbabwe Demographic Health Surveys (ZDHS) on 13,008 married/cohabiting women were analysed. Multinomial logistic regression models were used to examine the associations between the various forms of IPV and the nutritional status of women. We further estimated the prevalence of BMI ≥ 25.0 kg/m2 (overweight and obesity) by intimate partner violence type. The mean BMI of women was 24.3 kg/m2, more than one-fifth (24%) were overweight and about 12% were obese. Forty-three percent (43%) of women reported to have ever experienced at least one form of intimate partner violence. More than one-third (35%) of women who reported to have ever experienced at least one form of intimate partner violence had a BMI ≥ 25.0 kg/m2 (p< 0.01). Relative to normal weight, women who had ever experienced at least one form of IPV (i.e., physical, emotional, or sexual) were more likely to be obese (aOR = 2.59; 95% CI = 1.05-6.39). Women's exposure to any form of intimate partner violence was not significantly associated with the likelihood of being underweight or overweight relative to normal weight. The study findings show that women of reproductive age in Zimbabwe are at high risk of both IPV and excess weight. Moreover, we found a positive relationship between exposure to at least one form IPV and obesity. Public health interventions that target the well-being, empowerment and development of women are needed to address the complex issue of IPV and adverse health outcomes, including obesity.

Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind

BackgroundSeveral studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being.MethodsThis study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe.ResultsOverall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)].ConclusionDecomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.

HIV status, knowledge and prevention of cervical cancer amongst adolescent girls and women: a secondary data analysis.

Introductionthe objective of this manuscript was to describe the knowledge profiles and determinants of cervical cancer screening among HIV positive and negative adolescent girls and women in Zimbabwe.Methodswe conducted secondary statistical data analysis to explore the determinants of cervical cancer screening among HIV positive and negative adolescent girls and women using Zimbabwe Demographic Health survey for 2015-16.Resultsa total of 9054 adolescent girls aged 15-19, and women aged 20-49 were included in the analysis and the majority (63%) of them resided in rural areas. More than two-thirds (65.9%) had attained secondary level of education. The majority (41.3%) of the adolescent girls and women belonged to the Apostolic sect. A number of key determinants have been identified for being ever screened for cervical cancer. The odds of being ever being screened increased by age, OR(CI) 4.38 (3.22-5.94), p<0.001 for women who are 40 years and older when compared to adolescent and young woman who are between 15-24 years.Conclusionour study reports significant programmatic gaps in the provision of cervical cancer screening and treatment services in the country. The nascent Zimbabwe cervical cancer screening and treatment progamme will benefit from expansion of the number of facilities offering the services and the provision of more efficient health education to adolescent women and girls.

Associations of diarrhea episodes and seeking medical treatment among children under five years: Insights from the Zimbabwe Demographic Health Survey (2015-2016).

Diarrhea is a significant pediatric public health concern globally and places a significant burden on healthcare systems. In resource‐limited settings, the problems of diarrhea could be worse than reported. Continuously monitoring and understanding the changing epidemiology of diarrhea, including risk factors, remain an important aspect necessary to design effective public health interventions to reduce the incidence, outcomes and strain on healthcare resources caused by diarrheal illness. We, therefore, undertook this study to understand the factors associated with diarrhea as well as describe determinants for seeking medical treatment in children under‐five in Zimbabwe using the Zimbabwe Demographic and Health Survey 2015–2016 Data. Children with recent diarrhea were on average younger (mean age 22 months), compared to those who did not have an episode of diarrhea (mean age 30 months) p = .001. Incidence of recent diarrhea was lower among female children compared to their male counterparts (16% vs. 19%), p = .013. Incidence of diarrhea decreased with increasing maternal education level and so was the same for increasing wealth quintile. Those with unimproved sources of drinking water had a higher incidence of diarrhea. The wealth quintile remained the only factor associated with seeking medical attention for a recent diarrhea episode among children less than 6 years, with those in the highest wealth quintile being 2.49 times likely to do so, p = .031. The results are useful in informing pediatric public health policies and strategies for them to be successful in significantly reducing the incidence, morbidity, mortality and significant healthcare costs and burden to society associated with caring for children with diarrheal illnesses.

