Sterility in zambia.

BACKGROUND: Several regions such as Zambia in sub-Saharan Africa experience very high levels of sterility. Current explanations for high levels of sterility in Zambia have focused on biological determinants and have paid little attention to the plausible effects of social determinants of sterility. AIM: This study has two objectives. The first objective is to examine the extent of sterility in Zambia during 1980 and 1990. The second objective is to assess the contribution of selected social determinants to the current levels of sterility in Zambia. SUBJECTS AND METHODS: Sterility among women in Zambia is calculated for two periods in 1980 and 1990 using census data. The study used parity progression ratios for the calculation of sterility rates. Selected social determinants of Zambian sterility were obtained from the Demographic Health Survey (ZDHS). Net effects of selected social determinants were examined using logistic regression. RESULTS: High sterility levels were found in a few Zambian Provinces. During 1980 and 1990, the rates for North Western, Eastern and Western provinces remained considerably higher than for other Zambian provinces. It was found that social level variables remained strong and significant even after controlling for the effects of incidence of biological factors such as sexually transmitted diseases (STDs). CONCLUSIONS: The findings of the study support the importance of developing social policies for eradicating sterility. The argument that sterility is biological and that it is not amenable to social interventions perhaps needs revision in the light of the findings of this study.

Sexual activity among Zambian female teenagers: the role of interpersonal skills.

This study examined the relationship between interpersonal skills and sexual activity among female adolescents in Zambia. Data from 390 females in seven schools were analyzed. Results indicated that the inability to say no was associated with coital and noncoital sexual activity. The findings suggest that family planning programs should consider the role of interpersonal skills in controlling adolescent fertility.

Old age support in China: the role of the state and the family.

This study investigates the relationship between some support factors and the well-being of the elderly in China. The analytical models identify and compare the effects of each type of factor on the sense of well-being of elderly Chinese across rural and urban settings. Pension, health care, size of family, and living arrangements are the factors found to be significantly related to the perception of happiness among aged people in general. The strength of the effects of children and living arrangements varies depending on places of residency. The findings indicate the continuous role of the family support, and the increasingly important role of state support in promoting a sense of well-being among elderly Chinese.

Sexual activity among junior secondary school girls in Zambia.

This paper proposes a causal model of sexual activity among a randomly selected sample of 305 Junio secondary school girls in Zambia. The results indicate that liberal sexual attitudes influence romantic involvement with boys. Emotional involvement is likely to result in sexual activity. Traditional courtship forms are slowly being replaced by modern patterns of courtship behaviour. Policy and programme implications are discussed.

PIP: The initiation of sexual activity in Zambia often involves initial puberty rites followed by a brief period of courting which leads to family-influenced and -arranged marriages. However, the advent of modern education and mass schooling has reduced the family's and community's ability to regulate sexual activity among adolescents, while the duration of courtship has lengthened considerably due to the postponement of marriage. The likelihood of sexual activity increases with an increase in involvement with members of the opposite sex. The authors propose a causal model of sexual activity among a randomly selected sample of 305 junior secondary schoolgirls in Zambia. Liberal sexual attitudes were found to influence romantic involvement with boys, with emotional involvement likely to result in sexual activity. Traditional courtship forms are slowly being replaced by modern patterns of courtship. Policy and program implications are discussed.

Age effects on infant mortality controlling for race: a meta-analytical study.

The relationship between teenage fertility and infant mortality has been a controversial issue for some time. From a policy point of view, it is crucial to understand the nature of this relationship given that pregnancy among teenagers is on the rise globally. This study conducted a meta-analysis of the relationship between maternal age and infant mortality. Two important determinants, race and age, were considered; no evidence of a systematic relationship between age and infant mortality rates was found. The policy implications of this finding are considered.

PIP: A meta-analysis of the association between maternal age and infant mortality failed to substantiate any systematic relationship. A search of the published literature revealed 13 US studies that provided data on maternal age, maternal race, and the infant, neonatal, and perinatal mortality rates. The covariation between maternal age and mortality rates varied considerably, partly because of sampling variability. Moderated regression analyses indicated that, although age was not a significant determinant of mortality, race exerted a significant influence. Among teenagers, infant mortality rates were significantly higher among African-Americans and Hispanics than Whites, perinatal mortality was significantly lower for Hispanics than Whites, and neonatal mortality was significantly lower among African-Americans than Whites. Inability to control for socioeconomic status may have been a factor in these findings, however. These results suggest that programs for reducing infant mortality that target teenagers on the basis of age alone may risk overlooking the impact of race and other social factors. A broad-based socioeconomic approach, targeting lower-income pregnant women regardless of age and race, is recommended.

Age at menarche among adolescent females in Zambia: implication for family formation.

This study examines the relationships between age at menarche and two fertility related variables, expected age at marriage and expected number of children. The random sample consists of 525 secondary school-going females in the age range 13-21 years from the Copperbelt and Lusaka Central Provinces in Zambia. It was found that the age of menarche ranged from 10 to 18 years with a mean of 14.2 + 1.4 (mean + SD) years. The association between age at menarche and expected age at marriage was found to be weak but positive. Furthermore, the association of age at menarche with expected number of children was found to be weak but in the negative direction.

