Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe
Identifieur interne : 004481 ( Ncbi/Merge ); précédent : 004480; suivant : 004482Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe
Auteurs : Sema K. Sgaier [États-Unis] ; Sunny Sharma [Royaume-Uni] ; Maria Eletskaya [Royaume-Uni] ; Ram Prasad [Inde] ; Owen Mugurungi [Zimbabwe] ; Bushimbwa Tambatamba [Zambie] ; Getrude Ncube [Zimbabwe] ; Sinokuthemba Xaba [Zimbabwe] ; Alice Nanga [Royaume-Uni] ; Sehlulekile Gumede-Moyo [Royaume-Uni] ; Steve Kretschmer [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2017.
Abstract
As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed.
Url:
DOI: 10.1371/journal.pone.0181411
PubMed: 28749979
PubMed Central: 5531536
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<front><div type="abstract" xml:lang="en"><p>As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed.</p>
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<author><name sortKey="Hatzold, K" uniqKey="Hatzold K">K Hatzold</name>
</author>
<author><name sortKey="Biddle, Ak" uniqKey="Biddle A">AK Biddle</name>
</author>
<author><name sortKey="Madidi, N" uniqKey="Madidi N">N Madidi</name>
</author>
<author><name sortKey="Ncube, G" uniqKey="Ncube G">G Ncube</name>
</author>
</analytic>
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</author>
<author><name sortKey="Larke, N" uniqKey="Larke N">N Larke</name>
</author>
<author><name sortKey="Hatzold, K" uniqKey="Hatzold K">K Hatzold</name>
</author>
<author><name sortKey="Ncube, G" uniqKey="Ncube G">G Ncube</name>
</author>
<author><name sortKey="Weiss, Ha" uniqKey="Weiss H">HA Weiss</name>
</author>
<author><name sortKey="Mangenah, C" uniqKey="Mangenah C">C Mangenah</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Plank, Rm" uniqKey="Plank R">RM Plank</name>
</author>
<author><name sortKey="Wirth, Ke" uniqKey="Wirth K">KE Wirth</name>
</author>
<author><name sortKey="Ndubuka, No" uniqKey="Ndubuka N">NO Ndubuka</name>
</author>
<author><name sortKey="Abdullahi, R" uniqKey="Abdullahi R">R Abdullahi</name>
</author>
<author><name sortKey="Nkgau, M" uniqKey="Nkgau M">M Nkgau</name>
</author>
<author><name sortKey="Lesetedi, C" uniqKey="Lesetedi C">C Lesetedi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Plank, Rm" uniqKey="Plank R">RM Plank</name>
</author>
<author><name sortKey="Makhema, J" uniqKey="Makhema J">J Makhema</name>
</author>
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</author>
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</author>
<author><name sortKey="Halperin, D" uniqKey="Halperin D">D Halperin</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Mavhu, W" uniqKey="Mavhu W">W Mavhu</name>
</author>
<author><name sortKey="Mupambireyi, Z" uniqKey="Mupambireyi Z">Z Mupambireyi</name>
</author>
<author><name sortKey="Hart, G" uniqKey="Hart G">G Hart</name>
</author>
<author><name sortKey="Cowan, Fm" uniqKey="Cowan F">FM Cowan</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Waters, E" uniqKey="Waters E">E Waters</name>
</author>
<author><name sortKey="Li, M" uniqKey="Li M">M Li</name>
</author>
<author><name sortKey="Mugisa, B" uniqKey="Mugisa B">B Mugisa</name>
</author>
<author><name sortKey="Bowa, K" uniqKey="Bowa K">K Bowa</name>
</author>
<author><name sortKey="Linyama, D" uniqKey="Linyama D">D Linyama</name>
</author>
<author><name sortKey="Stringer, E" uniqKey="Stringer E">E Stringer</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Mavhu, W" uniqKey="Mavhu W">W Mavhu</name>
</author>
<author><name sortKey="Hatzold, K" uniqKey="Hatzold K">K Hatzold</name>
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</biblStruct>
<biblStruct></biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28749979</article-id>
<article-id pub-id-type="pmc">5531536</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0181411</article-id>
<article-id pub-id-type="publisher-id">PONE-D-16-38505</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Surgical and Invasive Medical Procedures</subject>
<subj-group><subject>Reproductive System Procedures</subject>
<subj-group><subject>Circumcision</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Age Groups</subject>
<subj-group><subject>Children</subject>