Parental Care on Under Five Child Health Outcomes in Zimbabwe

This study examines the effect of parental care on child health outcomes (stunting, wasting and underweight) in Zimbabwe. The study uses data from the Zimbabwe Demographic Health Survey (ZDHS) (1994-2015) by employing the Ordinary Least Method (OLS) regression approach. The results indicate that breastfeeding and vaccination on each count has a significant negative effect on under-five child health outcomes (stunting and wasting). On the contrary, child-size shows a significant positive effect on wasting and underweight among under-five children in Zimbabwe. Area of residence indicates an under five-child in an urban center is less likely to be wasting than its contemporary in a rural area. The individual effects of mothers’ education, wealth index, child’s sex and marital status show insignificant effects under-five child health outcomes. The policy implication is that health professionals should intensify education on early child suckling and succeeding dietary mix to obviate poor health outcomes. This study also implores the Ministry of Health and Child Care in Zimbabwe to review existing vaccination programmes by extending to households with poor child health outcomes found in inaccessible areas. As a contribution, this study provides a platform for deliberations on family care and child health care in African societies.

Intersection of HIV and Anemia in women of reproductive age: a 10-year analysis of three Zimbabwe demographic health surveys, 2005\u20132015

BackgroundWomen of reproductive age 15–49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. We conducted a secondary analysis to study the prevalence of and associated risk factors for anemia in women to elucidate the intersection of HIV and anemia using data from 3 cycles of Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005, 2010, and 2015.MethodsDHS design comprises of a two-stage cluster-sampling to monitor and evaluate indicators for population health. A field hemoglobin test was conducted in eligible women. Anemia was defined as hemoglobin < 11.0 g/dL in pregnant women; < 12.0 in nonpregnant women. Chi-squared test and multivariable logistic regression analysis accounting for complex survey design were used to determine the prevalence and risk factors associated with anemia.ResultsPrevalence (95% confidence interval (CI)) of anemia was 37.8(35.9–39.7), 28.2(26.9–29.5), 27.8(26.5–29.1) in 2005, 2010, and 2015, respectively. Approximately 9.4, 7.2, and 6.1%, of women had moderate anemia; (Hgb 7–9.9) while 1.0, 0.7, and 0.6% of women had severe anemia (Hgb < 7 g/dL)), in 2005, 2010, and 2015, respectively. Risk factors associated with anemia included HIV (HIV+: 2005: OR (95% CI) = 2.40(2.03–2.74), 2010: 2.35(1.99–2.77), and 2015: 2.48(2.18–2.83)]; Residence in 2005 and 2010 [(2005: 1.33(1.08–1.65), 2010: 1.26(1.03–1.53)]; Pregnant or breastfeeding women [2005: 1.31(1.16–1.47), 2010: 1.23(1.09–1.34)]; not taking iron supplementation [2005: 1.17(1.03–1.33), 2010: 1.23(1.09–1.40), and2015: 1.24(1.08–1.42)]. Masvingo, Matebeleland South, and Bulawayo provinces had the highest burden of anemia across the three DHS Cycles. Manicaland and Mashonaland East had the lowest burden.ConclusionThe prevalence of anemia in Zimbabwe declined between 2005 and 2015 but provinces of Matebeleland South and Bulawayo were hot spots with little or no change HIV positive women had higher prevalence than HIV negative women. The multidimensional causes and drivers of anemia in women require an integrated approach to help ameliorate anemia and its negative health effects on the women’s health. Prevention strategies such as promoting iron-rich food and food fortification, providing universal iron supplementation targeting lowveld provinces and women with HIV, pregnant or breastfeeding are required.

Maternal HIV and child anthropometric outcomes over time: an analysis of Zimbabwe demographic health surveys.

To understand the association between children's anthropometric measures and maternal HIV status in Zimbabwe and to determine whether these relationships changed over time. Data from Demographic Health Surveys in Zimbabwe rounds 2005, 2010, and 2015 were used to conduct cross-sectional analyses of child anthropometric measures (stunting, underweight, and wasting). Using separate logistic regression models for each of the anthropometric measures, we estimated the adjusted prevalence odds ratio (OR) of stunting, underweight, and wasting in children according to maternal HIV status. Moreover, we evaluated an interaction by survey year to evaluate change over time. Children of mothers with HIV had 32% greater odds [OR = 1.32, 95% confidence interval (CI) 1.16-1.5] of stunting, 27% greater odds (OR = 1.27, 95% CI 1.1-1.48) of underweight status and 7% greater odds (OR = 1.07, 95% CI 0.81-1.42) of wasting status, than children of mothers without HIV. These associations between maternal HIV status and child undernutrition did not differ by year (P > 0.05 for all interaction terms). In Zimbabwe, having a mother who tested positive for HIV at the time of the survey has been associated with greater child undernutrition over the last two decades with no significant change by survey round. This emphasizes the need for continued programming to address nutritional deficiencies, sanitation, and infectious disease prevention in this high-risk population. The greatest impact of maternal HIV status has been on child stunting and underweight, associated with poor long-term child development.

