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Molato BJ, Moloko-Phiri SS, Koen MP, Matsipane MJ. Support provided by outreach team leaders to caregivers of HIV/AIDS orphans in the North-West province of South Africa. BMC Nurs 2024; 23:605. [PMID: 39217361 PMCID: PMC11366136 DOI: 10.1186/s12912-024-02282-4] [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: 04/20/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The human immunodeficiency virus (HIV) and acquired immunodeficiency deficiency syndrome (AIDS) epidemic have left an overwhelming impact on communities worldwide, particularly in Sub-Saharan Africa, where its effects on family structures are particularly pronounced. Caregivers of HIV/AIDS orphans encounter challenges in fulfilling their caring duties. Consequently, they rely on the outreach team leaders (OTLs) for support to care for HIV/AIDS orphans. AIM This study aimed to explore and describe support provided by OTLs to caregivers of HIV/AIDS orphans in the North West Province of South Africa. METHODS The exploratory, descriptive, and contextual design meaning the study was conducted was in the contexts where caregivers of HIV/AIDS orphans reside. The study was conducted in five local municipalities in the Ngaka Modiri Molema district of the North West Province of South Africa. Ward-based outreach nurses were participants in the study. Semi-structured focus group interviews were used for data collection. Thematic analysis was used to analyze data. Throughout the study, ethical principles were adhered to. The study also adhered to four trustworthiness principles: credibility, confirmability, transferability, and dependability. RESULTS Three main themes emerged from this study: the conduction of home visits to caregivers of HIV/AIDS orphans, the coordination of a multidisciplinary team for support, and the facilitation of support groups. CONCLUSIONS This study revealed that that caregivers of children orphaned by HIV/AIDS benefitted from the support provided by OTLs in the North West province of South Africa. The support provided by OTLs harnessed positive relationship between caregivers and children orphaned by HIV/AIDS.
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Affiliation(s)
- Boitumelo Joy Molato
- NuMIQ Research Focus Area, School of Nursing, Faculty of Health Sciences, North West University Mahikeng campus, Private Bag X2046 Mmabatho 2745, Mafikeng, South Africa.
| | - Salaminah S Moloko-Phiri
- NuMIQ Research Focus Area, School of Nursing, Faculty of Health Sciences, North West University Mahikeng campus, Private Bag X2046 Mmabatho 2745, Mafikeng, South Africa
| | - Magdalena P Koen
- NuMIQ Research Focus Area, School of Nursing, Faculty of Health Sciences, North West University Mahikeng campus, Private Bag X2046 Mmabatho 2745, Mafikeng, South Africa
| | - Molekodi J Matsipane
- NuMIQ Research Focus Area, School of Nursing, Faculty of Health Sciences, North West University Mahikeng campus, Private Bag X2046 Mmabatho 2745, Mafikeng, South Africa
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Musonda P, Halwiindi H, Kaonga P, Ngoma-Hazemba A, Simpungwe M, Mweemba M, Tembo C, Zyambo C, Chisoso J, Munakampe M, Choonga P, Ngalamika O, Musukuma M, Chavula MP, Sichula N, Mweemba O, Zulu JM, Phiri H. HIV, syphilis and sexual-risk behaviours' prevalence among in-and out-of-school adolescent girls and young women in Zambia: A cross-sectional survey study. PLoS One 2024; 19:e0294545. [PMID: 38837995 DOI: 10.1371/journal.pone.0294545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In Zambia, 3.8% of young women and men aged 15-24 are HIV positive. However, like in most developing nations, HIV prevalence is higher among young women than young men (5.6% versus 1.8%). Despite the recognition of the rights of young people to sexual reproductive health (SRH) information and services, adolescent and young people (AYP) still face challenges in accessing healthcare in public health institutions including access to comprehensive knowledge on HIV/AIDs, HIV testing and contraceptives. The overall objective of the study was to collect baseline HIV, SRH and gender based violence (GBV) data at district level to inform the design of interventions targeting adolescent girls and young women (AGYW) aged 10-24 years in 20 districts of Zambia. METHODS A cross-sectional, mixed-methods study was conducted in 20 districts of Zambia with the highest incidence of HIV. Data was collected between August and October 2022 with a total response rate of 92% (12,813/13960), constituting 5979 (46.7%) in-school and 6834 (53.3%) out-of-school participants. RESULTS Overall, Mwinilunga, Chinsali, Chisamba and Chembe districts had the highest number of respondents, while Sinazongwe and Mungwi districts contributed the least. The overall age distribution was such that 12.6% (n = 1617) of those interviewed were aged 10 to 14 years, 35.4% (n = 4536) were aged 15-19 years, and 52.0% (n = 6660) were aged 20-24 years. The overall mean age at first sex among AGYW interviewed was 16.6 years which was broken down as follows: 16.2 years for in-school and 16.8 years for out of school. Overall, most of the respondents had first time sex with either their boyfriend (80.4%) or husband (15.6%), with 2.4% of the in-school participants reporting to have had their sexual debut in marriage compared to 21.0% among out-of-school AGYW. Prevalence of HIV was higher in the out-of-school compared to the in-school participants (5.5% vs 2.0%), Similarly, the prevalence of syphilis was higher in the out-of-school than the in-school participants (4.1% vs 1.5%). CONCLUSION The study focused on assessing the prevalence and vulnerability of HIV, syphilis, GBV, and SRH services uptake among adolescent girls and young women, and exploring factors affecting girls' stay-in-school and re-engagement. The study found that HIV and syphilis are still significant public health problems among adolescent girls and young women in Zambia, emphasizing the need for increased efforts to prevent and manage these infections.
