Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia
Identifieur interne : 005412 ( Main/Merge ); précédent : 005411; suivant : 005413Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia
Auteurs : Nkomba Kayeyi [Norvège] ; Ingvild F. Sand Y [Norvège] ; Knut Fylkesnes [Norvège]Source :
- BMC Public Health [ 1471-2458 ] ; 2009.
Abstract
Investigations of the association between socio-economic position indicators and HIV in East, Central and Southern Africa have chiefly focused on factors that pertain to individual-level characteristics. This study investigated the effect of neighbourhood educational attainment on HIV prevalence among young women in selected urban and rural areas in Zambia.
This study re-analysed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women aged 15–24 years (n = 1295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighbourhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighbourhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners).
HIV prevalence among young women aged 15–24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighbourhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural population, i.e. HIV prevalence decreased substantially by increasing level of neighbourhood education. The likelihood of infection in low vs. high educational attainment of neighbourhoods was 3.4 times among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighbourhood, the effect of the individual-level education differed by residence, i.e. a strong protective effect among urban women whereas tending to be a risk factor among rural women.
The findings suggested structural effects on HIV prevalence. Future research should include more detailed mapping of neighbourhood factors of relevance to HIV transmission as part of the effort to better understand the causal mechanisms involved.
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DOI: 10.1186/1471-2458-9-310
PubMed: 19706189
PubMed Central: 2753350
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Sand Y</name><affiliation wicri:level="1"><nlm:aff id="I1">Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen</wicri:regionArea><wicri:noRegion>N-5009 Bergen</wicri:noRegion></affiliation></author><author><name sortKey="Fylkesnes, Knut" sort="Fylkesnes, Knut" uniqKey="Fylkesnes K" first="Knut" last="Fylkesnes">Knut Fylkesnes</name><affiliation wicri:level="1"><nlm:aff id="I1">Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen</wicri:regionArea><wicri:noRegion>N-5009 Bergen</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19706189</idno><idno type="pmc">2753350</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2753350</idno><idno type="RBID">PMC:2753350</idno><idno type="doi">10.1186/1471-2458-9-310</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000C79</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C79</idno><idno type="wicri:Area/Pmc/Curation">000C78</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000C78</idno><idno type="wicri:Area/Pmc/Checkpoint">002840</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002840</idno><idno type="wicri:Area/Ncbi/Merge">000834</idno><idno type="wicri:Area/Ncbi/Curation">000834</idno><idno type="wicri:Area/Ncbi/Checkpoint">000834</idno><idno type="wicri:Area/Main/Merge">005412</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia</title><author><name sortKey="Kayeyi, Nkomba" sort="Kayeyi, Nkomba" uniqKey="Kayeyi N" first="Nkomba" last="Kayeyi">Nkomba Kayeyi</name><affiliation wicri:level="1"><nlm:aff id="I1">Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen</wicri:regionArea><wicri:noRegion>N-5009 Bergen</wicri:noRegion></affiliation></author><author><name sortKey="Sand Y, Ingvild F" sort="Sand Y, Ingvild F" uniqKey="Sand Y I" first="Ingvild F" last="Sand Y">Ingvild F. Sand Y</name><affiliation wicri:level="1"><nlm:aff id="I1">Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen</wicri:regionArea><wicri:noRegion>N-5009 Bergen</wicri:noRegion></affiliation></author><author><name sortKey="Fylkesnes, Knut" sort="Fylkesnes, Knut" uniqKey="Fylkesnes K" first="Knut" last="Fylkesnes">Knut Fylkesnes</name><affiliation wicri:level="1"><nlm:aff id="I1">Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>Centre for International Health, University of Bergen, Overlege Danielssens hus, 5th floor, Årstadveien 21, N-5009 Bergen</wicri:regionArea><wicri:noRegion>N-5009 Bergen</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Investigations of the association between socio-economic position indicators and HIV in East, Central and Southern Africa have chiefly focused on factors that pertain to individual-level characteristics. This study investigated the effect of neighbourhood educational attainment on HIV prevalence among young women in selected urban and rural areas in Zambia.</p></sec><sec sec-type="methods"><title>Methods</title><p>This study re-analysed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women aged 15–24 years (n = 1295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighbourhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighbourhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners).</p></sec><sec><title>Results</title><p>HIV prevalence among young women aged 15–24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighbourhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural population, i.e. HIV prevalence decreased substantially by increasing level of neighbourhood education. The likelihood of infection in low vs. high educational attainment of neighbourhoods was 3.4 times among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighbourhood, the effect of the individual-level education differed by residence, i.e. a strong protective effect among urban women whereas tending to be a risk factor among rural women.</p></sec><sec><title>Conclusion</title><p>The findings suggested structural effects on HIV prevalence. 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