Phyllis Mushati

The Biomedical Research and Training Institute, Salisbury, Harare Province, Zimbabwe

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Publications (20)104.02 Total impact

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    ABSTRACT: Evidence suggests that a regular and reliable transfer of cash to households with orphaned and vulnerable children has a strong and positive effect on child outcomes. However, conditional cash transfers are considered by some as particularly intrusive and the question on whether or not to apply conditions to cash transfers is an issue of controversy. Contributing to policy debates on the appropriateness of conditions, this article sets out to investigate the overall buy-in of conditions by different stakeholders and to identify pathways that contribute to an acceptability of conditions. The article draws on data from a cluster-randomized trial of a community-led cash transfer programme in Manicaland, eastern Zimbabwe. An endpoint survey distributed to 5167 households assessed community members' acceptance of conditions and 35 in-depth interviews and 3 focus groups with a total of 58 adults and 4 youth examined local perceptions of conditions. The study found a significant and widespread acceptance of conditions primarily because they were seen as fair and a proxy for good parenting or guardianship. In a socio-economic context where child grants are not considered a citizen entitlement, community members and cash transfer recipients valued the conditions associated with these grants. The community members interpreted the fulfilment of the conditions as a proxy for achievement and merit, enabling them to participate rather than sit back as passive recipients of aid. Although conditions have a paternalistic undertone and engender the sceptics' view of conditions being pernicious and even abominable, it is important to recognize that community members, when given the opportunity to participate in programme design and implementation, can take advantage of conditions and appropriate them in a way that helps them manage change and overcome the social divisiveness or conflict that otherwise may arise when some people are identified to benefit and others not.
    Health Policy and Planning 10/2014; 29(7):809-817. · 2.65 Impact Factor
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    ABSTRACT: We used baseline data, collected in July–September 2009, from a randomized controlled trial of a cash transfer program for vulnerable children in eastern Zimbabwe to investigate the effectiveness, coverage, and efficiency of census- and community-based targeting methods for reaching vulnerable children. Focus group discussions and in-depth interviews with beneficiaries and other stakeholders were used to explore community perspectives on targeting. Community members reported that their participation improved ownership and reduced conflict and jealousy. However, all the methods failed to target a large proportion of vulnerable children and there was poor agreement between the community- and census-based methods.
    World Development 01/2014; · 1.73 Impact Factor
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    ABSTRACT: In an HIV/AIDS epidemic driven primarily by heterosexual transmission, it is important to have an understanding of the human sexual behaviour patterns that influence transmission. We analysed the distribution and predictors of within-partnership sexual behaviour and condom use in rural Zimbabwe and generated parameters for use in future modelling analyses. A population-based cohort was recruited from a household census in 12 communities. A baseline survey was carried out in 1998-2000 with follow-up surveys after 3 and 5 years. Statistical distributions were fitted to reported within-partnership numbers of total, unprotected and protected sex acts in the past two weeks. Multilevel linear and logistic regression models were constructed to assess predictors of the frequency of unprotected sex and consistent condom use. A normal distribution of ln(sex acts+1) provided the best fit for total and unprotected sex acts for men and women. A negative binomial distribution applied to the untransformed data provided the best fit for protected sex acts. Condom use within partnerships was predominantly bimodal with at least 88% reporting zero or 100% use. Both men and women reported fewer unprotected sex acts with non-regular compared to regular partners (men: 0.26 fewer every two weeks (95% confidence interval 0.18-0.34); women: 0.16 (0.07-0.23)). Never and previously married individuals reported fewer unprotected sex acts than currently married individuals (never married men: 0.64 (0.60-0.67); previously married men: 0.59 (0.50-0.67); never married women: 0.51 (0.45-0.57); previously married women: 0.42 (0.37-0.47)). These variables were also associated with more consistent condom use. We generated parameters that will be useful for defining transmission models of HIV and other STIs, which rely on a valid representation of the underlying sexual network that determines spread of an infection. This will enable a better understanding of the spread of HIV and other STDs in this rural sub-Saharan population.