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Affiliation(s)
- Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Patrick Kaonga
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | | | - Mable Mweemba
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Chowa Tembo
- Ministry of Health in Zambia, Lusaka, Zambia
| | - Cosmas Zyambo
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - John Chisoso
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | | | - Owen Ngalamika
- School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mwiche Musukuma
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Noah Sichula
- School of Education, University of Zambia, Lusaka, Zambia
| | - Oliver Mweemba
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Henry Phiri
- Ministry of Health in Zambia, Lusaka, Zambia
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Nabunya P, Byansi W, Muwanga J, Bahar OS, Namuwonge F, Ssentumbwe V, Ssewamala FM. Family Factors and Gender Norms as Protective Factors Against Sexual Risk-Taking Behaviors Among Adolescent Girls in Southern Uganda. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2024; 11:111-121. [PMID: 38859819 PMCID: PMC11164544 DOI: 10.1007/s40609-022-00237-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 06/11/2024]
Abstract
Adolescent girls and young women are at a higher risk for HIV infection stemming from barriers to accessing comprehensive sexual health education, unequal cultural, social, and economic statuses, limited access to education and health care services, and gender-based violence. This makes adolescent girls susceptible to high-risk sexual behaviors. This study examines the protective role of family, social support factors and gender norms against sexual risk-taking behaviors among secondary school adolescent girls in Uganda. Baseline data from the National Institute of Mental Health-funded Suubi4Her study were analyzed. A total of 1260 girls aged 14-17 years and enrolled in the first or second year of secondary school were recruited across 47 secondary schools. Hierarchical linear regression models were conducted to determine the role of family, social support factors and gender norms on sexual risk-taking behaviors. Results indicate that traditional gender norms, family care and relationships, and social support were all associated with lower levels of sexual risk-taking intentions-a proxy for engaging in sexual risk behaviors. Findings point to the need to develop family level support interventions to equip adolescent girls with adequate sexual health-related knowledge and skills to facilitate safer sexual practices and reduce high-risk sexual-taking behaviors, as they develop and transition into young adulthood.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - William Byansi
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Joelynn Muwanga
- Department of Health and Human Services, New Hampshire, Division of Public Health, Littleton, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Fred M. Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
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Zango AB, Stutterheim SE, de Vries N, Crutzen R. Determinants of preventive sexual behaviours among first year university students in Beira city, central Mozambique: a cross-sectional study. Reprod Health 2024; 21:3. [PMID: 38191405 PMCID: PMC10773135 DOI: 10.1186/s12978-023-01733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Understanding determinants of preventive sexual behaviours is important for intervention efforts to support these behaviours and, thereby, reduce STIs and HIV burden. In general, there is limited insight into determinants of preventive behaviours among university students in Mozambique. Therefore, this study set out to assess both the prevalence and the determinants of condom use and voluntary counselling and testing (VCT) service use in first year university students. METHODS We conducted a cross-sectional study in May-September 2021, at the Universidade Católica de Moçambique and the Universidade Licungo, in Beira central Mozambique. We collected data on sociodemographic characteristics, heterosexual relationship experiences and personal determinants posited to be associated with condom use and VCT service use. We included 819 participants, who were selected using a clustered and random sampling design. We used Pearson's chi-square test to compare proportion and estimate the crude odd ratio as the effect size measure at 95% confidence interval, and Confidence Interval-Based Estimation of Relevance to determine correlation coefficients of means and the behaviours of interest at 95% confidence interval. RESULTS Condoms were used by 96.1% of male participants and 95.0% of female participants. Additionally, 55.1% of male participants and 57.5% of female participants had previously used VCT services. Condom use was associated