Men and family planning: toward a policy of male involvement.

PIP: The stated aim of this discussion is to examine the extent of male use of family planning and the nature of men's role in family planning in developing countries. Case studies are presented which are successful examples of strategies for involving men in family planning. Policies that aim to increase male involvement must be sensitive to cultural values, apply to a decentralized government approach toward information and supplies, include adequate political will, and consider the costs and benefits of changing values. A male family planning policy would not always be compatible with all fertility values in developing countries or traditional values of the older population. A policy should stress the value of male individuals contributing as much as possible for their own and others' welfare. Community participation is considered important in order to create a feeling of mutual support. A sizeable investment will be required for mass distribution of contraceptive information. Schools are viewed as an ideal place for educating youth about the problems of high fertility and about use of family planning methods, such as the condom. Religious organizations should be used to educate people about responsible parenthood and to minimize barriers to use of modern contraception. Comic books on how to use condoms are suggested as a good source. Local authorities who are trusted are useful in influencing acceptance among local populations. Local personnel may be trained as information disseminators. Adequate contraceptive information needs to be supplied to a wide audience. Lack of supply and inadequate information are given as two key reasons for insufficient use of male contraception. Condoms should be priced to be affordable to the average person and free to those with no income. Program strategies that proved successful are cited for Thailand's Mechai Viravaidya program and Bali's grass-roots program. The vasectomy program in Bangladesh is also noted for its success. Low levels of condom use are attributed to factors such as price, education, availability, accessibility, culture, religion, and economic conditions. Male sterilization levels can be enhanced with wider availability of clinics and provision of correct information for challenging beliefs that vasectomy is a form of castration.^ieng

Male college students and family planning use in Zambia.

PIP: The success of family planning depends on attitudes and knowledge about contraception. In this study, the correlation between ever use of contraception and health attitudes among men was assessed. 65 male participants were randomly selected from residence halls on the University of Lusaka campus in Lusaka, Zambia. Students reflected a diverse ethnic mix. The findings indicated that only 37.5% had approval from ethnic traditions for contraceptive use. Chi square tests rejected the null hypothesis that there is no relationship between the variables "ever use" and "ethnic orientation." 52.5% who reported ever use of contraception were juniors or seniors, which indicated little difference by level of education and ever use. Family planning ever use due to health reasons was reported by 70% of participants. These findings support the research of Manda on noncollege populations about use of condoms. College students do have favorable attitudes toward contraception and toward health. This research supports the public education campaign of the Ministry of Health to promote the practice of safe sex for health reasons and the prevention of AIDS, a widespread problem in Zambia.^ieng

Teenage sexual activity in Zambia: the need for a sex education policy.

Data from a study of teenage sexual activity among secondary school girls show the need for a sex education policy as a first step in controlling teenage fertility in Zambia. A large proportion of teenage females enter into close relationships with males at young ages and a high proportion of young females have engaged in sexual intercourse. Most of these sexually active females do not use family planning methods even though a large proportion of them have heard of modern methods. The teenagers receive very little sex education from their parents and a modern institutional sex education programme is needed.

PIP: The need for sex education was determined on the basis of information gleaned from a survey of 516 female high school students aged 13-20 years in urban provinces of Lusaka-Central and Copperbelt, Zambia. The aim of the survey was to assess the prevalence of sexual activity, the extent of knowledge of modern family planning (FP) methods, and the role of parents in educating their children about sexuality. The results showed that 71% had boyfriends of which 67% had a steady or close relationship. 48% of the sample were considered to be at high risk of sexual intercourse. Sexual activity in the 2-month period preceding the survey was reported as 27.3% for "rarely or more often." 31% of 17 years olds had engaged in intercourse; this compares with a Nairobi, Kenya, survey of secondary school females with 23.8% reporting on active sex life and a Nigerian study with 28% reporting sexual activity. 33% of 13 and 16 year olds and 24% of 17 and 20 year olds had intercourse more than very rarely. A statistically significant relationship was found between age and likelihood of intercourse. 94% had never used modern FP methods. 30% felt it was easy to discuss sexual matters with their mothers and 77% felt it was difficult to discuss sexual matters with their fathers. 65% had heard of modern FP methods; more were in the older age groups than younger age groups. Only 46% had gone through the formal initiation ceremony, which provides the traditional methods of sex education. The extent of premarital sexual activity, the limited communication with parents, the limited use of contraception, and the decline in traditional ceremonies points to the need for school-based sex education classes. The aim would be to improve parent-teenager communication and to provide reliable and accurate information. Birth control information and access need to be made available to unmarried women as a means for women to control their fertility and reduce the spread of sexually transmitted diseases. Zambian laws must be changes to reflect these needs.

Men and family planning in Zambia.