    PLoS ONE 01/2014; 9(2):e88378. · 3.53 Impact Factor
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    ABSTRACT: BACKGROUND: Cash transfer programmes are increasingly recognised as promising and scalable interventions that can promote the health and development of children. However, concerns have been raised about the potential for cash transfers to contribute to social division, jealousy and conflict at a community level. Against this background, and in our interest to promote community participation in cash transfer programmes, we examine local perceptions of a community-led cash transfer programme in Eastern Zimbabwe. METHODS: We collected and analysed data from 35 individual interviews and three focus group discussions, involving 24 key informants (community committee members and programme implementers), 24 cash transfer beneficiaries, of which four were youth, and 14 non-beneficiaries. Transcripts were subjected to thematic analysis and coding to generate concepts. RESULTS: Study participants described the programme as participatory, fair and transparent -- reducing the likelihood of jealousy. The programme was perceived to have had a substantial impact on children's health and education, primarily through aiding parents and guardians to better cater for their children's needs. Moreover, participants alluded to the potential of the programme to facilitate more transformational change, for example by enabling families to invest money in assets and income generating activities and by promoting a community-wide sense of responsibility for the support of orphaned and vulnerable children. CONCLUSION: Community participation, combined with the perceived impact of the cash transfer programme, led community members to speak enthusiastically about the programme. We conclude that community-led cash transfer programmes have the potential to open up for possibilities of participation and community agency that enable social acceptability and limit social divisiveness.
    BMC Public Health 04/2013; 13(1):342. · 2.08 Impact Factor
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    ABSTRACT: BACKGROUND: Cash-transfer programmes can improve the wellbeing of vulnerable children, but few studies have rigorously assessed their effectiveness in sub-Saharan Africa. We investigated the effects of unconditional cash transfers (UCTs) and conditional cash transfers (CCTs) on birth registration, vaccination uptake, and school attendance in children in Zimbabwe. METHODS: We did a matched, cluster-randomised controlled trial in ten sites in Manicaland, Zimbabwe. We divided each study site into three clusters. After a baseline survey between July, and September, 2009, clusters in each site were randomly assigned to UCT, CCT, or control, by drawing of lots from a hat. Eligible households contained children younger than 18 years and satisfied at least one other criteria: head of household was younger than 18 years; household cared for at least one orphan younger than 18 years, a disabled person, or an individual who was chronically ill; or household was in poorest wealth quintile. Between January, 2010, and January, 2011, households in UCT clusters collected payments every 2 months. Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing. Eligible households in all clusters, including control clusters, had access to parenting skills classes and received maize seed and fertiliser in December, 2009, and August, 2010. Households and individuals delivering the intervention were not masked, but data analysts were. The primary endpoints were proportion of children younger than 5 years with a birth certificate, proportion younger than 5 years with up-to-date vaccinations, and proportion aged 6-12 years attending school at least 80% of the time. This trial is registered with ClinicalTrials.gov, number NCT00966849. FINDINGS: 1199 eligible households were allocated to the control group, 1525 to the UCT group, and 1319 to the CCT group. Compared with control clusters, the proportion of children aged 0-4 years with birth certificates had increased by 1·5% (95% CI -7·1 to 10·1) in the UCT group and by 16·4% (7·8-25·0) in the CCT group by the end of the intervention period. The proportions of children aged 0-4 years with complete vaccination records was 3·1% (-3·8 to 9·9) greater in the UCT group and 1·8% (-5·0 to 8·7) greater in the CCT group than in the control group. The proportions of children aged 6-12 years who attended school at least 80% of the time was 7·2% (0·8-13·7) higher in the UCT group and 7·6% (1·2-14·1) in the CCT group than in the control group. INTERPRETATION: Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa, but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region. FUNDING: Wellcome Trust, the World Bank through the Partnership for Child Development, and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children.
    The Lancet 02/2013; · 39.21 Impact Factor
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    ABSTRACT: Census data, collected in July 2009, from 27,672 children were used to compare the effectiveness, coverage and efficacy of three household-based methods for targeting cash transfers to vulnerable children in eastern Zimbabwe: targeting the poorest households using a wealth index; targeting HIV-affected households using socio-demographic information (households caring for orphans, chronically-ill or disabled members; child-headed households); and targeting labour-constrained households using dependency ratios. All three methods failed to identify large numbers of children with poor social and educational outcomes. The wealth index approach was the most efficient at reaching children with poor outcomes whilst socio-demographic targeting reached more vulnerable children but was less efficient.