with discussing sexuality with mother, and self-efficacy for condom use negotiation, and negatively associated with attitudes that condoms reduce pleasure. VCT service use was associated with discussing sexuality with mother, sexual debut, having a sexual partner, and being in what they consider an important heterosexual relationship. Knowledge, attitude, self-efficacy and subjective norms were weakly associated with VCT service use. CONCLUSION In first year university students in Mozambique, reported condom use was high but VCT services were only used by about half of the participants. Interventions aiming to increase VCT service use should focus on improving communication between parents and their adolescent or young adult children, providing personalized risk information, demonstrating that VCT service use is pleasant and non-judgmental, improving users' confidence to schedule a visit, and preparing users for possible positive testing results.
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Affiliation(s)
- Arlinda Basílio Zango
- Departamento de Investigação, Faculdade de Ciências de Saúde, Universidade Católica de Moçambique, Beira, Mozambique.
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
| | - Sarah E Stutterheim
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Nanne de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Likoko S, Akokuwebe ME, Osuafor GN, Idemudia ES. "Health Outcomes of Grandparents Caring for Double Orphans in South Africa": What Are the Determinants? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7158. [PMID: 38131710 PMCID: PMC10743013 DOI: 10.3390/ijerph20247158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
In the 21st century, grandparenthood is a significant phenomenon in the fields of demography, gerontology, and sociology. It is mainly explored in the context of ageing, as it is poised to become one of the most significant demographic phenomena and social issues in contemporary South Africa. Therefore, this study examined the determinants associated with grandparents who are parenting as caregivers and the health challenges they are exposed to as caregivers. The National Income Dynamics Study (NIDS) Wave 5 dataset was utilised, and a total of 302,476 grandparents aged 25 years and older, who were reported to be primary caregivers of double orphans, were included in the analysis. Both bivariate and multivariate binary logistic regressions were performed to determine the predictors of the determinants of grandparents parenting as caregivers and their health challenges in South Africa. Estimated odds ratios (ORs) with 95% confidence intervals (CIs) were used, and the threshold for statistical significance was established at ρ < 0.05. A majority of the male and female grandparent caregivers were aged 24-34 years, were Black Africans (69.8%), had secondary education (46.9%), reported health challenges (HC) (59.7%), with 26.4% reporting headaches in the last 30 days. Logistic regression revealed that grandparent caregivers aged 55-64 years were 8.9 times more likely to report health challenges compared to those aged 25-34 years. Non-Black African grandparent caregivers were found to be 0.61 times less likely to report health challenges, compared to Black African grandparent caregivers. Those with perceived poor health status were 3.3 times more likely to report health challenges, compared to those with excellent perceived health status. Therefore, there is an urgent need to redesign health interventions to address these health burdens among grandparent caregivers and to take cognisance of providing economic and social support for these vulnerable populations.
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Affiliation(s)
- Salmon Likoko
- Statistics South Africa, ISIbalo House, Pretoria 0002, South Africa;
| | | | - Godswill Nwabuisi Osuafor
- Department of Population Studies and Demography, North-West University, Mafikeng 2735, South Africa;
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Nattabi J, Nabunya P, Kizito S, Nabayinda J, Kiyingi J, Ssewamala F. The Impact of Parent-Adolescent Communication on Reduction of Sexual Risk Possibility Among Adolescents: Findings from the Suubi-Maka Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3521-3530. [PMID: 37349655 PMCID: PMC10739570 DOI: 10.1007/s10508-023-02639-x] [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: 03/01/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
Sexual risky behaviors among adolescents and young people remain a major public health problem worldwide. This study examined the impact of parent-adolescent communication on adolescents' possibility to engage in risky behaviors. The study used baseline data from the Suubi-Maka Study (2008-2012) implemented in 10 primary schools in Southern Uganda. Binary logistic regression models were conducted to determine the association between parent-adolescent communication and sexual risk possibility. Results indicate that gender [OR 0.220, 95% CI 0.107, 0.455], age [OR 1.891, 95% CI 1.030, 3.471], household size [OR 0.661, 95% CI 0.479, 0.913], and comfort level of family communication [OR 0.944, 95% CI 0.899, 0.990] were significantly associated with lower levels of sexual risk possibility among adolescents. There is a need to build interventions that make it easy and comfortable for adolescents to have open discussion and communication with parents on sexual risk possibility, risky behaviors, and risky situations.
