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Article History

Received: 21 April 2020

Accepted: 19 January 2021

First Online: 30 January 2021

Ethics approval and consent to participate

: The study protocol was reviewed and approved by the University of Zambia Biomedical Research Ethics Committee, reference number 004–02-13 and the London School of Hygiene and Tropical Medicine Observational/Interventions Research Ethics Committee (reference number 6292) before the research was carried out. In addition, the Ministry of Health in Zambia also reviewed the research proposal after ethical approval had been granted. The research project was then discussed with relevant local authorities in the study district such as the District Health Management Team, community leaders and the in-charge personnel at the two health centres that were used as recruitment sites.At the beginning of each ANC booking session an explanation of the project was given to the group of first ANC attendees and their spouses/guardians/partners in addition to the routine weekly health talk. The information included the aims of the study, the methods of data and sample collection, number of participants required, potential advantages and disadvantages of participation and the expected benefits of carrying out the research. Potential participants were informed that participation was voluntary and participants could withdraw at any time. First ANC attendees who were willing to know more about the study were given the information sheet translated into the local language (Bemba).There was no age cut off for exclusion because inclusion of younger pregnant women was considered to be important in order to have better representation of pregnant women. The study was performed in accordance with the Declaration of Helsinki and all included participants signed informed consent. In the case of women aged below 18 years written consent was signed by their guardians after they assented. To ensure confidentiality interviews were conducted privately and each participant was assigned a unique identity number that was used to anonymise biological samples, questionnaires, and result record forms.

: Not applicable.

: The authors declare that they have no competing interests.