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Aliyu TK. Situational context of home-based sexual education in urban slums of Ibadan, Nigeria-evidence from a qualitative study. PLoS One 2024; 19:e0304200. [PMID: 38885279 PMCID: PMC11182513 DOI: 10.1371/journal.pone.0304200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 05/07/2024] [Indexed: 06/20/2024] Open
Abstract
This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria. A qualitative exploratory study was conducted in the Southeast and Northeast LGAs of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were tape-recorded, transcribed, and translated into English. Thematic analysis was adopted using ATLAS Ti 9 software. Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that despite understanding the need for SRH discussion, parents and adolescents lack effective communication on SRH issues due to the interference of unfiltered streetwise SRH knowledge and social media exposure. Also, SRH conversation between parents and adolescents promotes gender inequalities as different information is passed to adolescent girls and boys. Interventions that take into account situational occurrences must be geared towards enabling parents to give their adolescents early exposure to relevant, context-specific SRH knowledge.
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Affiliation(s)
- Taofeek Kolawole Aliyu
- Department of Sociology and Anthropology, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Sociology, Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
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Agu O, Agu IC, Eigbiremolen G, Akamike I, Okeke C, Mbachu C, Onwujekwe O. Sexual and reproductive health information needs; an inquiry from the lens of in-school adolescents in Ebonyi State, Southeast Nigeria. BMC Public Health 2024; 24:1105. [PMID: 38649935 PMCID: PMC11034149 DOI: 10.1186/s12889-024-18584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND It is important to understand the sexual and reproductive health (SRH) needs of adolescents from the adolescents themselves to address their needs properly. Hence, this paper provides new knowledge on the information needs on SRH among adolescent boys and girls in selected secondary schools in Ebonyi state, southeast Nigeria. METHOD A comparative assessment was conducted among adolescent boys and girls in public secondary schools that received a specific school-based SRH intervention (group A) and those that did not receive the intervention (group B). These schools were spread across six urban and rural local government areas in Ebonyi state, southeast Nigeria. A structured interviewer-administered questionnaire was used to collect data from 514 adolescents aged 13 to 18 on their stated needs for SRH information and services. Categorical variables were compared using the Chi-square test, and predictors were determined using logistic regression analysis. The statistical significance was determined at p < 0.05. RESULT Majority of the adolescents (82% of intervention group and 92% of non-intervention group) identified puberty and pubertal changes as perceived SRH information need for adolescents (χ2 = 7.94; p-value = 0.01). Adolescents who received SRH intervention have 3.13 (p < 0.001) times the odds of perceiving the need for adolescents to be provided with SRH information than adolescents who did not receive SRH intervention. The odds of perceiving the need for adolescents to be provided with SRH information for adolescents who reside in urban communities are 0.31 (p < 0.001) times the odds for adolescents who resides in rural communities. That is, the perception odds are higher adolescents who reside in rural communities. Multivariate regression of specific SRH information showed the location of residence as a strong predictor of adolescents' perceived need for information on 'puberty and pubertal changes' (OR = 0.30; p = 0.001), 'safe sex and sexual relations' (OR = 0.33; p < 0.001) and 'prevention of pregnancy and use of contraceptives' (OR = 0.28; p < 0.001). Adolescents in senior secondary school have 2.21 (p = 0.002) times the odds of perceiving the need for adolescents to be provided with specific SRH information than adolescents who are in junior secondary school. CONCLUSION Adolescents' age, location of residence, and study group were found to be strong predictors of SRH information needs. This suggests the need for in-school adolescents to be provided with substantial and continuous SRH information for healthy living and making informed SRH choices. In developing SRH interventions that will achieve optimal effectiveness in the lives of adolescents in school, different demographic factors should be considered for context-specific and appropriate strategies.
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Affiliation(s)
- Ozioma Agu
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria.
| | - Ifunanya Clara Agu
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Godstime Eigbiremolen
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Economics, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Ifeyinwa Akamike
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chinyere Okeke
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Nigeria
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Shamrock OW, Abu-Ba'are GR, Zigah EY, Dakpui HD, Adjaka G, LeBlanc NM, Alio AP, Nelson L. Community stigma, victimization, and coping strategies among gay, bisexual, and other cis-gender men who have sex with men in slum communities in Ghana. BSGH-003. BMC Public Health 2024; 24:966. [PMID: 38580970 PMCID: PMC10998418 DOI: 10.1186/s12889-024-18242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Gay, bisexual, and cis-gender men who have sex with men (GBMSM) face severe consequences, especially within stigmatized environments. However, very little is known about the experiences of GBMSM living in slums in SSA and Ghana. This study investigates the experiences of stigma, victimization, and coping strategies and proposes some interventional approaches for combating stigma facing GBMSM in slum communities. METHODS We engaged GBMSM living in slums in two major Ghanaian cities. We used a time-location sampling and collected data through in-depth individual interviews. Two major themes emerged from the study: (1) insecurities and criminalization of GBMSM activity, and (2) GBMSM coping strategies. RESULTS Findings show GBMSM experienced negative attitudes from the community due to their sexual behavior/orientation. GBMSM also developed coping strategies to avert negative experiences, such as hiding their identities/behavior, avoiding gender non-conforming men, and having relationships with persons outside their communities. CONCLUSION We propose interventions such as HIV Education, Empathy, Empowerment, Acceptance, and Commitment Therapy as possible measures to improve the experiences of GBMSM living in Ghanaian slum communities.
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Affiliation(s)
- Osman Wumpini Shamrock
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Gender Health Lab, Accra, Ghana
- Behavioral, Sexual and Gender Health Lab, University of Rochester, New Haven, Connecticut, USA
| | - Gamji Rabiu Abu-Ba'are
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Gender Health Lab, Accra, Ghana
- School of Public Health, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
- Behavioral, Sexual and Gender Health Lab, University of Rochester, New Haven, Connecticut, USA
| | | | | | - Gideon Adjaka
- Hope Alliance Foundation, Non-profit Organization, Accra, Ghana
| | - Natalie M LeBlanc
- School of Nursing, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Amina P Alio
- School of Public Health, University of Rochester, Rochester, USA
| | - LaRon Nelson
- School of Nursing, Yale University, West Haven, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
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Sidamo NB, Kerbo AA, Gidebo KD, Wado YD. Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque's Framework. Adolesc Health Med Ther 2024; 15:45-61. [PMID: 38562442 PMCID: PMC10984202 DOI: 10.2147/ahmt.s455517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State. Methods A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software. Results The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents' healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers' behaviors further hindering adolescents' ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents. Conclusion The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.
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Affiliation(s)
- Negussie Boti Sidamo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassa Daka Gidebo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Bishop AS, Nurius PS, Walker SC, Oxford ML. Sexual health variation among gang-involved youth in Washington state: Social ecological implications for research and practice. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:16-29. [PMID: 38391121 PMCID: PMC11026090 DOI: 10.1111/psrh.12251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Gang-involved youth experience greater disparities in sexual health compared to non-gang-involved youth. Yet, little is known about how and why sexual behaviors vary within the youth gang population. Developing relevant and effective service approaches requires an understanding of this variation and the environmental factors that influence patterns of sexual health risk. METHODOLOGY AND RESULTS Using latent class analysis, we identified four sexual behavior classes within a school-based sample of gang-involved youth in Washington State (N = 2060): Non-Sexually Active (54%), Limited Partners with Condom Use (14%), Multiple Partner with Sexting (19%), and High Sexual Vulnerability (13%). These classes were distinguished by age at sexual debut, number of sexual partners, condom use, and sexting. Interpersonal and macrosocial factors differentiated the classes, including multiform violence exposures, limited social support, and socioeconomic instability. We also found differences according to sexual identity and substance use. DISCUSSION Findings highlight the need for service approaches that are responsive to both the individual needs of gang-involved youth and the factors that shape their living environments. We discuss the implications for research and practice, including the potential utility of a harm reduction framework to promote sexual health and reduce disparities in the youth gang population.
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Affiliation(s)
- Asia S Bishop
- School of Social Work and Criminal Justice, University of Washington Tacoma, Tacoma, Washington, USA
- School of Social Work, University of Washington Seattle, Seattle, Washington, USA
| | - Paula S Nurius
- School of Social Work, University of Washington Seattle, Seattle, Washington, USA
| | - Sarah C Walker
- CoLab for Community and Behavioral Health Policy, Department of Psychiatry and Behavioral Health Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Monica L Oxford
- Barnard Center for Infant Mental Health and Development, School of Nursing, University of Washington, Seattle, Washington, USA
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Waghmare BV, Jajoo S. Navigating the Challenges: A Comprehensive Review of Adolescent Gynecological Problems. Cureus 2024; 16:e56200. [PMID: 38618317 PMCID: PMC11016329 DOI: 10.7759/cureus.56200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
This comprehensive review delves into the spectrum of adolescent gynecological problems, shedding light on the multifaceted challenges faced by individuals between the ages of 10 and 19. Covering normal developmental changes, common issues such as menstrual disorders, and the intricate interplay of psychosocial and cultural factors, the review provides a holistic understanding of adolescent gynecological health. Key findings underscore the importance of tailored education, destigmatizing reproductive health discussions, and recognizing the critical role of mental health in overall well-being. The conclusion issues a compelling call to action, urging healthcare providers to adopt patient-centered practices, educators to integrate comprehensive sexual education, and policymakers to advocate for inclusive policies. This review serves as a valuable resource, guiding collective efforts to enhance the well-being of adolescents as they navigate the challenges of gynecological health on their journey to adulthood.
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Affiliation(s)
- Bhavana V Waghmare
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shubhada Jajoo
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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7
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Agbenu I, Kyei J, Naab F. Female adolescent sexual reproductive health service utilization concerns: A qualitative enquiry in the Tema metropolis of Ghana. PLoS One 2024; 19:e0292103. [PMID: 38394260 PMCID: PMC10890758 DOI: 10.1371/journal.pone.0292103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/13/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Evidence globally indicates that female adolescents face numerous sexual and reproductive health (SRH) risks. Utilization of sexual reproductive health services among adolescents is of global health importance and plays a crucial role in adolescent sexual reproductive health outcomes and their quality of life. AIM The current study explored sexual reproductive health service utilization concerns among female adolescents in the Tema Metropolis in Southern Ghana using the Anderson and Newman Behavioural model of Health Service Utilization as a guiding framework. METHODS The study utilized a qualitative exploratory descriptive design. Purposive sampling was used to recruit female adolescents. In-depth face-to-face interviews were conducted using a semi-structured interview guide. In all, 12 interviews were conducted. Each interview lasted between 45 and 60 minutes. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Thematic analysis was guided by the constructs of the Anderson and Newman Behavioural model of health service utilization. RESULTS Utilization of sexual reproductive health services among female adolescents is low in the Tema metropolis. Factors such as unprotected non-consensual sexual activity or an unwanted pregnancy sometimes triggered the use of these services. Barriers to utilization identified include lack of awareness on sexual reproductive health services, unreliable sources of SRH information, underestimation of the severity of sexual reproductive health problems faced, unmet expectations and poor experiences with service providers. CONCLUSION The current study identified poor utilization of sexual reproductive health services among female adolescents within the Tema metropolis of Ghana. There is the need to increase the number of adolescent health corners, increase awareness about SRH services among adolescents, improve parent-child SRH communication and provide adequate training for healthcare providers to improve provider attitude towards adolescent SRH service delivery in order to increase utilization of sexual reproductive health services among female adolescents in the Metropolis.
