Adoption of safe water behaviors in Zambia: comparing educational and motivational approaches.

CONTEXT: In the developing world, drinking water is an important route for transmission of diarrheal disease, a leading cause of morbidity and mortality in children. OBJECTIVES: In Field Trial 1 (FT1) and Field Trial 2 (FT2), the effectiveness of the behavior change approach known as motivational interviewing (MI) was compared to the standard practice of health education alone in initiating and sustaining safe water treatment and storage behavior among community residents. In Field Trial 3 (FT3), MI was compared with social marketing. DESIGN: Community surveys were conducted prior to local health promoter training and at follow-up. SETTING AND PARTICIPANTS: Low socioeconomic status peri-urban communities in Zambia were project sites. Local volunteer health promoters from communities were trained in an adaptation of MI for safe water treatment and storage. INTERVENTIONS: All health promoters received instruction in the causes and prevention of diarrhea. Health promoters in the experimental (MI) groups received MI training. MAIN OUTCOME MEASURES: FT1 and FT3 measured detectable disinfectant levels in stored household water. FT2 measured disinfectant sales. FINDINGS: No significant differences between the treatment groups were found in FT1. Subsequent MI training incorporated lessons learned from the previous trial and resulted in much higher purchase rates of the disinfectant (FT2) and levels of disinfectant in stored household water (FT3) in the MI group. CONCLUSION: MI appears promising for public health initiatives in the developing world. Further research to improve and refine the method is needed.

Factors that determine utilization of modern contraceptives in East, Central and southern Africa.

A cross-sectional study to determine modern contraceptives utilization among women aged between 15 and 19 years was performed between September and October, 1991 in 5 countries of East Central and Southern Africa. The study involved both rural and urban area of Kenya, Uganda, Mauritius, Swaziland and Zambia. A total of 4513 women were interviewed of whom 2418 (53.6%) were from the urban areas while 2096 (46.4% were from the rural areas. The percentage distribution of contraceptive users was 33.2% in urban and 48.9% in rural areas. The proportion of users of traditional/natural contraception was 38.5%. Overall the prevalence of contraceptive use was 29.5%. Thus the natural/traditional methods were most popular in the region. The user rate of modern contraceptive methods ranged from 6.8% for Zambia to 60% for Mauritius. The study revealed that contraceptive prevalence rates were higher among women in urban areas (60%) than in rural areas (40%). The main factors influencing contraceptive use in order of importance included distance from residence to clinics, level of education attained, parity, marital status, approval by husbands/boyfriends and knowledge of family planning methods. Contraceptive use was highest in the age group of 20 to 34 years while it was lowest among young women aged 15-19 years.

Factors that Determine Utilisation of Mordern Contraceptives in East; Central and Southern Africa

A cross-sectional study to determine modern contraceptives utilization among women aged between 15 and 19 years was performed between September and October; 1991 in 5 countries of East Central and Southern Africa. The study involved both rural and urban area of Kenya; Uganda; Mauritius; Swaziland and Zambia. A total of 4513 women were interviewed of whom 2418 (53.6) were from the urban areas while 2096 (46.4were from the rural areas. The percentage distribution of contraceptive users was 33.2in urban and 48.9in rural areas. The proportion of users of traditional/natural contraception was 38.5. Overall the prevalence of contraceptive use was 29.5. Thus the natural/traditional methods were most popular in the region. The user rate of modern contraceptive methods ranged from 6.8for Zambia to 60for Mauritius. The study revealed that contraceptive prevalence rates were higher among women in urban areas (60) than in rural areas (40). The main factors influencing contraceptive use in order of importance included distance from residence to clinics; level of education attained; parity; marital status; approval by husbands/boyfriends and knowledge of family planning methods. Contraceptive use was highest in the age group of 20 to 34 years while it was lowest among young women aged 15-19 years

Sleeping sickness and tsetse awareness: a sociological study among the Tambo and Lambya of the northern Luangwa Valley, Zambia.

Data on awareness of tsetse flies and knowledge of trypanosomiasis were collected in May, 1988, in the Luangwa Valley of Isoka District in the Northern Province of Zambia. One thousand and nine hundred adult males and females were interviewed. There was a high level of fly awareness among all the respondents, regardless of duration of residence and age groups. Malaria was considered as the most serious illness in the community, and hence overshadowed the impact of trypanosomiasis in the community. Disease awareness gravity cannot be attributed to individual's socio-economic levels.

PIP: In May 1988, tropical disease researchers interviewed 1940 Tambo and Lambya men and women living in 2 chiefs' areas (Katyetye and Mweniwisi) of the Luangwa Valley of Isoka District in the Northern Province of Zambia to determine their knowledge of trypanosomiasis (sleeping sickness) and tsetse flies. 98.4% of the respondents who had lived in the area for at least one month knew that tsetse fly bites transmitted trypanosomiasis. 94.2% of those who lived in the area for 1 month also knew this. Only people who lived in the area for 1 month believed that witchcraft and bad water transmitted sleeping sickness (0.9% and 0.1% respectively). Approximately 73% reported tsetse flies to be uncommon in their villages. Just 2% believed trypanosomiasis to be a leading disease because its treatment often requires a long hospitalization. Most people (74%) thought malaria to be the most serious disease, because it occurs frequently and kills many people. Tsetse flies become ubiquitous during the rainy season. Further the Tropical Disease Research Centre in Ndola, Zambia has found extremely high tsetse densities along access roads and paths connecting villages. The researchers planned to use these results in developing a parasite control project in the area. Community health workers trained under the Primary Health Care project could conduct health education sessions about sleeping sickness in the area to increase awareness of the seriousness of the disease.

The problems of a social survey in epidemiology: an experience from a Zambian rural community.

A socio-economic study of 1097 people was carried out between November and December 1979. Demographic data and other health characteristics were obtained by census of the entire study population. Interviews covered disease awareness, perceived morbidity, health-care utilization, knowledge, attitudes and practices; all adults aged 15 years and above were interviewed 2 weeks before physical examinations were made. Age and literacy level were found to have no effect on the people's health-seeking behaviour in Kabinga. The results of this social survey failed to reveal the real practices of the community's use of both ethno-medicine and biomedicine.

PIP: A population segment was investigated in Kabinga, northern Zambia, in order to explore the use of biomedical ethnomedical health services and assess the knowledge of disease vectors. In this community schistosomiasis, malaria, anemia, and hookworm infestation was widespread. The population of 11 villages numbered 1097 people (545 males and 552 females) including 220 adults aged 15049. A WHO standardized questionnaire containing demographic and sociological questions was administered. The subjects were asked what action they would take when afflicted by malaria. The majority of 218 responders were women. The mean age for females was 35.2 years and for males it was 37.5 years. 4 responders did not know what to do if struck with malaria. Only .9% of both literate and illiterate adults indicated the use of African medicine in case of malaria. 62% of them went to the clinic or hospital for treatment during the last sickness episode. 29.2% of both genders did nothing, and only 2.4% of women turned to traditional medicine. 1 female could not recall what she did. 81% of the adult population attended either a clinic or a hospital for treatment during the previous 8 months. Most remembered using these facilities at least one (14 could not remember it). There was a significant correlation between refraining from the use of traditional medicine and utilization of the services of a clinic or hospital. Despite these findings, the answers were probably biased, because most women depend on their male counterparts for making decisions. Anthropologically oriented research methods could ensure reliability of data and reveal epidemiological problems in this community.