Knowledge, attitudes and behaviours of adolescents in relation to STIs, pregnancy, contraceptive utilization and substance abuse in the Mhlakulo region, Eastern Cape

Postnatal depression and its social-cultural influences among adolescent mothers: A cross sectional study

In rural Malawi, adolescent mothers represent 31% of pregnancies. While some adolescent mothers experience motherhood as an exciting, positive, and affirming experience, for others, it may increase their risk of postnatal depression (PND). Social norms and culture contribute to adolescent mothers' experiences and may influence their mental health. However, there is limited research around the prevalence of PND and its cultural influences among adolescent mothers. A cross-sectional survey was administered from 7th September 2021 to 31st March 2022. Three hundred and ninety-five adolescent postnatal mothers aged ≤19 were conveniently recruited at Mitundu hospital in Lilongwe, Malawi. The Edinburgh Postnatal Depression Scale was used to assess depression. A cutoff point of ≥ 10 was employed to categorize probable PND. Binary logistic regression was used to determine the predictors of depression. The mean age of participants was 17 (SD 1.157). and 43.6% (n = 172) presented with PND (EPDS scores ≥10). When all factors were considered in a binary logistic model, adolescents who had ever experienced intimate partner violence (IPV) were 13.6 times more likely to report PND after controlling for age and other predictors compared to those without an experience of IPV (aOR 13.6, p = 0.01, 95% CI 2.10-88.9). Participants whose families did not decide for them (regarding their care) were 2.3 times more likely to present with PND than those whose families decided for them (aOR 2.3 p = 0.03, 95% CI 1.04-5.2). Adolescent mothers who had interacted with their health worker were less likely to report PND than those who had no interaction with the health worker (aOR 0.4 P0.02, CI 0.17-0.67). Social and cultural factors can impact mental health of adolescent mothers. It is recommended that targeted and integrated interventions are developed, implemented. and evaluated. There is a need to improve policy and practice to better support adolescent mothers postnatally.

Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV

Adolescents in Africa are at high risk for HIV infection, other sexually transmitted infections (STIs) and bacterial vaginosis (BV). Since behavior and burden of STIs/BV may influence HIV risk, behavioral risk factors and prevalence of STIs/BV were compared in HIV-seronegative adolescent females (n = 298; 16-22 years) from two South African communities (Soweto and Cape Town). STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1, HSV-2, Treponema pallidum, and Haemophilus ducreyi) were detected by multiplex polymerase chain reaction, human papillomavirus (HPV) by Roche Linear Array, and BV by Nugent scoring. Rates of BV (Nugent ≥7; 46.6%) and HPV (66.8%) were high in both communities. Prevalence of C. trachomatis and N. gonorrhoeae were >2-fold higher in Cape Town than Soweto (Chlamydia: 42% [62/149] versus 18% [26/148], p < 0.0001; gonorrhoea 11% [17/149] versus 5% [7/148], p = 0.05). Only 24% of adolescents with vaginal discharge-causing STIs or BV were symptomatic. In South African adolescents, clinical symptoms compatible with vaginal discharge syndrome had a sensitivity of 23% and specificity of 85% for the diagnosis of discharge-causing STI or BV. In a region with high HIV prevalence and incidence, >70% of young women with treatable conditions that could enhance HIV risk would have been missed because they lacked symptoms associated with syndromic management.

From 'sugar daddies' to 'sugar babies': exploring a pathway among age-disparate sexual relationships, condom use and adolescent pregnancy in South Africa

Background Adolescent pregnancy has been linked to adverse outcomes. Most studies proposing risk pathways for adolescent pregnancy in South Africa are qualitative, hypothesising links among age-disparate relationships, reduced condom use and higher pregnancy rates. No known South African studies have quantitatively explored pathways to adolescent pregnancy.

OBJECTIVES

This study aimed to: (i) identify the factors associated with adolescent pregnancy and (ii) explore a pathway of risk by assessing whether condom use mediated the relationship between age-disparate sexual relationships and adolescent pregnancy.

METHODS

A cross-sectional survey of 447 sexually active girls aged 10-19 years was undertaken in six health districts of South Africa. Multivariate logistic regressions controlled for confounders. Mediation tests used bootstrapping.

RESULTS

Consistent condom use (β=-2.148, odds ratio (OR)=8.566, P≤0.001) and school enrolment (β=-1.600, OR=0.202, P≤0.001) were associated with lower pregnancy rates. Age-disparate sex (β=1.093, OR=2.982, P≤0.001) and long-term school absences (β=1.402, OR=4.061, P≤0.001) were associated with higher pregnancy rates. The indirect effect of age-disparate sex on adolescent pregnancy through condom use was significant, irrespective of age, age at sexual initiation, poverty and residential environment (B=0.4466, s.d.=0.1303, confidence interval: 0.2323-0.7428).

CONCLUSION

This survey supports hypotheses that inability to negotiate condom use in age-disparate sexual relationships may drive adolescent pregnancy. Interventions addressing these relationships, facilitating condom use and increasing access to sexual health services among adolescents might avert unwanted pregnancies.