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Affiliation(s)
- Innes Agbenu
- Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Josephine Kyei
- Department of Public Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Florence Naab
- Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
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Vizheh M, Zurynski Y, Braithwaite J, Rapport F. Determinants of women's agency in accessing and utilising reproductive healthcare services; a systematic review. CULTURE, HEALTH & SEXUALITY 2024; 26:248-264. [PMID: 37078806 DOI: 10.1080/13691058.2023.2200814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Women's agency is vital to access and use reproductive healthcare services, particularly in contexts where patriarchal beliefs and cultural norms limit women's desire to act on their goals or affect their access to essential resources. However, less is known about what resources enable women to exercise agency to access these services. A comprehensive systematic review was conducted to summarise existing evidence on the determinants of women's agency in accessing and using reproductive healthcare services. Various determinants were identified, including individual characteristics; household structure; reproductive health-related determinants; social relations; and economic factors. These determinants of women's agency in accessing reproductive healthcare services were strongly associated with social norms and cultural beliefs. Several gaps in the literature included inconsistent definitions and measurement of women's agency; lack of considering cultural sensitivities and socially acceptable practices in the conceptualisation and measurement of women's agency; a narrow focus on services related predominantly to pregnancy and birth, with other aspects of services including sexual health and safe abortion being largely unreported. The literature focused on developing countries in Africa and Asia, leaving a significant gap in knowledge about women's agency to access services in other geographical areas or among immigrant or refugee populations living in developed countries.
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Affiliation(s)
- Maryam Vizheh
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- National Health and Medical Research Council, Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- National Health and Medical Research Council, Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Parmar D, Berhe S, Bradley S, Fenny A, Aziato L, Ceesay H. Access to adolescent sexual and reproductive health services in Accra, Ghana: An exploratory qualitative study. Glob Public Health 2024; 19:2341420. [PMID: 38634489 DOI: 10.1080/17441692.2024.2341420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
Nearly 31% of the Ghanaian population are adolescents, and these populations persistently face high rates of teenage pregnancies and unsafe abortions. This is despite sexual and reproductive health (SRH) being taught in the school curriculum. In this qualitative study, we explore the factors affecting adolescents' access to, and experiences of, SRH services in Accra, Ghana. We conducted 12 focus group discussions (FGDs) with adolescents and 13 key informant interviews (KIs) in Ghana. The FGDs were conducted with school-going and out-of-school adolescents. KIIs were conducted with various stakeholders working with adolescents or in SRH services. All interviews were conducted in English, audio recorded and transcribed verbatim. We applied the Dahlgren-Whitehead Rainbow model of health determinants and used a thematic analysis. Eight themes were identified, across micro, meso and macro levels, that influence adolescents' SRH access and experience in Accra. These included: family, social networks, the role of schools, health providers and services, the policy landscape, gender norms, cultural norms, and poverty. The findings highlight several factors that influence adolescents' access to appropriate SRH services in this context and demonstrate the need for a multisectoral effort to address structural factors such as harmful gender norms and persistent poverty.
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Affiliation(s)
- Divya Parmar
- Department of Population Health Sciences, King's College London, London, UK
| | - Semira Berhe
- Department of Population Health Sciences, King's College London, London, UK
| | - Susan Bradley
- School of Health Sciences, City, University of London, London, UK
| | - Ama Fenny
- Institute of Statistical Social and Economic Research (ISSER), University of Ghana, Legon, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Agblevor EA, Darko NA, Acquah PA, Addom S, Mirzoev T, Agyepong IA. "We have nice policies but…": implementation gaps in the Ghana adolescent health service policy and strategy (2016-2020). Front Public Health 2023; 11:1198150. [PMID: 38148876 PMCID: PMC10749951 DOI: 10.3389/fpubh.2023.1198150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Although policies for adolescent health exist in Ghana, their implementation is challenging. Availability of services for adolescent sexual and reproductive health and adolescent mental health remains less than desired, with adolescent mental health being particularly neglected despite being an important contributor to poor health outcomes. This study presents an analysis of gaps in the implementation of the Ghana Adolescent Health Service Policy and Strategy (2016-2020), including how and why the context influenced the observed implementation gaps. Methods Data for this study is drawn from 17 in-depth interviews with purposefully identified key stakeholders in adolescent mental, sexual, and reproductive health across the national and subnational levels; four focus group discussions (FGDs) with district health management teams; and 11 FGDs with adolescents in and out of schools in four selected districts in the Greater Accra region. Data were analyzed using both inductive and deductive approaches. The deductive analysis drew on Leichter's conceptualization of context as structural, cultural, situational, and environmental factors. Results Of the 23 planned strategies and programs for implementing the policy, 13 (57%) were partially implemented, 6 (26%) were not implemented at all, and only 4 (17%) were fully implemented. Multiple contextual factors constrained the policy implementation and contributed to the majority of strategies not being implemented or partially implemented. These factors included a lack of financial resources for implementation at all levels of the health system and the related high dependence on external funding for policy implementation. Service delivery for adolescent mental health, and adolescent sexual and reproductive health, appeared to be disconnected from the delivery of other health services, which resulted in weak or low cohesion with other interventions within the health system. Discussion Bottom-up approaches that engage closely with adolescent perspectives and consider structural and cultural contexts are essential for effective policy implementation. It is also important to apply systemic and multi-sectoral approaches that avoid fragmentation and synergistically integrate policy interventions.
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Affiliation(s)
- Emelia Afi Agblevor
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Priscilla Ama Acquah
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Selasie Addom
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Tolib Mirzoev
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Irene Akua Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
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11
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Kibira SPS, Stillman M, Makumbi FE, Giorgio M, Nabukeera S, Nalwoga GK, Sully EA. Lived experiences and drivers of induced abortion among women in central Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002236. [PMID: 38055682 DOI: 10.1371/journal.pgph.0002236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023]
Abstract
Although unsafe abortions are preventable, they are one of the leading causes of maternal mortality and morbidity. Despite the serious potential health consequences, there is limited published information about drivers and challenges of obtaining abortions in restrictive settings such as Uganda. This limits efforts to improve programing for preventing unsafe abortion and providing comprehensive post abortion care. This study sought to understand the drivers and explain the lived abortion experiences among women from central Uganda, in an effort to promote greater access to safe reproductive healthcare services, and reduce unsafe abortions. This qualitative study included 40 purposely selected women who self-reported an abortion, living in Kampala and greater Rakai district, Uganda. They were part of a larger survey using respondent driven sampling, where seed participants were recruited from selected facilities offering post-abortion care, or through social referrals. Data were collected from May to September 2021 through in-depth interviews. Audio data were transcribed, managed using Atlas.ti 9, and analyzed thematically. The findings show that the underlying drivers stemmed from partners who were unsupportive, denied responsibility, or had raped/defiled women. Career and education decisions, stigma and fear to disappoint family also contributed. Women had feelings of confusion, neglect, betrayal, or shame after conception. Abortion and post-abortion experiences were mixed with physical and emotional pain including stigma, even when the conditions for safe abortion in the guidelines were satisfied. Although most women sought care from health facilities judged to provide safe and quality care, there was barely any counselling in these venues. Confidantes and health providers informed the choice of abortion methods, although the cost ultimately mattered most. The mental health of women whose partners are unsupportive or who conceive unintendedly need consideration. Abortion provided psychological relief from more complicated consequences of having an unplanned birth for women.
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Affiliation(s)
| | | | - Fredrick E Makumbi
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sarah Nabukeera
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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12
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Shamrock OW, Abu-Ba'are GR, Zigah EY, Apreku A, Agbemedu GRK, Boyd DT, Adjaka G, Nelson LE. Family rejection of non-hetero sexuality-Sexual orientation and behavior anonymity among sexual minority men in slum communities-BSGH 001. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001659. [PMID: 38039264 PMCID: PMC10691700 DOI: 10.1371/journal.pgph.0001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
It can be challenging for sexual minority men (SMM) to decide whether or not to disclose their sexual orientation or behavior. The implications of this decision are significant, especially when considering how their family might react. We interviewed individuals living in slum communities (n = 12) in Accra and Kumasi, Ghana. Our study found that two factors primarily influenced the decision of SMM to disclose their sexual orientation. Firstly, SMM feared facing harm from their families and, secondly, the close ties of SMM families to religious institutions in their communities, which taught against LGBTQ+ activities in the country. These findings contribute to understanding why SMM in Ghanaian slum communities choose to keep their sexual orientation anonymous. While no single intervention is enough to address the challenges associated with coming out, participants in the study agreed that a social support intervention that provides opportunities to educate and inform their families and community on LGBTQ+ activities could help them assimilate comfortably in their communities.
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Affiliation(s)
- Osman Wumpini Shamrock
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Gamji Rabiu Abu-Ba'are
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Amos Apreku
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Donte T Boyd
- College of Social Work, Ohio State University, Columbus, Ohio, United States of America
| | | | - LaRon E Nelson
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
- School of Nursing, Yale, Connecticut, United States of America
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Vizheh M, Zurynski Y, Braithwaite J, Rapport F. The impact of migration and settlement context on Iranian Women's agency in accessing and using reproductive healthcare services in Australia: A qualitative study. Health Place 2023; 83:103069. [PMID: 37499608 DOI: 10.1016/j.healthplace.2023.103069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/07/2023] [Accepted: 06/10/2023] [Indexed: 07/29/2023]
Abstract
This qualitative study aimed to understand how immigration and settlement context shape Iranian immigrants' agency in accessing and using reproductive healthcare services (RHCS). Twenty-one Iranian women of reproductive age (18-49 years) living in Australia were recruited in 2022 through social media platforms. The findings highlighted that although Iranian women's utilisation of RHCS in Australia is highly constrained by established sociocultural beliefs and values of their origin country, they become agents of making changes over their reproductive choices, reformulating beliefs and values, and taking control of reproductive health because of Australian sociocultural norms and context. This suggests a tension between the impacts of sociocultural contexts in their origin country and becoming agents of change after migrating to Australia. These findings need to be included in healthcare policy and practice to support greater consideration of cultural sensitivities and specific needs of immigrant women when accessing Australian RHCS.
