Browsing by Author "Rathod SD"

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Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study.
(2016-Mar-03) Rathod SD; Timæus IM; Banda R; Thankian K; Chilengi R; Banda A; Lemba M; Stringer JS; Chi BH; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.; Department of Population Studies, University of Zambia, Lusaka, Zambia.; Research, Publications and Dissemination Unit, Zambia Central Statistical Office, Lusaka, Zambia.; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.; Department of Gender Studies, University of Zambia, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVES: To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head. SETTING: Households in Lusaka District, Zambia, 2004-2011. PARTICIPANTS: 43,064 household heads (88% female) who enumerated 123,807 adult household members aged between 15 and 60 years. PRIMARY OUTCOME: Premature adult mortality. RESULTS: The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing. CONCLUSIONS: To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services.
Temporal Trends and Predictors of Modern Contraceptive Use in Lusaka, Zambia, 2004-2011.
(2015) Hancock NL; Chibwesha CJ; Stoner MC; Vwalika B; Rathod SD; Kasaro MP; Stringer EM; Stringer JS; Chi BH; Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3009 Old Clinic Building, Campus Box 7570, Chapel Hill, NC 27599-7570, USA; Centre for Infectious Disease Research in Zambia, 5032 Great North Road, P.O. Box 34681, 10101 Lusaka, Zambia.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3009 Old Clinic Building, Campus Box 7570, Chapel Hill, NC 27599-7570, USA.; Department of Obstetrics and Gynecology, University Teaching Hospital, P.O. Box 50110, Lusaka, Zambia.; Department of Epidemiology, University of North Carolina School of Public Health, 2101 McGavran-Greenberg Hall, CB No. 7435, Chapel Hill, NC 27599-7435, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Although increasing access to family planning has been an important part of the global development agenda, millions of women continue to face unmet need for contraception. MATERIALS AND METHODS: We analyzed data from a repeated cross-sectional community survey conducted in Lusaka, Zambia, over an eight-year period. We described prevalence of modern contraceptive use, including long-acting reversible contraception (LARC), among female heads of household aged 16-50 years. We also identified predictors of LARC versus short-term contraceptive use among women using modern methods. RESULTS AND DISCUSSION: Twelve survey rounds were completed between November 2004 and September 2011. Among 29,476 eligible respondents, 17,605 (60%) reported using modern contraception. Oral contraceptive pills remained the most popular method over time, but use of LARC increased significantly, from less than 1% in 2004 to 9% by 2011 (p < 0.001). Younger women (OR: 0.46, 95% CI: 0.34, 0.61) and women with lower levels of education (OR: 0.70, 95% CI: 0.56, 0.89) were less likely to report LARC use compared to women using short-term modern methods. CONCLUSIONS: Population-based assessments of contraceptive use over time can guide programs and policies. To achieve reproductive health equity and reduce unmet contraceptive need, future efforts to increase LARC use should focus on young women and those with less education.
Trends in all-cause mortality during the scale-up of an antiretroviral therapy programme: a cross-sectional study in Lusaka, Zambia.
(2014-Oct-01) Rathod SD; Chi BH; Kusanthan T; Chilopa B; Levy J; Sikazwe I; Mwaba P; Stringer JS; Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England .; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia .; Zambian Central Statistical Office, Lusaka, Zambia .; University of Zambia, Lusaka, Zambia .; Zambian Ministry of Health, Lusaka, Zambia .; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To follow the trends in all-cause mortality in Lusaka, Zambia, during the scale-up of a national programme of antiretroviral therapy (ART). METHODS: Between November 2004 and September 2011, we conducted 12 survey rounds as part of a cross-sectional study in Lusaka, with independent sampling in each round. In each survey, we asked the heads of 3600 households to state the number of deaths in their households in the previous 12 months and the number of orphans aged less than 16 years in their households and investigated the heads' knowledge, attitudes and practices related to human immunodeficiency virus (HIV). FINDINGS: The number of deaths we recorded - per 100 person-years - in each survey ranged from 0.92 (95% confidence interval, CI: 0.78-1.09) in September 2011, to 1.94 (95% CI: 1.60-2.35) in March 2007. We found that mortality decreased only modestly each year (mortality rate ratio: 0.98; 95% CI: 0.95-1.00; P = 0.093). The proportion of households with orphans under the age of 16 years decreased from 17% in 2004 to 7% in 2011. The proportions of respondents who had ever been tested for HIV, had a comprehensive knowledge of HIV, knew where to obtain free ART and reported that a non-pregnant household member was receiving ART gradually increased. CONCLUSION: The expansion of ART services in Lusaka was not associated with a reduction in all-cause mortality. Coverage, patient adherence and retention may all have to be increased if ART is to have a robust and lasting impact at population level in Lusaka.