Analysis of recent survey data reveals large differentials in child mortality among ethnic groups in countries throughout sub-Saharan Africa. These disparities correspond with the prominence of specific ethnic groups in the national political economy. In many countries where heads of state since independence have come from one or two ethnic groups-as in Côte d'Ivoire, Kenya, and Niger-these groups have experienced levels of early child mortality at least one-third lower than those of other groups. In other countries where there have been several transitions in state control, as in Ghana and Uganda, descendants of precolonial kingdoms such as Ashanti and Buganda have experienced much lower mortality than others. In most countries, the lower mortality of potent ethnic groups-who typically represent small proportions of national populations-is strongly related to economic privilege. Persistent inequalities among African ethnic groups deserve strong consideration in planning economic development and child health strategies.
High-quality research is a core input for policies and programs that seek to improve public health and social development. In the context of a pandemic, however, in-person data collection could spread coronavirus. Researchers across disciplines must safely and effectively balance the need for primary data while protecting participants, staff, and the communities in which they work. As the world learns how to mitigate the spread of coronavirus, research institutions across the globe are creating their own guidelines and approaches to resuming in-person activities as global governing bodies and governments lag behind in providing guidance. As the COVID-19 pandemic shapeshifts, the question of whether, where, and how to resume in-person data collection has generated collective action among public health experts and social scientists. The authors propose key principles and practical steps that researchers should consider when weighing the prospect of returning to in-person data collection. The recommendations arise from the Population Council-convened webinar, "Resuming In-Person Data Collection during COVID-19," that brought together scientists, ethicists, and research implementers who are pioneering adaptations across disciplines to in-person research activities during the pandemic.
The Male Circumcision (MC) Partnership was established with the support of the Gates Foundation and PEPFAR to scale up MC services in Zambia, in collaboration with the Zambian government. The MC Partnership is a five-year project led by Population Services International (Society for Family Health, Zambia), in partnership with Jhpiego, Marie Stopes International (MSI), and the Population Council. The ultimate objective of this study is to provide researchers and program managers with evidence-based recommendations for the collection of self-reported data on MC status through an assessment of different methods to describe and explain MC. Specifically, the study assessed tools for improving the reporting of circumcision status, including a) a detailed verbal description of male circumcision, b) an illustration of a circumcised and an uncircumcised penis, and c) computerized self-interviewing technology.
This article explores the use of an audio computer-assisted self-interviewing (audio-CASI) methodology in a household survey of adolescents in two districts of Kenya. Computer software was developed as part of a research project comparing audio-CASI with traditional methods of interviewing about sensitive behaviors, including sexual initiation, risky sexual behavior, coerced sex, and drug and alcohol use. The article describes the experience of carrying out a household-based study using computers and explores the technical challenges faced by the data-collection teams. Few problems emerged with the computer hardware and software despite the difficult interviewing conditions. The adolescent respondents easily adapted to the computerized interview and were able to complete the survey with minimal assistance. However, the computers were not a completely neutral part of the data-collection process and added to problems encountered during the fieldwork in one of the districts. Unexpected findings regarding respondents' perceptions of privacy and confidentiality were also observed.
Books reviewed in this article: Paul Demeny and Geoffrey Mcnicoll (eds.), Encyclopedia of Population Barbara Ehrenreich and Arlie Russell Hochschild (eds.), Global Woman: Nannies, Maids, and Sex Workers in the New Economy Food and Agriculture Organization of the United Nations, World Agriculture: Towards 2015/2030: An FAO Perspective and Summary Report Jeanne X. Kasperson and Roger E. Kasperson, Global Environmental Risk Richard Lynn, Eugenics: A Reassessment Douglas W. Maynard, Hanneke Houtkoop‐Steenstra, Nora Gate Schaeffer, and Johannes van der Zouwen (eds.), Standardization and Tacit Knowledge: Interaction and Practice in the Survey Anthony M. Messina (ed.), West European Immigration and Immigrant Policy in the New Century
AbstractPregnancy 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. In addition, multivariate Cox proportional hazards models using four rounds of longitudinal data from a sample of unmarried and never pregnant adolescent girls (n=1,853) show that girls who have engaged in transactional sex face a hazard of first premarital pregnancy almost 30 percent greater than their peers who have not, independent of the effect of other risk‐related sexual behaviors such as condom use and number of sexual partners. Identifying and understanding the role of transactional sex in adolescent pregnancy is important for designing effective curricula and programs that delay pregnancy, and highlights the importance of addressing access to economic resources in adolescent health outcomes.
