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Archdeacon N, Salmon-Mulanovich G, Lopez Florez L, Kothadia A, Castañeda K, Rusyidi B, Cole S, Tallman P. Teenage pregnancy in Tambogrande, Peru: causes, consequences and cycles of violence and disadvantage. CULTURE, HEALTH & SEXUALITY 2024; 26:563-574. [PMID: 37052126 DOI: 10.1080/13691058.2023.2193250] [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: 11/17/2022] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Teenage pregnancy carries adverse consequences for health and well-being. In this article, we investigate the perceived causes, consequences and cycles of violence and disadvantage associated with teenage pregnancy in Tambogrande, Peru using an applied anthropological approach. Data were drawn from a larger project investigating the relationship between water insecurity and gender-based violence in Indonesia and Peru. The analysis presented here is derived from 49 semi-structured interviews and 5 focus groups with local community members and stakeholders in Peru. Study participants highlighted two main factors contributing to teenage pregnancy in Tambogrande: machismo and religious deterrents to contraceptive use. Participants described how these factors overlapped, resulting in gendered power imbalances that increased the risk of violence, decreased educational opportunities, and reduced the economic independence of women. However, study participants stated that educational interventions targeting machismo could reduce teenage pregnancy and break the associated cycle of disadvantage. Future research will further investigate local social and gender norms to inform the design of a rights-based educational intervention, targeting upstream factors associated with teenage pregnancy in this area.
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Affiliation(s)
| | | | - Lucia Lopez Florez
- Institute for Nature, Earth and Energy, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Aman Kothadia
- Department of Anthropology, Loyola University Chicago, Chicago, IL, USA
| | - Karina Castañeda
- Institute for Nature, Earth and Energy, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Binahayati Rusyidi
- Department of Social Welfare, FISIP Universitas Padjadjaran, Jatinangor-Sumedang, West Java, Indonesia
| | - Stroma Cole
- School of Architecture and Cities, University of Westminster, London, UK
| | - Paula Tallman
- Department of Anthropology, Loyola University Chicago, Chicago, IL, USA
- The Keller Science Action Center, The Field Museum of Natural History, Chicago, IL, USA
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Bahar OS, Byansi W, Nartey PB, Ibrahim A, Boateng A, Kumbelim K, Nabunya P, McKay MM, Ssewamala FM. Self-esteem and self-concept as correlates of life satisfaction and attitudes toward school among Ghanaian girls. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:185-191. [PMID: 38205871 PMCID: PMC11114458 DOI: 10.1111/jora.12910] [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] [Received: 03/10/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024]
Abstract
During adolescence, youth experience several physical, psychosocial, and cognitive changes. Self-esteem and self-concept are identified as protective factors for adolescents in high-income countries, but studies are limited in sub-Saharan Africa. We examined the associations of self-esteem and self-concept with life satisfaction and attitudes toward school using baseline data from 97 Ghanaian adolescent girls at risk of school dropout. Ordinary Least Squares regression models were fitted to examine the association between self-esteem and self-concept on school attitudes and life satisfaction. Self-esteem was positively associated with life satisfaction. Self-concept was associated with more positive attitudes toward school. Hence, self-esteem and self-concept may be critical protective factors in promoting adolescent girls' life satisfaction and positive attitudes toward school.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - William Byansi
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, USA
| | | | | | - Alice Boateng
- Department of Social Work, University of Ghana, Accra, Ghana
| | | | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary M. McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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Adeyinka DA, Muhajarine N. Disentangling the link between social determinants of health and child survival in Nigeria during the Sustainable Development Goals era: a hierarchical path analysis of time-to-event outcome. J Biosoc Sci 2024; 56:357-375. [PMID: 38095080 DOI: 10.1017/s0021932023000305] [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] [Indexed: 02/15/2024]
Abstract
While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20-34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria.
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Affiliation(s)
- Daniel Adedayo Adeyinka
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, SK, Canada
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Nazeem Muhajarine
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, SK, Canada
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Kathono J, Nyongesa V, Mwaniga S, Obonyo G, Yator O, Wambugu M, Banerjee J, Breuer E, Duffy M, Lai J, Levy M, Njuguna S, Kumar M. Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach. PLoS One 2024; 19:e0290868. [PMID: 38165879 PMCID: PMC10760697 DOI: 10.1371/journal.pone.0290868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/17/2023] [Indexed: 01/04/2024] Open
Abstract
In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.
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Affiliation(s)
| | | | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Erica Breuer
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Malia Duffy
- St Ambrose University, Davenport, Iowa, United States of America
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, NY, United States of America
| | - Marcy Levy
- UNICEF Headquarters, New York, NY, United States of America
| | - Simon Njuguna
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States of America
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Wang T, Si L, Jiang Q. Induced abortions among Chinese adolescent girls. BMC Womens Health 2023; 23:597. [PMID: 37957592 PMCID: PMC10644521 DOI: 10.1186/s12905-023-02754-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: 06/17/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Induced abortion among adolescent girls is a global public health issue and a serious challenge in China, but still remains under-examined. We aimed to examine the overall trend and characteristics of induced abortions among Chinese adolescent girls and to investigate the factors associated with induced abortion. STUDY DESIGN Based on the 2017 China Fertility Survey, this study examined the trend and characteristics of induced abortions among adolescent girls with statistical analysis and multiple indicators of descriptive statistics from period and cohort perspectives, including induced abortion proportion and rate, age-specific cumulative proportion, and age-specific cumulative number of induced abortions in adolescent girls. RESULTS Between 1996 and 2016, the proportion and rate of adolescent induced abortions first increased and then decreased, and the mean age at the time of induced abortions among adolescent girls declined. The cumulative proportion of women who had experienced induced abortion at the age of 15-19 in a cohort is less than 2.5% but shows an upward trend. Over 70% of all adolescent induced abortions are premarital. The proportion of women with unintended pregnancy experiences increased and is higher among rural, less educated, and ethnic minority women. Similarly, the prevalence of induced abortion is higher among adolescent girls who live in rural areas, are less educated, and come from ethnic minorities. The cumulative number of induced abortions and premarital abortions increased with later cohorts. CONCLUSIONS This study shows an upward trend in adolescent-induced abortion and a decline in the age at the time of the induced abortion. Women in later birth cohort have a higher proportion of having experienced adolescent induced abortion. Adolescent girls who live in rural areas, who are less educated, or who are from ethnic minorities, are more likely to undergo induced abortions at the age of 15-19. More appropriate educational efforts and interventions are urgently needed to reduce the incidence of adolescent induced abortions.
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Affiliation(s)
- Tian Wang
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Quanbao Jiang
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China.
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Chamdimba E, Kabiru CW, Ushie BA, Munthali A, Thakwalakwa C, Ajayi AI. Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi. Reprod Health 2023; 20:114. [PMID: 37544984 PMCID: PMC10404372 DOI: 10.1186/s12978-023-01655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Pregnancy and childbearing in adolescence could negatively affect girls' health and socio-economic wellbeing across the life course. Previous studies on drivers of adolescent pregnancy in Africa have not fully considered the perspectives of parents/guardians vis-à-vis pregnant and parenting adolescents. Our study addresses this gap by examining pregnant and parenting adolescents' and parents/guardians' narratives about factors associated with early and unintended pregnancy. METHODOLOGY The descriptive study draws on qualitative data collected as part of a larger mixed-methods cross-sectional survey on the lived experiences of pregnant and parenting adolescents. Data were collected between March and May 2021 in Blantyre, Malawi, using semi-structured interview guides. We interviewed 18 pregnant and parenting adolescent girls, 10 parenting adolescent boys, and 16 parents/guardians of pregnant and parenting adolescents. Recorded interviews were transcribed verbatim into the English language by bilingual transcribers. We used the inductive-thematic analytical approach to summarize the data. FINDINGS The data revealed several interconnected and structural reasons for adolescents' vulnerability to early and unintended pregnancy. These include adolescents' limited knowledge and access to contraceptives, poverty, sexual violence, school dropout, COVID-19 school closures, and being young and naively engaging in unprotected sex. While some parents agreed that poverty and school dropout or COVID-19 related school closure could lead to early pregnancies, most considered stubbornness, failure to adhere to abstinence advice and peer influence as responsible for adolescent pregnancies. CONCLUSION Our findings contribute to the evidence on the continued vulnerability of girls to unintended pregnancy. It highlights how parents and adolescents hold different views on reasons for early and unintended pregnancy, and documents how divergent views between girls and their parents may contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unintended pregnancies will require altering community attitudes about young people's use of contraceptives and engaging parents, education sector, civil society organizations and community and religious leaders to develop comprehensive sexuality education programs to empower in- and out-of school adolescents.
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Affiliation(s)
- Elita Chamdimba
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Alister Munthali
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | | | - Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Ajayi AI, Athero S, Muga W, Kabiru CW. Lived experiences of pregnant and parenting adolescents in Africa: A scoping review. Reprod Health 2023; 20:113. [PMID: 37537592 PMCID: PMC10401816 DOI: 10.1186/s12978-023-01654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Previous studies have not synthesized existing literature on the lived experiences of pregnant and parenting adolescents (aged 10-19) in Africa. Such evidence synthesis is needed to inform policies, programs, and future research to improve the well-being of the millions of pregnant or parenting adolescents in the region. Our study fills this gap by reviewing the literature on pregnant and parenting adolescents in Africa. We mapped existing research in terms of their substantive focus, and geographical distribution. We synthesized these studies based on thematic focus and identified gaps for future research. METHODS We used a three-step search strategy to find articles, theses, and technical reports reporting primary research published in English between January 2000 and June 2021 in PubMed, Jstor, AJOL, EBSCO Host, and Google Scholar. Three researchers screened all articles, including titles, abstracts, and full text, for eligibility. Relevant data were extracted using a template designed for the study. Overall, 116 studies met the inclusion criteria and were included in the study. Data were analyzed using descriptive and thematic analyses. RESULTS Research on pregnant and parenting adolescents is limited in volume and skewed to a few countries, with two-fifths of papers focusing on South Africa (41.4%). Most of the studies were African-led (81.9%), received no funding (60.3%), adopted qualitative designs (58.6%), and were published between 2016 and 2021 (48.3%). The studies highlighted how pregnancy initiates a cycle of social exclusion of girls with grave implications for their physical and mental health and social and economic well-being. Only 4.3% of the studies described an intervention. None of these studies employed a robust research design (e.g., randomized controlled trial) to assess the intervention's effectiveness. Adolescent mothers' experiences (26.7%) and their education (36.2%) were the most studied topics, while repeat pregnancy received the least research attention. CONCLUSION Research on issues affecting pregnant and parenting adolescents is still limited in scope and skewed geographically despite the large burden of adolescent childbearing in many African countries. While studies have documented how early pregnancy could result in girls' social and educational exclusion, few interventions to support pregnant and parenting adolescents exist. Further research to address these gaps is warranted.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya.
| | - Sherine Athero
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Winstoun Muga
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya
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Obonyo G, Nyongesa V, Duffy M, Kathono J, Nyamai D, Mwaniga S, Yator O, Levy M, Lai J, Kumar M. Diverse policy maker perspectives on the mental health of pregnant and parenting adolescent girls in Kenya: Considerations for comprehensive, adolescent-centered policies and programs. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000722. [PMID: 37339107 DOI: 10.1371/journal.pgph.0000722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
The pregnancy rate in Kenya among adolescent girls is among the highest in the world. Adolescent girls experience increased risk of anxiety and depression during pregnancy and postpartum which can result in poor health outcomes for both mother and baby, and negatively influence their life course. Mental health is often given low priority in health policy planning, particularly in Sub-Saharan Africa (SSA). There is an urgent need to address the treatment gap and provide timely mental health promotion and preventative services, there is a need to focus on the shifting demographic of SSA-the young people. To understand perspectives on policymakers on the mental health prevention and promotion needs of pregnant and parenting adolescent girls, we carried out a series of interviews as part of UNICEF funded helping pregnant and parenting adolescents thrive project in Kenya. We interviewed 13 diverse health and social policy makers in Kenya to understand their perspectives on the mental health experiences of pregnant and parenting adolescent girls and their ideas for optimizing mental health promotion. Six principal themes emerged including the mental health situation for adolescent girls, risk factors for poor mental health and barriers to accessing services for adolescent girls, health seeking behavior effect on maternal and child health outcomes, mental health promotion, protective factors for good mental health, and policy level issues. Examination of existing policies is required to determine how they can fully and effectively be implemented to support the mental health of pregnant and parenting adolescent girls.
