Differences in condom access and use and associated factors between persons with and without disabilities receiving social cash transfers in Luapula province, Zambia-A cross-sectional study.

Persons with disabilities are disadvantaged in accessing sexual and reproductive health services, including condoms. In this study, we investigated whether condom access and use and their associated factors differed between persons with and without disabilities. We used data from adults in households receiving the Government of Zambia social cash transfers (SCT) in four districts of Luapula province. Condom access and use was the outcome. Disability, defined by the Washington Group Short Set Questions on Disability, was the main predictor. We performed logistic regression analyses to determine the associations between condom access and use and disability. In multivariable analyses, we controlled for covariates including age, sex, marital status, poverty status, HIV testing, and receiving the SCT. The sample comprised 1,143 people aged 16-49, with a median age of 21 years (interquartile range 18-28); 57.4% (n = 656) were female, 86.5% (n = 989) accessed and used condoms, and 17.9% (n = 205) were disabled, rating themselves with a 3 or a 4 on a scale of 1 = "not limited" to 4 = "cannot at all" in performing any of the six daily functions (seeing, hearing, walking, cognition, self-care, or communicating). Nearly sixty percent(58.5% (n = 120)) of persons with disabilities were female, 79.5% (n = 163) reported being very poor, 87.8% (n = 180) reported receiving SCT, and 86.3% (n = 177) reported accessing and using condoms. Condom access and use did not differ between persons with and without disabilities (adjusted odds ratio: 1.09; 95% confidence interval [CI]: 0.60-1.98]). We found no differences between persons with and without disabilities in condom access and use. We established that individual-level factors such as age, sex, marital status, and knowledge of being HIV positive might play a more important role in condom access and use than disability. Condom promotion interventions should account for these factors.

Associations of Sustainable Development Goals Accelerators With Adolescents' Well-Being According to Head-of-Household's Disability Status-A Cross-Sectional Study From Zambia.

Objectives: We examined associations between accelerators (interventions impacting ≥2 SDG targets) and SDG-aligned well-being indicators among adolescents 16-24 years old in Zambia. Methods: We surveyed adults from 1,800 randomly sampled households receiving social cash transfers. We examined associations between accelerators (social cash transfers, life-long learning, mobile phone access) and seven well-being indicators among adolescents using multivariate logistic regressions. Results: The sample comprised 1,725 adolescents, 881 (51.1%) girls. Mobile phone access was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p < 0.001), informal cash transfers (aOR 1.82, p = 0.004), and seeking mental health support (aOR 1.61, p = 0.020). Social cash transfers were associated with no disability-related health restrictions (aOR 2.56, p = 0.004) and lesser odds of seeking mental health support (aOR 0.53, p = 0.029). Life-long learning was associated with informal cash transfers (aOR 3.49, p < 0.001) and lower school enrollment (aOR 0.70, p = 0.004). Adolescents with disabled head-of-household reported worse poverty, good health but less suicidal ideation. Conclusions: Social cash transfers, life-long learning, and mobile phone access were positively associated with well-being indicators. Adolescents living with disabled head-of-household benefited less. Governments should implement policies to correct disability-related inequalities.

Facing the quality of life: physical illness, anxiety, and depression symptoms among people living with HIV in rural Zambia - a cross-sectional study.

Widespread access to ART has not improved the quality of life (QoL) for people living with HIV (PLHIV). We used the United Nations Disability project (UNPRPD) evaluation data to examine how physical illness, anxiety, and depression shape the QoL of PLHIV in households receiving the social cash transfers safety nets in Luapula, Zambia. We explored associations between each outcome - physical illness, anxiety, depression symptoms - and age, gender, poverty, hunger and disability, using univariable and multivariable regressions. We adjusted p-values for multiple hypothesis testing with sharpened Qs. The sample comprised 1925 respondents 16-55 years old, median age 31 (IQR 22-42 years), majority women (n = 1514, 78.6%). Two-thirds (1239, 64.4%) reported having a physical illness, a third (671, 34.9%) anxiety, and nine per cent (366) depression symptoms. More HIV positive people had a disability (34.6%, 53 versus 28.3%, 502; Q = 0.033), were physically ill (72.5%, 111 versus 63.7%, 1128; Q = 0.011), and two-fold (aOR 1.97 95% CI 1.31-2.94) more likely to report depression symptoms than HIV negative peers. Food insecurity and disability among PLHIV may worsen their physical illnesses, anxiety, depression symptoms, and other QoL domains. More research on the quality of life of PLHIV in poverty is required.

Women with disabilities in hearing: the last mile in the elimination of mother-to-child transmission of HIV - a cross-sectional study from Zambia.

This article explored the differences in HIV testing in the elimination of mother-to-child transmission of HIV (EMTCT) between women with and without disabilities aged 16-55 years, reported being pregnant and receiving the social cash transfers (SCT) social safety nets in Luapula province, Zambia. We tested for associations between HIV testing in EMTCT and disability using logistic regression analyses. We calculated a functional score for each woman to determine if they had mild, moderate or severe difficulties and controlled for age, intimate partner sexual violence, and the SCT receipt. Of 1692 women, 29.8% (504) reported a disability, 724 (42.8%) mild, 203 (12.0%) moderate, and 83 (4.9%) severe functional difficulties (adjusted odds ratio [aOR] 1.33; 95% confidence interval [CI] 1.04-1.70). Women with moderate (aOR 2.04; 95% CI 1.44-2.88) or mild difficulties (aOR 1.66; 95% CI 1.32-2.08) or with a disability in cognition (aOR 1.67 95% CI 1.22-2.29) reported testing more for HIV than women without disabilities; Women with a disability in hearing (aOR 0.36 CI 0.16-0.80) reported testing less for HIV. Disability is common among women receiving the SCT in the study area accessing HIV testing in the EMTCT setting. HIV testing in EMTCT is challenging for women with disabilities in hearing.

