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Background Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through the Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing adolescent sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs) experiences in addressing ASRHR problems in rural health systems in Zambia. Methodology The study was conducted under the Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aimed to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted 21 qualitative in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services. Results The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referrals to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution. Conclusion This study provides significant insight on the important roles that teachers and CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescent SRHR problems.

Additional file 1.

Additional file 1. Interview guide _ English version.

BackgroundThe burden of disease attributable to tobacco smoking and harmful alcohol consumption poses a major threat to sustainable development in most low- and middle-income countries. However, evidence on tobacco use and harmful alcohol consumption to inform context-specific interventions addressing these harmful social behaviours is limited in the African context. This study aimed to determine the sociodemographic factors associated with daily tobacco smoking and binge drinking in Zambia.MethodsThe study stems from nationwide population-based representative survey data collected using the World Health Organization’s STEPwise approach for non-communicable disease risk factor surveillance in 2017 among 18–69-year-old Zambians. The main outcomes were daily tobacco smoking and binge drinking, and the demographic and socioeconomic variables included sex, marital status, age, residence, level of education and occupation. Prevalence ratios (PR) were calculated using log-binomial regression analysis.ResultsOverall, 4302 individuals (weighted percentage 49.0% men and 51.0% women) participated in the survey. The prevalence of daily tobacco smoking was 9.0%, and 11.6% of participants engaged in binge drinking, both of which were higher among men than women (17.1% vs. 1.3% and 18.6% vs. 5.3%, respectively). The adjusted prevalence of daily tobacco smoking was 14.3 (95% CI: 9.74-21.01) times higher in men than women, and 1.44 (95% CI 1.03-1.99) times higher in the > 45-year-old group compared to the 18–29-year-old group. Significant positive associations with daily tobacco smoking were found among those with no education 2.70 (95% CI 1.79- 4.07) or primary education 1.86 (95% CI 1.22-2.83) compared to those with senior secondary or tertiary education. The adjusted prevalence of daily tobacco smoking was 0.37 times lower (95% CI 0.16-0.86) among students and homemakers compared to employed participants. The adjusted prevalence of binge drinking was 3.67 times higher (95% CI 2.83-4.76) in men than in women. Significantly lower adjusted prevalences of binge drinking were found in rural residents 0.59 (95% CI: 0.46-0.77) compared to urban residents and in students/homemakers 0.58 (95% CI: 0.35-0.94) compared to employed participants.ConclusionThis study shows huge differences between men and women regarding tobacco smoking and binge drinking in Zambia. A high occurrence of tobacco smoking was observed among men, older members of society and those with lower levels of education, while binge drinking was more common in men and in those living in urban areas. There is a need to reshape and refine preventive and control interventions for tobacco smoking and binge drinking to target the most at-risk groups in the country.

Additional file 1. In-depth interview guide – male partner, Interview topics for male partners.

Additional file 2. Codebook for K99 qualitative data. Codebook developed for the parent study.

Additional file 2. PRISMA-ScR Checklist.docx PRISMA checklist for scoping reviews

Additional file 3. excluded studies.docx Studies excluded (DOCX 27 kb)

Additional file 1: Annexe 1. Feasibility Testing Tick-list.

Additional file 1. Search History_Medline.docx Illustrative Search Strategy

Additional file 2: Annexe 2. Feasibility Testing Agenda.

Additional file 1.

Additional file 4. Explanations.docx Explanations for why choices affected fertility

Additional file 5. Consequences.docx Feared consequences of infertility