Characteristics of new contraceptive acceptors in Zimbabwe

This report examines the characteristics of all new acceptors entering the Zimbabwe National Family Planning Council (ZNFPC) program from 4-8 March 1985. During the study period, ZNFPC clinics and community-based distributors provided 3,269 new clients with modern family planning methods. More than half of the women were under the age of 25 years and had fewer than three living children. When asked why they were initiating the use of modern contraception, 90 percent of the women indicated that their intention was to space or delay the next pregnancy ("spacers"), while 10 percent indicated that they wished to stop reproduction ("stoppers"). A comparison of the two groups suggests that the average "spacer" among new acceptors is 24 years old and has 2.6 living children, of whom the youngest is 12.0 months, while the average "stopper" is 34 years old and has 6.2 living children, of whom the youngest is 25.9 months.     

Intergenerational participatory discussion groups foster knowledge exchange to improve child nutrition and food security in northern Malawi

This article assesses the effectiveness of a participatory, intergenerational, dialogue approach in addressing gender and generational conflicts related to both child nutrition and agriculture. Analysis of 46 interviews and 3 focus groups with smallholder farmers in rural agrarian communities with high rates of child malnutrition in northern Malawi suggested that participatory discussion can lead to positive change, including increasing child feeding frequency and dietary diversity. An intergenerational, transformative, and holistic approach to nutrition education which integrates agricultural and gender issues can effectively address sensitive conflicts within households and communities that affect child nutrition, and come up with local solutions.     

Mokola virus in domestic mammals, South Africa

We recently identified 2 Mokola viruses from domestic mammals (a dog and a cat) in South Africa. These cases occurred 8 years after the last reported case of infection with this virus. Our findings emphasize the endemicity of rabies-related lyssaviruses in South Africa and the need to better understand the epidemiology of Mokola viruses.     

Intergenerational Participatory Discussion Groups Foster Knowledge Exchange to Improve Child Nutrition and Food Security in Northern Malawi

This article assesses the effectiveness of a participatory, intergenerational, dialogue approach in addressing gender and generational conflicts related to both child nutrition and agriculture. Analysis of 46 interviews and 3 focus groups with smallholder farmers in rural agrarian communities with high rates of child malnutrition in northern Malawi suggested that participatory discussion can lead to positive change, including increasing child feeding frequency and dietary diversity. An intergenerational, transformative, and holistic approach to nutrition education which integrates agricultural and gender issues can effectively address sensitive conflicts within households and communities that affect child nutrition, and come up with local solutions.     

Insights into SARS-CoV-2 in Angola during the COVID-19 peak: Molecular epidemiology and genome surveillance

Background

In Angola, COVID-19 cases have been reported in all provinces, resulting in >105,000 cases and >1900 deaths. However, no detailed genomic surveillance into the introduction and spread of the SARS-CoV-2 virus has been conducted in Angola. We aimed to investigate the emergence and epidemic progression during the peak of the COVID-19 pandemic in Angola.

Methods

We generated 1210 whole-genome SARS-CoV-2 sequences, contributing West African data to the global context, that were phylogenetically compared against global strains. Virus movement events were inferred using ancestral state reconstruction.

Results

The epidemic in Angola was marked by four distinct waves of infection, dominated by 12 virus lineages, including VOCs, VOIs, and the VUM C.16, which was unique to South-Western Africa and circulated for an extended period within the region. Virus exchanges occurred between Angola and its neighboring countries, and strong links with Brazil and Portugal reflected the historical and cultural ties shared between these countries. The first case likely originated from southern Africa.

Conclusion

A lack of a robust genome surveillance network and strong dependence on out-of-country sequencing limit real-time data generation to achieve timely disease outbreak responses, which remains of the utmost importance to mitigate future disease outbreaks in Angola.     