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Affiliation(s)
| | | | - Malia Duffy
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
- Saint Ambrose University, Davenport, Iowa, United States of America
| | - Joseph Kathono
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Nairobi Metropolitan Services, Nairobi, Kenya
| | | | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya
- Vrije University, Amsterdam, Netherlands
| | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Marcy Levy
- UNICEF Headquarters, New York, New York, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, New York, United States of America
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Namukisa M, Kamacooko O, Lunkuse JF, Ruzagira E, Price MA, Mayanja Y. Incidence of unintended pregnancy and associated factors among adolescent girls and young women at risk of HIV infection in Kampala, Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1089104. [PMID: 36910339 PMCID: PMC9995850 DOI: 10.3389/frph.2023.1089104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023] Open
Abstract
Background In sub-Saharan Africa, one in every five young women becomes pregnant, and 50% of these are unintended. Pregnancies in adolescent girls and young women (AGYW) are associated with poorer maternal and neonatal outcomes and a high abortion rate, yet data are still limited on incident pregnancies among AGYW in vulnerable situations. We studied the incidence and factors associated with unintended pregnancy among AGYW who were frequently engaged in transactional sex in Kampala, Uganda. Methods We analyzed data from a study that investigated the uptake of oral pre-exposure prophylaxis among AGYW from January 2019 to December 2020. Volunteers attended 3-monthly study visits for 12 months each. Contraceptive services were provided to interested volunteers free of charge. Interviewers collected data on sociodemographics, sexual behavior, reproductive health outcomes, and substance use. Pregnancy was determined by testing for beta-human chorionic gonadotropin hormone in urine. The pregnancy incidence rate was estimated using the Kaplan-Meier technique, and logistic regression was used to determine the correlates of pregnancy. Results We included 285 volunteers with a mean age of 19.9 [standard deviation (SD), ± 2.24] years; 54.7% had attained secondary school education or higher, 57.2% were single (never married), 92.6% reported engaging in transactional sex, 21.0% reported sex work as their main job, 51.9% consumed alcohol in the month prior to the interview, of whom 12.8% consumed alcohol daily, and 25.3% had Chlamydia trachomatis/Neisseria gonorrhoeae. The mean age at first sexual intercourse was 15.7 (SD, ±2.1) years. We recorded 44 pregnancies over 187.2 person-years of follow-up, an incidence of 23.5 per 100 person-years [95% confidence interval (CI), 17.5-31.6]. Incident pregnancies were more likely among volunteers who had ≥10 sexual partners in the past 3 months [adjusted risk ratio (aRR) 1.97; 95% CI, 1.05-3.70] and those who reported not using contraception (aRR 5.89; 95% CI, 2.74-12.66). Incident pregnancies were less likely among those who reported alcohol consumption in the past month (aRR 0.52; 95% CI, 0.30-0.90). Conclusion The incidence of unintended pregnancy was high despite the availability of free contraceptive services. We recommend sociobehavioral studies to explore this further. Sexual and reproductive health campaigns should strengthen demand creation and motivation to use contraception among young women with multiple sexual partners.
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Affiliation(s)
- Mary Namukisa
- Department of Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Onesmus Kamacooko
- Department of Data and Statistics, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Jane Frances Lunkuse
- Department of Data and Statistics, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Department of HIV Epidemiology and Intervention, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matt A. Price
- Department of Epidemiology, IAVI, New York, NY, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Yunia Mayanja
- Department of HIV Epidemiology and Intervention, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
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Ditshwane B, Mokgatle MM, Oguntibeju OO. Awareness, Utilization and Perception of Sexually Transmitted Infections Services Provided to Out-of-School-Youth in Primary Health Facilities in Tshwane, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031738. [PMID: 36767123 PMCID: PMC9913921 DOI: 10.3390/ijerph20031738] [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: 12/09/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Despite the availability of different health care initiatives and interventions, young people are still faced with barriers in accessing reproductive health care services; thus, they are exposed to health-related issues such as sexually transmitted infections. AIM To determine the awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in primary health facilities in the Tshwane district, Gauteng Province, South Africa. METHODS The study employed a quantitative, cross-sectional descriptive survey with a sample size of 219 to determine the level of awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in Tshwane district. RESULTS Out-of-school-youth between the ages of 18-24 years participated in the study. Most of the participants (90.8%, n = 199) were female. Service utilization was high in females compared to their male counterparts. There is availability of youth-friendly services in primary health care facilities, however, the level of service utilization among young people is still a challenge evidenced by 12.1% (n = 74) of participants who never sought treatment for STIs, although they had STI symptoms. Furthermore, 52.0% reported that they were not happy with the health services they received when they had STIs. These findings clearly indicate a gap in service delivery for young people regarding reproductive health issues; thus, the low health care seeking behavior among the youth. Condom use was 69.1% and/or inconsistently used among the youth; about 80% of the participants had low perceptions of the risk of contracting STIs. The self-reported risks of HIV and AIDS was 46.8%. Approximately 20% reported that they would not refuse to have sex if their partner did not want to use condoms. These findings showed risky behavior among the participants, and shows that the level of awareness about the risk of contracting STIs is still poor. CONCLUSIONS Irrespective of facilities with youth-friendly services, out-of-school-youth still display poor perceptions about sexually transmitted infections services due to health care providers' attitudes, limited resources, and working hours. Furthermore, the level of awareness regarding sexually transmitted infections is poor, hence the display of risky sexual behaviors.
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Affiliation(s)
- Boitumelo Ditshwane
- School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Matilda M. Mokgatle
- School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Oluwafemi O. Oguntibeju
- Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 3575, South Africa
- Correspondence: ; Tel.: +27-219538495
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Bernard C, Hassan SA, Humphrey J, Thorne J, Maina M, Jakait B, Brown E, Yongo N, Kerich C, Changwony S, Qian SRW, Scallon AJ, Komanapalli SA, Enane LA, Oyaro P, Abuogi LL, Wools-Kaloustian K, Patel RC. Impacts of the COVID-19 pandemic on access to HIV and reproductive health care among women living with HIV (WLHIV) in Western Kenya: A mixed methods analysis. Front Glob Womens Health 2022; 3:943641. [PMID: 36578364 PMCID: PMC9790904 DOI: 10.3389/fgwh.2022.943641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The COVID-19 pandemic has impacted access to health services. Our objective was to understand the pandemic's impact on access to HIV, pregnancy, and family planning (FP) care among women living with HIV (WLHIV). Methods Data were collected after June 2020, when questions about the pandemic were added to two ongoing mixed methods studies using telephone surveys and in-depth interviews among WLHIV in western Kenya. The Chaguo Langu (CL) study includes primarily non-pregnant WLHIV receiving HIV care at 55 facilities supported by AMPATH and the Opt4Mamas study includes pregnant WLHIV receiving antenatal care at five facilities supported by FACES. Our outcomes were self-reported increased difficulty refilling medication, accessing care, and managing FP during the pandemic. We summarized descriptive data and utilized multivariable logistic regression to evaluate predictors of difficulty refilling medication and accessing care. We qualitatively analyzed the interviews using inductive coding with thematic analysis. Results We analyzed 1,402 surveys and 15 in-depth interviews. Many (32%) CL participants reported greater difficulty refilling medications and a minority (14%) reported greater difficulty accessing HIV care during the pandemic. Most (99%) Opt4Mamas participants reported no difficulty refilling medications or accessing HIV/pregnancy care. Among the CL participants, older women were less likely (aOR = 0.95, 95% CI: 0.92-0.98) and women with more children were more likely (aOR = 1.13, 95% CI: 1.00-1.28) to report difficulty refilling medications. Only 2% of CL participants reported greater difficulty managing FP and most (95%) reported no change in likelihood of using FP or desire to get pregnant. Qualitative analysis revealed three major themes: (1) adverse organizational/economic implications of the pandemic, (2) increased importance of pregnancy prevention during the pandemic, and (3) fear of contracting COVID-19. Discussion The two unique participant groups included in our study encountered overlapping problems during the COVID-19 epidemic. Access to HIV services and antiretrovirals was interrupted for a large proportion of non-pregnant WLHIV in western Kenya, but access to pregnancy/family planning care was less affected in our cohort. Innovative solutions are needed to ensure HIV and reproductive health outcomes do not worsen during the ongoing pandemic.
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Affiliation(s)
- Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Shukri A. Hassan
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - John Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julie Thorne
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Mercy Maina
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Beatrice Jakait
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | | | - Caroline Kerich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sammy Changwony
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Shirley Ru W. Qian
- Department of Public Health, University of Washington, Seattle, WA, United States
| | - Andrea J. Scallon
- Jackson School of International Studies, University of Washington, Seattle, WA, United States
| | | | - Leslie A Enane
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | | | - Lisa L. Abuogi
- Department of Pediatrics, University of Colorado, Denver, CO, United States
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Rena C. Patel
- Department of Medicine, University of Washington, Seattle, WA, United States
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Vázquez-Rodríguez EM, Vázquez-Rodríguez CF, Ortega-Betancourt NV, Perez BG, Vázquez-Nava F, Jaime PA. Factors Associated with Early Sexual Activity in Adolescents Residing in an Urban Area of Northeastern Mexico Who Use WhatsApp or Facebook. J Community Health 2022; 48:309-314. [PMID: 36409400 DOI: 10.1007/s10900-022-01162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/22/2022]
Abstract
Early sexual activity has been associated with unplanned pregnancy and sexually transmitted infections. In recent decades, the prevalence of early sexual activity and social media use has increased. However, the relationship between these variables has been little studied. Consequently, we examined the relationships of some factors present in the family and personal environment with early sexual activity in adolescents who use and do not use the WhatsApp and Facebook platforms. Through a cross-sectional study, data from 1328 adolescents aged 13 to 19 years were analyzed. Data collection was carried out using a self-administered questionnaire. Of the total participants, 35.7% reported early sexual activity, and 37.7% reported using social networks such as WhatsApp and Facebook. The mean age of onset of sexual activity was 15.59 ± 1.56 years. Multivariate logistic regression analysis showed significant associations of not studying (adjusted OR 4.70; CI 95% 1.31-16.78), consuming alcohol (adjusted OR 3.71; CI 95% 2.44-5.65) and having parents who consumed alcoholic beverages in the home (adjusted OR 1.48; 95% CI 1.03-2.12) with ESA. In the family and personal environment, some factors favored early sexual activity in young people who used the WhatsApp and Facebook applications. This information should be used by authorities in the health and education sectors to strengthen preventive programs targeting health risk habits and behaviors in adolescents.