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Affiliation(s)
- Maryam Vizheh
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia; National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia; National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
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Baraki SG, Thupayagale-Tshweneagae GB. Socio-cultural factors perceived to influence sexual behaviours of adolescents in Ethiopia. Afr J Prim Health Care Fam Med 2023; 15:e1-e10. [PMID: 37526559 PMCID: PMC10476444 DOI: 10.4102/phcfm.v15i1.3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Adolescence is a period of transition from childhood to adulthood. It is the age of experimentation. They are vulnerable to the undesirable effect of sexual and reproductive health (SRH) problems such as human immunodeficiency virus, sexually transmitted infections and unsafe abortion and childbirth-related risks. AIM To explore and describe perceived organisational, community and societal level factors that influence sexual behaviours among adolescents in Ethiopia. SETTING The study was conducted by public health care organisations, youth centres and non-governmental organisations in Addis Ababa, Ethiopia. METHODS A qualitative descriptive study design was conducted with purposively selected health professionals and adolescents in Addis Ababa from June 2019 to February 2020. The data were collected using in-depth interviews, key informant interviews and focus group discussions. Transcribed interviews were imported to ATLAS. ti 7 for coding, categorising and creating themes using thematic analysis. Lincoln and Guba's model was used to ensure trustworthiness and ethical standards were applied. RESULTS Poor school involvement, social norms on sexual behaviour and lack of condom acceptability by the general population, financial problems and the gap in law enforcement were found perceived factors influencing sexual behaviour of adolescents. CONCLUSION Adolescents are engaging in various risky sexual behaviours because of various organisational, community level and societal level factors, which emphasises the need to introduce social and culturally acceptable age-appropriate comprehensive sexuality education for adolescents and other multilevel interventions.Contribution: Provide an in-depth understanding of the influence of sociocultural issues related to adolescent sexual behaviour for health system stakeholders.
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Affiliation(s)
- Semere G Baraki
- Department of Public Health, Menelik II Medical and Health Science College, Addis Ababa.
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Sidamo NB, Kerbo AA, Gidebo KD, Wado YD. Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review. Open Access J Contracept 2023; 14:103-118. [PMID: 37398897 PMCID: PMC10312343 DOI: 10.2147/oajc.s411924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023] Open
Abstract
Background In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap. Methods This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review. Results From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents. Conclusion This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.
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Affiliation(s)
- Negussie Boti Sidamo
- School of Public Health, College of Health and Medicine Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health and Medicine Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassa Daka Gidebo
- School of Public Health, College of Health and Medicine Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Chola M, Hlongwana KW, Ginindza TG. Motivators and Influencers of Adolescent Girls' Decision Making Regarding Contraceptive Use in Four Districts of Zambia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3614. [PMID: 36834308 PMCID: PMC9961957 DOI: 10.3390/ijerph20043614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls' contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents' contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls' contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents' decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Ampofo AG, Boyes AW, Asibey SO, Oldmeadow C, Mackenzie LJ. Prevalence and correlates of modifiable risk factors for cervical cancer and HPV infection among senior high school students in Ghana: a latent class analysis. BMC Public Health 2023; 23:340. [PMID: 36793003 PMCID: PMC9930033 DOI: 10.1186/s12889-022-14908-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND While health risk behaviours are likely to co-occur, there is dearth of studies exploring the clustering of cervical cancer and HPV infection risk factors among adolescents. This study aimed to determine: 1) the prevalence of modifiable risk factors for cervical cancer and HPV infection, 2) the clustering of modifiable risk factors for cervical cancer and HPV infection, and 3) factors associated with the identified clusters. METHODS Female students (aged 16-24 years, N = 2400) recruited from 17 randomly selected senior high schools in the Ashanti Region, Ghana completed a questionnaire assessing modifiable risk factors for cervical cancer and HPV infection including sexual experience, early sexual intercourse (< 18 years), unprotected sex, smoking, sexually transmitted infections (STIs); multiple sexual partners (MSP) and smoking. Latent class analysis explored separate classes of students according to their risk factor profiles for cervical cancer and HPV infection. Latent class regression analysis explored factors associated with latent class memberships. RESULTS Approximately one in three students (34%, 95%CI: 32%-36%) reported exposure to at least one risk factor. Two separate classes emerged: high-risk and low-risk (cervical cancer: 24% and 76% of students, respectively; HPV infection: 26% and 74% of students, respectively). Compared to participants in the low-risk classes i) the cervical cancer high-risk class were more likely to report exposure to oral contraceptives; early sexual intercourse (< 18 years); STIs; MSP and smoking; and ii) the HPV infection high risk class were more likely to report exposure to sexual intercourse; unprotected sex and MSP. Participants with higher risk factor knowledge had significantly higher odds of belonging to cervical cancer and HPV infection high-risk classes. Participants with greater perceived susceptibility to cervical cancer and HPV infection were more likely to belong to the high-risk HPV infection class. Sociodemographic characteristics and greater perceived seriousness about cervical cancer and HPV infection had significantly lower odds of belonging to both high-risk classes. CONCLUSIONS The co-occurrence of cervical cancer and HPV infection risk factors suggests that a single school-based multi-component risk reduction intervention could concurrently target multiple risk behaviours. However, students in the high risk class may benefit from more complex risk reduction interventions.
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Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia. .,Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Allison W. Boyes
- grid.266842.c0000 0000 8831 109XHealth Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cEquity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Shadrack Osei Asibey
- grid.462504.10000 0004 0439 6970Faculty of Applied Sciences and Technology, Kumasi Technical University, Kumasi, Ghana
| | | | - Lisa J. Mackenzie
- grid.266842.c0000 0000 8831 109XHealth Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cEquity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
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Chola M, Hlongwana KW, Ginindza TG. Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2744. [PMID: 36768107 PMCID: PMC9915938 DOI: 10.3390/ijerph20032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Whitton A, Swahn MH, Culbreth R, Kasirye R. Attitudes and risky sexual behavior among youth in Kampala, Uganda: Empirical analyses of risk factors by gender. PEC INNOVATION 2022; 1:100090. [PMID: 36532298 PMCID: PMC9757820 DOI: 10.1016/j.pecinn.2022.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study sought to examine gender differences and the influence of peer and parental perceptions on sexual risk behaviors among an at-risk sample of youth living in Kampala, Uganda. METHODS Using the cross-sectional Kampala Youth Survey (2014) based in Kampala, Uganda (n = 1134), bivariate and multivariable logistic regressions were conducted to determine the odds of sexual risk behaviors based on peer and parental influence variables and gender. RESULTS The perceptions of peer, adult, and parental opinions on sexual activity were significantly associated with varying levels across all risky sexual behaviors explored. When indexed and adjusted for other variables, females compared to males were at increased odds of participating in 3-4 risky sexual behaviors (OR: 0.63, 95% CI: 0.44, 0.90) and 5-6 risky sexual behaviors (OR: 0.38, 95% CI: 0.21, 0.68) compared to zero risky sexual behaviors. CONCLUSIONS Adolescent sexual risk behaviors are subject to peer and parental influence and vary between genders. INNOVATION This study emphasizes the importance of peer influences in adolescent sexual risk behaviors. Many of these youth are orphans, which may explain the lack of association between parental influences and sexual risk behavior. School-based and community-based interventions may be effective at preventing risky sexual behaviors for this vulnerable population.
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Affiliation(s)
- Alaina Whitton
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Rachel Culbreth
- Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA
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Mpunga DM, Chenge FM, Mambu TNM, Akilimali PZ, Mapatano MA, Wembodinga GU. Determinants of the use of contraceptive methods by adolescents in the Democratic Republic of the Congo: results of a cross-sectional survey. BMC Womens Health 2022; 22:478. [DOI: 10.1186/s12905-022-02084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Family planning (FP) is an effective strategy to prevent unintended pregnancies of adolescents. We aimed at identifying the socio-demographic factors underlying the low use of contraceptive methods by teenage girls in the Democratic Republic of the Congo (DRC).
Methods
A secondary analysis targeting teenage girls aged 15–19 was carried out on the Performance, Monitoring and Accountability project 2020 (PMA 2020) round 7 data, collected in Kinshasa and Kongo Central provinces. The dependent variable was the “use of contraceptive methods by sexually active teenage girls”, calculated as the proportion of teenagers using modern, traditional or any contraceptive methods. Independent variables were: level of education, age, province, religion, marital status, number of children, knowledge of contraceptive methods and household income. Pearson's chi-square and logistic regression tests helped to measure the relationship between variables at the alpha significance cut point of 0.05.
Results
A total of 943 teenagers were interviewed; of which 22.6, 18.1 and 19.9% used any contraceptive method respectively in Kinshasa, Kongo Central and overall. The use of modern contraceptive methods was estimated at 9.9, 13.4 and 12.0% respectively in Kinshasa, Kongo Central and overall. However, the use of traditional methods estimated at 8.0% overall, was higher in Kinshasa (12.7%) and lower (4.7%) in Kongo Central (p < .001). Some factors such as poor knowledge of contraceptive methods (aOR = 8.868; 95% CI, 2.997–26.240; p < .001); belonging to low-income households (aOR = 1.797; 95% CI, 1.099–2.940; p = .020); and living in Kongo central (aOR = 3.170; 95% CI, 1.974–5.091; p < .001) made teenagers more likely not to use any contraceptive method.
Conclusion
The progress in the use of contraceptive methods by adolescent girls is not yet sufficient in the DRC. Socio-demographic factors, such as living in rural areas, poor knowledge of FP, and low-income are preventing teenagers from using FP methods. These findings highlight the need to fight against such barriers; and to make contraceptive services available, accessible, and affordable for teenagers.
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Agu IC, Mbachu CO, Ezenwaka U, Eze I, Ezumah N, Onwujekwe O. Gender norms and ideologies about adolescent sexuality: A mixed-method study of adolescents in communities, south-eastern, Nigeria. FRONTIERS IN SOCIOLOGY 2022; 7:810411. [PMID: 36226127 PMCID: PMC9548641 DOI: 10.3389/fsoc.2022.810411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sexual and reproductive health choices and behaviors of adolescents are shaped by gender norms and ideologies which are grounded in cultural beliefs. This study examined the perspectives of adolescents about the influence of gender norms and ideologies on sexuality. METHODS A cross-sectional study was undertaken in three urban and three rural communities in south-eastern Nigeria using quantitative and qualitative research methods. A modified cluster sampling procedure was used to select respondents. Data were collected from 1,057 adolescents and twelve focus group discussions with unmarried adolescents aged 13 to 18 years. For the quantitative data, univariate, bivariate and probit regression analyses were performed using Stata while the thematic framework approach was used to analyze qualitative data. RESULTS The dominant beliefs among adolescents are that: it is wrong for unmarried adolescents to have sex (86.4%); unmarried adolescents should abstain from sex (89.3%); consent should be obtained before sexual intercourse (89.1%); it is a girl's responsibility to ensure she does not get pregnant (66.5%), and sex should be initiated by boys (69.6%). Gender (boy or girl) was a predictor of belief in premarital abstinence (t-value = -3.88), belief that premarital sexual intercourse is acceptable provided contraceptive is used (t-value = 3.49, CI 1.14-0.49), belief that premarital sexual intercourse is wrong (t-value = -2.24) and, belief that sex should be initiated by boys only (t-value = -4.37). Adolescent boys were less likely to believe in pre-marital abstinence and less likely to believe that pre-marital sex among adolescents is wrong compared to girls. They were also more likely to believe adolescents can have sex provided contraceptive is used compared to girls. Qualitative findings revealed adolescents' beliefs that girls feel shy initiating sex and that boys experience more urge for sex hence, boys were perceived to be responsible for initiating sex. Both boys and girls experience pressure to have sex however, boys were described to experience more pressure from peers to have sex. Peer-to-peer communication, quest for material possessions and low socioeconomic conditions contribute to peer pressure to engage in sex. CONCLUSION Adolescents' beliefs about sexuality underline the need to contextualize interventions to address these norms and ideologies.