This paper examines the sociodemographic factors which influence familiarity with methods of family planning among 85 males holding low paying jobs in the University of Zambia, Lusaka. The results showed that wife's education had a significant and positive effect on husband's familiarity with family planning methods. In the longer term, female education is likely to emerge as an important factor in the onset of fertility decline in Zambia.

PIP: Communication between marriage partners is one way men become familiar with family planning (FP). In this study the role of women's education in husband's familiarity with FP methods is examined among 85 low income (around 4464 kwacha average annual income) male employees of the University of Zambia. The men in the sample were all literate and most were non-Catholic. Wife's work status, husband's monthly income, husband's education, desire for more children, religious affiliation, and urban born were control variables. The findings were that the pill and the IUD were the best-known female methods. 22% knew about condoms, and 8% about vasectomy, but 70% were familiar with abstinence, which is widespread as a traditional FP method among Africans. 78% communicated with their partners about FP and 47% spoke with friends about FP. 29% considered FP a women's responsibility. 44% thought that their mothers would approve of FP use. In the regression analysis, wives' education and religion were significantly related to familiarity of FP methods (p.05). Familiarity increased with increases in wives' level of education. Wives' education was related to use of family planning, i.e., 36% of women with a primary education used FP compared with 12% of women with primary or less education. The government of Zambia encourages modern family planning for child spacing and fertility control. Successful policy implementation will depend on the extent to which women's education is recognized as important in promoting modern methods. Deterrents to modern contraceptive use are the existing laws which require married women to have their husband's permission to obtain contraceptives from clinics. Creating easier access to FP among women is likely to increase familiarity of FP among husbands and equal sharing in decision making about contraception.

Immunisation coverage in Lusaka, Zambia; implications of the social setting.

This paper develops a conceptual framework for examining the process of immunisation and explores the sociodemographic determinants of vaccination in Zambia. About 300 mothers with children under 3 years of age were interviewed in urban Lusaka. The analyses suggest that sociostructural, as well as cultural, processes influence the attrition process and immunisation programmes should focus on the uniqueness of each stage. In addition, programmes to improve women's education and to reduce male gender preferences are needed.

PIP: Data from 277 low income mothers in Lusaka, Zambia were analyzed to determine the effect certain biosocial variables had on immunization coverage of 3-year old children. About 90% began the immunization schedule but the % fell consistently up to DPT3. Only about 48% were fully immunized. 70% of infants in each birth cohort received all the vaccinations except for measles. The largest dropout percentage occurred before the measles shot. The 1985 birth cohort represented the largest percentage not immunized against measles (about 35%), but they had the highest overall rates of immunization. The 1986 birth cohort had the lowest immunization rates. Increased educational levels of mothers increased the chances of immunization. In addition, all children of mothers working outside the home were vaccinated against some diseases compared with 12./5% of children of mothers who do not work outside the home who received no vaccinations. Among children with some immunization, boys tended to have received more vaccinations than girls. Girls were 2.32 times more likely to have received the BCG than boys, but were also more likely to stop at this stage this stage than boys. Boys were more likely than girls to stop at the 3rd stage. Other than the 2nd stage, attrition rates for girls were always lower than for boys. Further lower attrition rates were tied in with higher levels of education. Younger mothers were more likely to have their children who had received a BCG vaccination return for the DPT1 vaccination than older mothers, but age did not influence immunization converge at other stages. These results suggest that immunization programs should focus on improving the chance of vaccination at each stage, especially the last stage. They also highlight the need for these programs to improve women's education and reduce son preferences.

Teenage fertility in developing countries.

PIP: Data were taken from "A Compilation of Age Specific Fertility Rates for Developing Countries" (US Bureau of Census, 1979) to compile a detailed profile of teenage fertility in developing countries as a basis for designing policies at an international level. Of the 127 countries for which data were available, 65 countries which had data for circa 1965 and 1970 were considered for this analysis. In 1960, the average number of births/1000 women aged 15-19 years was 116; in 1965 the average was 106. There was considerable variation in teenage fertility rates among countries in the developing world. The coefficients of variation of the number of births/1000 women aged 15-19 years were 47% in 1960 and approximately 44% in 1965. Both the Asian and African regions contained countries with very low teenage fertility rates, 31/1000 women aged 15-19 years in 1960. The lowest 1960 rate for Latin American countries was 50/1000. The largest proportion of all births in 1960 occurred in Latin America, 38%. The countries of Oceania contributed the smallest, 7.2% of the total teen births in 1960. Teenage fertility rates declined in all regions during 1960-65. The analysis of teen fertility rates of developing countries reveals several problematical aspects which have implications for policy formulation, including: the teen fertility rates of developing countries are very high relative to developed nations; and despite the fact that Africa and Latin America have higher teen fertility levels compared to the rest of the developing world, few international agencies have targeted Africa and Latin America as priorities for birth control activities.^ieng

Subvalvar aneurysms of the left ventricle.

Five cases of subvalvar aneurysm of the left ventricle are reported. The location of the aneurysm was sub-mitral in three and sub-aortic in two. The clinical, echocardiographic, angiocardiographic and pathological features are described.