As COVID-19 vaccines are becoming more available, there is also a growing need to understand the population receiving the doses, existing inequalities and the intention to getting the second vaccine dose among the populations that receive the vaccines. We evaluated gender inequalities and intention to uptake of the second dose of COVID-19 AstraZeneca vaccine among adult populations in selected urban facilities of Lusaka, Zambia. A cross-sectional study design was conducted between May and June 2021 among adults who received AstraZeneca vaccine from three selected urban facilities of Lusaka, Zambia. Phone-based interviews were conducted 6 weeks after the first dose of the vaccine. Descriptive analysis and mixed-effect logistic regression were done using STATA version 16.2. Of the 1321 adults who had received AstraZeneca vaccine, 868 respondents completed the questionnaire. About, 47% (408/868) were females and 53% (460/868) were males. Median age in the study was 40 years. Majority of males were educated (54%) and employed (57%). Furthermore, majority of females that got the first dose of AstraZeneca reported experiencing side effects (76.98%) compared to males (64.24%). Among study participants, 93.7% intended to receive the AstraZeneca vaccine, of whom 46.7% (380/814) were females and 52.9% (434/814) were males. Majority of participants that did not intend to get a second dose were not married (55.56%). Only age (AOR, 1.05; 95% CI, 1.02–1.08) predicted intention to getting a second dose of AstraZeneca vaccine. We found important gender-dependent differences in the side effects reported by females that received the first dose of Astra Zeneca. Finding that intention to get the second dose of the vaccine increased with age suggests a need for enhancing COVID-19 vaccination programmes targeting young people and a need for further research to identify specific adverse effects of COVID-19 Astra Zeneca vaccines.

Globally, 12 million girls aged 15–19 give birth each year, and Africa hosts 19% of youth aged 15–24. In Zambia, 29% of adolescents experience childbirth, with variations by age. Projections suggest a continued rise in these trends by 2030. Zambia came up with Adolescent Health Strategic Plan 2011–2015 among the specific policies being advocated for was Adolescent-Friendly Health Services (ADFHS) in order to mitigate among others adolescent fertility. The study aims to investigate socio-economic disparities and predictors of fertility in Zambian adolescents aged 15 to 19. The study used a cross-sectional study design utilized the 2018 Zambia Demographic Health Survey (ZDHS). The variable of interest in this study is “total number of children ever born” among adolescents aged 15 to 19 years. The explanatory variables that were used in the study were demographic, socio-economic, behavioral and community level factors. The Rao–Scott Chi-square test was used to test for association between categorical variables. Determinants of adolescent fertility were identified through a multilevel ordinal logistic regression conducted at a significance level of 5%. Analysis in the study was carried out using Stata version 14.2. A total of 3,000 adolescents were involved in the study, revealing that 75.88% had not given birth, 21.14% had one child, and 2.98% had at least two children. The findings revealed that education played a protective role, with adjusted odds ratios (AOR) of 0.47 (95% CI, 0.23–0.97), 0.21 (95% CI, 0.10–0.47), and 0.03 (95% CI, 0.00–0.54) for primary, secondary, and tertiary education, respectively. On the other hand, certain factors were associated with an elevated risk of fertility. These included the age of adolescents, educational attainment, marital status, wealth index, contraceptive use, exposure to family planning (FP) messages, being educated about FP at health facilities, and age at first sexual encounter. Among contextual factors, only community age at first birth was identified as a predictor of fertility, AOR, 1.59 (95% CI, 1.01–2.52). The study highlights sociodemographic disparities in adolescent fertility, emphasizing the need for targeted sexual reproductive health policies. Education protects against having more than one child, while marital status significantly influences fertility, particularly for married adolescents. The research provides valuable insights into the complex factors shaping adolescent fertility in Zambia, offering guidance for interventions and policies to support this vulnerable demographic.

Introduction: Malnutrition in women in reproductive age (WRA) is associated with distinct types of public health problems such as preterm birth, low birth weight, malnourished children, poor psychological health and high mortality. The study aimed at investigating the risk factors associated with underweight, overweight and obesity among WRA and map their spatial distribution. Methods: The study used the 2013/2014 Zambia Demographic Health Survey (ZDHS) data and survey proportional odds model was fitted to the data. Spatial effects were modeled using Quantum Geographic Information System (QGIS) version 2.18.1 to develop univariate choropleth maps. Results: 14,377 WRA were enrolled into the study. Overweight was more prevalent (15.87%) compared to underweight (10.22%) and obesity (6.47%). The findings revealed that a higher wealth index, age, having a car, using contraceptives, being married or divorced similarly increased the odds of being at or beyond a particular category of nutrition status. The spatial analysis also suggested Lusaka and Copperbelt were more prone to overweight and obesity, whereas Western had increased prevalence of underweight. Conclusion: Appropriate nutritional and economic programs are highly recommended in specific provinces of Zambia. Programs to curb overweight and obesity should be directed more to Lusaka and Copperbelt while underweight programs to Western province. Keywords: Underweight; overweight; obesity