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Affiliation(s)
- Ifunanya Clara Agu
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Irene Eze
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Mprah WK, Opoku MP, Duorinaah J, Nketsia W. Level of satisfaction and sexual and reproductive health needs of deaf persons in Ghana: a sequential explanatory mixed method study. BMC Health Serv Res 2022; 22:1152. [PMID: 36096825 PMCID: PMC9469610 DOI: 10.1186/s12913-022-08515-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background The intersection between deafness and culture in sub-Saharan African contexts such as Ghana has culminated in restricted access to sexual and reproductive health (SRH) services. While some attention has been given to the barriers faced by deaf persons in accessing SRH services, discussion of their needs and satisfaction with SRH services is at an embryonic stage. This lends support to the use of sequential mixed-method study design to assess the level of satisfaction and SRH needs of deaf persons. Methods This study was guided by explanatory sequential mixed-method study design. Thus, a two-phase data collection approach was adopted. In Phase I, a 32-item questionnaire with 16 items each for satisfaction regarding SRH services and SRH needs, was used for data collection from 288 deaf persons recruited from 3 of the 16 regions in Ghana. The data were subjected to the following computations: means, t-tests, analysis of variance, correlations, and multiple regression. In Phase II, a semi-structured interview guide was used to collect data from 60 participants who were drawn from the earlier pool. The interviews were subjected to thematic analysis. Results The results showed of correlation and multiple analyses showed a small relationship and significant contribution of needs in the variance of satisfaction. Also, there was a convergence between both the qualitative and quantitative data as participants confirmed the lack of consideration given to the needs of deaf persons regarding SRH service provisions. Conclusion Deaf persons who took part in this study were unsatisfied with SRH services due to barriers such as sign language interpreters and inaccessible information. Consequently, they expressed the need for preferred mode of communication and expedition of awareness creation on SRH. The study findings warrant the need for policymakers to inculcate the needs of deaf person in SRH services to improve access and thus, enhance satisfaction. For instance, recommendations such as the training of health professionals in the use of sign language could be considered in future SRH policy and other implications, are discussed.
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Wood SN, Sarnak DO, Kibira SP, Zimmerman LA, Karp C, Makumbi F, Moreau C. Who uses covertly and what is the impact on contraceptive dynamics? Evidence from a national cohort of women in Uganda. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13667.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Little is known regarding the specific role of covert use (i.e., use of contraception without partner knowledge) in contraceptive discontinuation and switching. Among a nationally representative cohort of women in Uganda, we sought to: 1) compare characteristics of covert, overt, and non-users of contraception at baseline; 2) assess the effect of using contraception covertly on switching and discontinuation over a one-year period. Methods: Analyses utilized PMA2020 Uganda Round 6 (April–May 2018), with longitudinal analyses incorporating data from a one-year follow-up survey (May–June 2019). Both cross-sectional (n=1,764) and longitudinal (n=616) samples included women in need of contraception. For cross-sectional analyses, multinomial regression compared risk of overt/covert use vs. non-use by user characteristics and logistic regression compared the odds of covert vs. overt use among contraceptive users. For longitudinal analyses, multinomial regression examined risk of contraceptive switching and discontinuation by baseline covert vs. overt use status. Results: Among contraceptive users, 14.1% reported using covertly. In cross-sectional analyses, higher wealth (aRRR=1.74; 95% CI=1.19-2.54), secondary or higher education (aRRR=2.52; 95% CI=1.42-4.49), and middle parity (aRRR=1.24; 95% CI=1.00, 2.28) were associated with an increased risk of overt use, and higher wealth (aRRR=2.08; 95% CI=1.09-3.98) and polygyny (aRRR=1.60; 95% CI=1.01-2.54) with covert use, compared to non-use. Among contraceptive users, women within polygynous unions had double the odds of using covertly compared to those with monogamous partners (aOR=1.97; 95% CI=1.28-3.03). Longitudinal analyses revealed large proportions of overt and covert users switched (30% overt, 26% covert) or discontinued methods (32% overt, 37% covert) at one-year follow-up, however, neither switching nor discontinuation was significantly related to overt/covert use status at baseline. Conclusions: Though significant differences by covert use status were not detected, approximately 33% of users discontinued over one year; these women represent important beneficiaries of family planning programming as they may remain at risk for unintended pregnancy.
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Okeke CC, Mbachu CO, Agu IC, Ezenwaka U, Arize I, Agu C, Obayi C, Onwujekwe O. Stakeholders' perceptions of adolescents' sexual and reproductive health needs in Southeast Nigeria: a qualitative study. BMJ Open 2022; 12:e051389. [PMID: 35676003 PMCID: PMC9185505 DOI: 10.1136/bmjopen-2021-051389] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study explored the perceptions of adult stakeholders on adolescents sexual and reproductive health (SRH) needs, variations of perceived needs by different social stratifiers and adolescent's perceived interventions to address these needs. This will provide evidence that could be useful for policy and programme reviews for improving access and use of services in to meet the SRH needs of adolescents. DESIGN A qualitative cross-sectional study was conducted in Ebonyi state, Southeast, Nigeria. Data were analysed using thematic framework and content analysis approaches. SETTING AND PARTICIPANTS This qualitative study was conducted in six selected local government areas in Ebonyi state, Nigeria. The study participants comprised of adult stakeholders including community leaders, adolescent boys and girls aged 13-18 years. Adolescents were purposively selected from schools, skill acquisition centres and workplaces. A total of 77 in-depth interviews, 6 (with community leaders) and 12 (with adolescents) focus group discussions were conducted using pretested question guides. RESULTS Adolescent SRH needs were perceived to be unique and special due to their vulnerability, fragility and predisposition to explore new experiences. Recurring adolescent SRH needs were: SRH education and counselling; access to contraceptive services and information. These needs were perceived to vary based on sex, schooling and marital status. Adolescent girls were perceived to have more psychological needs, and more prone to negative health outcomes. Out-of-school adolescents were described as more vulnerable, less controlled, less supervised and more prone to sexual abuse. Unmarried adolescents were perceived more vulnerable to sexual exploitation and risks, while married were perceived to have more maternal health service needs. CONCLUSIONS Perceptions of adolescents' SRH needs converge among stakeholders (including adolescents) and are thought to vary by gender, schooling and marital status. This calls for well-designed gender-responsive interventions that also take into consideration other social stratifiers and adolescent's perceived SRH intervention strategies.
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Affiliation(s)
- Chinyere Cecilia Okeke
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chinyere Ojiugo Mbachu
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ifunanya Clara Agu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ifeyinwa Arize
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chibuike Agu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chinonso Obayi
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Nsukka, Enugu, Nigeria
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Kamke K, Stewart JL, Widman L. Multilevel Barriers to Sexual Health Behavior Among Vulnerable Adolescent Girls in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:822-833. [PMID: 36212514 PMCID: PMC9542138 DOI: 10.1007/s13178-021-00594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 06/03/2023]
Abstract
Introduction Most sexual health interventions focus on individual-level predictors of sexual behavior. Given the considerable influence of environmental factors on adolescent girls' sexual health, current interventions may be insufficient to promote safer sex. In this study, we aimed to understand adolescent girls' anticipated barriers to engaging in safer sex behavior after completing a brief, web-based sexual health intervention called HEART. Methods This study used qualitative interviews with 50 adolescent girls who were recruited from community-based organizations that serve vulnerable youth. All participants were 12 to 19 years old (mean age=15.62, SD=1.83), and identified with a marginalized racial/ethnic group (58% Black; 18% Latinx; 24% Asian, biracial, or multiracial). Further, 24% identified as LGBTQ+, and 58% were sexually active. Results Guided by the social ecological model, we delineate six unique barriers to safer sex discussed by adolescents: partner manipulation, slut shaming, unclear sexual values, present time orientation, embarrassment, and access to sexual and reproductive health services. Discussion We conclude with recommendations for addressing these barriers to optimize adolescent girls' sexual health.
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Affiliation(s)
- Kristyn Kamke
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - J. L. Stewart
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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Odimegwu CO, Ugwu NH. A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa. Reprod Health 2022; 19:119. [PMID: 35549967 PMCID: PMC9096753 DOI: 10.1186/s12978-022-01407-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite national and international commitments and efforts to prevent risky sexual behaviours, a high proportion of young people in South Africa are engaged in risky sexual behaviour. However, most efforts are currently directed toward addressing individual-level factors at the expense of not addressing neighbourhood-level determinants such as social disorganisation, contributing to risky sexual behaviour among young people in South Africa. This study investigated the multilevel factors of risky sexual behaviours among young people by gender in South Africa, using the lens of socio-ecological and social disorganisation frameworks. METHODS Data from a nationally representative sample of 1268 males and 2621 females aged 15-24 years, giving a total of, 3889 never-married youths, were drawn from the 2016 South Africa Demographic and Health Survey. Analysis was conducted using multilevel mixed-effect logistic regressions with random community-level effects. RESULTS Findings show that youth who were from a heterogeneous ethnic group (AOR = 0.49, CI: 0.35-0.67), household size of 5 + members (AOR = 0.78, CI: 0.54-1.15), community education (AOR = 0.97, CI: 0.72-1.32) were associated with low engagement in multiple sexual partnerships. Youths who were employed (AOR = 0.84, CI: 0.59-1.18), and from high-level community poverty (AOR = 0.76, CI: 0.58-1.00) were also associated with reduced odds of unprotected sex. In addition, older youth aged 20-24 years (AOR = 12.6, CI: 9.93-16.00); secondary education attainment (AOR = 1.01, CI 0.58-1.77); family structure (AOR = 1.37, CI: 0.75-1.15); Gauteng province (AOR = 1.45 CI: 0.92-2.28); residential mobility (AOR = 1.25, CI: 1.02-1.53), community media exposure to contraceptives (unprotected sex) (AOR = 1.38, CI: 1.09-1.76) were more likely to engage in risky sexual behaviour. CONCLUSION The study revealed that neighbourhood and individual-level factors were important in explaining the factors associated with risky sexual behaviour among young people in South Africa. In addition, engagement in risky sexual behaviour was high, with minimal variation among young females and males in South Africa. It specifies that the practice of risky sexual behaviour is significantly associated with multilevel factors of social disorganisation that cut across gender. These results imply that there is a need to review policies of sexual risks reduction for each gender, which might help mitigate the adverse effects of social disorganisation for women and men youths in South Africa.
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Affiliation(s)
- Clifford Obby Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nebechukwu Henry Ugwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Institute for Development Studies, University of Nigeria, Enugu Campus, Nigeria.