Societal risk factors for overweight and obesity in women in Zimbabwe: a cross-sectional study

BackgroundOverweight and obesity are well-recognized risk factors for various non-communicable diseases. Evidence shows an increasing burden of overweight and obesity in low and middle-income countries, especially in women. Little is known about the risk factors in Zimbabwe. The aim of this study was to determine the socioeconomic risk factors for overweight and obesity in non-pregnant adult Zimbabwean women.MethodsA cross-sectional study was conducted using the 2015 Zimbabwe Demographic Health Survey (n = 8904) data on the adult female population aged 15 to 49. Body mass index (BMI) was calculated by dividing the body weight by height squared. The socio-economic variables studied were age, marital status, residence, province, religion, education, household wealth index, household size, access to mass media and the use of contraception. Prevalence of overweight (BMI ≥ 25–29.9 kg/m2) and obesity (BMI ≥30 kg/m2) were determined. Simple and multivariable logistic regressions were then used to ascertain any relationships.ResultsThe weighted prevalence of overweight and obesity in adult females was 34.2 and 12.3% respectively. The odds for being overweight and obese were significantly higher with increasing age (Adjusted Odds Ratio (AOR 2.76, 95% CI:2.45–3.11 for overweight and AOR 3.24, 95% CI:2.69–3.90 for obesity) with marriage (AOR 1.58, 95% CI:1.38–1.79 for overweight and AOR 1.54, 95% CI:1.27–1.87 for obesity), high wealth status (AOR 4.01, 95% CI:2.93–5.50 for overweight and AOR 6.97, 95% CI:4.08–11.9 for obesity), and the use of hormonal contraception (AOR 1.24, 95% CI:1.07-1.41 for overweight and AOR 1.35, 95% CI:1.10–1.64 for obesity). Additionally, having higher education increased the odds of being obese (AOR 1.44, 95% CI:1.07–1.96) while being Christian increased the odds for being overweight (AOR 1.13, 95% CI:1.00–1.28).ConclusionsThe prevalence of overweight and obesity among women in Zimbabwe was high. The key social factors associated were older age, being married, being wealthy and the use of hormonal contraception. Having a higher education and being Christian also increased the risk of being obese and overweight respectively. The design of multi-faceted overweight and obesity reduction programs for women that focus on increasing physical activity and strengthening of social support systems are necessary to combat this epidemic.

Exploring Factors That Influence the Uptake of Maternal Health Care Services by Women in Zimbabwe

The study investigated factors that influence the uptake of maternal healthcare services by women in Zimbabwe, using a logit model. Data from the Zimbabwe Demographic Health Survey (ZDHS, 2015) was used. Deteriorating maternal health indicators motivated the study. The effect of socio-economic and demographic factors on the probability of utilising maternal healthcare services was examined. Descriptive statistics and a logit model were used for data analysis. Results from the logit model show that region of residence, insurance cover, educational level, employment status, maternal age, birth order, place of residence, number of living children, maternal age and household income all influence the utilisation of maternal healthcare services by women in Zimbabwe. Basing on research findings, the study recommends that relevant authorities make more available vocational training centres and education institutions since education was found to influence the uptake of maternal healthcare services. There is need to encourage family planning so as to reduce the number of children, especially among the apostolic sect, which affects the uptake of maternal healthcare. Compulsory national health insurance schemes could be adopted to mitigate the effect of low income that discourages the use of institutional facilities for delivery. The issue of balanced regional development needs to be pursued through accelerating devolution to ensure equal access to maternal healthcare facilities in all provinces.