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Affiliation(s)
- Jennifer Nattabi
- International Center for Child Health and Development, Washington University in St. Louis Brown School, Brown Hall, Office 112, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development, Washington University in St. Louis Brown School, Brown Hall, Office 112, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Samuel Kizito
- International Center for Child Health and Development, Washington University in St. Louis Brown School, Brown Hall, Office 112, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development, Washington University in St. Louis Brown School, Brown Hall, Office 112, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Joshua Kiyingi
- International Center for Child Health and Development, Washington University in St. Louis Brown School, Brown Hall, Office 112, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Fred Ssewamala
- International Center for Child Health and Development, Washington University in St. Louis Brown School, Brown Hall, Office 112, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
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Okot C, Laker F, Apio PO, Madraa G, Kibone W, Pebalo Pebolo F, Bongomin F. Prevalence of Teenage Pregnancy and Associated Factors in Agago District, Uganda: A Community-Based Survey. Adolesc Health Med Ther 2023; 14:115-124. [PMID: 37577045 PMCID: PMC10417689 DOI: 10.2147/ahmt.s414275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
Background Teenage pregnancy remains a common public health and social problem associated with negative health outcomes. We determined the prevalence and factors associated with teenage pregnancy among teenage girls aged 13-17 years in Agago district, Uganda. Methods We conducted a community-based, cross-sectional study between October and November 2020 in Lapono Sub-County, Agago district among teenage girls 13-17 years. Multi-stage sampling technique was used. Parishes, villages, and households were randomly selected (computer generated random numbers were used for household selection). In each household, one participant was randomly selected for interview and pregnancy testing. We collected data on socio-demographic factors using a pre-tested semi-structured questionnaire. All eligible participants were tested for urine human chorionic gonadotropin (hCG). Multivariable logistic regression analysis was done to determine independent predictors of teenage pregnancy, with p<0.05 considered statistically significant. Results A total of 289 eligible participants, with a mean age of 15.1±1.5 years, were enrolled. Most (n=246, 81.5%) participants had attained primary education, 18 (6.2%) were married, 41 (14.2%) used alcohol, 62 (21.5%) had a history of sexual intercourse and 32 (11.1%) were sexually abused. The prevalence of teenage pregnancy was 2.8% (n=8). Factors significantly associated with teenage pregnancy were alcohol consumption (adjusted odds ratio (aOR): 13.2, 95% Confidence Interval (95% CI): 1.7-100.6, p=0.013) and having secondary/tertiary education (aOR: 10.2, 95% CI: 1.5-71.9, p=0.02). Conclusion The study findings suggest that teenage pregnancy is still a public health and social problem in Agago district, Uganda. Interventions discouraging alcohol consumption and promoting education among teenagers are key in addressing the burden of teenage pregnancies in the district.