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Gillespie B, Balen J, Allen H, Soma-Pillay P, Anumba D. Shifting Social Norms and Adolescent Girls' Access to Sexual and Reproductive Health Services and Information in a South African Township. QUALITATIVE HEALTH RESEARCH 2022; 32:1014-1026. [PMID: 35592927 PMCID: PMC9189597 DOI: 10.1177/10497323221089880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges.
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Affiliation(s)
- Bronwen Gillespie
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Haddijatou Allen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Dilly Anumba
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Strong J. Men's involvement in women's abortion-related care: a scoping review of evidence from low- and middle-income countries. Sex Reprod Health Matters 2022; 30:2040774. [PMID: 35323104 PMCID: PMC8956302 DOI: 10.1080/26410397.2022.2040774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Men’s involvement in abortion is significant, intersecting across the individual, community and macro factors that shape abortion-related care pathways. This scoping review maps the evidence from low- and middle-income countries relating to male involvement in abortion trajectories. Five databases were searched, using search terms, to yield 7493 items published in English between 01.01.2010 and 20.12.2019. 37 items met the inclusion criteria for items relating to male involvement in women’s abortion trajectories and were synthesised using an abortion-related care-seeking framework. The majority of studies were conducted in sub-Saharan Africa and were qualitative. Evidence indicated that male involvement was significant, shaping the ability for a woman or girl to disclose her pregnancy or abortion decision. Men as partners were particularly influential, controlling resources necessary for abortion access and providing or withdrawing support for abortions. Denial or rejection of paternity was a critical juncture in many women’s abortion trajectories. Men’s involvement in abortion trajectories can be both direct and indirect. Contextual realities can make involving men in abortions a necessity, rather than a choice. The impact of male (lack of) involvement undermines the autonomy of a woman or girl to seek an abortion and shapes the conditions under which abortion-seekers are able to access care. This scoping review demonstrates the need for better understanding of the mechanisms, causes and intensions behind male involvement, centring the abortion seeker within this.
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Affiliation(s)
- Joe Strong
- PhD Researcher, Department of Social Policy, London School of Economics and Political Science, London, UK. Correspondence:
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Munea AM, Alene GD, Debelew GT, Sibhat KA. Socio-cultural context of adolescent sexuality and youth friendly service intervention in West Gojjam Zone, Northwest Ethiopia: a qualitative study. BMC Public Health 2022; 22:281. [PMID: 35148701 PMCID: PMC8840675 DOI: 10.1186/s12889-022-12699-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recognizing that adolescents face barriers in accessing services, may feel embarrassed, face stigma on sexual matters, or have concerns about judgmental providers, youth-friendly service (YFS) has been introduced to deliver health services that meet the sexual and reproductive health (SRH) needs of young people. Evidences on the role of YFS in addressing the socio-cultural norms influence unmarried adolescent SRH behaviour are limited. Therefore, this study explore whether the socio-cultural norms influencing adolescent SRH behaviour vary between youth friendly service program and non Program areas in West Gojjam Zone, North West Ethiopia. METHODS Qualitative case study design was employed to explore the socio-cultural context of adolescent sexuality. Purposive sampling was used to identify study participants. Data were collected from 112 participants both from YFS program and non-program areas using semi-structured in-depth interviews, key informants, and focus group discussions guides. A total of 18 key informant interviews, twelve FGDs and four in-depth interviews were conducted. Participants were comprised from unmarried adolescents, parents, religious leaders, community elders, health professionals, teachers, and unmarried adolescents who experienced SRH problem. Thematic analysis was used to summarized the data. RESULTS The socio-cultural norms related to adolescent sexuality in both YFS program and non-program areas indicated that the community is intolerant to premarital sex, SRH service utilization (eg., contraceptive use) by unmarried adolescent; and discourage SRH communication with unmarried adolescents. According to the participants, premarital sex and SRH service use were not accepted by the community. Moreover, participants believed that, having communication on SRH issues with unmarried adolescents are equivalent to encouraging them to initiate sex, therefore, should not be practiced. CONCLUSION The socio-cultural norms influencing adolescent sexual behaviour were more or less the same between settings. In both areas, the socio-cultural context discourages YFS intervention like SRH communication and service use. Also, the YFS program does not modify the socio-cultural norm affecting adolescent sexuality. Therefore, the YFS interventions strategies should give due emphasis to the socially accepted sexual norms like sexual abstinence.
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Affiliation(s)
| | - Getu Degu Alene
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kerebih Asrese Sibhat
- Department of social work and social development, faculty of social sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Hémono R, Packel L, Gatare E, Baringer L, Ippoliti N, McCoy SI, Hope R. Digital self-care for improved access to family planning and reproductive health services among adolescents in Rwanda: preliminary findings from a pilot study of CyberRwanda. Sex Reprod Health Matters 2022; 29:2110671. [PMID: 36083099 PMCID: PMC9467528 DOI: 10.1080/26410397.2022.2110671] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Adolescents experience significant barriers, including stigma and discrimination, to accessing voluntary family planning and reproductive health (FP/RH) services in Rwanda. Self-care interventions have been shown to reduce social barriers to FP/RH care, but little is known about the effectiveness of digital self-care for adolescents, particularly in low-resource settings. This paper presents findings from a pilot study of CyberRwanda, a digital self-care intervention providing comprehensive sexuality education and confidential online ordering of contraceptives for school-aged youth in Rwanda through a rights-based approach. A mixed-methods pilot study was conducted from November 2019 to February 2020 to assess feasibility, acceptability, and engagement and to inform a future impact evaluation. Surveys were administered to a random sample of 158 students aged 12–19 years in three secondary schools. In-depth interviews were conducted with students, parents, teachers, pharmacists, district-level administrators, and youth centre staff. Descriptive statistics were calculated and qualitative data were analyzed using a thematic coding approach. One hundred and fifty-eight surveys and 28 interviews were conducted. Results revealed high demand for CyberRwanda in schools. Students were interested in engaging with the program and found the FP/RH content relevant to their needs. However, few purchased contraceptive products through the online ordering system. There are preliminary indications that CyberRwanda may improve access to FP/RH information. An extended implementation period and further research are needed to measure the long-term impacts of the program and evaluate whether this digital self-care intervention can increase uptake of contraceptive methods and reduce adolescent pregnancy among school-aged youth.
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Affiliation(s)
- Rebecca Hémono
- Research Manager, Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Laura Packel
- Research Director, Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Emmyson Gatare
- Research Lead, YLabs Rwanda, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | - Laura Baringer
- Project Director, YLabs Rwanda, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | | | - Sandra I. McCoy
- Evaluation Principal Investigator, Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Rebecca Hope
- Chief Executive Officer, YLabs Rwanda, Berkeley, CA, USA
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Perera S, Swartz A. "An Unchanging God in a Changing World": Sexual Practice and Decision-Making among Christian Women in South Africa. JOURNAL OF RELIGION AND HEALTH 2021; 60:4045-4060. [PMID: 34115264 PMCID: PMC8840811 DOI: 10.1007/s10943-021-01305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 06/12/2023]
Abstract
This study explored the relationship between sexual health and religion among young, Pentecostal Christian women navigating the transition to adulthood in Khayelitsha township, in the City of Capetown, South Africa. Between February and August 2019, eleven semi-structured interviews and three focus group discussions were conducted. Thematic analysis and discourse analysis were used to analyse the data collected. The study found that the relationship between sexual health and religion was complex and multifaceted, shaped by the religious dichotomisation of "right" and "wrong", socio-economic constraints and culture. Despite the perceived decline of religious influence on the sexual and social lives of youth, religion continues to play an instrumental role in shaping the dreams, aspirations and lifestyles of young people, especially as they transition to adulthood. We argue therefore, that religion is a significant spiritual and cultural resource that young women use to develop their sexual and social identities, although it cannot always be equated with their sexual practice or decision-making related to sexual health. In the light of this, churches should still be seen as key partners in the fight against HIV as their involvement can act as a stabilising force for young people dealing with poverty and uncertainty. Church engagement with young people should offer programmes that include but are not limited to sexual health.
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Affiliation(s)
- Shehani Perera
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Family context and individual characteristics in antenatal care utilization among adolescent childbearing mothers in urban slums in Nigeria. PLoS One 2021; 16:e0260588. [PMID: 34843583 PMCID: PMC8629214 DOI: 10.1371/journal.pone.0260588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Adolescent pregnancy contributes significantly to the high maternal mortality in Nigeria. Research evidence from developing countries consistently underscores Antenatal Care (ANC) among childbearing adolescents as important to reducing high maternal mortality. However, more than half of pregnant adolescents in Nigeria do not attend ANC. A major gap in literature is on the influence of family context in pregnant adolescent patronage of ANC services. Methods The study utilized a cross-sectional survey with data collected among adolescent mothers in urban slums in three Nigerian states namely, Kaduna, Lagos, and Oyo. The survey used a multi-stage sampling design. The survey covered a sample of 1,015, 1,009 and 1,088 childbearing adolescents from each of Kaduna, Lagos, and Oyo states respectively. Data were analyzed at the three levels: univariate, bivariate and multivariate. Results Overall, about 70 percent of female adolescents in our sample compared with 75 percent in the Demographic and Health Survey (DHS) had any antenatal care (ANC) visit. About 62 percent in our sample compared with 70 percent in the DHS had at least 4 ANC visits, and, about 55 percent in our sample compared with 41 percent of the DHS that had 4 ANC visits in a health facility with skilled attendant (4ANC+). Those who have both parents alive and the mother with post-primary education have higher odds of attending 4ANC+ visits. The odds of attending 4ANC+ for those who have lost both parents is almost 60% less than those whose parents are alive, and, about 40% less than those whose mothers are alive. The influence of mother’s education on 4ANC+ attendance is more significant with large disparity when both parents are dead. Conclusion The study concludes that identifying the role of parents and community in expanding access to ANC services among adolescent mothers is important in improving maternal health in developing countries.
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Decker MR, Wood SN, Byrne ME, Yao-N’dry N, Thiongo M, Gichangi P, M. OlaOlorun F, Koffi AK, Radloff S, Ahmed S, O. Tsui A. Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings. PLoS One 2021; 16:e0257009. [PMID: 34843466 PMCID: PMC8629179 DOI: 10.1371/journal.pone.0257009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence). METHODS Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use. FINDINGS Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing. INTERPRETATION AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.