The fertility revolution in Zimbabwe with special regards to proximate determinants of fertility

The role of proximate determinants in moderating fertility decline is well documented in developing countries. In Zimbabwe, however, there is a limited understanding of the role of proximate determinants on fertility levels and trends. This study aimed to examine the role of proximate determinants of fertility (namely marriages, postpartum infecundity and contraception) using the Bongaarts proximate determinants model. The impact of these determinants is studied on a sample of married women aged 15–49 years’ and corresponding cross-sectional data obtained through the six consecutive Zimbabwe Demographic Health Surveys (ZDHSs) hold in 1988, 1994, 1999, 2005 and 2015. The results reveal that the overall fertility declined from 5.4, 3.8 and 4.0 children per woman observed among 1988, 1999 and 2015 ZDHSs, respectively. This change was caused by the contraceptive inhibitive effect, which correspondingly increased from 3.00 to 4.65 and 6.45 children per woman. The fertility stalling observed in 1999 and after that is caused by postpartum infecundity and marital fertility inhibition which decreased with time. Moreover, contraceptive inhibition effect increased with education, wealth quintiles, and urban residence. In contrast, marital and postpartum infecundity fertility inhibition effects inversely correlate with education, wealth quintiles, and the place of residence. Therefore, to foster further fertility decline to replacement level, policies should promote contraceptive adoption, more extended breastfeeding periods and delay entry into early marriages. Furthermore, women empowerment, especially the promotion of female education to higher education and female employment, could be useful tools to further fertility decline.

Factors Associated With HIV Infection in Zimbabwe Over a Decade From 2005 to 2015: An Interval-Censoring Survival Analysis Approach.

Objectives: The main objective of this study was to compare results from two approaches for estimating the effect of different factors on the risk of HIV infection and determine the best fitting model.Study design: We performed secondary data analysis on cross-sectional data which was collected from the Zimbabwe Demographic Health Survey (ZDHS) from 2005 to 2015.Methods: Survey and cluster adjusted logistic regression was used to determine variables for use in survival analysis with HIV status as the outcome variable. Covariates found significant in the logistic regression were used in survival analysis to determine the factors associated with HIV infection over the 10 years. The data for the survival analysis were modeled assuming age at survey imputation (Model 1) and interval-censoring (Model 2).Results: Model goodness of fit test based on the Cox-Snell residuals against the cumulative hazard indicated that Model 1 was the best model. On the contrary, the Akaike Information Criterion (AIC) indicated that Model 2 was the best model. Factors associated with a high risk of HIV infection were being female, number of sexual partners, and having had an STI in the past year prior to the survey.Conclusion: The difference between the results from the Cox-Snell residuals graphical method and the model estimates and AIC value maybe due to the lack of adequate methods to test the goodness-of -fit of interval-censored data. We concluded that Model 2 with interval-censoring gave better estimates due to its consistency with the published results from literature. Even though we consider the interval-censoring model as the superior model with regards to our specific data, the method had its own set of limitations.

Feasibility and Sustainability of Community Based Health Insurance in Rural Areas Case Study of Musana, Zimbabwe

The Zimbabwe Demographic Health Survey (ZDHS 2010-11) showed that only 6 percent of the population is covered by health insurance in Zimbabwe. This study investigated the feasibility, acceptability and sustainability of Community Based Health Insurance (CBHI) as an alternative to pooling risk and financing social protection in Zimbabwe. Willingness to Pay (WTP) for health insurance and socioeconomic data were collected through interviews with 121 household heads selected using a 2-stage sampling procedure on 14 villages in Musana and Domboshava rural areas, a population which is largely unemployed and reliant on subsistence agriculture. A CBHI scheme was established and followed up for 3 years documenting data on visits made, financial contributions from recruited households and their actual health expenditures. Findings indicate that CBHI is generally accepted as a means of health insurance in rural communities. The median willingness to pay for health insurance was $5.43 against monthly expenditures ranging of up to $180. The low WTP is attributable to low incomes as only 3.4 percent of the respondents relied on formal employment. Trust issues, adverse selection, moral hazard, and administration costs were challenges threatening sustainability of CBHI. A financial gap averaging 42% was generally on a downward trend and was closed by the end of the follow-up study as contributions were equivalent to medical expenses. We conclude that CBHI is feasible, has potential for sustainability and should be considered as a springboard for the planned Zimbabwean National Health Insurance.