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Affiliation(s)
| | | | | | - Brian Gonzalez Perez
- Department of Research, Faculty of Medicine, Tampico. Autonomous University of Tamaulipas, Calle Reforma 100-B, Col. Árbol Grande, 89136, Cd. Madero, Tampico, Mexico
| | - Francisco Vázquez-Nava
- Department of Research, Faculty of Medicine, Tampico. Autonomous University of Tamaulipas, Calle Reforma 100-B, Col. Árbol Grande, 89136, Cd. Madero, Tampico, Mexico.
| | - Paz Avila Jaime
- Department of Research, Faculty of Medicine, Tampico. Autonomous University of Tamaulipas, Calle Reforma 100-B, Col. Árbol Grande, 89136, Cd. Madero, Tampico, Mexico
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What explains the large disparity in child stunting in the Philippines? A decomposition analysis. Public Health Nutr 2022; 25:2995-3007. [PMID: 34602121 PMCID: PMC9991861 DOI: 10.1017/s136898002100416x] [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: 11/06/2022]
Abstract
OBJECTIVE About one-third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children. DESIGN Using the 2015 Philippine National Nutrition Survey, we conducted a linear probability model to examine the determinants of child stunting and then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children. SETTING Philippines. PARTICIPANTS 1881 children aged 6-23 months participated in this study. RESULTS The overall stunting prevalence was 38·5 % with a significant gap between poor and non-poor (45·0 % v. 32·0 %). Maternal height, education and maternal nutrition status account for 26 %, 18 % and 17 % of stunting inequality, respectively. These are followed by quality of prenatal care (12 %), dietary diversity (12 %) and iron supplementation in children (5 %). CONCLUSIONS Maternal factors account for more than 50 % of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children.
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Does dropout from school matter in taking antenatal care visits among women in Bangladesh? An application of marginalized poisson-poisson mixture model. BMC Pregnancy Childbirth 2022; 22:476. [PMID: 35698030 PMCID: PMC9190147 DOI: 10.1186/s12884-022-04794-w] [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: 07/01/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background There exists a lack of research in explaining the link between dropout from school and antenatal care (ANC) visits of women during pregnancy in Bangladesh. The aim of this study is to investigate how the drop out from school influences the ANC visits after controlling the relevant covariates using an appropriate count regression model. Methods The association between the explanatory variables and the outcome of interest, ANC visits, have been performed using one-way analysis of variance/independent sample t-test. To examine the adjusted effects of covariates on the marginal mean of count data, Marginalized Poison-Poisson mixture regression model has been fitted. Results The estimated incidence rate of antenatal care visits was 10.6% lower for the mothers who were not continued their education after marriage but had at least 10 years of schooling (p-value <0.01) and 20.2% lower for the drop-outed mothers (p-value <0.01) than the mothers who got continued their education after marriage. Conclusions To ensure the WHO recommended 8+ ANC visits for the pregnant women of Bangladesh, it is essential to promote maternal education so that at least ten years of schooling should be completed by a woman and dropout from school after marriage should be prevented.
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Nowshin N, Kapiriri L, Davison CM, Harms S, Kwagala B, Mutabazi MG, Niec A. Sexual and reproductive health and rights of "last mile" adolescents: a scoping review. Sex Reprod Health Matters 2022; 30:2077283. [PMID: 35666196 PMCID: PMC9176670 DOI: 10.1080/26410397.2022.2077283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.
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Affiliation(s)
- Nahela Nowshin
- PhD Student, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada. Correspondence:
| | - Lydia Kapiriri
- Associate Professor, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Colleen M Davison
- Associate Professor, Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sheila Harms
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Betty Kwagala
- Associate Professor, Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Anne Niec
- Professor, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Kons K, Biney AAE, Sznajder K. Factors Associated with Adolescent Pregnancy in Sub-Saharan Africa during the COVID-19 Pandemic: A Review of Socioeconomic Influences and Essential Interventions. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:386-396. [PMID: 38596281 PMCID: PMC10903609 DOI: 10.1080/19317611.2022.2084199] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 04/11/2024]
Abstract
Objective: A literature review was conducted to analyze the impact of COVID-19 on documented preexisting determinants of adolescent pregnancy in sub-Saharan Africa such as poverty, inequitable gender norms, low access to education, and reproductive health services. Methods: The terms "sub-Saharan Africa," "Gender Norms," "Poverty," and "Adolescent Pregnancy" were used to search the literature for preexisting determinants of adolescent pregnancy in academic and grey literature. "COVID-19" was added to investigate the potential consequences of the pandemic. The literature revealed similar experiences in adolescent girls during the Ebola outbreak, which lead to the analysis of government and healthcare official responses to previous epidemics. Results: The literature review revealed that the relationship between identified micro (inequitable gender norms, transactional sex, sexual and gender-based violence, early marriage, and menstruation) and macro (poverty, education, and healthcare) factors contributing to adolescent pregnancy were exacerbated by the COVID-19 pandemic. Conclusion: Three realistic targets including, expanding and communicating available reproductive health resources, prioritizing the role of women in the economy, and ensuring return to school should be included as part of current COVID-19 mitigation programs. Additionally, these interventions should be incorporated in future public health preparedness plans to reduce the risk of adolescent pregnancy during public health emergencies.
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Affiliation(s)
- Kelly Kons
- Penn State College of Medicine, Hershey, PA, USA
| | - Adriana A E Biney
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Kristin Sznajder
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Sobngwi-Tambekou JL, Tsague-Agnoux M, Fezeu LK, Ndonko F. Teenage childbearing and school dropout in a sample of 18,791 single mothers in Cameroon. Reprod Health 2022; 19:10. [PMID: 35033103 PMCID: PMC8761331 DOI: 10.1186/s12978-021-01323-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Adolescent childbearing increases the risk of adverse health and social consequences including school dropout (SDO). However, it remains unclear why some teenage mothers drop out of school and others do not, especially in sub-Saharan Africa settings. We aimed to investigate the background and behavioral characteristics of single mothers, associated with school dropout in a sample of 18,791 Cameroonian girls, who had their first child during adolescence. Methods We used data from a national registry of single mothers, collected during the years 2005–2008 and 2010–2011. Both bivariate analysis and logistic binary regression models were used to explore the relationship between adolescence motherhood and SDO controlling for a range of socio-economic, family, sexual and health seeking behavior characteristics. Results Among the 18,791 single mothers, 41.6% had dropped out of school because of pregnancy. The multivariable regression model showed that SDO was more common in those who were evicted from their parental home (aOR: 1.85; 95% CI: 1.69–2.04), those who declared having other single mothers in their family (aOR: 1.16; 95% CI 1.08–1.25) and in mothers who had their first child before 15. Using modern contraceptive methods, having declared no sexual partner during the last year and having less than 2 children were associated with a reduced likelihood of school dropout. Conclusions Strong social support is essential to ensure school continuity in this vulnerable population. Dropping out of school may put the teenage mother more at risk of unsafe health behaviour and new pregnancies. There is compelling, worldwide evidence that pregnancy and birth during teenage years are significant contributors to high school dropout rates, especially in developing countries. Research has also shown that education continuity of teenage mothers can lessen the long term negative social consequences of teenage pregnancies and childbearing. In this study, we investigated the factors associated with school dropout in a sample of Cameroonian teenage mothers. The information collected included socio-economic, family, sexual characteristics, and health-seeking behavior. Among the 18,791 single mothers, 41.6% had dropped out of school because of pregnancy. School dropout was more common in those who were evicted from their parental home, those who declared having other single mothers in their family and in mothers who had their 1st child before 15. Using modern contraceptive methods, having declared no sexual partner during the last year and having less than 2 children were associated with a reduced likelihood of school dropout. In conclusion, strong social support is essential to ensure school continuity in this vulnerable population. Dropping out of school may put the teenage mother more at risk of unsafe health behaviour and new pregnancies.
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Affiliation(s)
- Joëlle L Sobngwi-Tambekou
- RSD Institute, Rue de l'Université, Po Box 7535, Yaoundé, Cameroon. .,Université Catholique d'Afrique Centrale (UCAC), Yaoundé, Cameroon. .,London School of Economics and Political Science, London, UK.
| | | | - Léopold K Fezeu
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), 93017, Bobigny, France
| | - Flavien Ndonko
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Yaoundé, Cameroon
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Woollett N, Bandeira M, Marunda S, Mudekunye L, Ebersohn L. Adolescent pregnancy and young motherhood in rural Zimbabwe: Findings from a baseline study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e377-e386. [PMID: 33825254 DOI: 10.1111/hsc.13362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/23/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
Pregnant adolescents and young mothers comprise a vulnerable group, particularly in low and middle income countries, yet there is limited research describing this population, particularly in rural Zimbabwe. Using tablet-administered questionnaires concerning maternal and child health, sexual and reproductive health, psychosocial well-being and parenting, we recruited 442 pregnant and young mothers (14-24 years) with the support of social workers from health facilities. We found high levels of poverty amidst increased rates of marriage, including child marriage (almost 20%). Participants had poor sexual and reproductive health knowledge and uptake of contraception was low (only 35% respondents reported current use). Although almost 60% girls had completed Form 2, 24% had only completed Grade 1 and just 4% were still engaged in schooling. Girls reported inadequate social support amidst high caretaking responsibilities and change in relocation for marriage, compromising mental health. Most of the pregnancies were unintended (approximately 60%) which had consequences on attachment and parenting where roughly 40% of our sample reported difficulties and lack of enjoyment in caring for their babies. Investments in interventions that address these vulnerabilities for pregnant adolescents and young mothers, and capitalise on available resources, are critical to improve health and interrupt cycles of risk for the next generation.
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Affiliation(s)
- Nataly Woollett
- Faculty of Health Sciences, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Monica Bandeira
- Unit 2 Waterfront Office Park, REPSSI, Randburg, South Africa
| | | | | | - Liesel Ebersohn
- Centre for the Study of Resilience and Department of Educational Psychology, Faculty of Education, University of Pretoria, Pretoria, South Africa
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Cruz E, Cozman FG, Souza W, Takiuti A. The impact of teenage pregnancy on school dropout in Brazil: a Bayesian network approach. BMC Public Health 2021; 21:1850. [PMID: 34645405 PMCID: PMC8515724 DOI: 10.1186/s12889-021-11878-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As reported by the World Health Organization, adolescent pregnancy is a major public health concern given its impact on the life of mothers and their family members. In this study we investigated possible cause-effect relations between teenage pregnancy and school dropout, and other attributes that gravitate around them, using the Bayesian network approach. METHODS We used a database prepared by the Adolescent House Project and invited experts in the areas of Health, Education and Social Assistance to answer a survey containing questions aimed at detecting possible causal relationships. To perform the statistical analysis and the numerical simulations we employed the language and formalism of Bayesian networks. RESULTS The analysis indicated a strong cause-effect relation between teenage pregnancy and school dropout, bolstered by economic vulnerability. We were able to identify the profile of the female teenager who drops out from school: white girls older than 15 years who got pregnant at least once, are not working to generate an income, and who belong to the group where the family income is less than or equal to US$780 per month. Also we detected the "maternal impact factor", i.e., the effect caused by whether or not the mothers of the teenagers have experienced teenage pregnancy. CONCLUSION There are many factors that lead teenagers to drop out of school; we confirmed not only the commonsense notion that pregnancy of the teenager is a major factor but found that a history of teenage pregnancy on the part of the mother is a major factor. Moreover, Bayesian networks emerged as an interesting mathematical framework to perform the statistical analysis.
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Affiliation(s)
- Emerson Cruz
- Escola Politécnica, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Wilson Souza
- Programa Saúde do Adolescente, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil.
| | - Albertina Takiuti
- Programa Saúde do Adolescente, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil.