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Affiliation(s)
- Christopher Okot
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Florence Laker
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Pamela Okwir Apio
- Makerere Lung Institute, School of Medicine, Makerere University, Kampala, Uganda
| | - Grace Madraa
- Department of Rural Development and Agri-Business, Faculty of Agriculture, Gulu University, Gulu, Uganda
| | - Winnie Kibone
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis Pebalo Pebolo
- Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Pathmendra P, Raggatt M, Lim MS, Marino JL, Skinner SR. Exposure to Pornography and Adolescent Sexual Behavior: Systematic Review. J Med Internet Res 2023; 25:e43116. [PMID: 36853749 PMCID: PMC10015350 DOI: 10.2196/43116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Formative experiences in adolescence lay the foundation for healthy and pleasurable romantic and sexual relationships. Exposure to pornography may affect these experiences. OBJECTIVE We aimed to synthesize evidence published in the past decade on the relationship between exposure to pornography and sexual behavior (earlier age of first sex [<16 years], condomless sex, past-year multiple partners [>1], lifetime multiple partners [>1], group sex, sexual aggression including forced sex, paid sex, teenage pregnancy, and history of sexually transmitted infection) in adolescents aged between 10 and 19 years. METHODS We identified 19 eligible studies by searching MEDLINE, PsycINFO, Cochrane, CINAHL, Embase, and Web of Science databases from January 2010 to November 2022. RESULTS Out of 8 studies that assessed earlier age of first sex, 5 studies, including 1 longitudinal study, found a statistically significant association with exposure to pornography. Given that most studies were cross-sectional or had substantial limitations, causal inference could not be made. Also, exposure to pornography was not measured consistently. The evidence was conflicting or insufficient to draw any conclusions regarding other outcomes. CONCLUSIONS More quantitative research is needed to elucidate the association between pornography exposure and sexual behavior, and sex education should adopt evidence-based approaches to minimize the potential harms from pornography. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021227390; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227390.
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Affiliation(s)
- Pranujan Pathmendra
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | | | - Megan Sc Lim
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jennifer L Marino
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital and University of Melbourne, Parkville, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Kids Research, Sydney Children's Hospitals Network, Westmead, Australia
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Luwedde M, Sserwanja Q, Katantazi N. Determinants of age at first sex inequality between women and men youth in Uganda: A decomposition analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000303. [PMID: 36962531 PMCID: PMC10021423 DOI: 10.1371/journal.pgph.0000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/12/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Teenage pregnancies and sexually transmitted diseases are major public health problems in Uganda. Early sexual debut is one of the main routes of these public health problems. This study aimed to identify factors that explain age at first sex inequality between men and women Ugandan youth. METHODS This study used secondary data from a cross-sectional Uganda demographic health survey (2016). Participants were 10 189 sexually experienced youth. Using Stata 14, intermediary analysis was done to assess the statistical association between explanatory variables and age at first sex in a multiple logistic regression analysis. Oaxaca decomposition was used to decompose factors that explain inequalities in age at first sex between men and women youth. RESULTS Intermediary results showed Islam, many household members, residing in the eastern region, and being divorced/widowed were predictors of early age at first sex. While secondary education, higher education, blue-collar jobs, and being 20 to 30 years old were protective factors against early age at first sex. Material, behavior/cultural, psychosocial, and demographic explanatory factors jointly explained a statistically significant portion of the observed gap in early age at first sex between women and men youth. More women were at a disadvantage at an early age at first sex compared to men youth. About 96.37% of this gap was explained by unequal distribution of material, behavior/cultural, psychosocial, and demographic factors between men and women youth. Relationship to household head (49%), education (16.87%), occupation (8,94%), number of household members (8.57%), using the internet (7.99%), and reading newspapers or magazines (4.39%) made a significant contribution to the explanation of early age at first sex inequality between men and women youth. CONCLUSIONS Results showed early age at first sex inequality between women and men youth that favored men. Programs designed to address early age at first sex and related health outcomes must combat inequities in education, employment opportunities, access to sexual reproductive information through internet, and newspapers or magazines between men and women youth. They should also foster household relationships and monitor girls.