<subj-group><subject>Infants</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Families</subject>
<subj-group><subject>Children</subject>
<subj-group><subject>Infants</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Neuroscience</subject>
<subj-group><subject>Cognitive Science</subject>
<subj-group><subject>Cognitive Psychology</subject>
<subj-group><subject>Decision Making</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Psychology</subject>
<subj-group><subject>Cognitive Psychology</subject>
<subj-group><subject>Decision Making</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject>
<subj-group><subject>Psychology</subject>
<subj-group><subject>Cognitive Psychology</subject>
<subj-group><subject>Decision Making</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Neuroscience</subject>
<subj-group><subject>Cognitive Science</subject>
<subj-group><subject>Cognition</subject>
<subj-group><subject>Decision Making</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Geographical Locations</subject>
<subj-group><subject>Africa</subject>
<subj-group><subject>Zimbabwe</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Families</subject>
<subj-group><subject>Fathers</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Geographical Locations</subject>
<subj-group><subject>Africa</subject>
<subj-group><subject>Zambia</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Families</subject>
<subj-group><subject>Mothers</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Age Groups</subject>
<subj-group><subject>Adolescents</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe</article-title>
<alt-title alt-title-type="running-head">Demand-side insights for VMMC sustainability phase design</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Sgaier</surname>
<given-names>Sema K.</given-names>
</name>
<role content-type="http://credit.casrai.org/">Conceptualization</role>
<role content-type="http://credit.casrai.org/">Formal analysis</role>
<role content-type="http://credit.casrai.org/">Funding acquisition</role>
<role content-type="http://credit.casrai.org/">Supervision</role>
<role content-type="http://credit.casrai.org/">Writing – original draft</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sharma</surname>
<given-names>Sunny</given-names>
</name>
<role content-type="http://credit.casrai.org/">Formal analysis</role>
<role content-type="http://credit.casrai.org/">Investigation</role>
<role content-type="http://credit.casrai.org/">Methodology</role>
<role content-type="http://credit.casrai.org/">Project administration</role>
<role content-type="http://credit.casrai.org/">Supervision</role>
<role content-type="http://credit.casrai.org/">Visualization</role>
<role content-type="http://credit.casrai.org/">Writing – original draft</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Eletskaya</surname>
<given-names>Maria</given-names>
</name>
<role content-type="http://credit.casrai.org/">Formal analysis</role>
<role content-type="http://credit.casrai.org/">Investigation</role>
<role content-type="http://credit.casrai.org/">Methodology</role>
<role content-type="http://credit.casrai.org/">Project administration</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Prasad</surname>
<given-names>Ram</given-names>
</name>
<role content-type="http://credit.casrai.org/">Formal analysis</role>
<role content-type="http://credit.casrai.org/">Investigation</role>
<role content-type="http://credit.casrai.org/">Methodology</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mugurungi</surname>
<given-names>Owen</given-names>
</name>
<role content-type="http://credit.casrai.org/">Resources</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tambatamba</surname>
<given-names>Bushimbwa</given-names>
</name>
<role content-type="http://credit.casrai.org/">Resources</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ncube</surname>
<given-names>Getrude</given-names>
</name>
<role content-type="http://credit.casrai.org/">Resources</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Xaba</surname>
<given-names>Sinokuthemba</given-names>
</name>
<role content-type="http://credit.casrai.org/">Resources</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nanga</surname>