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Matovu JKB, Bukenya JN, Kasozi D, Kisaka S, Kisa R, Nyabigambo A, Tugume A, Bwanika JB, Mugenyi L, Murungi I, Serwadda D, Wanyenze RK. Sexual-risk behaviours and HIV and syphilis prevalence among in- and out-of-school adolescent girls and young women in Uganda: A cross-sectional study. PLoS One 2021; 16:e0257321. [PMID: 34506577 PMCID: PMC8432796 DOI: 10.1371/journal.pone.0257321] [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: 02/03/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Adolescent girls and young women (AGYW) are at increased risk of sexually transmitted infections (STIs). We assessed sexual-risk behaviours and HIV and syphilis prevalence among AGYW in Uganda to inform the design of target-specific risk-reduction interventions. Methods This analysis utilizes data from 8,236 AGYW aged 10–24 years, collected in 20 districts, between July and August 2018. AGYW engaged in sexual-risk behaviour if they: a) reported a history of STIs; or b) had their sexual debut before age 15; or c) engaged in sex with 2+ partners in the past 12 months; or c) did not use or used condoms inconsistently with their most recent partners. We diagnosed HIV using DetermineTMHIV-1/2, Stat-PakTMHIV-1/2 and SD Bioline. We used SD Bioline Syphilis test kits to diagnose syphilis and Treponema Pallidum Hemagglutination Assay for confirmatory syphilis testing. Comparison of proportions was done using Chi-square (χ2) tests. Data were analysed using STATA (version 14.1). Results Of 4,488 AGYW (54.5%) that had ever had sex, 12.9% (n = 581) had their sexual debut before age 15; 19.1% (n = 858) reported a history of STIs. Of those that had ever had sex, 79.6% (n = 3,573) had sex in the 12 months preceding the survey; 75.6% (n = 2,707) with one (1) and 24.2% (n = 866) with 2+ partners. Condom use with the most recent sexual partner was low, with only 20.4% (n = 728) reporting consistent condom use while 79.6% (n = 2,842) reported inconsistent or no condom use. In-school AGYW were significantly less likely to have ever had sex (35.6% vs. 73.6%, P<0.001), to have had sexual debut before age 15 (7.7% vs. 15.5%, P<0.001) or to engage in sex with 2+ partners (5.3% vs. 15.8%, P<0.001). Consistent condom use was significantly higher among in-school than out-of-school AGYW (40.1% vs. 12.7%, P<0.001). Overall, 1.7% (n = 143) had HIV while 1.3% (n = 104) had syphilis. HIV and syphilis prevalence was higher among out-of-school than in-school AGYW (HIV: 2.6% vs. 0.9%; syphilis: 2.1% vs. 0.5%, respectively). Conclusion In-school AGYW engaged in more protective sexual behaviors and had less HIV and syphilis than their out-of-school counterparts. These findings suggest a need for target-specific risk-reduction interventions stratified by schooling status.
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Affiliation(s)
- Joseph K. B. Matovu
- Makerere University School of Public Health, Kampala, Uganda
- Busitema University Faculty of Health Sciences, Mbale, Uganda
- * E-mail:
| | | | - Dickson Kasozi
- Makerere University School of Public Health, Kampala, Uganda
| | - Stephens Kisaka
- Makerere University School of Public Health, Kampala, Uganda
| | - Rose Kisa
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | | | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
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Muchiri S. Impact of Free/Subsidized Secondary School Education on the Likelihood of Teenage Motherhood. Demography 2021; 58:1401-1421. [PMID: 34228085 DOI: 10.1215/00703370-9357498] [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: 11/19/2022]
Abstract
Several countries in sub-Saharan Africa, including Kenya, have introduced free/subsidized secondary education. This paper examines the role of these free/subsidized education policies on teenage motherhood. To identify the causal effect, I exploit the timing of a national reform in Kenya that eliminated/subsidized secondary school fees using a difference-in-difference estimation design. Using the 2014 Kenya Demographic and Health Survey (DHS), I estimate that the likelihood of teenage motherhood decreased by approximately 5 percentage points after the policy's implementation. This study reiterates that the teenage period is crucial in terms of developing human capital through formal schooling. In most developing countries, parents often determine and fund human capital, which makes household wealth/income a critical factor in human capital accumulation and its intergenerational process. I also highlight positive externalities from educational-centered policies, such as long-term economic growth, poverty reduction, and reduction of social welfare dependency.
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Affiliation(s)
- Steve Muchiri
- Department of Economics and Finance, Eastern Connecticut State University, Windham, CT, USA
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22
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Bukuluki P, Kisaakye P, Mwenyango H, Palattiyil G. Adolescent sexual behaviour in a refugee setting in Uganda. Reprod Health 2021; 18:131. [PMID: 34167555 PMCID: PMC8222959 DOI: 10.1186/s12978-021-01181-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children under 18 years old constituted more than half (52%) of the refugee population in 2017. Adolescent Sexual and reproductive health is an essential component of primary health care. Yet, not every refugee adolescent is able to access sexual and reproductive health services. Methods Using quantitative data from 356 refugee adolescents and qualitative data (17 in-depth interviews and nine key informant interviews), we examine refugee adolescent sexual behaviour in Bidibidi settlement—the largest refugee settlement in Uganda using a binary logistic regression model. Results The results show that 25% of refugee adolescents in Bidibidi refugee settlement had ever had sex. After controlling for all factors, results show that refugee adolescents aged 16–18 years (OR = 3.47; 95% CI = 1.09–10.94), males (OR = 17.59; 95% CI = 4.48–69.07), not in school (OR = 14.57; 95% CI = 2.20–96.35) were more likely to engage in sexual behaviour than their counterparts. Refugee adolescents who do not agree that a girl cannot get pregnant if she has sex while standing up (knowledge about getting pregnant) were significantly less associated with sexual behaviour (OR = 0.30; 95% CI = 0.10–0.85). Conclusions Results from this study show that keeping refugee adolescents in school and providing sexual and reproductive health information are likely to delay refugee adolescents’ engagement in sexual behaviour. Therefore, there is need to promote keeping refugee adolescents in school in order to improve sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda. Sexual and reproductive health is an essential component of primary health care. Limited access to sexual and reproductive health (SRH) services for adolescent refugees particularly in low income countries can affect their reproductive health. Similarly, limited knowledge of the determinants of sexual behaviour of adolescent refugees in low income countries puts them at risk of SRH challenges. This study uses quantitative data from 356 adolescent refugees and qualitative (17 in-depth interviews with adolescent refugees and nine key informant interviews with service providers) to examine the factors that influence the sexual behaviour of adolescent refugees in Bidibidi refugee settlement. The findings show that older age, male sex, not being in school and having knowledge of getting pregnant were associated with sexual behaviour among adolescent refugees in Bidibidi refugee settlement in Uganda. There is need to promote keeping refugee adolescents in school and providing them with relevant SRH information to contribute to improving sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda.
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Affiliation(s)
- Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda.
| | - Hadijah Mwenyango
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - George Palattiyil
- Social Work, School of Social and Political Science, The University of Edinburgh, Scotland, UK
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Melesse DY, Cane RM, Mangombe A, Ijadunola MY, Manu A, Bamgboye E, Mohiddin A, Kananura RM, Akwara E, du Plessis E, Wado YD, Mutua MK, Mekonnen W, Faye CM, Neal S, Boerma T. Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa. Reprod Health 2021; 18:117. [PMID: 34134718 PMCID: PMC8210338 DOI: 10.1186/s12978-021-01125-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. Methods We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban–rural residence and educational status (primary or less versus secondary or higher education). Results In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000–2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10–14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban–rural and wealth-related inequalities remained stagnant or widened during 2000–2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. Conclusion Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01125-8.
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Affiliation(s)
- Dessalegn Y Melesse
- Countdown To 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
| | - Réka M Cane
- Women's and Children's Health Program, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | | | | | - Eniola Bamgboye
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Abdu Mohiddin
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Rornald M Kananura
- Department of Health Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Elsabé du Plessis
- Countdown To 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Yohannes D Wado
- African Population and Health Research Center, Nairobi, Kenya
| | - Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Cheikh M Faye
- African Population and Health Research Center, Dakar, Senegal
| | - Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Hampshire, UK
| | - Ties Boerma
- Countdown To 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
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24
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Women Do Not Utilise Family Planning According to Their Needs in Southern Malawi: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084072. [PMID: 33924290 PMCID: PMC8070605 DOI: 10.3390/ijerph18084072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022]
Abstract
Malawi is a low-income country with a high maternal mortality rate. This study aimed to investigate the use of contraception and factors associated with unmet need of family planning among fertile women in selected health facilities in southern Malawi. A cross-sectional study design was employed using a validated questionnaire to investigate the unmet need. A total of 419 pregnant women, who attended antenatal clinics at a central hospital and two district hospitals, voluntarily participated in the study. Logistic regression analysis was used to identify possible factors associated with unmet needs. Amongst the participants, 15.1% reported unmet need, 27.0% had never used a contraceptive method, and 27.2% had an unwanted pregnancy. Being married, 20-24 years of age, living in a rural area, and high parity were protective factors against having unmet need regarding family planning. Malawi, a country with a young population and a high fertility rate, has a high level of unmet family planning need. Barriers and facilitators need to be identified and addressed at different levels by the health care system, society, and the government of Malawi.
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25
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Levy M, Duffy M, Pearson J, Akuno J, Oduong S, Yemaneberhan A, Coombs A, Davis N, Yonga I, Kerubo Mokaya R. Health and social outcomes of HIV-vulnerable and HIV-positive pregnant and post-partum adolescents and infants enrolled in a home visiting team programme in Kenya. Trop Med Int Health 2021; 26:640-648. [PMID: 33662176 PMCID: PMC9291167 DOI: 10.1111/tmi.13568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives HIV‐positive and HIV‐vulnerable pregnant adolescent girls and adolescent mothers face significant barriers and vulnerabilities. Infants born to adolescent mothers are also more likely to die and be exposed to life‐threatening conditions. This paper presents findings from an evaluation of a programme that used a home visitation model and offered a case‐management, team‐focused approach to increase family and community supportiveness to enhance health and social service uptake among pregnant adolescent girls and adolescent mothers in Kenya. Methods The study used a quasi‐experimental design with before and after comparisons among a non‐randomised population to examine the effectiveness of bi‐monthly household visits to 384 enrolled pregnant adolescent girls, adolescent mothers (ages 10–19) and their infants (0–24 months) between March 2018 and February 2019 in three counties in Kenya. Results During the programme, household support increased from 57% to 85%, while 100% of eligible participants were on ART and virally suppressed (total of 20 adolescents). Nearly all pregnant adolescent girls (94%) delivered under skilled care vs. 78% of those who were post‐partum at the time of enrolment (P < 0.001); 100% of infants (total of 17 infants) had an up‐to‐date PCR test with no seroconversions. Uptake of modern family planning increased from 39% at baseline to 64% at end line (P < 0.001). The referral rate declined from 84% to 78% from baseline to end line with low uptake of referrals for mental health services (17.3%). Conclusions A team‐focused approach of home visits to HIV‐vulnerable and HIV‐positive pregnant and post‐partum adolescent girls and their infants combined with efforts to reduce stigma and increase supportiveness of households and the community can help address critical socio‐cultural and behavioural barriers to accessing and using health and social services.
