The impacts of covid-19 on gender dynamics and power relations among men and women involved in cross border fish trade in Zambia and Malawi

This paper explores the impact of the COVID-19 pandemic and the measures to mitigate it on gender dynamics and power relations among men and women involved in cross border fish trade in Zambia and Malawi and the ensuing policy implications to support the fisheries value chain. The paper is based on qualitative and quantitative data collected in Zambia and Malawi in October and November 2021. We conducted quantitative surveys implemented the Cognitive Edge Sensemaker Tool and the Emergency Market Mapping and Analysis toolkit (EMMA to understand the dynamics of cross border fish trade before and during the COVID-19 pandemic. A social relations approach, focusing on gender relations, was used to analyze the data. Findings suggest that women cross-border fish traders are caught up in a complex web of networks and relationships that are disempowering to them. Some measures put in place to mitigate the impact of the COVID-19 pandemic lacked an understanding of the historical perspective and dynamics of women in fish trading communities further marginalizing men and women cross border fish traders. Some measures exacerbated hidden violence against women and overt forms of violence against men. Since most of the violence occur across state boundaries, there is a need for inter-country coordination to ensure that the rights of women and men cross border fish traders are protected. Policy measures could include educating police officers for even-handedness when enforcing COVID-19 rules and providing mechanisms for reporting abusive practices.

Effect of agricultural diversification on dietary diversity in rural households with children under 5 years of age in Zambia

Micronutrient deficiencies in low-income countries are associated with the monotonous consumption of nutrient-deficient crops, contributing to childhood stunting with far-reaching socioeconomic consequences. To promote nutrition sensitive agriculture, policy makers in such countries have embarked on policy initiatives that encourage agricultural diversification in smallholder farming systems. This paper investigates the link between agricultural diversification and two key indicators of food and nutrition security among children under 5 years in rural Zambia. Data from the 2015 Rural Agricultural Livelihoods Survey and regression models are used to explain household dietary diversity and months of inadequate household food provisioning among 7934 households. Factors associated with the key outcome variables include land cultivated, household size, total livestock units, household head education, households receiving extension information, and use of productivity-enhancing inputs such as fertilizers. Although the results demonstrate that agricultural diversification is positively associated with the household dietary diversity score, the relationship is not statistically significant. Further, the study findings illustrate that agricultural diversity is negatively associated with months of inadequate household food provisioning but that this relationship is also not statistically significant. The implication for policy is that other interventions such as productivity enhancement and behavioral change communication need to be scaled up.

Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya

Background

Estimately, 70–80% of cancer cases are diagnosed in late stages in Kenya with breast cancer being a common cause of mortality among women where late diagnosis is the major ubiquitous concern. Numerous studies have focused on epidemiological and health policy dynamics essentially underestimating the determining factors that shape people’s choices and cues to health care service uptake. The study sought to evaluate the knowledge, attitude and health seeking behavior towards breast cancer and its screening in a quest to explain why women present for prognosis and treatment when symptomatic pointers are in advanced stages, impeding primary prevention strategies.

Methods

Eight focus groups (6–10 members per group) and four key informant interviews were conducted among adult participants from rural and urban settings. Sessions were audio-recorded and transcribed. A thematic analysis of the data was based on the concepts of the health belief model. Data analysis was conducted using NVIVO10.

Results

Most women perceived breast cancer as a fatal disease and conveyed fear of having early screening. Rural women preferred self-prescribed medications and the use of alternative medicine for long periods before presenting for professional care on suspicion that the lump is cancerous. Accessibility to equipped health facilities, lack of information to establish effective follow-up treatment and low-income status were underscored as their major health seeking behavior barriers whereas, urban women identified marital status as their main barrier. Key informant interviews revealed that health communication programs emphasized more on communicable diseases. This could in part explain why there is a high rate of misconception and suspicion about breast cancer among rural and urban women in the study setting.

Conclusions

Creating breast cancer awareness alongside clear guidelines on accessing screening and treatment infrastructure is critical. It was evident, a diagnosis of breast cancer or lump brings unexpected confrontation with mortality; fear, pain, cultural barriers, emotional and financial distress. Without clear referral channels to enable those with suspicious lumps or early stage disease to get prompt diagnosis and treatment, then well-meaning awareness will not necessarily contribute to reducing morbidity and mortality.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0571-7) contains supplementary material, which is available to authorized users.

Challenges and opportunities of optimal breastfeeding in the context of HIV option B+ guidelines

Background

In 2013, the World Health Organization released a new set of guidelines widely known as Option B+. Prior to that there were guidelines released in 2010. Option B+ recommends lifelong antiretroviral treatment for all pregnant and breastfeeding women living with Human Immunodeficiency Virus. The study aimed at investigating challenges and opportunities in implementing Infant and Young Child Feeding in the context of Prevention of Mother To Child Transmission (PMTCT) guidelines among HIV positive mothers of children aged 0–24 months. The study also examined implications presented by implementing the 2013 PMTCT consolidated guidelines in the transition phase from the 2010 approach in Zambia.

Methods

A mixed methods approach was employed in the descriptive cross sectional study utilizing semi structured questionnaires and Focused Group Discussions. Further, data was captured from the Health Information Management System.

Results

During the PMTCT transition, associated needs and challenges in institutionalizing the enhanced guidelines from option A and B to option B+ were observed. Nonetheless, there was a decline in Mother to Child Transmission (MTCT) of HIV rates with an average of 4%. Mothers faced challenges in complying with optimal breastfeeding practices owing to lack of community support systems and breast infections due to poor breast feeding occasioned by infants’ oral health challenges. Moreover, some mothers were hesitant of lifelong ARVs. Health workers faced programmatic and operational challenges such as compromised counseling services.

Conclusion

Despite the ambitious timelines for PMTCT transition, the need to inculcate new knowledge and vary known practice among mothers and the shift in counseling content for health workers, the consolidated guidelines for PMTCT proved effective. Some mothers were hesitant of lifelong ARVs, rationalizing the debated paradigm that prolonged chemotherapy/polypharmacy may be a future challenge in the success of ART in PMTCT. Conflicting breast feeding practices was a common observation across mothers thus underpinning the need to strongly invigorate Infant and Young Child Feeding information sharing across the continuum of heath care from facility level to community and up to the family; for cultural norms, practices and attitudes enshrined within communities play a vital role in child care.