The role of maternal ideations on breastfeeding practices in northwestern Nigeria: a cross-section study.

Background: Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices.

What are we learning about HIV testing in informal settlements in KwaZulu-Natal, South Africa? Results from a randomized controlled trial.

Background: Recent evidence highlighting high HIV incidence and prevalence in informal settlements suggests that they are environments that foster HIV risk. Given growing urbanization in sub-Saharan Africa, there is a critical need to assess the successes and challenges of implementing HIV testing, prevention and treatment interventions in these contexts.

Methods: We randomly selected a household-based sample of 1528 adult men (18-35) and women (18-24) living in 18 randomly selected communities in KZN, South Africa.

Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: a cross-sectional analysis.

Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019.

Understanding family planning outcomes in northwestern Nigeria: analysis and modeling of social and behavior change factors.

Background: Northwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval.

Depressive symptoms, HIV-related stigma and ART adherence among caregivers of children in vulnerable households in rural southern Malawi.

Background: Few studies have explored the association between depressive symptoms, HIV infection and stigma in vulnerable populations. The objective of this study is to examine factors associated with depressive symptoms among caregivers living in vulnerable households in Malawi and assess how reported depressive symptoms and other factors affect ART adherence among caregivers who report testing positive for HIV and currently on ART.

Methods: We interviewed 818 adult caregivers of children aged 0-17 years living in vulnerable households in 24 health facility catchment areas in five districts in rural southern Malawi in 2016-2017.

Assessment of an adolescent-girl-focused nutritional educational intervention within a girls' empowerment programme: a cluster randomised evaluation in Zambia.

Objective: Adolescent girls are at risk for both macro- and micronutrient deficiencies affecting growth, maternal and child health. This study assessed the impact of an adolescent-girl-tailored nutritional education curriculum on nutritional outcomes, including knowledge, dietary behaviour, anthropometry and anaemia.

Design: A cluster-randomised evaluation was conducted with two study arms: girls in mentor-led weekly girls' groups receiving sexual and reproductive health and life-skills training assigned to an age-appropriate nutritional curriculum and control girls in the weekly girls' groups without the nutritional education.

The impact of the Adolescent Girls Empowerment Program (AGEP) on short and long term social, economic, education and fertility outcomes: a cluster randomized controlled trial in Zambia.

Background: Adolescent girls in Zambia face risks and vulnerabilities that challenge their healthy development into young women: early marriage and childbearing, sexual and gender-based violence, unintended pregnancy and HIV. The Adolescent Girls Empowerment Program (AGEP) was designed to address these challenges by building girls' social, health and economic assets in the short term and improving sexual behavior, early marriage, pregnancy and education in the longer term. The two-year intervention included weekly, mentor-led, girls group meetings on health, life skills and financial education.

Transitions to adulthood and the changing body mass index of adolescent girls in Zambia.

Adolescent girls in low- and middle-income countries often experience several important life transitions, including school-leaving, marriage, and childbearing. Understanding how these transitions are associated with changes in the nutritional status of adolescent girls and young women (AGYW) is crucial for programs that aim to improve nutritional outcomes among youth and promote healthy transitions to adulthood. We investigated the associations between adolescent transitions and body mass index (BMI) among a cohort of 4887 adolescent girls in Zambia aged 10-19 years when first interviewed in 2013.

Does schooling protect sexual health? The association between three measures of education and STIs among adolescents in Malawi.

While multiple studies have documented shifting educational gradients in HIV prevalence, less attention has been given to the effect of school participation and academic skills on infection during adolescence. Using the Malawi Schooling and Adolescent Study, a longitudinal survey that followed 2,649 young people aged 14-17 at baseline from 2007 to 2013, we estimate the effect of three education variables: school enrolment, grade attainment, and academic skills-numeracy and Chichewa literacy-on herpes simplex virus type 2 (HSV-2) and HIV incidence using interval-censored survival analysis. We find that grade attainment is significantly associated with lower rates of both HSV-2 and HIV among girls, and is negatively associated with HSV-2 but not HIV among boys.

Evidence-Based Process for Prioritizing Positive Behaviors for Promotion: Zika Prevention in Latin America and the Caribbean and Applicability to Future Health Emergency Responses.

Since the 2015 Zika outbreak in Latin America and the Caribbean, a plethora of behavior change messages have been promoted to reduce Zika transmission. One year after the United States Agency for International Development (USAID) initiated its Zika response, more than 30 variants of preventive behaviors were being promoted. This situation challenged social and behavior change (SBC) programming efforts that require a coordinated response and agreed upon set of focus behaviors to be effective.

"When He Asks for Sex, You Will Never Refuse": Transactional Sex and Adolescent Pregnancy in Zambia.

Pregnancy among adolescent girls in Zambia is a significant concern on its own and as a factor in school dropout and early marriage, with one-third of girls aged 15-19 having experienced pregnancy. Using qualitative and quantitative data from the Adolescent Girls Empowerment Program, we explore transactional sex as a driver of adolescent pregnancy. In qualitative interviews, transactional sex was repeatedly discussed as the main driver of pregnancy, as respondents indicated that when a girl feels that she "owes" a man sex, it prevents her from declining sex or using condoms.

Cluster randomized evaluation of Adolescent Girls Empowerment Programme (AGEP): study protocol.

Background: Adolescents in less developed countries such as Zambia often face multi-faceted challenges for achieving successful transitions through adolescence to early adulthood. The literature has noted the need to introduce interventions during this period, particularly for adolescent girls, with the perspective that such investments have significant economic, social and health returns to society. The Adolescent Girls Empowerment Programme (AGEP) was an intervention designed as a catalyst for change for adolescent girls through themselves, to their family and community.