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Affiliation(s)
- Marcy Levy
- International Division, John Snow, Inc., Boston, MA, USA
| | - Malia Duffy
- International Division, John Snow, Inc., Boston, MA, USA
| | | | - Job Akuno
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Samuel Oduong
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | | | | | - Nicole Davis
- International Division, John Snow, Inc., Boston, MA, USA
| | - Isabella Yonga
- United States Agency for International Development Kenya and East Africa Village Market, Nairobi, Kenya
| | - Rose Kerubo Mokaya
- United States Agency for International Development Kenya and East Africa Village Market, Nairobi, Kenya
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26
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Jiang W, Osborn L, Drake AL, Unger JA, Matemo D, Kinuthia J, John-Stewart G, Ronen K. Recent Diagnosis, Lower Rates of HIV Disclosure, and High Technology Access in Pregnant Adolescent Girls and Young Women Living With HIV: A Descriptive Study. J Assoc Nurses AIDS Care 2021; 32:205-213. [PMID: 33136655 PMCID: PMC7985848 DOI: 10.1097/jnc.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wenwen Jiang
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Lusi Osborn
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Alison L. Drake
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jennifer A. Unger
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Daniel Matemo
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Keshet Ronen
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
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Mezmur H, Assefa N, Alemayehu T. Teenage Pregnancy and Its Associated Factors in Eastern Ethiopia: A Community-Based Study. Int J Womens Health 2021; 13:267-278. [PMID: 33664597 PMCID: PMC7924244 DOI: 10.2147/ijwh.s287715] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background Teenage pregnancy is a global issue raising concerns for all who are interested in the health and well-being of young women and their children. It carries major health and social issues with unique medical and psychosocial consequences for both adolescents and society in general. This study aimed at assessing the prevalence and factors associated with teenage pregnancy in eastern Ethiopia. Methods A community-based cross-sectional study was conducted. Multi-stage simple random sampling procedure was used to select 2258 female teenagers. Interviewer-administered questionnaire was used for data collection. Data were entered into EpiData and analyzed using stata software. The Poisson regression model with robust variance estimation was used to examine the association of the independent variable with teenage pregnancy. An adjusted prevalence ratio (APR) with 95% confidence intervals (CI) was reported. Results The prevalence of teenage pregnancy was 30.2% (95% CI: 28.3, 32.1). Age 16–17 years old (APR=7.05; 95% CI: 4.15,11.96), 17–18 years old (APR=9.85; 95% CI: 5.72,16.98), not being in school (APR=2.83; 95% CI: 1.93,4.16), lack of formal education (APR=1.11; 95% CI: 1.03,1.19), being married (APR=3.59; 95% CI: 2.83,4.56), parental divorce (APR=1.24; 95% CI: 1.08,1.42), having elder sister who had a history of teenage pregnancy (APR=1.11; 95% CI: 1.02,1.21), and not knowing fertile period in menstrual cycle (APR=1.31; 95% CI: 1.16,1.47) were independently associated with teenage pregnancy. Conclusion One in three teenagers had been pregnant. Age, not being in school, lack of formal education, being married, parental divorce, having an elder sister who had a history of teenage pregnancy, and not knowing fertile period during the menstrual cycles were the factors associated with teenage pregnancy. In Ethiopia, further efforts are required in the prevention of teenage pregnancy, keeping girls in school and strengthening the policy of delaying child marriage, particularly in rural areas.
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Affiliation(s)
- Haymanot Mezmur
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Alemayehu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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28
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Te Lindert L, van der Deijl M, Elirehema A, van Elteren-Jansen M, Chitanda R, van den Akker T. Perceptions of Factors Leading to Teenage Pregnancy in Lindi Region, Tanzania: A Grounded Theory Study. Am J Trop Med Hyg 2021; 104:1562-1568. [PMID: 33617475 DOI: 10.4269/ajtmh.20-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/18/2020] [Indexed: 11/07/2022] Open
Abstract
High prevalence of teenage pregnancy in low-income countries impacts health, social, economic, and educational situations of teenage girls. To acquire better understanding of factors leading to high prevalence of teenage pregnancy in rural Lindi region, Tanzania, we explored perspectives of girls and key informants by conducting a facility-based explorative qualitative study according to the grounded theory approach. Participants were recruited from Mnero Diocesan Hospital using snowball sampling, between June and September 2018. Eleven pregnant teenagers, two girls without a teenage pregnancy, and eight other key informants were included. In-depth interviews (including photovoice) and field observations were conducted. Analysis of participant perspectives revealed five main themes: 1) lack of individual agency (peer pressure, limited decision-making power, and sexual coercion); 2) desire to earn money and get out of poverty; 3) dropping out of school contributing to becoming pregnant; 4) absence of financial, material, psychological, or emotional support from the environment; and 5) limited access to contraception. A majority of girls reported the pregnancy to be unplanned, whereas some girls purposely planned it. Our findings and the resulting conceptual framework contribute to a new social theory and may inform national and international policies to consider the needs and perspectives of teenagers in delaying pregnancy and promoting sexual and reproductive health in Tanzania and beyond.
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Affiliation(s)
- Luka Te Lindert
- 1Department of Medical Humanities, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | | | - Agripa Elirehema
- 2Department of Obstetrics and Gynaecology, Mnero Diocesan Hospital, Mnero, Tanzania
| | - Marianne van Elteren-Jansen
- 1Department of Medical Humanities, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Raynald Chitanda
- 2Department of Obstetrics and Gynaecology, Mnero Diocesan Hospital, Mnero, Tanzania
| | - Thomas van den Akker
- 3Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.,4Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
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29
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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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Ajayi AI, Odunga SA, Oduor C, Ouedraogo R, Ushie BA, Wado YD. "I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls. Reprod Health 2021; 18:19. [PMID: 33482843 PMCID: PMC7821647 DOI: 10.1186/s12978-021-01078-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background While the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15–19 in two Kenya counties with the highest rate of teenage pregnancy. Methods We used the “In Their Hands” (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls’ reasons for having unintended pregnancy. Results Overall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22–2.20), had primary or no formal education (AOR 1.50 95% CI 1.11–2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25–2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies. Conclusion A massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya.
| | - Sally Atieno Odunga
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Clement Oduor
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Ramatou Ouedraogo
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Yohannes Dibaba Wado
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
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Thorne JG, Buitendyk M, Wawuda R, Lewis B, Bernard C, Spitzer RF. The reproductive health fall-out of a global pandemic. Sex Reprod Health Matters 2020; 28:1763577. [PMID: 32364037 PMCID: PMC7887987 DOI: 10.1080/26410397.2020.1763577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Julie G. Thorne
- Assistant Professor, Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada; Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Marie Buitendyk
- AMPATH-RH Team Leader, Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada; Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Righa Wawuda
- Senior Registrar, ObsGyn, Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Brianne Lewis
- Global Women's Health & Equity Fellow, Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Caitlin Bernard
- Assistant Professor, Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN, USA; Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Rachel F. Spitzer
- Vice Chair, Global Women's Health, Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada; Department of Reproductive Health, Moi University, Eldoret, Kenya
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Chemutai V, Nteziyaremye J, Wandabwa GJ. Live Experiences of Adolescent Mothers Attending Mbale Regional Referral Hospital: A Phenomenological Study. Obstet Gynecol Int 2020; 2020:8897709. [PMID: 33335551 PMCID: PMC7723483 DOI: 10.1155/2020/8897709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/24/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adolescence is a period of transition from childhood to adulthood, and is a critical stage in ones' development. It is characterized by immense opportunities and risks. By 2016, 16% of the world's population was of adolescents, with 82% residing in developing countries. About 12 million births were in 15-19 year olds. Sub-Saharan Africa, particularly East Africa, has high adolescent pregnancy rates, as high as 35.8% in eastern Uganda. Maternal mortality ratio (MMR) attributable to 15-19 years olds is significant with 17.1% of Uganda's MMR 336/100.000 live births being in this age group. Whereas research is awash with contributing factors to such pregnancies, little is known about lived experiences during early motherhood. This study reports the lived experiences of adolescent mothers attending Mbale Hospital. MATERIALS AND METHODS A phenomenological study design was used in which adolescent mothers that were attending Young Child Clinic were identified from the register and simple random sampling was used to select participants. We called these mothers by way of phone numbers and asked them to come for focus group discussions that were limited to 9 mothers per group and lasting about 45 minutes-1 hour. Ethical approval was sought and informed written consent obtained from participants. At every focus group discussion, the data which had largely been taken in local languages was transcribed and translated verbatim into English. RESULTS The research revealed that adolescent mothers go through hard times especially with the changes of pregnancy and fear of unknown during intrapartum and immediate postpartum period and are largely treated negatively by family and other community members in addition to experiencing extreme hardships during parenting. However, these early mothers' stress is alleviated by the joy of seeing their own babies. CONCLUSION Adolescent motherhood presents a high risk group and efforts to support them during antenatal care with special adolescent ANC clinics and continuous counseling together with their household should be emphasized to optimize outcome not only during pregnancy but also thereafter. Involving these mothers in technical courses to equip them with skills that can foster self-employment and providing support to enable them pursue further education should be explored.
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Affiliation(s)
- Violet Chemutai
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Box 1460, Mbale, Uganda
- Department of Community and Public Health, Faculty of Health Sciences Busitema University, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
| | - Julius Nteziyaremye
- Department of Community and Public Health, Faculty of Health Sciences Busitema University, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Busitema University, Mbale Town, Uganda
| | - Gabriel Julius Wandabwa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Busitema University, Mbale Town, Uganda
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A Survey on Prevalence and Knowledge of Family Planning among Women of Childbearing Age in the Provincial Settings of the Gambia: A Descriptive Cross-Sectional Study. Adv Prev Med 2020; 2020:8862290. [PMID: 33204537 PMCID: PMC7661120 DOI: 10.1155/2020/8862290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Family planning (FP) is one of the fundamental pillars of safe motherhood and reproductive health rights. In developing countries, women with unmet need for FP constitute a significant proportion of all women of reproductive age and it is an ongoing public health challenge in the Gambia. The study aimed to determine the women's proportion of contraceptive uptake and knowledge of FP methods. Methods The study employed a community-based descriptive cross-sectional study conducted for 643 women of reproductive age (15-49 years) from the selected clusters in rural Gambia through a multistage sampling technique. A pretested structured interview questionnaire was used to collect data. Univariate analysis using frequencies and percentages were used to present results in this study. Data entry and analysis were done using IBM SPSS version 24. Results The overall contraceptive prevalence rate was 30.4%, while the CPR for married or in the union was 34.2%. About 86% of women reported child spacing as the major benefits of FP, while 49.5% reported amenorrhea as the most common side effect of contraceptives. Injectable (Depo-Provera, Noristerat, and ) and pills (progesterone and combined) were the two most common FP methods used at 58.5% and 44.0%, respectively. Conclusion The present study showed a moderately low contraceptive uptake. Thus, there is a need to focus FP services for women in rural areas, emphasizing the quality of services and gender equality. The study further recommends strengthening and mainstreaming of male involvement and religious leaders participation in FP interventions and the initiation of a communication program that explicitly promotes interspousal communication.