This study investigates the reporting of premarital sex in rural southern Malawi. It summarizes the results of an interview‐mode experiment conducted with unmarried young women aged 15–21 in which respondents were randomly assigned to either an audio computer‐assisted self‐interview (ACASI) or a conventional face‐to‐face (FTF) interview. In addition, biomarkers were collected for HIV and three STIs: gonorrhea, chlamydia, and trichomoniasis. Prior to collecting the biomarkers, nurses conducted a short face‐to‐face interview in which they repeated questions about sexual behavior. The study builds on earlier research among adolescents in Kenya where we first investigated the feasibility and effectiveness of ACASI. In both Malawi and Kenya, the mode of interviewing and questions about types of sexual partners affect the reporting of sexual activity. Yet the results are not always in accordance with expectations. Reporting for "ever had sex" and "sex with a boyfriend" is higher in the FTF mode. When we ask about other partners as well as multiple lifetime partners, however, the reporting is consistently higher with ACASI, in many cases significantly so. The FTF mode produced more consistent reporting of sexual activity between the main interview and a subsequent interview. The association between infection status and reporting of sexual behavior is stronger in the FTF mode, although in both modes a number of young women who denied ever having sex test positive for STIs/HIV.
The Adolescent Girls Empowerment Program (AGEP) intervention was conducted over two years to support more than 11,000 vulnerable adolescent girls in Zambia. It was led by the Population Council in partnership with the Young Women's Christian Association of Zambia (YWCA), the National Savings and Credit Bank of Zambia (Natsave), and the Government of Zambia. To assess the impact of AGEP on mediating and longer-term demographic, reproductive, and health outcomes, Population Council researchers designed and implemented a longitudinal, cluster randomized controlled trial across all program areas. This brief presents the final AGEP findings, highlighting, in the Zambian context, what can be changed for girls through a girl-level intervention that focuses on building social, health, and economic assets. The program was successfully able to improve sexual and reproductive health knowledge and self-efficacy, however, additional interventions are needed to: 1) address social and cultural norms on girls' education, rights, and values at the household, school, and community levels; and 2) address the underlying economic constraints that might prevent girls from participating and/or fully benefiting from the program.
AbstractAntenatal 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. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0–30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8–20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancy, the most commonly cited reasons for non-use were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2 and 2.1 times more likely to attend ANC4+ times, respectively. Women who held positive views about health facilities for childbirth had 1.2 and 2.6 times higher likelihood of attending ANC4+ times and having a facility delivery, respectively, while women who believed ANC was only for sickness or pregnancy complications had a 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes. To improve pregnancy and childbirth practices in north-western Nigeria, Social and Behavioural Change programmes could address a range of psychosocial factors across cognitive, emotional and social domains which have been found in this study to be significantly associated with pregnancy and childbirth behaviours: raising knowledge and dispelling myths, building women's confidence to access services, engaging spousal support in decision-making and improving perceived (and actual) maternal health services quality.
Adolescence is a critical period in the lives of young people and potentially a time to reap lasting benefits from interventions that improve general, sexual, nutritional, and maternal and child health. The government of Zambia is committed to improving the nutritional status of adolescents and pregnant women and their children. Nonetheless, adolescent girls in Zambia remain at risk for macro- and micro-nutrient deficiencies that have deleterious effects on growth, development, and maternal and child health. The Adolescent Girls Empowerment Program (AGEP) nutritional curriculum, developed in partnership with PATH, was tailored to provide age-appropriate information and covered six sessions on nutrition. This brief summarizes the impact of the nutrition curriculum on nutrition outcomes of adolescents and their children one year after the AGEP program ended. The results of this rigorous randomized evaluation indicate that the AGEP nutrition training component with context-relevant participatory and interactive educational sessions did not improve adolescent or child nutritional outcomes.
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. We then assess the validity of the data by evaluating the reporting of sexual experience against three biological markers. Results suggest that ACASI elicits higher reporting of some key indicators than FTFI does, but self‐reports from all interview modes were subject to validity concerns when compared with biomarker data. The study highlights the important role that biomarkers can play in sexual behavior research.