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Affiliation(s)
- Mary Luwedde
- Heart for Girls Initiative Uganda, Kayunga, Uganda
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Gumede D, Meyer-Weitz A, Zuma T, Shahmanesh M, Seeley J. A qualitative investigation of facilitators and barriers to DREAMS uptake among adolescents with grandparent caregivers in rural KwaZulu-Natal, South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000369. [PMID: 36962500 PMCID: PMC10022343 DOI: 10.1371/journal.pgph.0000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/31/2022] [Indexed: 06/18/2023]
Abstract
Adolescents with grandparent caregivers have experienced challenges including the death of one or both parents due to HIV in sub-Saharan Africa. They may be left out of existing HIV prevention interventions targeting parents and children. We investigated the facilitators and barriers to DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) programme uptake among adolescents with grandparent caregivers across different levels of the socio-ecological model in rural South Africa. Data were collected in three phases (October 2017 to September 2018). Adolescents (13-19 years old) and their grandparent caregivers (≥50 years old) (n = 12) contributed to repeat in-depth interviews to share their perceptions and experiences regarding adolescents' participation in DREAMS. Data were triangulated using key informant interviews with DREAMS intervention facilitators (n = 2) to give insights into their experiences of delivering DREAMS interventions. Written informed consent or child assent was obtained from all individuals before participation. All data were collected in isiZulu and audio-recorded, transcribed verbatim and translated into English. Thematic and dyadic analysis approaches were conducted guided by the socio-ecological model. Participation in DREAMS was most effective when DREAMS messaging reinforced existing norms around sex and sexuality and when the interventions improved care relationships between the adolescents and their older caregivers. DREAMS was less acceptable when it deviated from the norms, raised SRH information that conflicts with abstinence and virginity, and when youth empowerment was perceived as a potential threat to intergenerational power dynamics. While DREAMS was able to engage these complex families, there were failures, about factors uniquely critical to these families, such as in engaging children and carers with disabilities and failure to include adolescent boys in some interventions. There is a need to adapt HIV prevention interventions to tackle care relationships specific to adolescent-grandparent caregiver communication.
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Affiliation(s)
- Dumile Gumede
- Centre for General Education, Durban University of Technology, Durban, South Africa
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Anna Meyer-Weitz
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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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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Okumu M, Logie CH, Ansong D, Mwima S, Hakiza R, Newman PA. Exploring the Protective Value of Using Sexting for Condom Negotiation on Condom use Determinants and Practices Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda. AIDS Behav 2022; 26:3538-3550. [PMID: 35476165 DOI: 10.1007/s10461-022-03677-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
Given the global growth of adolescent texting, we evaluate texting-based sexual communication as a potential site for interventions encouraging condom use cascades, particularly among displaced adolescents-a population with disproportionate levels of sexually transmitted infections, including HIV. With data from 242 forcibly displaced adolescents in the slums of Kampala, Uganda, we used path analysis to examine pathways from gender/dating relationship to condom determinant (knowledge of where to access condoms) and practices (access/use of condoms), through sexting-based condom negotiation, controlling for sexting practices. We found direct pathways from gender (boys vs. girls) and from dating relationship (dating vs. not) to condom determinant. Sexting-based condom negotiation partially mediated the pathway from gender/dating relationship to condom determinant, and fully mediated the pathways from gender/dating relationship to condom practices. Future digital sexual health interventions should consider the utility of texting-based applications in promoting knowledge and use of condoms among adolescents.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W Nevada St, Urbana, IL, 61801, USA.
- School of Social Sciences, Uganda Christian University, Mukono, Uganda.
| | - Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, ON, M5S 1V4, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health (UNU- INWEH), 204-175 Longwood Rd S, L8P 0A1, Hamilton, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, Canada
- Canada Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - David Ansong
- School of Social Work, University of North Carolina- Chapel Hill, 325 Pittsboro St CB#3550, Chapel Hill, NC, 27599, USA
| | - Simon Mwima
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W Nevada St, Urbana, IL, 61801, USA
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | - Peter A Newman
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, ON, M5S 1V4, Toronto, Canada
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13
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Do Community-based Livelihood Interventions Affect Sexual and Reproductive Health and Rights of Young People in Slum Areas of Uganda: a Difference-in-difference with Kernel Propensity Score Matching Analysis. J Urban Health 2022; 99:164-189. [PMID: 35034278 PMCID: PMC8866584 DOI: 10.1007/s11524-021-00596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
Slum dwellers across Africa have been targeted in interventions whose impacts remain unclear. We evaluated the impact of a livelihood intervention on the sexual and reproductive health and rights (SRHR) of young people in the slum areas of Kampala, Uganda. We carried out a repeated cross-sectional survey in 2014 and 2017 to examine the impact of community-based livelihood interventions on the SRHR of young people in the slum areas of Kampala, Uganda. Impacts were observed such as reduced sexual activity, reduction in aspects of gender-based violence attitudes and beliefs, increased access to and decision-making about contraceptive and family-planning services, increased availability and affordability of SRHR services, reduced need to seek further knowledge on SRHR, reduced barriers to HIV testing, and increased knowledge of health responsibilities. Unexpected results included: increased proportion of young people who had ever had sex, decreased mean age of sexual debut, unaffordability of contraceptives, and increased culturally shaped attitudes and social norms related to gender-based violence. We observed no impact on condom use, consensual sex and sexual assault, the number of sexual partners, knowledge about HIV/AIDS, stigma and discrimination against people living with HIV/AIDS, affordability of male and female condoms, and uptake of HIV testing services. Rights-based interventions are crucial to how we understand the SRHR of young people in complex sociocultural environments. While the livelihood interventions made significant impacts on the SRHR of young people, there are questions about how such interventions address deeply rooted sociocultural practices to maximise outcomes.