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Yah CS, Ndlovu S, Kutywayo A, Naidoo N, Mahuma T, Mullick S. The prevalence of pregnancy among adolescent girls and young women across the Southern African development community economic hub: A systematic review and meta-analysis. Health Promot Perspect 2020; 10:325-337. [PMID: 33312928 PMCID: PMC7723002 DOI: 10.34172/hpp.2020.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/29/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Despite the high rate of HIV infections, there is still high rate of early unprotected sex, unintended pregnancy, and unsafe abortions especially among unmarried adolescent girls and young women (AGYW) 10-24 years of age in sub Saharan Africa. AGYW face challenges in accessing health care, contraception needs, and power to negotiate safer sex. This study aimed to estimate the rate of pregnancy among AGYW aged 10-24, 10-19 and 15-19 years in the Southern African Development Community (SADC) economic region. Methods: A systematic review and meta-analysis was used to describe the prevalence of pregnancy among AGYW in 15 SADC member countries between January 2007 and December2017. The articles were extracted from PubMed/MEDLINE, African Index Medicus, and other reports. They were screened and reviewed according to PRISMA methodology to fulfil study eligibility criteria. Results: The overall regional weighted pregnancy prevalence among AGYW 10-24 years of age was 25% (95% CI: 21% to 29%). Furthermore, sub-population 10-19 years was 22% (95% CI:19% to 26%) while 15-19 years was 24% (18% to 30%). There was a significant heterogeneity detected between the studies (I=99.78%, P < 0.001), even within individual countries. Conclusion: The findings revealed a high pregnancy rate among AGYW in the SADC region. This prompts the need to explore innovative research and programs expanding and improving sexual and reproductive health communication to reduce risk and exposure of adolescents to early planned, unplanned and unwanted pregnancies, SRHR challenges, access to care, HIV/STIs, as well as other risk strategies.
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Affiliation(s)
- Clarence S. Yah
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sithembiso Ndlovu
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Kutywayo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepo Mahuma
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sanchez EK, Speizer IS, Tolley E, Calhoun LM, Barrington C, Olumide AO. Influences on seeking a contraceptive method among adolescent women in three cities in Nigeria. Reprod Health 2020; 17:167. [PMID: 33115489 PMCID: PMC7594415 DOI: 10.1186/s12978-020-01019-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite international support for increasing access to contraceptives among adolescents, gaps in use still exist worldwide. Past research has identified barriers to use across all levels of the socioecological model including restrictive policies, a lack of youth friendly services, and knowledge gaps. This study was conducted to further identify influences on contraceptive use among adolescent girls in Nigeria in hopes of guiding future policies and programs. METHODS In 2018, 12 focus group discussions (FGD) were conducted in three cities in Nigeria with young women ages 15-24 with the objective of determining what and who influence adolescents' contraceptive seeking behaviors. A vignette structure was used to identify perceptions on injunctive and descriptive community norms that influence adolescent contraceptive behaviors. The FGDs were conducted by members of the University of Ibadan Centre for Population and Reproductive Health (CPRH) and analyzed by a researcher at the University of North Carolina-Chapel Hill's Carolina Population Center using a thematic analysis approach. RESULTS Participants identified community level resistance to sex and contraceptive use among unmarried adolescents though also acknowledged that these adolescent behaviors are still occurring despite established norms. Concerns about side effects and the preservation of fertility were frequently attached to contraceptive use and pointed to as a reason for community resistance to contraceptive use among this population. Participants saw peers, parents and partners as influencers on a girl's decision to seek a method, though each were believed to play a different role in that decision. CONCLUSION The findings show that that despite barriers created by established injunctive norms, young women with a supportive social network can access contraceptive methods despite these barriers. By harnessing the influence of peers, partners and parents, the Nigerian family planning efforts can strive to improve the health and well-being of young people.
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Affiliation(s)
- Elynn Kann Sanchez
- Department of Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina, USA
| | - Ilene S Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina, USA. .,Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, 27516, USA.
| | - Elizabeth Tolley
- Department of Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina, USA.,, FHI 360, Durham, North Carolina, USA
| | - Lisa M Calhoun
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, 27516, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina, USA
| | - Adesola O Olumide
- Institute of Child Health, University of Ibadan, College of Medicine, Ibadan, Nigeria
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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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De Neve JW, Karlsson O, Canavan CR, Chukwu A, Adu-Afarwuah S, Bukenya J, Darling AM, Harling G, Moshabela M, Killewo J, Fink G, Fawzi WW, Berhane Y. Are out-of-school adolescents at higher risk of adverse health outcomes? Evidence from 9 diverse settings in sub-Saharan Africa. Trop Med Int Health 2019; 25:70-80. [PMID: 31692194 DOI: 10.1111/tmi.13328] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We analysed mutually comparable surveys on adolescent attitudes and behaviours from nine sites in seven sub-Saharan African countries, to determine the relationship between school enrolment and adolescent health outcomes. METHODS Data from the Africa Research, Implementation Science, and Education Network cross-sectional adolescent health surveys were used to examine the associations of current school enrolment, self-reported general health and four major adolescent health domains: (i) sexual and reproductive health; (ii) nutrition and non-communicable diseases; (iii) mental health, violence and injury; and (iv) healthcare utilisation. We used multivariable Poisson regression models to calculate relative risk ratios with 95% confidence intervals (CI), controlling for demographic and socio-economic characteristics. We assessed heterogeneity by gender and study site. RESULTS Across 7829 adolescents aged 10-19, 70.5% were in school at the time of interview. In-school adolescents were 14.3% more likely (95% CI: 6-22) to report that their life is going well; 51.2% less likely (95% CI: 45-67) to report ever having had sexual intercourse; 32.6% more likely (95% CI: 9-61) to report unmet need for health care; and 30.1% less likely (95% CI: 15-43) to report having visited a traditional healer. School enrolment was not significantly associated with malnutrition, low mood, violence or injury. Substantial heterogeneity was identified between genders for sexual and reproductive health, and in-school adolescents were particularly less likely to report adverse health outcomes in settings with high average school enrolment. CONCLUSIONS School enrolment is strongly associated with sexual and reproductive health and healthcare utilisation outcomes across nine sites in sub-Saharan Africa. Keeping adolescents in school may improve key health outcomes, something that can be explored through future longitudinal, mixed-methods, and (quasi-)experimental studies.
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Affiliation(s)
- Jan-Walter De Neve
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Centre for Economic Demography, Lund University, Lund, Sweden
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Angela Chukwu
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Justine Bukenya
- Department of Community Health, Makerere University School of Public Health, Kampala, Uganda
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Guy Harling
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute, Kwa-Zulu Natal, South Africa
| | - Mosa Moshabela
- Africa Health Research Institute, Kwa-Zulu Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Peterson AJ, Donze M, Allen E, Bonell C. Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:91-107. [PMID: 31108026 DOI: 10.1363/psrh.12102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.
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Affiliation(s)
- Amy J Peterson
- Program Manager, ETR, Scotts Valley, CA
- Doctoral Degree Candidate, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London
| | - Melissa Donze
- City Research Scientist, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York
| | - Elizabeth Allen
- Professor, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London
| | - Chris Bonell
- Professor, Department of Public Health Sociology, London School of Hygiene and Tropical Medicine, London
- Head, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London
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Stoner MCD, Rucinski KB, Edwards JK, Selin A, Hughes JP, Wang J, Agyei Y, Gomez-Olive FX, MacPhail C, Kahn K, Pettifor A. The Relationship Between School Dropout and Pregnancy Among Adolescent Girls and Young Women in South Africa: A HPTN 068 Analysis. HEALTH EDUCATION & BEHAVIOR 2019; 46:559-568. [PMID: 30819011 DOI: 10.1177/1090198119831755] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Prevention of both school dropout and teen pregnancy represent clear public health priorities for South Africa, yet their complex and potentially cyclical relationship has not been fully explored. Objective. To further understand how this relationship operates, we analyzed data from a randomized trial of young women aged 13 to 20 years enrolled in school in rural South Africa to estimate the association between pregnancy and subsequent dropout and between dropout and subsequent pregnancy. Method. We examined inverse probability (IP) of exposure-weighted survival curves for school dropout by pregnancy and for pregnancy by school dropout. We used weighted curves to calculate 1-, 2-, and 3-year risk differences and risk ratios. Additionally, we used an IP-weighted marginal structural cox model to estimate a hazard ratio (HR) for each relationship. Results. Dropout from school was associated with subsequent pregnancy (HR 3.58; 95% confidence interval [CI] [2.04, 6.28]) and pregnancy was associated with subsequent school dropout (HR 2.36; 95% CI [1.29, 4.31]). Young women who attended school but attended fewer days had a higher hazard of pregnancy than those who attended more school (HR 3.64; 95% CI [2.27, 5.84]). Conclusion. Pregnancy is both a cause and a consequence of school dropout. Consideration of school attendance and academic performance could ultimately enhance pregnancy prevention efforts in this population. Programs should be tailored differently for (1) girls who have dropped out of school, (2) those who are in school and at risk for pregnancy, and (3) those who are in school and become pregnant.
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Affiliation(s)
- Marie C D Stoner
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jessie K Edwards
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda Selin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James P Hughes
- 3 University of Washington, Seattle, WA, USA.,4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jing Wang
- 4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yaw Agyei
- 2 Johns Hopkins University, Baltimore, MD, USA
| | - F Xavier Gomez-Olive
- 5 University of the Witwatersrand, Johannesburg, South Africa.,6 INDEPTH Network, Accra, Ghana
| | - Catherine MacPhail
- 5 University of the Witwatersrand, Johannesburg, South Africa.,7 University of Wollongong, Wollongong, New South Wales, Australia
| | - Kathleen Kahn
- 5 University of the Witwatersrand, Johannesburg, South Africa.,6 INDEPTH Network, Accra, Ghana.,8 Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,5 University of the Witwatersrand, Johannesburg, South Africa
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The multigenerational effects of adolescent motherhood on school readiness: A population-based retrospective cohort study. PLoS One 2019; 14:e0211284. [PMID: 30726256 PMCID: PMC6364914 DOI: 10.1371/journal.pone.0211284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022] Open
Abstract
Background Children born to adolescent mothers generally perform more poorly on school readiness assessments than their peers born to adult mothers. It is unknown, however, whether this relationship extends to the grandchildren of these adolescent mothers. This paper examines the multi-generational outcomes associated with adolescent motherhood by testing whether the grandchildren of adolescent mothers also have lower school readiness scores than their peers; we further assessed if this relationship was moderated by whether the child’s mother was an adolescent mother. Methods We used population-based data to conduct the retrospective cohort study of children born in Manitoba, Canada, 2000–2009, whose mothers were born 1979–1997 (n = 11,326). Overall school readiness and readiness on five domains of development were analyzed using logistic regression models. Results Compared with children whose mothers and grandmothers were both ≥ 20 at the birth of their first child, those born to grandmothers who were < 20 and mothers who were ≥ 20 years old at the birth of their first child had 39% greater odds of being not ready for school (95% CI: 1.22–1.60). Children whose grandmothers were ≥ 20 and mothers were < 20 at the birth of their first child had 25% greater odds of being not ready for school (95% CI: 1.11–1.41), and children born to grandmothers and mothers who were both <20 at the birth of their first child had 35% greater odds of being not ready for school (95% CI: 1.18–1.54). Conclusions These findings suggest a multigenerational effect of adolescent motherhood on school readiness.