    Social Science [?] Medicine 10/2012; · 2.73 Impact Factor
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    ABSTRACT: To compare socio-demographic patterns in access to antiretroviral therapy (ART) across four community HIV cohort studies in Africa. Data on voluntary counselling and testing and ART use among HIV-infected persons were analysed from Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and Manicaland (Zimbabwe), where free ART provision started between 2004 and 2007. ART coverage was compared across sites by calculating the proportion on ART among those estimated to need treatment, by age, sex and educational attainment. Logistic regression was used to identify socio-demographic characteristics associated with undergoing eligibility screening at an ART clinic within 2 years of being diagnosed with HIV, for three sites with information on diagnosis and screening dates. Among adults known to be HIV-infected from serological surveys, the proportion who knew their HIV status was 93% in Karonga, 37% in Kisesa, 46% in Masaka and 25% in Manicaland. Estimated ART coverage was highest in Masaka (68%) and lowest in Kisesa (2%). The proportion of HIV-diagnosed persons who were screened for ART eligibility within 2 years of diagnosis ranged from 14% in Kisesa to 84% in Masaka, with the probability of screening uptake increasing with age at diagnosis in all sites. Higher HIV testing rates among HIV-infected persons in the community do not necessarily correspond with higher uptake of ART, nor more equitable treatment coverage among those in need of treatment. In all sites, young adults tend to be disadvantaged in terms of accessing and initiating ART, even after accounting for their less urgent need.
    Tropical Medicine & International Health 08/2012; 17(8):e38-48. · 2.94 Impact Factor
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    ABSTRACT: Abstract The high prevalence of human immunodeficiency virus/acquired immune deficiency syndrome in sub-Saharan Africa has resulted in a dramatic increase in orphans and vulnerable children (OVC) over the past decade. These children typically rely on extended family networks for support, but the magnitude of the crisis has resulted in traditional familial networks becoming overwhelmed and more economically and socially vulnerable. Previous research consistently demonstrates the positive influence of household asset ownership on children's well-being. Using data from impoverished households caring for OVC in rural Manicaland Province, Zimbabwe, this study explores the influence of household asset ownership on OVC health vulnerability (HV) and social vulnerability (SV). Findings indicate that asset ownership is associated with significantly lower SV, in terms of school attendance and birth registration. Yet, assets do not emerge as a direct influence of OVC HV as measured by disease and chronic illness, although having a chronically ill adult in the household increases HV. These findings suggest that asset ownership, specifically a combination of fixed and movable assets, may offset the influence of other risk factors for children's SV.
    AIDS Care 05/2012; · 1.60 Impact Factor
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    ABSTRACT: Social capital—especially through its “network” dimension (high levels of participation in local community groups)—is thought to be an important determinant of health in many contexts. We investigate its effect on HIV prevention, using prospective data from a general population cohort in eastern Zimbabwe spanning a period of extensive behavior change (1998–2003). Almost half of the initially uninfected women interviewed were members of at least one community group. In an analysis of 88 communities, individuals with higher levels of community group participation had lower incidence of new HIV infections and more of them had adopted safer behaviors, although these effects were largely accounted for by differences in socio-demographic composition. Individual women in community groups had lower HIV incidence and more extensive behavior change, even after controlling for confounding factors. Community group membership was not associated with lower HIV incidence in men, possibly refecting a propensity among men to participate in groups that allow them to develop and demonstrate their masculine identities—often at the expense of their health. Support for women's community groups could be an effective HIV prevention strategy in countries with large-scale HIV epidemics.
    Population and Development Review 06/2011; 37(2):333 - 359. · 2.22 Impact Factor
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    ABSTRACT: Social capital—especially through its “network” dimension (high levels of participation in local community groups)—is thought to be an important determinant of health in many contexts. We investigate its effect on HIV prevention, using prospective data from a general population cohort in eastern Zimbabwe spanning a period of extensive behavior change (1998–2003). Almost half of the initially uninfected women interviewed were members of at least one community group. In an analysis of 88 communities, individuals with higher levels of community group participation had lower incidence of new HIV infections and more of them had adopted safer behaviors, although these effects were largely accounted for by differences in socio-demographic composition. Individual women in community groups had lower HIV incidence and more extensive behavior change, even after controlling for confounding factors. Community group membership was not associated with lower HIV incidence in men, possibly refecting a propensity among men to participate in groups that allow them to develop and demonstrate their masculine identities—often at the expense of their health. Support for women's community groups could be an effective HIV prevention strategy in countries with large-scale HIV epidemics.