<given-names>Alice</given-names>
</name>
<role content-type="http://credit.casrai.org/">Resources</role>
<role content-type="http://credit.casrai.org/">Supervision</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gumede-Moyo</surname>
<given-names>Sehlulekile</given-names>
</name>
<role content-type="http://credit.casrai.org/">Resources</role>
<role content-type="http://credit.casrai.org/">Supervision</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kretschmer</surname>
<given-names>Steve</given-names>
</name>
<role content-type="http://credit.casrai.org/">Conceptualization</role>
<role content-type="http://credit.casrai.org/">Formal analysis</role>
<role content-type="http://credit.casrai.org/">Investigation</role>
<role content-type="http://credit.casrai.org/">Methodology</role>
<role content-type="http://credit.casrai.org/">Project administration</role>
<role content-type="http://credit.casrai.org/">Resources</role>
<role content-type="http://credit.casrai.org/">Supervision</role>
<role content-type="http://credit.casrai.org/">Writing – review & editing</role>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor001">*</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Surgo Foundation, Washington, District of Columbia, United States of America</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Department of Global Health, University of Washington, Seattle, Washington, United States of America</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Ipsos Healthcare, London, United Kingdom</addr-line>
</aff>
<aff id="aff005"><label>5</label>
<addr-line>Final Mile Consulting, Mumbai, India</addr-line>
</aff>
<aff id="aff006"><label>6</label>
<addr-line>Ministry of Health and Child Care, Harare, Zimbabwe</addr-line>
</aff>
<aff id="aff007"><label>7</label>
<addr-line>Ministry of Community Development, Mother and Child Health, Lusaka, Zambia</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Spearman</surname>
<given-names>Paul</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>Cincinnati Children's Hospital Medical Center, UNITED STATES</addr-line>
</aff>
<author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>
SS and AN are employed on salary with Ipsos Healthcare, the organization contracted by the funder to carry out the research documented in this publication. RP is employed on salary with Final Mile Consulting, the organization sub-contracted as an organization to carry out the Phase II Ethnolabs portion of the research documented in this publication. This does not alter our adherence to PLOS ONE policies on sharing data and materials.</p>
</fn>
<corresp id="cor001">* E-mail: <email>stevek@surgofoundation.org</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>27</day>
<month>7</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection"><year>2017</year>
</pub-date>
<volume>12</volume>
<issue>7</issue>
<elocation-id>e0181411</elocation-id>
<history><date date-type="received"><day>28</day>
<month>9</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>30</day>
<month>6</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>© 2017 Sgaier et al</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Sgaier et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:href="pone.0181411.pdf"></self-uri>
<abstract><p>As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed.</p>
</abstract>
<funding-group><award-group id="award001"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000865</institution-id>
<institution>Bill and Melinda Gates Foundation</institution>
</institution-wrap>
</funding-source>
<award-id>24210</award-id>
</award-group>