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Dimitriu M, Ionescu CA, Matei A, Viezuina R, Rosu G, Ilinca C, Banacu M, Ples L. The problems associated with adolescent pregnancy in Romania: A cross-sectional study. J Eval Clin Pract 2019; 25:117-124. [PMID: 30334316 DOI: 10.1111/jep.13036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/01/2022]
Abstract
RATIONALE The extent of pregnancy in adolescents and young adults, especially in low and middle-income countries, is a source of increasing concern given its social and economic impact. AIMS AND OBJECTIVE We hypothesized that there would be correlations between female patients becoming pregnant at a young age and practices such as harmful alcohol misuse, cigarette smoking, and drug use, the use of toxic substances, low educational attainment, and an essential absence of health care seeking about the outcome of adolescent pregnancies. METHODS We performed a prospective cross-sectional study of patients who gave birth between August and November 2017 at St. Pantelimon Emergency Hospital in Bucharest, Romania. Seventy-four patients aged 14 to 20 years, with a mean maternal age of 18.07 years, were enrolled in the study and answered a 15-item questionnaire about their social, educational, and medical background. RESULTS Fifty-three patients (71.6%) gave birth by caesarean section and 21 (28.3%) by vaginal delivery. Notably, patients aged 14 to 16 years had a lower rate of caesarean delivery compared with those aged 17 to 20 years. Moreover, 83.0% of the caesarean sections and 76.1% of the vaginal deliveries were at term. With reference to age and type of delivery, women are more likely to give birth by caesarean section at any age group (the association is not statistically significant at P < .05), except for the age of 15 years (five out of six patients in our sample had a spontaneous birth). Smoking was the most common risk behavior in the sample (45.9%, n = 34), followed by alcohol consumption (17.5%, n = 13) and drug use (5.40%, n = 4). CONCLUSIONS A high percentage of caesarean delivery was reported, particularly in patients aged >17 years. The percentage of female participants who underwent a caesarean delivery for their second pregnancy was significantly higher than compared with primipara participants. Patients receiving consistent antenatal care visits compared with those who did not monitor their pregnancy did not differ in the likelihood of undergoing a caesarean section.
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Affiliation(s)
- Mihai Dimitriu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cringu Antoniu Ionescu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandra Matei
- Department Obstetrics Gynecology "Sf Pantelimon" Clinical Emergency Hospital, Bucharest, Romania
| | - Roxana Viezuina
- Department Obstetrics Gynecology "Sf Pantelimon" Clinical Emergency Hospital, Bucharest, Romania
| | - George Rosu
- Department Obstetrics Gynecology "Sf Pantelimon" Clinical Emergency Hospital, Bucharest, Romania
| | - Corina Ilinca
- Faculty of Sociology and Social Work, Statistical Office University of Bucharest, Bucharest, Romania
| | - Mihai Banacu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Galárraga O, Harries J, Maughan-Brown B, Cooper D, Short SE, Lurie MN, Harrison A. The Empower Nudge lottery to increase dual protection use: a proof-of-concept randomised pilot trial in South Africa. REPRODUCTIVE HEALTH MATTERS 2018; 26:1510701. [PMID: 30212281 PMCID: PMC6242330 DOI: 10.1080/09688080.2018.1510701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The objective of this study is to measure the preliminary efficacy of a pilot intervention, grounded in behavioural economics, increasing adherence of dual protection (simultaneous use of effective modern contraception and a barrier method, such as a condom) to protect against HIV, other sexually transmitted infections, and unintended pregnancy. Between 2015 and 2016, 100 women aged 18-40 years, seeking post-abortion care in Cape Town, South Africa were recruited to Empower Nudge, a randomised controlled trial to test a lottery incentive intervention designed to increase dual protection. At baseline, the mean age of participants was 27 years; 82% of them were from South Africa; 58% self-identified as Black African; average education completed was 11.7 years. At three months, assignment to the lottery intervention was associated with higher odds of returning for study visits (OR: 6.0; 95%CI: 2.45 to 14.7, p < 0.01), higher condom use (OR: 4.5; 95%CI: 1.43 to 14.1; p < 0.05), and higher use of dual protection (OR: 3.16; 95%CI: 1.01 to 9.9; p < 0.05). Only 60% of the study population returned after three months and only 38% returned after six months. Women who receive post-abortion care represent a neglected population with an urgent need for HIV and pregnancy prevention. Dual protection is a critically important strategy for this population. Lottery-based behavioural economics strategies may offer possible ways to increase dual protection use in this population. Further research with larger samples, longer exposure time, and more sites is needed to establish fully powered efficacy of lottery incentives for dual protection; using objective verification for monitoring.
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Affiliation(s)
- Omar Galárraga
- a Associate Professor, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Faculty Associate, Population Studies and Training Center (PSTC), Brown University , Providence , RI , USA
| | - Jane Harries
- b Director, Women's Health Research Unit; and Associate Professor, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Brendan Maughan-Brown
- c Senior Research Officer, Southern Africa Labour and Development Research Unit , University of Cape Town , Cape Town , South Africa
| | - Diane Cooper
- d Professor, School of Public Health, University of the Western Cape, Cape Town, South Africa; Adjunct Faculty Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Susan E Short
- e Director, Population Studies and Training Center (PSTC); and Professor, Department of Sociology, Brown University , Providence , RI , USA
| | - Mark N Lurie
- f Faculty Associate, Population Studies and Training Center (PSTC) , Brown University , Providence , RI , USA
- g Associate Professor, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA
| | - Abigail Harrison
- f Faculty Associate, Population Studies and Training Center (PSTC) , Brown University , Providence , RI , USA
- h Associate Professor, Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
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Galappaththi-Arachchige HN, Zulu SG, Kleppa E, Lillebo K, Qvigstad E, Ndhlovu P, Vennervald BJ, Gundersen SG, Kjetland EF, Taylor M. Reproductive health problems in rural South African young women: risk behaviour and risk factors. Reprod Health 2018; 15:138. [PMID: 30111335 PMCID: PMC6094577 DOI: 10.1186/s12978-018-0581-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 08/02/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND South African young women continue to be vulnerable, with high prevalence of teenage pregnancy, HIV, sexually transmitted infections (STIs) and female genital schistosomiasis (FGS). This study seeks to examine the underlying factors that may be associated with these four adverse reproductive health outcomes. METHODS In a cross-sectional study of 1413 sexually active of young women, we explored these four adverse reproductive health outcomes by considering socio-demographic factors, socio-economic factors, sexual risk behaviour, substance abuse and knowledge about reproductive health by using a questionnaire. Consenting participants were asked about previous pregnancies and were tested for HIV, STIs and FGS. Multivariable regression analyses were used to explore the factors associated with these four reproductive health outcomes. RESULTS 1. Early pregnancy: Among the young women, 44.4% had already been pregnant at least once. Associated factors were hormonal contraceptives, (adjusted odds ratio (AOR): 17.94, 95% confidence interval (CI): 12.73-25.29), and sexual debut < 16 years (AOR: 3.83, 95% CI: 2.68-5.47). Living with both parents (AOR 0.37, 95% CI: 0.25-0.57) and having a steady partner (AOR: 0.43, 95% CI: 0.24-0.76) were identified as protective factors against pregnancy. 2. HIV: HIV prevalence was 17.1%. The odds of having HIV were higher in intergenerational (AOR: 2.06, 95% CI: 1.05-4.06) and intragenerational relationships (AOR: 1.51 95% CI: 1.06-2.15), compared to age-homogenous relationships. Other associated factors were: condom use (AOR: 1.60, 95% CI: 1.16-2.20), number of times treated for an STI (AOR: 1.32, 95% CI: 1.02-1.71), and total number of partners (AOR: 1.14, 95% CI: 1.03-1.28). 3. STIs: Participants who had at least one STI (40.5%) were associated with total partner number (AOR 1.17, 95% CI: 1.06-1.30), and testing HIV positive (AOR: 1.88, 95% CI 1.41-2.50). 4. FGS: FGS prevalence (19.7%) was associated with previous anti-schistosomal treatment (AOR: 2.18, 95% CI: 1.57-3.05). CONCLUSION There is a high prevalence of pregnancy, HIV, STIs and FGS among sexually active young women in rural KwaZulu-Natal. Multidisciplinary approaches are urgently needed for educational and health literacy programs prior to sexual debut, and health care facilities, which should be made accessible for young women.
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Affiliation(s)
- Hashini Nilushika Galappaththi-Arachchige
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siphosenkosi G. Zulu
- Department of Infection Prevention and Control, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Kristine Lillebo
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Erik Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gynaecology, Women and Children’s Division, Ullevaal University Hospital, Oslo, Norway
| | | | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand, Norway
- Department of Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Wechsberg WM, Browne FA, Carney T, Myers B, Minnis A, MacDonald R, Ndirangu JW, Turner LB, Howard BN, Rodman N. The Young Women's Health CoOp in Cape Town, South Africa: Study protocol for a cluster-randomised trial for adolescent women at risk for HIV. BMC Public Health 2018; 18:859. [PMID: 29996792 PMCID: PMC6042235 DOI: 10.1186/s12889-018-5665-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/04/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND South Africa remains the global epicentre of HIV infection, and adolescent women have the highest incidence of HIV in the country. South Africa also has high rates of alcohol and other drug (AOD) use, violence, and gender inequality. Violence converges with AOD use, gender inequities and other disparities, such as poverty, to increase sexual risk and poor educational attainment for adolescent women. This study seeks to test the efficacy of peer recruitment and cofacilitation of the Young Women's Health CoOp (YWHC), a comprehensive gender-focused intervention to reduce HIV risk behaviours and increase the uptake of HIV counselling and testing (HCT) among out-of-school, adolescent women who use AODs. The YWHC is facilitated by local research staff and supported by peers. METHODS This cluster-randomised trial is enrolling participants into two arms: a control arm that receives standard HCT, and an intervention arm that receives the YWHC. Participants are enrolled from 24 economically disadvantaged communities in Cape Town, South Africa. These geographically distinct communities serve as clusters that are the units of randomisation. This study uses adolescent peer role models and research field staff to recruit marginalised adolescent women. At baseline, participants complete a questionnaire and biological testing for HIV, recent AOD use, and pregnancy. The core intervention is delivered in the month following enrollment, with linkages to health services and educational programmes available to participants throughout the follow-up period. Follow-up interviews and biological testing are conducted at 6 and 12 months post enrollment. DISCUSSION The study findings will increase knowledge of the efficacy of a comprehensive HCT, gender-focused programme in reducing AOD use, victimisation, and sexual risk behaviour and increase uptake services for out-of-school, adolescent women who use AODs. The trial results could lead to wider implementation of the YWHC for vulnerable adolescent women, a key population often neglected in health services. TRIAL REGISTRATION Trial registration no: NCT02974998 , November 29, 2016.
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Affiliation(s)
- Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Psychiatry and Behavioral Medicine, Duke University School of Medicine, Durham, NC USA
- Psychology in the Public Interest, North Carolina State University, Raleigh, NC USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Alexandra Minnis
- Women’s Global Health Imperative, RTI International, San Francisco, CA USA
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Robert MacDonald
- Western Cape Social Development, Western Cape Government, Cape Town, South Africa
| | - Jacqueline W. Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Leslie B. Turner
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Brittni N. Howard
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Nathaniel Rodman
- Research Computing Division, RTI International, Research Triangle Park, NC USA
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Rosenberg M, Pettifor A, Duta M, Demeyere N, Wagner RG, Selin A, MacPhail C, Laeyendecker O, Hughes JP, Stein A, Tollman S, Kahn K. Executive function associated with sexual risk in young South African women: Findings from the HPTN 068 cohort. PLoS One 2018; 13:e0195217. [PMID: 29608615 PMCID: PMC5880379 DOI: 10.1371/journal.pone.0195217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/05/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Heightened sexual risk in adolescence and young adulthood may be partially explained by deficits in executive functioning, the set of cognitive processes used to make reasoned decisions. However, the association between executive function and sexual risk is understudied among adolescent girls and young women, particularly in low- and middle-income countries. METHODS In a cohort of 853 young women age 18-25 in rural Mpumalanga province, South Africa, we evaluated executive function with three non-verbal cognitive tests: I. a rule-finding test, II. a trail-making test, and III. a figure drawing test. Using log-binomial regression models, we estimated the association between lower executive function test scores and indicators of sexual risk (unprotected sex acts, concurrent partnerships, transactional sex, and recent HSV-2 infection). RESULTS In general, young women with lower executive function scores reported higher frequencies of sexual risk outcomes, though associations tended to be small with wide confidence intervals. Testing in the lowest quintile of Test I was associated with more unprotected sex [aPR (95% CI): 1.4 (1.0, 1.8)]. Testing in the lowest quintile of Test II was associated with more concurrent relationships and transactional sex [aPR (95% CI): 1.6 (1.1, 2.5) and 1.7 (1.3, 2.4), respectively], and testing in the lowest four quintiles of Test III was associated with more concurrent relationships [aPR (95% CI): 1.7 (1.0, 2.7)]. CONCLUSIONS These results demonstrate an association between low executive function and sexual risk in South African young women. Future work should seek to understand the nature of this association and whether there is promise in developing interventions to enhance executive function to reduce sexual risk.