Antenatal care (ANC) plays a crucial role in preventing and detecting pregnancy risks, facilitating prompt treatment, and disseminating essential information to expectant mothers. This role is particularly vital in developing countries, where a 4.65% rise in maternal mortality rate was observed in 2022, with over 800 maternal and 7,700 perinatal deaths reported. The study aimed at investigating the spatial temporal patterns and associated factors of timing and inadequacy of antenatal care utilization in Zambia, from 1992 to 2018 using a Generalized Linear Mixed Effect Model (GLMM) approach. The study utilized the Zambia Demographic Health Survey (ZDHS) database. The relationship between dependent and independent variables was examined using the Rao-Scott Chi-square test. Predictors of inadequate utilisation of ANC were identified through the multilevel generalised linear model. Spatial effects were modeled using Quantum Geographic Information System (QGIS) version 3.34.1 to develop univariate choropleth maps. A total of 45, 140 (31, 482 women had less than 8 ANC visits and 2, 004 had 8 or more ANC visits) women with a prior childbirth were included in the study. The findings in the study revealed that among women aged 15 to 19 years in 1992, 1996 and 2013/14, the rates of inadequate antenatal care utilization (less than eight ANC visits) was 90.87%, 90.99%, and 99.63%, respectively. Lack of formal education was associated with inadequate ANC from 1992 to 2018, with percentages ranging from 91.12% to 99.64%. They were notable geospatial variations in the distribution of ANC underutilization across provinces with Luapula, Muchinga, Northwestern, Northern and Eastern recording higher proportions. Furthermore, the study showed that higher education (AOR, 0.30; 95% Confidence Interval, CI, 0.14–0.63; p = 0.001), and wealth index (AOR, 0.34; 95% CI, 0.17–0.70; p = 0.003) correlated with reduced odds of inadequate ANC utilization. In conclusion, this study highlights worrisome trends in ANC utilization in Zambia, with a significant rise in inadequacy, especially in adhering to the WHO’s recommended eight ANC visits. Over the period from 1996 to 2018, there was a discernible decline in the prevalence of delayed initiation of ANC. The findings underscore a notable disparity between current ANC practices and established guidelines. Additionally, various factors predicting suboptimal ANC attendance have been identified. These insights call for targeted interventions to address the identified challenges and improve the overall quality and accessibility of ANC services in Zambia.

In Zambia, neonatal mortality still remains a noteworthy public health problem with a current rate of 27 deaths per 1000 and ranking 162 out of 195 countries globally. The study aimed to investigate the spatial variations and predictors of neonatal mortality in rural Zambia among HIV-infected and non-infected mothers using the national-level data from the 2018 Zambia Demographic and Health Survey (ZDHS). Statistical analyses were conducted using the Rao – Scott Chi-square test to assess associations between neonatal mortality and categorical variables. Additionally, a multilevel mixed effect logistic regression model was used to examine predictors of neonatal mortality. Geospatial variations of neonatal mortality across Zambia’s ten provinces were mapped using Quantum Geographical Information System (QGIS) version 3.34.1. Data analysis was performed using R and Stata version 14.2. This study examined the spatial variations and predictors of neonatal mortality among HIV-infected and non-infected mothers in rural Zambia using the 2018 Zambia Demographic Health Survey dataset. Key findings include the protective role of maternal education, with those having secondary or higher education showing reduced odds of neonatal mortality. Women aged 20–24 years in the study had higher odds of neonatal death compared to younger mothers, while delivering in public health facilities was associated with increased neonatal mortality. Maternal HIV status had no significant impact on neonatal outcomes. Spatial analysis revealed significant regional disparities, with high mortality rates in Central, Southern, and Eastern provinces, while North Western Province had lower rates. These results emphasize the need for improved healthcare quality, targeted maternal education programs, and region-specific interventions to address neonatal mortality in Zambia.

Grand multiparity, defined as having five or more births, is a significant public health problem, especially in low resource settings where fertility rates are generally higher than in high-resource settings due to socio-economic factors such as poverty and low levels of women’s education, as well as disparities in access to modern contraceptives and advanced medical care. The study aimed to investigate the factors associated with grand multiparity in Zambia. The study analysed data from the 2018 Zambia Demographic and Health Survey (ZDHS) using a weighted sample of 13,683 women aged 15–49 years. Univariate analysis was used to present percent distributions of the selected background characteristics of women. Bivariate analysis was used to examine the association between selected background characteristics and grand multiparity. Multivariable logistic regression was then performed to identify factors of grand multiparity among women aged 15–49 years in Zambia. The prevalence of grand multiparity among women in Zambia was estimated at 24%. Women aged 25–29 years, 30–34 years, and 35 years or older had significantly higher odds of grand multiparity compared to women aged 15–24 years, with the highest odds observed in women aged 35 years or older (aOR=56.31, 95% CI: 11.626–272.780). Women with a first birth at age 25 years or older were 86% less likely to experience grand multiparity (aOR=0.14, 95% CI: 0.084–0.238). Higher education and wealth were protective factors, with women who attained secondary education (aOR=0.28, 95% CI: 0.182–0.418) and higher education (aOR=0.09, 95% CI: 0.046–0.174) having reduced odds of grand multiparity. Women from richer households were also less likely to experience grand multiparity (aOR=0.48, 95% CI: 0.337–0.701). Rural residence (aOR=1.46, 95% CI: 1.111–1.911) and contraceptive use (aOR=1.29, 95% CI: 1.074–1.545) were associated with increased odds of grand multiparity. Women with shorter birth intervals (less than 24 months) were almost three times more likely to be grand multiparous (aOR=2.74, 95% CI: 1.741–4.326). The findings underscore the complex interplay of socio-demographic factors in shaping reproductive patterns in Zambia. Strategies to reduce grand multiparity should consider promoting delayed marriage, increasing access to education and addressing rural-urban disparities in healthcare access and family planning services.