Does money buy happiness? Evidence from an unconditional cash transfer in Zambia.

The relationship between happiness and income has been at the center of a vibrant debate, with both intrinsic and instrumental importance, as emotional states are an important determinant of health and social behavior. We investigate whether a government-run unconditional cash transfer paid directly to women in poor households had an impact on self-reported happiness. The evaluation was designed as a cluster-randomized controlled trial in rural Zambia across 90 communities. The program led to a 7.5 to 10 percentage point impact on women's happiness after 36- and 48-months, respectively (or 0.19-0.25 standard deviations over the control group mean). In addition, women have higher overall satisfaction regarding their young children's well-being, including indicators of satisfaction with their children's health and positive outlook on their children's future. Complementary analysis suggests that self-assessed relative poverty (as measured by comparison to other households in the community) is a more important mediator of program effects on happiness than absolute poverty (as measured by household consumption expenditures). Although typically not the focus of such evaluations, impacts on psychosocial indicators, including happiness, should not be discounted as important outcomes, as they capture different, non-material, holistic aspects of an individual's overall level of well-being.

Can unconditional cash transfers raise long-term living standards? Evidence from Zambia.

In Africa, state-sponsored cash transfer programs now reach nearly 50 million people. Do these programs raise long-term living standards? We examine this question using experimental data from two unconditional cash transfer programs implemented by the Zambian Government. We find far-reaching effects of the programs both on food security and consumption as well as on a range of productive outcomes. After three years, household spending is on average 67 percent larger than the value of the transfer received, implying a sizeable multiplier effect, which works through increased non-farm activity and agricultural production.

Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia.

There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes; however, questions remain surrounding design features responsible for impacts. In addition, virtually no evidence exists from the African region. This study explores the impact of Zambia's Child Grant Program on a range of maternal health utilization outcomes using a randomized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012. Results indicate that while there are no measurable program impacts among the main sample, there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services. The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar settings to impact maternal health.

The Social and Productive Impacts of Zambia's Child Grant.

Accumulated evidence from dozens of cash transfer programs across the world suggest that there are few interventions that can match the range of impacts and cost-effectiveness of a small, predictable monetary transfer to poor families in developing countries. However, individual published impact assessments typically focus on only one program and one outcome. This article presents two-year impacts of the Zambian Government's Child Grant, an unconditional cash transfer to families with children under age five, across a wide range of domains including consumption, productive activity and women and children's outcomes, making this one of the first studies to assess both protective and productive impacts of a national unconditional cash transfer program. We show strong impacts on consumption, food security, savings and productive activity. However, impacts in areas such as child nutritional status and schooling depend on initial conditions of the household, suggesting that cash alone is not enough to solve all constraints faced by these poor, rural households. Nevertheless, the apparent transformative effects of this program suggest that unconditional transfers in very poor settings can contribute to both protection and development outcomes.

The impact of Zambia's unconditional child grant on schooling and work: results from a large-scale social experiment.

This paper reports the impact on child schooling and work of the Government of Zambia's Child Grant Program (CGP), an unconditional cash transfer program targeted to households with children under age 3 years in three districts of the country. Although the CGP's focus is on very young children, we look to see if the program has impacts on older children who are not the explicit target group. We use data from a large-scale social experiment involving 2,519 households, half of whom were randomized out to a delayed-entry control group, that was implemented to assess the impact of the program. We find that the CGP has no discernable impact on school enrollment of children age 7-14. However when we break the sample by older (11-14) and younger (7-10) children - based on the grade structure of the Zambian schooling system - we find a significant impact among children age 11-14 which coincided with the exact age range where sharp drop-out begins to occur in Zambia with point estimates in the range of 7-8 percentage points. Finally, we provide evidence on the potential pathways through which the unconditional cash transfer impacts on enrollment. Households in the CGP spend more on education, and in particular on uniforms and shoes, two items cited as key barriers to school enrollment in study areas.

The effect of food insecurity on mental health: panel evidence from rural Zambia.

A growing number of studies show support for a positive association between food insecurity and poor mental health in developing countries. Few of these studies, however, explore the relationship statistically employing longitudinal data. This study combines ethnography with randomly sampled household-level panel data (two waves) collected in 2009 to examine the association between food insecurity and mental health in rural Zambia. Mental health was measured using the Self-Reporting Questionnaire and food insecurity was assessed utilizing a modified 7-item scale based on local coping strategies used during food shortages. A multilevel linear regression model was employed with repeated measures nested within individuals (N = 280 observations) living in 81 households nested within 16 villages. Regression results confirm the postulated positive association between poor mental health and food insecurity. Food insecurity during the dry season, the time of year in rural Zambia when many households are typically food secure, had a subsequent greater effect on mental health than food insecurity during the rainy season. The difference in the effect was statistically significant at the five-percent level. In a country where mental health care resources are severely lacking, policy and applied efforts aimed at improving access to key agricultural resources, thereby increasing agricultural output, could potentially produce beneficial mental health outcomes.