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Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States of America
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mihaela Duta
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Amanda Selin
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, NIAID, NIH, Baltimore, MD, United States of America
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Alan Stein
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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THE ASSOCIATION BETWEEN SEXUAL BEHAVIOURS AND INITIATION OF POST-SECONDARY EDUCATION IN SOUTH AFRICA. J Biosoc Sci 2018; 51:59-76. [PMID: 29352817 DOI: 10.1017/s0021932017000670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although young people in South Africa are growing up in an era where their socioeconomic circumstances are seemingly better than those of their parents' generation, they face greater risks in their trajectory to adulthood. This is mainly because the environment in which they are making sexual decisions is also rapidly evolving. Currently, South Africa has the highest prevalence of HIV and AIDS in the world among young people aged 15-24. This study examined the effect of sexual behaviours initiated in adolescence on enrolment in post-secondary education. The analysis was conducted using data from the longitudinal Cape Area Panel Study (CAPS, Waves 1-5) conducted in 2002-2009, which focused on young people's sexual behaviours in Cape Town, South Africa. The sample was restricted to 3213 individuals who reported sexual debut during adolescence. Using logistic regression models fitted separately for males and females, the results revealed that several factors acted as either hindrances or protective factors to enrolment in post-secondary education. Early sexual debut (by age 17) was negatively associated with participation in tertiary education. Other variables that had a negative effect included not using contraception at first sex, parenthood, engaging in risky behaviours such as illegal substance use, cigarette smoking and drinking alcohol and neglect of school homework (doing less than an hour a day). Higher levels of parental education (except for paternal education in the female model), urban residence and higher aspirations and analogous behaviours (studying) acted as protective factors and were positively associated with post-secondary education initiation. The paper also points to the relationship between early sexual debut and persistent socioeconomic inequality and provides empirical evidence for re-thinking policy development and implementation around schooling and sex education.
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Rosenberg M, Pettifor A, Twine R, Hughes JP, Gomez-Olive FX, Wagner RG, Sulaimon A, Tollman S, Selin A, MacPhail C, Kahn K. Evidence for sample selection effect and Hawthorne effect in behavioural HIV prevention trial among young women in a rural South African community. BMJ Open 2018; 8:e019167. [PMID: 29326192 PMCID: PMC5781067 DOI: 10.1136/bmjopen-2017-019167] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We examined the potential influence of both sample selection effects and Hawthorne effects in the behavioural HIV Prevention Trial Network 068 study, designed to examine whether cash transfers conditional on school attendance reduce HIV acquisition in young South African women. We explored whether school enrolment among study participants differed from the underlying population, and whether differences existed at baseline (sample selection effect) or arose during study participation (Hawthorne effect). METHODS We constructed a cohort of 3889 young women aged 11-20 years using data from the Agincourt Health and socio-Demographic Surveillance System. We compared school enrolment in 2011 (trial start) and 2015 (trial end) between those who did (n=1720) and did not (n=2169) enrol in the trial. To isolate the Hawthorne effect, we restricted the cohort to those enrolled in school in 2011. RESULTS In 2011, trial participants were already more likely to be enrolled in school (99%) compared with non-participants (93%). However, this association was attenuated with covariate adjustment (adjusted risk difference (aRD) (95% CI): 2.9 (- 0.7 to 6.5)). Restricting to those enrolled in school in 2011, trial participants were also more likely to be enrolled in school in 2015 (aRD (95% CI): 4.9 (1.5 to 8.3)). The strength of associations increased with age. CONCLUSIONS Trial participants across both study arms were more likely to be enrolled in school than non-participants. Our findings suggest that both sample selection and Hawthorne effects may have diminished the differences in school enrolment between study arms, a plausible explanation for the null trial findings. The Hawthorne-specific findings generate hypotheses for how to structure school retention interventions to prevent HIV.
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Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - F Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
- INDEPTH Network, Accra, Ghana
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Afolabi Sulaimon
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Amanda Selin
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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Yussif AS, Lassey A, Ganyaglo GYK, Kantelhardt EJ, Kielstein H. The long-term effects of adolescent pregnancies in a community in Northern Ghana on subsequent pregnancies and births of the young mothers. Reprod Health 2017; 14:178. [PMID: 29284506 PMCID: PMC5747083 DOI: 10.1186/s12978-017-0443-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022] Open
Abstract
Background In Ghana, adolescents represent 22% of the total population. The rates of adolescent pregnancies are high. Of all births registered in the country in 2014, 30% were by adolescents, and 14% of adolescents aged between 15 and 19 years had begun childbearing. Pregnancies and deliveries of adolescents are accompanied by more risks as compared to older women. The aim of the study was to explore the long-term effects of adolescent pregnancies on subsequent pregnancies and births and on the socioeconomic status of the women. Method A cross-sectional interviewer-performed survey of a purposive sample of 400 women in one community of Northern Ghana was conducted. Relationships between the age at first pregnancy and complications such as cesarean section, preterm or stillbirth and others were explored in 143 patients using the statistical program SPSS (Statistical Package for the Social Sciences). Result Results show that adolescent women (<19 years at their first pregnancy) have an 80% higher risk for a cesarean section for the first and subsequent births as compared to older women (≥ 19 years). Furthermore, younger mothers have a 45% higher risk of stillbirths and a 30% increased risk of losing their baby within the first 6 weeks after birth. There was no difference in the socioeconomic status between the two age groups. Conclusion Adolescent pregnancies are risk factors for the outcome of subsequent pregnancies of these mothers. This study, for the first time, shows that not only the first pregnancy and birth of very young women are negatively influenced by the early pregnancy but also subsequent pregnancies and births. While this study is of a purposive sample of women in one community, the clinical relevance of this study should not only be interesting for healthcare practitioners in Northern Ghana and other African regions but also for prevention campaigns in these regions.
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Affiliation(s)
- Anne-Sophie Yussif
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
| | - Anyetei Lassey
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | | | - Eva J Kantelhardt
- Faculty of Medicine, Department of Gynecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany.
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Mori AT, Kampata L, Musonda P, Johansson KA, Robberstad B, Sandøy I. Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial. Trials 2017; 18:604. [PMID: 29258591 PMCID: PMC5735867 DOI: 10.1186/s13063-017-2350-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Early marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa. Birth complications are also one of the leading causes of death among adolescent girls. This paper outlines a protocol for a cost-benefit analysis (CBA) and an extended cost-effectiveness analysis (ECEA) of a comprehensive adolescent pregnancy prevention program in Zambia. It aims to estimate the expected costs, monetary and non-monetary benefits associated with health-related and non-health outcomes, as well as their distribution across populations with different standards of living. Methods The study will be conducted alongside a cluster-randomized controlled trial, which is testing the hypothesis that economic support with or without community dialogue is an effective strategy for reducing adolescent childbearing rates. The CBA will estimate net benefits by comparing total costs with monetary benefits of health-related and non-health outcomes for each intervention package. The ECEA will estimate the costs of the intervention packages per unit health and non-health gain stratified by the standards of living. Cost data include program implementation costs, healthcare costs (i.e. costs associated with adolescent pregnancy and birth complications such as low birth weight, pre-term birth, eclampsia, medical abortion procedures and post-abortion complications) and costs of education and participation in community and youth club meetings. Monetary benefits are returns to education and averted healthcare costs. For the ECEA, health gains include reduced rate of adolescent childbirths and non-health gains include averted out-of-pocket expenditure and financial risk protection. The economic evaluations will be conducted from program and societal perspectives. Discussion While the planned intervention is both comprehensive and expensive, it has the potential to produce substantial short-term and long-term health and non-health benefits. These benefits should be considered seriously when evaluating whether such a program can justify the required investments in a setting with scarce resources. The economic evaluations outlined in this paper will generate valuable information that can be used to guide large-scale implementation of programs to address the problem of the high prevalence of adolescent childbirth and school drop-outs in similar settings. Trial registration ClinicalTrials.gov, NCT02709967. Registered on 2 March 2016. ISRCTN, ISRCTN12727868. Registered on 4 March 2016.
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Affiliation(s)
- Amani Thomas Mori
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway. .,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway. .,Muhimbili University of Health and Allied Sciences, P.O. Box 65001, 11103, Dar es Salaam, Tanzania.
| | - Linda Kampata
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Patrick Musonda
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Kjell Arne Johansson
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Bjarne Robberstad
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Ingvild Sandøy
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
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Biney AAE, Nyarko P. Is a woman's first pregnancy outcome related to her years of schooling? An assessment of women's adolescent pregnancy outcomes and subsequent educational attainment in Ghana. Reprod Health 2017; 14:123. [PMID: 28974268 PMCID: PMC5627413 DOI: 10.1186/s12978-017-0378-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/08/2017] [Indexed: 11/21/2022] Open
Abstract
Background Adolescent pregnancy and childbearing pose challenges to young women’s educational attainment. Studies show that while adolescent childbearing reduces educational attainment, not becoming pregnant and resorting to induced abortion when pregnant increases women’s educational levels. This study examined relationships between adolescents’ resolution of their first pregnancies and subsequent educational outcomes, for all women ages 20–49 years and across three age cohorts: 20–29, 30–39 and 40–49 year olds. Methods Using the 2007 Ghana Maternal Health Survey (GMHS) dataset, we conducted ANOVA, bivariate and multivariate linear regression analyses on 8186 women ages 20–49 years. Women’s first adolescent pregnancy outcomes were measured as live births, induced abortions, spontaneous abortions or no pregnancy, while educational attainment constituted their years of schooling. Results Findings showed years of schooling was highest for women who had induced abortions, and lowest for those who experienced live births. Women with live births as teenagers experienced significantly fewer years of schooling compared to their counterparts who terminated their pregnancies. Also, women with miscarriages and stillbirths exhibited levels similar to those who gave birth. Although women with no teenage births had higher educational levels than their childbearing counterparts, controlling for age at first pregnancy resulted in similar years of schooling compared to those who gave birth. Finally, the 30 to 39 year olds were the only age group whose results contradicted those of all women. These findings may be due to the socio-economic and political events that affected women’s educational attainment at the time. Conclusions Childbearing during adolescence does impact women’s educational attainment levels. Therefore, in addition to encouraging young mothers to continue schooling, all other interventions to help keep young girls in school must focus on preventing and/or delaying their adolescent pregnancies.
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Affiliation(s)
- Adriana A E Biney
- Regional Institute for Population Studies (RIPS), University of Ghana, P. O. Box LG 96, Legon, Accra, Ghana.
| | - Philomena Nyarko
- Ghana Statistical Service (GSS), P. O. Box GP 1098, Head Office Building, Finance Close, Accra, Ghana
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