    Population and Development Review 01/2011; 37(2):333-59. · 2.22 Impact Factor
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    ABSTRACT: To add to the evidence on the impact of national HIV prevention programs in reducing HIV risk in sub-Saharan African countries. Statistical analysis of prospective data on exposure to HIV prevention programs, relatives with AIDS and unemployment, and sexual behavior change and HIV incidence, in a population cohort of 4047 adults, collected over a period (1998-2003) when HIV prevalence and risk-behavior declined in eastern Zimbabwe. Exposure to HIV prevention programs and relatives with AIDS-but not unemployment-increased from 1998 to 2003. Men and women exposed to media campaigns and HIV/AIDS meetings had greater knowledge and self-efficacy, attributes that were concomitantly protective against HIV infection. Women attending community HIV/AIDS meetings before recruitment were more likely than other women to adopt lower-risk behavior (96.4% vs. 90.8%; adjusted odds ratio, 3.09; 95% confidence interval [CI], 1.27-7.49) and had lower HIV incidence (0.9% vs. 1.8%; adjusted incidence rate ratio, 0.63; 95% CI, 0.32-1.24) during the intersurvey period. Prior exposure to relatives with AIDS was not associated with differences in behavior change. More newly unemployed men as compared with employed men adopted lower-risk behavior (84.2% vs. 76.0%; adjusted odds ratio, 2.13; 95% CI, 0.98-4.59). Community-based HIV/AIDS meetings reduced risk-behavior amongst women who attended them, contributing to HIV decline in eastern Zimbabwe.
    Sexually transmitted diseases 01/2011; 38(6):475-82. · 2.58 Impact Factor
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    ABSTRACT: In recent years, HIV prevalence has begun to decline in Zimbabwe, which has been associated with reductions in sexual risk behaviour. Here, we analyse the determinants of HIV incidence in this period of decline and estimate the population-level impact of identified risk factors. A population-based cohort of 1672 HIV-negative adult males and 2465 HIV-negative adult females was recruited between 1998 and 2000. Each individual was then followed-up 3 years later. The influence and inter-relationship of social, behavioural and demographic variables were examined using a proximate determinants framework. To explore the population-level influence of a variable, methods were developed for estimating a risk factor's contribution to the reproductive number (CRN). HIV incidence was 19.9 [95% confidence interval (CI) 16.3-24.2] per 1000 person years in men and 15.7 (95% CI 13.0-18.9) in women. Multiple sexual partners, having an unwell partner, and reporting another sexually transmitted disease were risk factors that captured the main aspects of the proximate determinants framework: individual behaviour, partnership characteristics and the probability of transmission, respectively. If the proximate determinants fully captured risk of HIV infection, underlying factors would not influence a fully parameterized model. However, a number of underlying social and demographic determinants remained important in regression models after including the proximate determinants. For both sexes, having multiple sexual partners made a substantial CRN, but, for women, no behaviour explained more than 10% of new infections. The proximate determinants did not explain the majority of new infections at the population level. This may be because we have been unable to measure some risks, but identifying risk factors assumes that those acquiring infections are somehow different from others who do not acquire infections. That they are not suggests that in this generalized epidemic there is little difference in readily identifiable characteristics of the individual between those who acquire infection and those who do not.
    International Journal of Epidemiology 03/2008; 37(1):88-105. · 6.98 Impact Factor
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    ABSTRACT: HIV prevalence declined in Manicaland, eastern Zimbabwe, between 1998 and 2003. During this period, adult mortality in men was stable, whereas female mortality increased to levels similar to those of men. We examine the trends in mortality from 2003 to 2005. A population-based cohort was recruited from a household census in 12 communities. A baseline survey was conducted between 1998 and 2000, with the first and second follow-up surveys occurring after 3 and 5 years, respectively. Using checklists of the resident population at the previous round, adult deaths were reported to enumerators by surviving household members or community informants. Age-standardized adult mortality rates for men increased slightly but not significantly over time (1998-2000: 24/1000 person-years; 2001-2002: 26/1000 person-years; 2003-2005: 31/1000 person-years), reflecting a sharp rise in mortality among HIV-positive individuals (62, 79 and 105 per 1000 person-years). Female mortality rose sharply initially but levelled off after 2001 (15, 26 and 26 per 1000 person-years) also caused by the pronounced increase in mortality among HIV-positive women (35, 75 and 88/1000 person-years; 7/1000 person-years for HIV-negative men and women in all periods); 69% of adult male deaths and 74% of adult female deaths were attributable to HIV/AIDS in 2003-2005. In men, mortality was similar and stable in towns, estates, roadside business centres and subsistence farming areas. In women, mortality rose in towns and subsistence farming areas between 1998 and 2002 and was greater in towns than in other locations. Recent data indicate that adult mortality may be stabilizing in eastern Zimbabwe after the recent downturn in HIV prevalence.