Performance of Kalon herpes simplex virus 2 assay using dried blood spots among young women in Uganda.

The study evaluated the performance of the Kalon HSV-2 assay on dried blood spots (DBS) of various dilutions compared with plasma from young women aged 18-24 years in Uganda. We estimated the sensitivity and specificity of three DBS dilutions using plasma as the reference. All three evaluated DBS dilutions yielded low sensitivities and specificities with DBS 1:2 yielding the highest concurrence.

Randomized evaluation and cost-effectiveness of HIV and sexual and reproductive health service referral and linkage models in Zambia.

Background: Provision of HIV prevention and sexual and reproductive health services in Zambia is largely characterized by discrete service provision with weak client referral and linkage. The literature reveals gaps in the continuity of care for HIV and sexual and reproductive health. This study assessed whether improved service delivery models increased the uptake and cost-effectiveness of HIV and sexual and reproductive health services.

Women's Perceptions and Misperceptions of Male Circumcision: A Mixed Methods Study in Zambia.

Women's perceptions of male circumcision (MC) have implications for behavioral risk compensation, demand, and the impact of MC programs on women's health. This mixed methods study combines data from the first two rounds of a longitudinal study (n = 934) and in-depth interviews with a subsample of respondents (n = 45) between rounds. Most women correctly reported that MC reduces men's risk of HIV (64% R1, 82% R2).

Behavior change pathways to voluntary medical male circumcision: narrative interviews with circumcision clients in Zambia.

As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets.

Acceptability of the Nestorone®/ethinyl estradiol contraceptive vaginal ring: development of a model; implications for introduction.

Objectives: Develop and test a theoretical acceptability model for the Nestorone®/ethinyl estradiol contraceptive vaginal ring (CVR); explore whether domains of use within the model predict satisfaction, method adherence and CVR continuation.

Study Design: Four domains of use were considered relative to outcome markers of acceptability, that is, method satisfaction, adherence and continuation. A questionnaire to evaluate subjects' experiences relative to the domains, their satisfaction (Likert scale) and adherence to instructions for use was developed and administered to 1036 women enrolled in a 13-cycle Phase 3 trial.

Making the cut: evidence-based lessons for improving the informed consent process for voluntary medical male circumcision in Swaziland and Zambia.

The informed consent (IC) process for voluntary medical male circumcision (VMMC) was evaluated in Zambia and Swaziland as VMMC programs scaled up. In-depth interviews (IDIs) were conducted with clients 1 week after surgery to explore understanding of IC and gauge how expectations of MC surgery compared to actual experiences. In Zambia, key opinion leaders (KOLs) were also interviewed.

Using biomarkers to assess the validity of sexual behavior reporting across interview modes among young women in Kampala, Uganda.

Understanding the transmission dynamics of HIV and other sexually transmitted infections is critically dependent on accurate behavioral data. This study investigates the effect of the mode of questionnaire delivery on the quality of sexual behavior reporting in a 2010 survey conducted in Kampala, Uganda, among 18-24-year-old women. We compare the reported prevalence of five sexual outcomes across three interview modes: traditional face-to-face interviewing (FTFI) in which question rewording was permitted, FTFI administered via computer-assisted personal interviewing (CAPI) in which questions were read as written, and audio computer-assisted self-interviewing (ACASI) in which participants listened to prerecorded questions and entered responses using a computer touchscreen.

Challenges in measuring the sequencing of life events among adolescents in Malawi: a cautionary note.

Using data from two rounds of the Malawi Schooling and Adolescent Survey, this research note examines consistency of retrospective reporting on the timing and sequencing of sexual initiation, school leaving, and marriage. The analysis, which compares reporting of events both within and between rounds, indicates substantial inconsistency in reporting of event sequences and highlights difficulties in measuring transitions to adulthood in sub-Saharan Africa with survey data.

Herpes simplex virus type 2 cross-sectional seroprevalence and the estimated rate of neonatal infections among a cohort of rural Malawian female adolescents.

Objective: To assess herpes simplex virus type 2 (HSV-2) seroprevalence among rural Malawian adolescent women and estimate the number of neonatal herpes infections among infants of these adolescents.

Methods: A longitudinal cohort study of adolescents (14-16 years at entry) residing in rural Malawi was initiated in 2007 with annual observation. HSV-2 testing was introduced in 2010.

The effect of school status and academic skills on the reporting of premarital sexual behavior: evidence from a longitudinal study in rural Malawi.

Purpose: Reliable data on sexual behavior are needed to identify adolescents at risk of acquiring human immunodeficiency virus or other sexually transmitted diseases, as well as unintended pregnancies. This study aimed to investigate whether schooling status and literacy and numeracy skills affect adolescents' reports of premarital sex, collected using audio computer-assisted self-interviews.

Methods: We analyzed data on 2,320 participants in the first three rounds of the Malawi Schooling and Adolescent Study to estimate the level of inconsistency in reporting premarital sex among rural Malawian adolescents.

Social desirability bias in sexual behavior reporting: evidence from an interview mode experiment in rural Malawi.

Context: Social desirability bias is problematic in studies that rely on self-reported sexual behavior data. Where gender norms create different expectations about socially acceptable behavior, males and females face distinct pressures in reporting certain outcomes, which can distort assessments of risk for HIV and STIs.

Methods: In 2009, relationship and sexual behavior data were collected from 1,750 never-married males and females aged 16-18 via audio computer-assisted self-interviewing (audio-CASI) during the third round of the Malawi Schooling and Adolescent Study.