Impact of the adolescent and youth sexual and reproductive health strategy on service utilisation and health outcomes in Zimbabwe.

Poor reproductive health among youth and adolescents threatens their future health and economic wellbeing in Zimbabwe amidst a high HIV/AIDS prevalence. This study evaluates the impact of a multi-pronged adolescent sexual and reproductive health (ASRH) strategy implemented by government of Zimbabwe between 2010 and 2015 to improve ASRH in terms of the uptake of condoms and HIV testing as well as outcomes in terms of sexually transmitted infection (STI) prevalence and HIV prevalence. We combine the difference in difference and propensity score matching methods to analyse repeated Zimbabwe demographic health survey cross-sectional datasets. Young people aged 15–19 years at baseline in 2010, who were exposed for the entire five-year strategy are designated as the treatment group and young adults aged 25–29 at baseline as the control. We find that the ASRH strategy increased HIV testing amongst youth by 36.6 percent, whilst treatment of STIs also increased by 30.4 percent. We also find that the HIV prevalence trajectory was reduced by 0.7 percent. We do not find evidence of impact on condom use and STI prevalence. The findings also suggest that although HIV testing increased for all socio-economic groups that were investigated, the effect was not the same. Lastly, we do not find evidence supporting that more resources translate to better ASRH outcomes. We recommend designing future ASRH strategies in a way that differentiates service delivery for youths in HIV hotspots, rural areas and out of school. We also recommend improving the strategy’s coordination and monitoring, as well as aligning and enforcing government policies that promote sexual and reproductive health rights.

Early Initiation and Exclusivity of Breastfeeding in Rural Zimbabwe: Impact of a Breastfeeding Intervention Delivered by Village Health Workers

ABSTRACTBackgroundSuboptimal breastfeeding contributes to >800,000 global child deaths annually. Optimal breastfeeding includes early initiation (EI) and exclusive breastfeeding (EBF) for the first 6 mo.ObjectivesWe tested the hypothesis that an intervention targeting context and infant age-specific barriers to EI and EBF will achieve a higher EI and EBF prevalence than those of women participating in the concurrently conducted 2015 Zimbabwe Demographic Health Survey (Z-DHS).MethodsWe designed an intervention to promote EI and EBF, and implemented it within the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Intervention modules were delivered at 4 perinatal time points by government-employed village health workers. We compared EI and EBF prevalence among SHINE women who provided outcomes at 1 mo (n = 2442) and 3 mo (n = 2728), with women in the 2015 Z-DHS.ResultsIn cross-sectional analyses EI prevalence was 86.6% and 64.3% in the SHINE and Z-DHS samples, respectively; absolute difference (95% CI) = 22.4% (17.5%, 27.3%). EBF prevalence was similarly high (>80%) in both surveys during the first month of life; during 1 to <2 mo, 2 to <3 mo, 3 to <4 mo, 4 to <5 mo, and 5 to <6 mo, EBF prevalence was, respectively, 85%, 90%, 90%, 84%, and 75% in SHINE, and 71%, 65%, 35%, 26%, and 25% in Z-DHS; absolute difference (95% CI) = 50.2% (34.7%, 65.7%) at 5 to <6 mo. Cesarean delivery, mother's belief that intimate partner violence was sometimes justifiable, and having a male infant negatively modified the effects of the intervention.ConclusionsThe SHINE intervention achieved a high prevalence of EI and EBF. Concurrently addressing gender norms will be critical to make further progress. Formative studies to identify context- and infant age-specific barriers to EI and EBF may inform improvement of breastfeeding practices elsewhere. Important work remains to scale up this intervention beyond a research setting. SHINE was registered at www.clinicaltrials.gov as NCT01824940.

Segmented polynomials for incidence rate estimation from prevalence data.

The study considers the problem of estimating incidence of a non remissible infection (or disease) with possibly differential mortality using data from a(several) cross-sectional prevalence survey(s). Fitting segmented polynomial models is proposed to estimate the incidence as a function of age, using the maximum likelihood method. The approach allows automatic search for optimal position of knots, and model selection is performed using the Akaike information criterion. The method is applied to simulated data and to estimate HIV incidence among men in Zimbabwe using data from both the NIMH Project Accept (HPTN 043) and Zimbabwe Demographic Health Surveys (2005-2006). Copyright © 2016 John Wiley & Sons, Ltd.