    AIDS (London, England) 12/2007; 21 Suppl 6:S81-6. · 4.91 Impact Factor
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    ABSTRACT: In Zimbabwe, socioeconomic development has a complicated and changeable relationship with HIV infection. Longitudinal data are needed to disentangle the cyclical effects of poverty and HIV as well as to separate historical patterns from contemporary trends of infection. We analysed a large population-based cohort in eastern Zimbabwe. The wealth index was measured at baseline on the basis of household asset ownership. The associations of the wealth index with HIV incidence and mortality, sexual risk behaviour, and sexual mixing patterns were analysed. The largest decreases in HIV prevalence were in the top third of the wealth index distribution (tercile) in both men at 25% and women at 21%. In men, HIV incidence was significantly lower in the top wealth index tercile (15.4 per 1000 person-years) compared with the lowest tercile (27.4 per 1000 person-years), especially among young men. Mortality rates were significantly lower in both men and women of higher wealth index. Men of higher wealth index reported more sexual partners, but were also more likely to use condoms. Better-off women reported fewer partners and were less likely to engage in transactional sex. Partnership data suggests increasing like-with-like mixing in higher wealth groups resulting in the reduced probability of serodiscordant couples. HIV incidence and mortality, and perhaps sexual risk, are lower in higher socioeconomic groups. Reduced vulnerability to infection, led by the relatively well off, is a positive trend, but in the absence of analogous developments in vulnerable groups, HIV threatens to become a disease of the poor.
    AIDS (London, England) 12/2007; 21 Suppl 7:S57-66. · 4.91 Impact Factor
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    ABSTRACT: Early mathematical models varied in their predictions of the impact of HIV/AIDS on population growth from minimal impact to reductions in growth, in pessimistic scenarios, from positive to negative values over a period of 25 years. Models predicting negative rates of natural increase forecast little effect on the dependency ratio. Twenty years later, HIV prevalence in small towns, estates, and rural villages in eastern Zimbabwe, has peaked within the intermediate range predicted by the early models, but the demographic impact has been more acute than was predicted. Despite concurrent declines in fertility, fueled in part by HIV infections (total fertility is now 8% lower than expected without an epidemic), and a doubling of the crude death rate because of HIV/AIDS, the rate of natural population increase between 1998 and 2005 remained positive in each socioeconomic stratum. In the worst-affected areas (towns with HIV prevalence of 33%), HIV/AIDS reduced growth by two-thirds from 2.9% to 1.0%. The dependency ratio fell from 1.21 at the onset of the HIV epidemic to 0.78, the impact of HIV-associated adult mortality being outweighed by fertility decline. With the benefit of hindsight, the more pessimistic early models overestimated the demographic impact of HIV epidemics by overextrapolating initial HIV growth rates or not allowing for heterogeneity in key parameters such as transmissibility and sexual risk behavior. Data collected since the late 1980s show that there was a mismatch between the observed growth in the HIV epidemic and assumptions made about viral transmission.
    Proceedings of the National Academy of Sciences 10/2007; 104(37):14586-91. · 9.81 Impact Factor
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    ABSTRACT: Beginning sexual activity introduces an individual to the risk of acquiring sexually transmitted infections. In this study, cross-sectional behavioral data linked to HIV-status from 4,138 men and 4,948 women interviewed in rural Zimbabwe are analyzed to investigate the distribution and consequences of early first sex. We find that age at first sex (at a median age of 19 years for males and 18 years for females) has declined among males over the past 30 years but increased recently among females. Those in unskilled employment, those not associated with a church, and women without a primary education begin to have sex earlier than others. Early sexual debut before marriage precedes a lifetime of greater sexual activity but with more consistent condom use. Women who begin to have sex earlier than others of their age are more likely to be infected with HIV. This finding can be explained by their having a greater lifetime number of sexual partners than those whose first sexual experience occurs later.