"We grandmothers know plenty": breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi

This paper has two purposes: first of all, we examine grandmothers' role and views of child feeding practices in northern Malawi, and their influence on younger women's practices. Secondly, we consider the implications of these findings for health promotion activities and models of health education. Data were collected from semi-structured interviews, focus groups and a participatory workshop. Findings demonstrate that, to address child feeding practices which have an effect on nutrition, attention must be paid to the broader context that influences child nutrition, including extended family relations. Paternal grandmothers have a powerful and multifaceted role within the extended family in northern Malawi, both in terms of childcare and in other arenas such as agricultural practices and marital relations. Grandmothers often differ in their ideas about early child feeding from conventional Western medicine. Some practices have existed in the area at least since colonial times, and have strong cultural significance. Despite the important integrated role, older women have within households and communities in this part of Malawi, hospital personnel often have disparaging and paternalistic attitudes towards 'grannies' and their knowledge. Health education rarely involves grandmothers, and even if they are involved, their perspectives are not taken into consideration. Hospital staff often reject grandmother knowledge as part of a broader modernization paradigm which views 'traditional knowledge' as backward. Grandmothers view current child health conditions within a broader context of changing livelihood conditions and a high prevalence of HIV/AIDS. The paper concludes by discussing the challenges of involving grandmothers in health education, and the difficulties of incorporating local knowledge into a medical system that largely rejects it.     

Cultural competence: a framework for promoting voluntary medical male circumcision among VaRemba communities in Zimbabwe

Almost a decade after the formal introduction of voluntary medical male circumcision (VMMC) as an important technology for HIV prevention, its implementation is still fraught with acceptability challenges. This is especially true among ethnic groups where male circumcision is conducted as a rite of passage into adulthood. In this article we question why VMMC is being met with resistance despite widespread awareness of its promise to reduce HIV incidence in a culturally circumcising community in Zimbabwe. In-depth and key informant interviews were conducted with selected VaRemba initiation graduates and surgeons respectively in Mposi area in Mberengwa to explore why VMMC has not been readily accepted in their community. Findings suggest that male circumcision among VaRemba is not only the removal of prepuce but comprises a secretive and rich curriculum rooted in their culture and identity. Such a conceptualisation renders some social and programmatic impediments for VMMC uptake. To scale up VMMC uptake among VaRemba, we argue for a reorganisation and adaptation of VMMC services in a culturally competent way that accounts for local conceptions of circumcision and respect for the cultural beliefs and practices of VaRemba communities.     

Preferences of urban Zimbabweans for health and life lived at different ages

OBJECTIVE: To determine the age-weighting preferences of urban Zimbabweans in relation to health care priorities. METHOD: A total of 67 randomly selected residents of a high-density area of Harare participated in the study. Participants were asked "person trade-off" questions to determine their preferences in terms of the numbers of people of various ages who would be saved from death and from suffering a year of ill-health relative to the number of 30-year-olds who would be saved from these eventualities. FINDINGS: The responses indicate that the value of averting a year of ill-health was judged greatest for 15-year-olds and was equal for people aged 1, 30, and 45 years. The value of averting a death primarily reflected the expected years of life lost, but the influence of age-weighting was evident in that 15 years was the most highly valued age. CONCLUSION: Although the age-weighting curves did not correspond exactly with the Global Burden of Disease (GBD) age-weights, Zimbabweans showed a preference for saving the lives of young adults. The GBD age-weights should be used to determine the disability-adjusted life years lost in the Zimbabwean population.     

The decline of anti-trypanosomal antibody levels in cattle after treatment with trypanocidal drugs and in the absence of tsetse challenge

The decline of anti-trypanosomal antibody levels in cattle after treatment with trypanocidal drugs was investigated using an anti-trypanosomal antibody-detection enzyme-linked immunosorbent assay (ELISA). The decline of antibody levels differed between experimental animals but went through two phases. During the first 5 months after trypanocidal drug treatment, the decline is rapid with a monthly average decline of 10% of the average percentage positivity during the treatment. Between months 6 and 13 after treatment, the monthly average decline was only 3.6% of the average percentage positivity at the moment of treatment. It took a total of 13 months for all the experimental animals to become seronegative. The usefulness of the anti-trypanosomal antibody-detection enzyme-linked immunosorbent assay (ELISA) in the monitoring of tsetse control operations is discussed.