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Affiliation(s)
- Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nathalie Yao-N’dry
- Association Ivoirienne pour le Bien-Etre Familial (AIBEF), Abidjan, Côte d’Ivoire
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | | | - Alain K. Koffi
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy O. Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Bain LE. Understanding the meaning of autonomy in adolescent pregnancy decision-making: lessons from Ghana. Pan Afr Med J 2021; 40:34. [PMID: 34795815 PMCID: PMC8571928 DOI: 10.11604/pamj.2021.40.34.29220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction adolescent pregnancy in Ghana, like in most low and middle income countries, is an issue of immense public health importance. Pregnant adolescents are faced with the stronger dilemma of either terminating the unwanted pregnancy or keeping it. This discourse which is based on findings from empirical research in Accra Ghana aims at contributing to the usefulness of understanding the meaning and scope of autonomy when it comes to providing ethically grounded, and adolescent friendly, reproductive health care services to pregnant adolescents. The aim of this work was to document the meaning and determinants of autonomous decision making among pregnant adolescents in the James Town area of Accra, Ghana. Methods thirty (30) semi-structured in depth interviews were conducted among adolescents who had been pregnant at least once, 23 in depth interviews among purposively selected stakeholders (parents, teachers, NGO staff working in reproductive health, community volunteers), and 8 focus group discussions among parents, teachers, adolescent students who had not been pregnant before, and adolescents who had at least one pregnancy in the past. Data were transcribed verbatim and analyzed thematically. Results most adolescents reported that the final decision to continue a pregnancy to term or go in for an abortion was taken by them. The partner´s willingness to take responsibility of the pregnant adolescent and baby, as well as financial considerations, were main players in deciding upon the pregnancy outcomes. Cultural desirability for children and health care provider/father paternalism (power dynamics) in the decision-making process were central considerations in the decision-making process. Unaffordable and unfriendly safe abortion services pushed adolescents to either continue pregnancies to term against their will, or opt to visit unsafe abortion care providers. Conclusion adolescents stand to make truly autonomous decisions if they are provided with the right information, at the right time, at the right place, by the right persons, and in the right way. Health system, economic, and cultural factors play significant roles in rendering pregnant adolescent autonomy meaningful when deciding upon their pregnancy outcomes. Continuing pregnancies to term against one´s will or being forced to go in for an abortion are ethically unjustified. Further research is required to examine the long-term consequences of forced pregnancy terminations or births.
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Affiliation(s)
- Luchuo Engelbert Bain
- Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, United Kingdom.,Global South Health Services and Research, GSHS, Amsterdam, The Netherlands
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Agu IC, Mbachu CO, Ezenwaka U, Okeke C, Eze I, Arize I, Ezumah N, Onwujekwe O. Variations in utilization of health facilities for information and services on sexual and reproductive health among adolescents in South-East, Nigeria. Niger J Clin Pract 2021; 24:1582-1589. [PMID: 34782494 DOI: 10.4103/njcp.njcp_48_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Adolescents' sexual and reproductive health has an important influence on a country's long-term national growth. There is a high level of burden due to poor adolescent sexual and reproductive health (ASRH) in Nigeria, especially the Ebonyi State. Evidence shows that in the Sub-Saharan African region, most adolescents experience poor access to information and other services relating to their sexual and reproductive health. Many cultures in Africa see matters around sex and sexuality as social taboos. Aims This study aimed to access variations in the utilization of health facilities for sexual and reproductive health information and services among adolescents in the Ebonyi State, Nigeria. This will inform the design of interventions to improve ASRH. Patients and Methods A total of 1,057 in-school and out-of-school adolescents aged 13-18 years were selected using cluster sampling of households from the six selected local government areas (LGAs) in this cross-sectional survey. Structured questionnaires were used to collect data. Descriptive statistics were performed alongside stratification analysis. Tabulation, bivariate and multivariate logistic regression analyses were undertaken. A household wealth index was calculated using the total household consumption calculated divided by the number of people in the household (per capita household consumption). The per capita household consumption was used to categorize the households into socioeconomic quintiles. The variable was used to differentiate key variables into socioeconomic quintile equity analysis. Results A majority of the respondents had never visited any type of health facility to receive either sexual and reproductive health (SRH) information (90.2%) or services (97.1%). The utilization rate of health facilities for SRH information was 9.8% while for other SRH services was 2.8%. The patent medicine vendor (PMV) was the most visited type of facility for SRH information and other services. Schooling was a strong predictor of health facilities' utilization for SRH information (P < 0.01) and other services (P < 0.01). Conclusion Utilization of health facilities for information and services among adolescents in the Ebonyi State is very low and favorable toward informal service providers such as PMVs. The establishment and strengthening of the existing youth-friendly centers, school clinics, and occasional outreach programs designed specifically to target adolescents would perhaps improve adolescents' access to adequate information and health facility utilization for sexual, reproductive, and health services.
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Affiliation(s)
- I C Agu
- Health Policy Research Group; Institute of Public Health, University of Nigeria Nsukka, Nsukka, Nigeria
| | - C O Mbachu
- Health Policy Research Group; Institute of Public Health; Department of Community Medicine, University of Nigeria Nsukka, Nsukka, Nigeria
| | - U Ezenwaka
- Health Policy Research Group; Health Administration and Management, Nsukka, Nigeria
| | - C Okeke
- Health Policy Research Group; Institute of Public Health; Department of Community Medicine, University of Nigeria Nsukka, Nsukka, Nigeria
| | - I Eze
- Health Policy Research Group, Nsukka, Nigeria
| | - I Arize
- Health Policy Research Group; Health Administration and Management, Nsukka, Nigeria
| | - N Ezumah
- Health Policy Research Group, Nsukka, Nigeria
| | - O Onwujekwe
- Health Policy Research Group; Health Administration and Management, Nsukka, Nigeria
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Decker MR, Wood SN, Thiongo M, Byrne ME, Devoto B, Morgan R, Bevilacqua K, Williams A, Stuart HC, Wamue- Ngare G, Heise L, Glass N, Anglewicz P, Gummerson E, Gichangi P. Gendered health, economic, social and safety impact of COVID-19 on adolescents and young adults in Nairobi, Kenya. PLoS One 2021; 16:e0259583. [PMID: 34752473 PMCID: PMC8577767 DOI: 10.1371/journal.pone.0259583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infectious disease outbreaks like COVID-19 and their mitigation measures can exacerbate underlying gender disparities, particularly among adolescents and young adults in densely populated urban settings. METHODS An existing cohort of youth ages 16-26 in Nairobi, Kenya completed a phone-based survey in August-October 2020 (n = 1217), supplemented by virtual focus group discussions and interviews with youth and stakeholders, to examine economic, health, social, and safety experiences during COVID-19, and gender disparities therein. RESULTS COVID-19 risk perception was high with a gender differential favoring young women (95.5% vs. 84.2%; p<0.001); youth described mixed concern and challenges to prevention. During COVID-19, gender symmetry was observed in constrained access to contraception among contraceptive users (40.4% men; 34.6% women) and depressive symptoms (21.8% men; 24.3% women). Gender disparities rendered young women disproportionately unable to meet basic economic needs (adjusted odds ratio [aOR] = 1.21; p<0.05) and in need of healthcare during the pandemic (aOR = 1.59; p<0.001). At a bivariate level, women had lower full decisional control to leave the house (40.0% vs. 53.2%) and less consistent access to safe, private internet (26.1% vs. 40.2%), while men disproportionately experienced police interactions (60.1%, 55.2% of which included extortion). Gender-specific concerns for women included menstrual hygiene access challenges (52.0%), increased reliance on transactional partnerships, and gender-based violence, with 17.3% reporting past-year partner violence and 3.0% non-partner sexual violence. Qualitative results contextualize the mental health impact of economic disruption and isolation, and, among young women, privacy constraints. IMPLICATIONS Youth and young adults face gendered impacts of COVID-19, reflecting both underlying disparities and the pandemic's economic and social shock. Economic, health and technology-based supports must ensure equitable access for young women. Gender-responsive recovery efforts are necessary and must address the unique needs of youth.
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Affiliation(s)
- Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kristin Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Anaise Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - H. Colleen Stuart
- Johns Hopkins Carey Business School, Baltimore, MD, United States of America
| | - Grace Wamue- Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
- Women’s Economic Empowerment Hub, Kenyatta University, Nairobi, Kenya
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, United States of America
- Center for Global Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Elizabeth Gummerson
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Exploring condom use decision-making among adolescents: the synergistic role of affective and rational processes. BMC Public Health 2021; 21:1894. [PMID: 34666719 PMCID: PMC8527692 DOI: 10.1186/s12889-021-11926-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Condom use remains the most effective behavioural method for the prevention of HIV and unplanned pregnancies. However, condom use remains inconsistent among young people. Exploring the condom use decision-making processes that adolescents engage in might provide information that would assist in the prevention of many challenges related to poor sexual and reproductive health outcomes. This study therefore aimed to explore the factors that influenced decision-making about sexual debut and condom use of adolescents from two schools in the Western Cape, South Africa. METHODS A sample of 16 adolescents were selected using purposive sampling. Data were collected using semi-structured, individual interviews. Thematic analysis was used to analyse the data generated. RESULTS The link between sexual debut and affective processes was frequently discussed in condom use decision-making. Decisions about sexual debut were influenced by the belief that sex was a perceived symbol of 'true love' on the one hand, and respect for perceived parental expectations of age-appropriate sex, on the other. Condom use decision-making was shaped by adolescents' concerns about their future and lack of stability in their lives. Adolescents' fears of pregnancy, parenthood and disease shaped their condom use decision-making. It became evident that rational and affective decision-making in condom use choice were not mutually exclusive, but that these processes happened simultaneously. CONCLUSIONS The study highlighted the role of affective states as part of the process of examining alternatives when deciding to use a condom or not. Interventions to strengthen condom use decision-making should therefore incorporate not only rational but also affective processes to improve adolescent sexual and reproductive outcomes.
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Socio-demographic determinants of pregnancy termination among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa. BMC Pregnancy Childbirth 2021; 21:598. [PMID: 34481462 PMCID: PMC8417988 DOI: 10.1186/s12884-021-04064-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most of the unintended pregnancies that occur among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) end up in pregnancy termination. In this study, the socio-demographic determinants of pregnancy termination among AGYW (aged 15-24) in selected countries with high fertility rates in SSA were examined. METHODS This was a cross-sectional analysis of data from the most recent Demographic and Health Surveys of nine countries in SSA. The countries included are Angola, Burkina Faso, Burundi, Chad, Gambia, Mali, Niger, Nigeria, and Uganda. A total of 62,747 AGYW constituted the sample size for the study. Fixed and random effects models were used to examine the determinants of pregnancy termination with statistical significance at p < 0.05. RESULTS Higher odds of pregnancy termination were found among AGYW aged 20-24, those who were cohabiting and married, those who listened to radio and watched television at least once a week and those who lived in communities with high literacy level. Conversely, the odds of pregnancy termination were lower among AGYW with three or more births and those with secondary/higher education. CONCLUSION The socio-demographic determinants of pregnancy termination among AGYW in this study were age, level of education, marital status, exposure to radio and television, parity, and community literacy level. The findings provide the needed information for designing health interventions to reduce unwanted pregnancies and unsafe abortions in countries with high fertility rates in SSA. It is recommended that governments and non-governmental organisations in these countries should enhance sexuality education and regular sensitization of adolescent sexual and reproductive health programmes targeted at AGYW who are at risk of pregnancy termination.