    Studies in Family Planning 04/2007; 38(1):1-10. · 1.28 Impact Factor
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    ABSTRACT: Households form the basic social and economic building blocks of sub-Saharan African societies. Household viability is threatened by sustained crisis-level mortality in widely disseminated HIV epidemics. This article describes the impact of adult deaths on households in small towns, estates, and villages in eastern Zimbabwe. A stratified baseline household census was conducted, and 9842 adults were interviewed, tested for HIV infection, and followed up after 3 years. For 374 (93%) of 404 respondents who died, verbal autopsies were conducted with caregivers and data were collected on income foregone, health care and funeral expenditure, and household dissolution and relocation. The household impact of AIDS and non-AIDS deaths was compared. Deaths occurred disproportionately in more urban and low-income households, with AIDS deaths more often resulting in the loss of the household head (57% vs. 46%, adjusted odds ratio [AOR] = 2.47; P = 0.003). The median gross expenditure on health care and funerals was 25 US dollars (interquartile ratio [IQR]: 5-88) and 73 US dollars (IQR: 43-128), respectively, with external contributions being substantial for funerals (25 US dollars, IQR: 10-54). Households with AIDS deaths spent more on health care (incidence rate ratio = 1.83; 95% confidence interval: 1.06 to 3.15) and had more frequently dissolved or relocated (39% vs. 27%, AOR = 1.87; P = 0.038) than those with non-AIDS deaths. Households migrated disproportionately to rural villages. Despite the extended family system, adult deaths undermine the viability of sub-Saharan African households. HIV epidemics have greatly increased adult mortality, and AIDS deaths can be particularly destabilizing.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 03/2007; 44(2):188-95. · 4.65 Impact Factor
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    ABSTRACT: To compare alternative methods to vital registration systems for estimating adult mortality, and describe patterns of mortality in Manicaland, Zimbabwe, which has been severely affected by HIV. We compared estimates of adult mortality from (1) a single question on household mortality, (2) repeated household censuses, and (3) an adult cohort study with linked HIV testing from Manicaland, with a mathematical model fitted to local age-specific HIV prevalence (1998 -2000). The crude death rate from the single question (29 per 1000 person-years) was roughly consistent with that from the mathematical model (22 -25 per 1000 person-years), but much higher than that from the household censuses (12 per 1000 person-years). Adult mortality in the household censuses (males 0.65; females 0.51) was lower than in the cohort study (males 0.77; females 0.57), while mathematical models gave a much higher estimate, especially for females (males 0.80 -0.83; females 0.75 -0.80). The population attributable fraction of adult deaths due to HIV was 0.61 for men and 0.70 for women, with life expectancy estimated to be 34.3 years for males and 38.2 years for females. Each method for estimating adult mortality had limitations in terms of loss to follow-up (cohort study), under-ascertainment (household censuses), transparency of underlying processes (single question), and sensitivity to parameterization (mathematical model). However, these analyses make clear the advantages of longitudinal cohort data, which provide more complete ascertainment than household censuses, highlight possible inaccuracies in model assumptions, and allow direct quantification of the impact of HIV.
    Bulletin of the World Health Organisation 04/2006; 84(3):189-97. · 5.25 Impact Factor
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    ABSTRACT: The lifetime risk of acquiring HIV infection in many rural as well as urban areas of southern Africa is currently as high as two-in-three. For women, much of this risk still accrues rapidly at young ages despite high levels of knowledge about HIV/AIDS. Thus, programmes that are more participatory and address underlying structural and community-level factors appear to be essential. We use cross-sectional data from a large-scale, population-based survey in rural eastern Zimbabwe to describe the relationships between membership of different forms of community group and young women's chances of avoiding HIV. Our results show that participation in local community groups is often positively associated with successful avoidance of HIV, which, in turn, is positively associated with psychosocial determinants of safer behaviour. However, whether or not these relationships hold depends on a range of factors that include how well the group functions, the purpose of the group, and the education level of the individual participant. We identify factors that may influence the social capital value of community groups in relation to HIV prevention at the individual, group, and community levels. Young women with secondary education participate disproportionately in well-functioning community groups and are more likely to avoid HIV when they do participate. Longitudinal studies are needed: (i) to establish whether community group membership supports the development of safer lifestyles or merely has greater appeal to individuals already predisposed towards such lifestyles, and (ii) to pinpoint directions of causality between hypothesised mediating factors. In-depth research is needed on the specific qualities of community groups that enhance their contribution to HIV control. However, our findings suggest that promotion of and organisational development and training among community groups could well be an effective HIV control strategy.
    Social Science [?] Medicine 07/2004; 58(11):2119-32. · 2.73 Impact Factor
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Publication Stats

301 Citations
104.02 Total Impact Points

Institutions

  • 2007–2014
    • The Biomedical Research and Training Institute
      Salisbury, Harare Province, Zimbabwe
  • 2006–2013
    • Imperial College London
      • Department of Infectious Disease Epidemiology
      London, ENG, United Kingdom
  • 2012
    • Chestnut Hill College
      Boston, Massachusetts, United States
  • 2004
    • University of Oxford
      Oxford, England, United Kingdom
    • University of Zimbabwe
      Salisbury, Harare Province, Zimbabwe