Background Teenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy as well as its individual and contextual determining factors. Methods A total pooled weighted sample of 10,010 teenagers (in the age group 15–19) from four waves of the Zambia Demographic and Health Surveys were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Bayesian parameter estimates were produced using lme4 package in R statistical programming environment. Results Results of the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four survey. In multilevel analysis, the odds of being pregnant were higher for teenagers who were employed (aOR = 1.21, 95% CI: 1.02–1.42), married (aOR = 7.71, 95% CI: 6.31–9.52) and those with knowledge of ovulation period (aOR = 1.58, 95% CI: 1.34–1.90). On the other hand, belonging to households in high wealth quintiles, being literate, exposure to mass-media family planning messages and delayed sexual debut were associated with decreased odds of teenage pregnancy. Conclusion The study shows that teenage pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy include marital status, and employment, knowledge of ovulation period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.

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Background We aimed to explore HIV RNA (ribonucleic acid) virologic levels greater than 1,000 copies/millilitre (ml), among HIV-positive adolescents aged 15–24 years, establish the spread of CD4 T- cell counts and inspect characteristics of adolescents presenting with new HIV infections, including co-infections with Hepatitis B virus and syphilis. Methods We analysed data from the Zambia Population-based HIV Impact Assessment 2016 survey. Two-stage stratified cluster probability sample design was used to select the target population. Our study truncated the population to focus on the age-group 15–24 whose biomarker tests and household information were complete. Our primary outcome measure was “New HIV-positive Infections among 15-24-year-olds” defined as HIV-positive biomarker samples presenting with HIV RNA ≥ 1,000 copies/ml without detectable ARVs. We tested associations between new HIV infections and clinical characteristics using negative binomial models adjusting for age, sex, education, marital-status, residence among several covariates. Results Overall, 2·3% ([166/7320], 95% CI: 1·9–2·6) adolescents aged 15–24 years were diagnosed with new HIV infections, with greater proportions among females (3·3% [139/4,165], 95% CI: 2·8–3·9) than males (0·86% [27/3,155], 95% CI: 0·6–1·2). Almost half (47·6%) of seroconversions had HIV RNA ≥ 50,000 copies/ml and an average CD4 + T-cell count of 479 cells/mm 3. HBV– positive adolescents (IRR 8·6, 95% CI: 2·9–24·9, P < 0·001, model 2) were at increased risk of new infections unlike those testing positive for syphilis antibodies (IRR 1·22, 95% CI: 0·2–8·3, P < 0·84). Adjusting for confounders revealed that being married or cohabiting, testing positive for HBV, being a rural resident and attaining higher than secondary education emerged as strongest correlates of new infections. Conclusion High baseline levels of viral load and low CD4 + T-cell count in recent HIV infections among adolescents indicate weak immune repertoire at first diagnosis, increasing the risk of contagion. As the epidemic continues to spread within the adolescent population, HIV-infection will become more complex and greater proportions of adolescents will likely be infected by regular partners. This suggests growing need for interventions targeted at stable partnerships and intensified public health campaigns specific for adolescents.

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IntroductionTeenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy and early motherhood as well as its individual and contextual determining factors. MethodsA total pooled weighted sample of 10,010 teenagers (in the age group 15 to 19) from four waves of the Zambia Demographic and Health Surveys (ZDHS) were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Parameter estimates were produced using Bayesian Markov chain Monte Carlo (MCMC) Methods in BRMS.ResultsResults show that the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four ZDHS waves. In multilevel analysis, the odds of being pregnant were higher for teenagers who were aged between 18 and 19 years (AOR = 2.57, 95% CI: 2.20-2.98), employed (AOR= 1.24, 95% CI: 1.06-1.46) married (AOR =8.33, 95% CI: 6.84-10.26) and those with knowledge of fertile period (AOR=1.69, 95% CI: 1.43-2.00). On the other hand, being in higher wealth quintile, 15-17 years of age, exposure to family planning messages and delayed sexual debut were associated with decreased odds of early teenage pregnancy. ConclusionThe study shows that early pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy and early motherhood include age, marital status, and employment, knowledge of fertility period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.