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Keogh SC, Otupiri E, Castillo PW, Li NW, Apenkwa J, Polis CB. Contraceptive and abortion practices of young Ghanaian women aged 15-24: evidence from a nationally representative survey. Reprod Health 2021; 18:150. [PMID: 34275462 PMCID: PMC8286596 DOI: 10.1186/s12978-021-01189-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background Young Ghanaian women experience high rates of unmet need for contraception and unintended pregnancy, and face unique barriers to accessing sexual and reproductive health services. This study provides a comprehensive national analysis of young women’s contraceptive and abortion practices and needs. Methods In 2018, we conducted a nationally representative survey of women aged 15–49, including 1039 women aged 15–24. We used descriptive statistics, multivariable logistic and multinomial regression to compare young versus older (25–49 year-old) women’s preferred contraceptive attributes, reasons for discontinuing contraception, quality of counseling, use of Primolut N-tablet, method choice correlates, and friends’ and partners’ influence. We also examined youth’s self-reported abortion incidence, abortion methods, post-abortion care, and barriers to safe abortion. Results Among Ghanaian 15–24 year-olds who had ever had sex, one-third (32%) were using contraception. Compared to older women, they had higher desires to avoid pregnancy, lower ever use of contraception, more intermittent sexual activity, and were more likely to report pregnancies as unintended and to have recently ended a pregnancy. Young contraceptors most commonly used condoms (22%), injectables (21%), withdrawal (20%) or implants (20%); and were more likely than older women to use condoms, withdrawal, emergency contraception, and N-tablet. They valued methods for effectiveness (70%), no risk of harming health (31%) nor future fertility (26%), ease of use (20%), and no effect on menstruation (19%). Infrequent sex accounted for over half of youth contraceptive discontinuation. Relative to older women, young women’s social networks were more influential on contraceptive use. The annual self-reported abortion rate among young women was 30 per thousand. Over half of young women used abortion methods obtained from non-formal providers. Among the third of young women who experienced abortion complications, 40% did not access treatment. Conclusions Young people’s intermittent sexual activity, desire for methods that do not harm their health, access barriers and provider bias, likely contribute to their greater use of coital-dependent methods. Providers should be equipped to provide confidential, non-discriminatory counseling addressing concerns about infertility, side effects and alternative methods. Use of social networks can be leveraged to educate around issues like safe abortion and correct use of N-tablet. Young Ghanaian women can experience difficulties accessing sexual and reproductive health services, and many are not using contraception despite wanting to avoid pregnancy. To better understand their needs, we describe their preferences and behaviors around contraception and abortion. We surveyed a nationally representative sample of women aged 15–49, and compared young (15–24) versus older (25–49) women’s contraceptive preferences, reasons for stopping contraception, quality of counseling, friends’ and partners’ influence on contraceptive use, and use of abortion. One-third of 15–24 year-olds who ever had sex were using contraception. Compared to older women, young women’s pregnancies were more likely to be unintended and to end in abortion. Young women most commonly used condoms, injectables, withdrawal or implants; and were more likely than older women to use condoms, withdrawal, emergency contraception, and Primolut N-tablet. They preferred methods that were effective, did not harm their health or future fertility, were easy to use, and did not disrupt their menstrual cycle. Over half of young women who stopped contraception did so because they were not having sex regularly. Friends had more influence on contraceptive use among young women than older women. Each year on average, there were 30 abortions per 1000 young women. Over half of young women who had abortions used methods from non-formal providers, and 40% of those who had complications did not get treated. Providers should be equipped to provide confidential, non-discriminatory counseling about contraceptive side effects and options. Social networks can be used to educate women about safe abortion.
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Affiliation(s)
- Sarah C Keogh
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA.
| | - Easmon Otupiri
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Naomi W Li
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
| | - Joana Apenkwa
- St. Michael's Nursing and Midwifery Training College, Pramso, Ghana
| | - Chelsea B Polis
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
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Mwoka M, Ajayi AI, Kibunja G, Cheruiyot C, Ouedraogo R, Juma K, Igonya EK, Opondo W, Otukpa E, Kabiru C, Ushie BA. Cocreated regional research agenda for evidence-informed policy and advocacy to improve adolescent sexual and reproductive health and rights in sub-Saharan Africa. BMJ Glob Health 2021; 6:bmjgh-2021-005571. [PMID: 33811099 PMCID: PMC8023722 DOI: 10.1136/bmjgh-2021-005571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Meggie Mwoka
- Policy Engagement and Communications, African Population and Health Research Center, Nairobi, Kenya
| | - Anthony Idowu Ajayi
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Grace Kibunja
- Policy Engagement and Communications, African Population and Health Research Center, Nairobi, Kenya
| | - Collins Cheruiyot
- Policy Engagement and Communications, African Population and Health Research Center, Nairobi, Kenya
| | - Ramatou Ouedraogo
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Juma
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Emmy Kageha Igonya
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Winnie Opondo
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Emmanuel Otukpa
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline Kabiru
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
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Ahinkorah BO, Seidu AA, Hagan JE, Archer AG, Budu E, Adoboi F, Schack T. Predictors of Pregnancy Termination among Young Women in Ghana: Empirical Evidence from the 2014 Demographic and Health Survey Data. Healthcare (Basel) 2021; 9:705. [PMID: 34200654 PMCID: PMC8228613 DOI: 10.3390/healthcare9060705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/29/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
Pregnancy termination remains a delicate and contentious reproductive health issue because of a variety of political, economic, religious, and social reasons. The present study examined the associations between demographic and socio-economic factors and pregnancy termination among young Ghanaian women. This study used data from the 2014 Demographic and Health Survey of Ghana. A sample size of 2114 young women (15-24 years) was considered for the study. Both descriptive (frequency, percentages, and chi-square tests) and inferential (binary logistic regression) analyses were carried out in this study. Statistical significance was pegged at p < 0.05. Young women aged 20-24 were more likely to have a pregnancy terminated compared to those aged 15-19 (AOR = 3.81, CI = 2.62-5.54). The likelihood of having a pregnancy terminated was high among young women who were working compared to those who were not working (AOR = 1.60, CI = 1.19-2.14). Young women who had their first sex at the age of 20-24 (AOR = 0.19, CI = 0.10-0.39) and those whose first sex occurred at first union (AOR = 0.57, CI = 0.34-0.96) had lower odds of having a pregnancy terminated compared to those whose first sex happened when they were less than 15 years. Young women with parity of three or more had the lowest odds of having a pregnancy terminated compared to those with no births (AOR = 0.39, CI = 0.21-0.75). The likelihood of pregnancy termination was lower among young women who lived in rural areas (AOR = 0.65, CI = 0.46-0.92) and those in the Upper East region (AOR = 0.18, CI = 0.08-0.39). The findings indicate the importance of socio-demographic factors in pregnancy termination among young women in Ghana. Government and non-governmental organizations in Ghana should help develop programs (e.g., sexuality education) and strategies (e.g., regular sensitization programs) that reduce unintended pregnancies which often result in pregnancy termination. These programs and strategies should include easy access to contraceptives and comprehensive sexual and reproductive health education. These interventions should be designed considering the socio-demographic characteristics of young women. Such interventions will help to achieve Sustainable Development Goal 3.1 that seeks to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia;
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast 0494, Ghana; (A.-A.S.); (E.B.)
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast 0494, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 1001 31, 33501 Bielefeld, Germany;
| | - Anita Gracious Archer
- School of Nursing and Midwifery, University of Health and Allied Sciences, Sokode-Lokoe PMB 31, Ho 342-0041, Ghana;
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast 0494, Ghana; (A.-A.S.); (E.B.)
| | - Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast 729, Ghana;
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 1001 31, 33501 Bielefeld, Germany;
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Loll D, Fleming PJ, Stephenson R, King EJ, Morhe E, Manu A, Hall KS. Factors associated with reproductive autonomy in Ghana. CULTURE, HEALTH & SEXUALITY 2021; 23:349-366. [PMID: 32301400 DOI: 10.1080/13691058.2019.1710567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 12/27/2019] [Indexed: 06/11/2023]
Abstract
Reproductive autonomy is essential for women to achieve reproductive rights and freedom. However, the factors associated with reproductive autonomy in various contexts have not been explored. The aim of this analysis was to understand the socio-demographic, reproductive history and social context variables associated with two validated reproductive autonomy sub-scales among 516 young Ghanaian women age 15 to 24. We used multiple linear regression modelling to test associations between covariates of interest and the communication sub-scale and decision-making sub-scale. Covariates included age, educational attainment, ethnic group, employment, religion, religious attendance, relationship type, previous pregnancy, previous abortion, social support for adolescent sexual and reproductive health, and social stigma towards adolescent sexual and reproductive health. Results from final models demonstrated that factors associated with the communication scale included education (p = 0.008), ethnic group (p = 0.039), and social support for adolescent sexual and reproductive health (B = 0.12, p = 0.003). Factors associated with the decision-making scale included ethnic group (p = 0.002), religion (p = 0.003), religious attendance (p = 0.043), and previous pregnancy (p = 0.008). Communication reproductive autonomy and decision-making reproductive autonomy were associated with different factors, providing insight into potential intervention approaches and points. Social support for adolescent sexual and reproductive health was associated with increases in young women's abilities to communicate with their partners about sexual and reproductive health issues including sex, contraceptive use and fertility.
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Affiliation(s)
- Dana Loll
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Paul J Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth J King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Emmanuel Morhe
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adom Manu
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Strong J. Exploring the roles of men and masculinities in abortion and emergency contraception pathways, Ghana: a mobile phone-based mixed-methods study protocol. BMJ Open 2021; 11:e042649. [PMID: 33550252 PMCID: PMC7925914 DOI: 10.1136/bmjopen-2020-042649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Global commitments have established goals of achieving universal sexual and reproductive health and rights (SRHR) access, but critical obstacles remain. Emergency contraception and induced abortion are overlooked in policy and research. Men's roles in the SRHR of others are significant, particularly as obstacles to universal SRHR. Evidence on gender, masculinities and SRHR is essential to understand and reduce the barriers faced by individuals seeking to avoid the conception or continuation of a pregnancy. METHODS AND ANALYSIS This study aims to understand men's masculinities and their relationships with emergency contraception and abortion. The protocol presents a multimethod study of men aged over 18 years in James Town, Accra, Ghana. In response to the COVID-19 pandemic, the research will use two mobile-based methods: a survey and in-depth interviews. Using respondent-driven sampling, an estimated 789 men will be recruited to participate in the survey, asking questions on their knowledge, attitude, behaviours and roles in emergency contraception and abortion. In-depth interviews focused on constructions of masculinity will be conducted with a purposive sample of men who participated in the survey. Data will be analysed concurrently using multiple regression analyses of quantitative data and abductive analysis of qualitative data. ETHICS AND DISSEMINATION Ethical approval has been granted by the London School of Economics and Political Science and the Ghana Health Service. The findings in this study will: engage with emerging research on masculinities and SRHR in Ghana and elsewhere; offer methodological insight for future research; and provide evidence to inform interventions to reduce obstacles for emergency contraception and abortion care seekers. Dissemination will occur at all levels-policy, academic, community-including multiple academic articles, policy briefs, workshops and presentations, conference papers, and theatre/radio-based performances of key messages.