<funding-statement>The Bill and Melinda Gates Foundation, the funding organization for this research, contracted Ipsos Healthcare, as an organization, to carry out the research documented in this publication. Ipsos Healthcare, as an organization, subcontracted Final Mile Consulting, as an organization, to carry out the Phase II Ethnolabs portion of the research documented in this publication. At the time of the funding and research, the authors SK, SS, ME, AN and SGM were on salaried employment with Ipsos Healthcare. Currently, SS and AN are still employed on salary with Ipsos Healthcare. SK, ME and SGM are each currently employed at their respective other organizations. RP was and is on salaried employment by Final Mile Consulting. As salaried employees of Ipsos Healthcare and Final Mile Consulting, respectively, none of these authors individually benefited financially from the funding of the research when it was carried out, nor individually benefit financially from the publication of this research. The funding organization did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of the authors listed above are articulated in the ‘author contributions’ section.</funding-statement>
</funding-group>
<counts><fig-count count="4"></fig-count>
<table-count count="7"></table-count>
<page-count count="17"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>The data are the property of the governments of Zimbabwe and Zambia, and may be made available on request for researchers who meet the criteria for access to confidential data. Requests for access to the data can be made to the following: Zimbabwe Ministry of Health & Childcare, Box CY1122, Causeway, Harare, Zimbabwe, Tel: +263 4 290 1210; Zambia Ministry of Community Development, Mother and Child Health Community House, Sadzu Road. Lusaka, Zambia, Tel: +260 211 225 327.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>The data are the property of the governments of Zimbabwe and Zambia, and may be made available on request for researchers who meet the criteria for access to confidential data. Requests for access to the data can be made to the following: Zimbabwe Ministry of Health & Childcare, Box CY1122, Causeway, Harare, Zimbabwe, Tel: +263 4 290 1210; Zambia Ministry of Community Development, Mother and Child Health Community House, Sadzu Road. Lusaka, Zambia, Tel: +260 211 225 327.</p>
</notes>
</front>
</pmc>
<affiliations><list><country><li>Inde</li>
<li>Royaume-Uni</li>
<li>Zambie</li>
<li>Zimbabwe</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
<li>Massachusetts</li>
<li>Washington (État)</li>
</region>
<settlement><li>Londres</li>
<li>Seattle</li>
</settlement>
<orgName><li>Université de Washington</li>
</orgName>
</list>
<tree><country name="États-Unis"><noRegion><name sortKey="Sgaier, Sema K" sort="Sgaier, Sema K" uniqKey="Sgaier S" first="Sema K." last="Sgaier">Sema K. Sgaier</name>
</noRegion>
<name sortKey="Kretschmer, Steve" sort="Kretschmer, Steve" uniqKey="Kretschmer S" first="Steve" last="Kretschmer">Steve Kretschmer</name>
<name sortKey="Sgaier, Sema K" sort="Sgaier, Sema K" uniqKey="Sgaier S" first="Sema K." last="Sgaier">Sema K. Sgaier</name>
<name sortKey="Sgaier, Sema K" sort="Sgaier, Sema K" uniqKey="Sgaier S" first="Sema K." last="Sgaier">Sema K. Sgaier</name>
</country>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Sharma, Sunny" sort="Sharma, Sunny" uniqKey="Sharma S" first="Sunny" last="Sharma">Sunny Sharma</name>
</region>
<name sortKey="Eletskaya, Maria" sort="Eletskaya, Maria" uniqKey="Eletskaya M" first="Maria" last="Eletskaya">Maria Eletskaya</name>
<name sortKey="Gumede Moyo, Sehlulekile" sort="Gumede Moyo, Sehlulekile" uniqKey="Gumede Moyo S" first="Sehlulekile" last="Gumede-Moyo">Sehlulekile Gumede-Moyo</name>
<name sortKey="Nanga, Alice" sort="Nanga, Alice" uniqKey="Nanga A" first="Alice" last="Nanga">Alice Nanga</name>
</country>
<country name="Inde"><noRegion><name sortKey="Prasad, Ram" sort="Prasad, Ram" uniqKey="Prasad R" first="Ram" last="Prasad">Ram Prasad</name>
</noRegion>
</country>
<country name="Zimbabwe"><noRegion><name sortKey="Mugurungi, Owen" sort="Mugurungi, Owen" uniqKey="Mugurungi O" first="Owen" last="Mugurungi">Owen Mugurungi</name>
</noRegion>
<name sortKey="Ncube, Getrude" sort="Ncube, Getrude" uniqKey="Ncube G" first="Getrude" last="Ncube">Getrude Ncube</name>
<name sortKey="Xaba, Sinokuthemba" sort="Xaba, Sinokuthemba" uniqKey="Xaba S" first="Sinokuthemba" last="Xaba">Sinokuthemba Xaba</name>
</country>
<country name="Zambie"><noRegion><name sortKey="Tambatamba, Bushimbwa" sort="Tambatamba, Bushimbwa" uniqKey="Tambatamba B" first="Bushimbwa" last="Tambatamba">Bushimbwa Tambatamba</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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