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Affiliation(s)
- Joe Strong
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Mukendi DM, Mukalenge FC, Ali MM, Mondo TMN, Utshudienyema GW. [Adolescents and teachers´ knowledge, attitude and practice towards contraception: results from a qualitative study conducted in the Democratic Republic of the Congo]. Pan Afr Med J 2021; 38:121. [PMID: 33912291 PMCID: PMC8051221 DOI: 10.11604/pamj.2021.38.121.21678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 01/12/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction the purpose of this study was to assess adolescents and teachers´ knowledge, attitude and practices towards family planning (FP). Methods in 2018, a qualitative study was conducted among seven teachers and 62 teenagers aged 15-19 years based on the Theory of Reasoned Action published by Fishbein and Ajzen in 2011. Data were collected from six focus group (FG) with adolescents and seven semi-structured interviews of teachers. They were analyzed using Atlas Ti software on the basis of a deductive approach. Results periodic abstinence, male condoms and pills were the only contraceptive methods reported. Adolescents and teachers were apprehensive about using artificial contraceptive methods other than irregularly used male condom. Girls prefer natural methods fearing side effects. The majority of adolescents wanted to be informed about FP in school; however, they felt that the content of the Life Education Course (EVIE) was insufficient and that teachers lacked of openness. Peers, brothers, sisters and internet were the main sources of information. Mothers were an important source of information especially for girls, unlike fathers who were generally less appreciated. Conclusion knowledge about FP is weak. Misconceptions about contraception lead to the use of ineffective practices to prevent unintended pregnancies. Training programs to improve teachers´ knowledge should be developed and the content of the EVIE course should be formalized and regulated.
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Affiliation(s)
- Dieudonné Mpunga Mukendi
- Ecole de Santé Publique de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Faustin Chenge Mukalenge
- Ecole de Santé Publique de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Mapatano Mala Ali
- Ecole de Santé Publique de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Thérèse Mambu Nyangi Mondo
- Ecole de Santé Publique de Kinshasa, Faculté de Médecine, Université de Kinshasa, Kinshasa, République Démocratique du Congo
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Understanding the barriers to Ghanaian midwives’ ability to provide quality care: Using classic Grounded theory methodology in a new context. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Silverman JG, Challa S, Boyce SC, Averbach S, Raj A. Associations of reproductive coercion and intimate partner violence with overt and covert family planning use among married adolescent girls in Niger. EClinicalMedicine 2020; 22:100359. [PMID: 32382722 PMCID: PMC7198910 DOI: 10.1016/j.eclinm.2020.100359] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In Niger the prevalence of girl child marriage and low female control over family planning (FP) has resulted in the world's highest adolescent fertility. Male control of FP is associated with intimate partner violence (IPV) and reproductive coercion (RC). We assessed associations of IPV and RC with FP use among married adolescent girls (ages 13-19 years) in Dosso, Niger (N = 1072). METHODS Multivariable, cross-sectional regression models assessed associations between physical IPV, sexual IPV, and RC and any FP use, FP use with husband knowledge (overt use), and FP use without husband knowledge (covert use). FINDINGS One in four married adolescent girls using FP reported doing so without husband's knowledge. Unadjusted and adjusted models indicated that physical IPV and RC were associated with covert FP use (vs. no use and vs. overt use), but not with overt use vs. no use. Only physical IPV remained significantly associated with covert use in models including all three forms of violence (AOR: 1.94 vs. any use; AOR: 3.63 vs. overt use). INTERPRETATION Married adolescents experiencing physical IPV or RC were more likely that others to use FP without their husbands' knowledge. No form of GBV affected odds of FP use with husbands' knowledge. Current results suggest caution regarding promoting engagement of men in decisions to use FP in this context, as this may undermine the reproductive autonomy of girls and women who will choose to use FP without the knowledge of their male partners.
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Affiliation(s)
- Jay G Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sneha Challa
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sabrina C Boyce
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
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Mpunga-Mukendi D, Mukalenge Chenge F, Ali Mapatano M, Nyangi Mondo Mambu T, Utshudienyema Wembodinga G. Assessing Comprehensive Sexuality Education Programs in the Democratic Republic of the Congo: Adolescents’ and Teachers’ Knowledge, Attitudes and Practices towards Contraception. Health (London) 2020. [DOI: 10.4236/health.2020.1211104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Loll D, Fleming PJ, Manu A, Morhe E, Stephenson R, King EJ, Hall KS. Reproductive autonomy and pregnancy decision-making among young Ghanaian women. Glob Public Health 2019; 15:571-586. [PMID: 31766950 DOI: 10.1080/17441692.2019.1695871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Decision-making regarding the outcome of a pregnancy may include participation of the woman herself, her sexual partner, parents, family, and/or community. This paper examines who had the most say in the outcome of young Ghanaian women's last pregnancy and whether this correlated with her level of reproductive autonomy (RA). We analysed cross-sectional data from 380 previously pregnant young women in urban Ghana. We measured communication and decision-making RA using modified scales ranging from 3 (low RA) to 12 (high RA). We tested unadjusted associations between the RA sub-scales and who made the pregnancy decision (self, partner, both together, or someone else) and used multinomial regression models to understand these associations when controlling for sociodemographic, reproductive history, and social context variables. In final models, a one-point increase in decision-making RA was associated with an adjusted relative risk ratio of 0.79 (95% CI: 0.66-0.93; p = 0.006) of partner having the most say as compared to the woman having the most say. The communication RA scale was not associated. Programmes that increase RA may be effective in increasing women's rights to execute decisions about reproductive health and outcomes. Future research should explore this notion and the role of pregnancy disclosure in this relationship.
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Affiliation(s)
- Dana Loll
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Paul J Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Abubakar Manu
- Department of Population, Family, and Reproductive Health, University of Ghana School of Public Health, Legon, Ghana
| | - Emmanuel Morhe
- Department of Obstetrics and Gynecology, University of Health and Allied Sciences, Hohoe, Ghana
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth J King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Engelbert Bain L, Zweekhorst MBM, Amoakoh-Coleman M, Muftugil-Yalcin S, Omolade AIO, Becquet R, de Cock Buning T. To keep or not to keep? Decision making in adolescent pregnancies in Jamestown, Ghana. PLoS One 2019; 14:e0221789. [PMID: 31483813 PMCID: PMC6726415 DOI: 10.1371/journal.pone.0221789] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/14/2019] [Indexed: 01/31/2023] Open
Abstract
Background Jamestown, an urban coastal slum in Accra, Ghana, has one of the highest adolescent pregnancy rates in the country. We sought to understand the decision (to keep or terminate) factors and experiences surrounding adolescent pregnancies. Methods Thirty semi-structured indepth interviews were carried out among adolescents (aged 13–19 years) who had been pregnant at least once. Half of these were adolescent mothers and the other half had at least one past experience of induced abortion. A pretested and validated questionnaire to assess the awareness and use of contraception in adolescent participants was also administered. To aid social contextualization, semi-structured in depth interviews were carried out among 23 purposively selected stakeholders. Results The main role players in decision making included family, friends, school teachers and the partner, with pregnant adolescents playing the most prominent role. Adolescents showed a high degree of certainty in deciding to either abort or carry pregnancies to term. Interestingly, religious considerations were rarely taken into account. Although almost all adolescents (96.1%) were aware of contraception, none was using any prior to getting pregnant. Of the 15 adolescents who had had abortion experiences, 13 (87.0%) were carried out under unsafe circumstances. The main barriers to accessing safe abortion services included poor awareness of the fairly liberal nature of the Ghanaian abortion law, stigma, high cost and non-harmonization of safe abortion service fees, negative abortion experiences (death and bleeding), and distrust in the health care providers. Adolescents who chose to continue their pregnancies to term were motivated by personal and sociocultural factors. Conclusion Decision-making in adolescent pregnancies is influenced by multiple external factors, many of which are modifiable. Despite legal access to services, options for the safe termination of pregnancy or its prevention are not predominantly taken, resulting in a high number of negative experiences and outcomes. Including safe abortion care within the sexual and reproductive health package, could diminish barriers to safe abortion services. Given the vulnerability of the Jamestown setting, a comprehensive sexual education package that addresses the main decision factors is recommended. Interventions aiming to reduce adolescent pregnancy rates should also recognize that adolescent pregnancies are culturally acceptable in some settings, and under certain circumstances, are desired by the adolescents themselves.
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Affiliation(s)
- Luchuo Engelbert Bain
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France
- * E-mail:
| | - Marjolein B. M. Zweekhorst
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mary Amoakoh-Coleman
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Seda Muftugil-Yalcin
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Renaud Becquet
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France
| | - Tjard de Cock Buning
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Kaiser JL, Fong RM, Hamer DH, Biemba G, Ngoma T, Tusing B, Scott NA. How a woman's interpersonal relationships can delay care-seeking and access during the maternity period in rural Zambia: An intersection of the Social Ecological Model with the Three Delays Framework. Soc Sci Med 2019; 220:312-321. [PMID: 30500609 PMCID: PMC6323354 DOI: 10.1016/j.socscimed.2018.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/31/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022]
Abstract
To reduce maternal mortality, countries must continue to seek ways to increase access to skilled care during pregnancy and delivery. In Zambia, while antenatal attendance is high, many barriers exist that prevent women from delivering with a skilled health provider. This study explores how the individuals closest to a pregnant woman in rural Zambia can influence a woman's decision to seek and her ability to access timely maternity care. At four rural health centers, a free listing (n = 167) exercise was conducted with mothers, fathers, and community elders. Focus group discussions (FGD) (n = 135) were conducted with mothers, fathers, mothers-in-law, and community health workers (CHWs) to triangulate findings. We analyzed the FGD data against a framework that overlaid the Three Delays Framework and the Social Ecological Model. Respondents cited husbands, female relatives, and CHWs as the most important influencers during a woman's maternity period. Husbands have responsibilities to procure resources, especially baby clothes, and provide the ultimate permission for a woman to attend ANC or deliver at a facility. Female relatives escort the woman to the facility, assist during her wait, provide emotional support, assist the nurse during delivery, and care for the woman after delivery. CHWs educate the woman during pregnancy about the importance of facility delivery. No specific individual has the role of assisting with the woman's household responsibilities or identifying transport to the health facility. When husbands, female relatives, or CHWs do not fulfill their roles, this presents a barrier to a woman deciding to deliver at the health facility (Delay 1) or reaching a health facility (Delay 2). An intervention to help women better plan for acquiring the needed resources and identifying the individuals to escort her and those to perform her household responsibilities could help to reduce these barriers to accessing timely maternal care.
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Affiliation(s)
- Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA.
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA; Section of Infectious Diseases, Department of Medicine, Boston Medical Center, One Boston Medical Center Pl, Boston, MA, 02118, USA
| | - Godfrey Biemba
- Zambia Center for Applied Health Research and Development, Plot 4186 Addis Ababa Drive, Long Acres, P.O. Box 30910, Lusaka, Zambia
| | - Thandiwe Ngoma
- Zambia Center for Applied Health Research and Development, Plot 4186 Addis Ababa Drive, Long Acres, P.O. Box 30910, Lusaka, Zambia
| | - Brittany Tusing
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA
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