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Lee E, Yang Y. Moderating the Effects of Health Behaviors on Sexual Intercourse among Adolescents: A Cross-Sectional Study Using the 2020 Adolescent Health Behavior Survey. J Korean Acad Nurs 2022; 52:499-510. [DOI: 10.4040/jkan.22080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Eunmi Lee
- College of Nursing, Jeonbuk National University, Jeonju, Korea
| | - Youngran Yang
- College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
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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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Sexual and reproductive health knowledge and behaviour of adolescent boys and girls aged 10-19 years in western Kenya: evidence from a cross-sectional pilot survey. J Biosoc Sci 2021; 54:792-811. [PMID: 34315560 DOI: 10.1017/s0021932021000353] [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: 11/05/2022]
Abstract
This paper reports findings of a pilot survey of adolescent sexual and reproductive health (ASRH) knowledge and behaviour in Homabay County of western Kenya. The study was based on a cross-sectional survey of 523 male and female adolescents aged 10-19 years from 32 Community Health Units (CHUs). Bivariate analysis of gender differences and associations between ASRH knowledge and behaviour was followed with two-level logistic regression analysis of predictors of ASRH behaviour (sexual activity, unprotected sex, HIV testing), taking individual adolescents as level-1 and CHUs as level-2. The findings reveal important gender differences in ASRH knowledge and behaviour. While male adolescents reported higher sexual activity (ever had sex, unprotected last sex), female adolescents reported higher HIV testing. Despite having lower HIV/AIDS knowledge, female adolescents were more likely to translate their SRH knowledge into appropriate behaviour. Education emerged as an important predictor of ASRH behaviour. Out-of-school adolescents had significantly higher odds of having ever had sex (aOR=3.3) or unprotected last sex (aOR=3.2) than their in-school counterparts of the same age, gender and ASRH knowledge, while those with at least secondary education had lower odds of unprotected sex (aOR=0.52) and higher odds of HIV testing (aOR=5.49) than their counterparts of the same age, gender and SRH knowledge who had primary education or lower. However, being out of school was associated with higher HIV testing (aOR=2.3); and there was no evidence of significant differences between younger (aged 10-14) and older (aged 15-19) adolescents in SRH knowledge and behaviour. Besides individual-level predictors, there were significant community variations in ASRH knowledge and behaviour, with relatively more-deprived CHUs being associated with poorer indicators. The overall findings have important policy/programme implications. There is a need for a comprehensive approach that engages schools, health providers, peers, parents/adults and the wider community in developing age-appropriate ASRH interventions for both in-school and out-of-school adolescents in western Kenya.
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Multiple sexual partnerships and associated factors among young psychoactive-substance-users in informal settlements in Kampala, Uganda. PLoS One 2020; 15:e0239323. [PMID: 33021998 PMCID: PMC7537871 DOI: 10.1371/journal.pone.0239323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Multiple sexual partnerships increase the risk of transmission of HIV and can be exacerbated by substance abuse. However, the association between psychoactive substance use and multiple sexual partnerships among young people in informal settlements of low-income countries is not well known. This study established the prevalence of multiple sexual partnerships and associated factors among young psychoactive-substance-users in informal settlements in Kampala, Uganda. METHODS This was a cross-sectional study involving 744 young (aged 18-24 years), sexually active, psychoactive substance-users selected from 12 of the 57 informal settlements of Kampala City. The prevalence of multiple sexual partnerships and their differential distribution by socio-demographic strata was established. Modified Poisson regression models were run in Stata 14 software to generate prevalence rate ratios for the factors associated with multiple sexual partnerships. RESULTS About 40.6% (37.9% of males and 50.0% of females) had engaged in multiple sexual partnerships in the last 30 days. Engaging in multiple sexual partnerships in the last 30 days was positively associated with being female (PR 1.29, 95% CI: 1.03-1.63); staying in the informal settlement for 6-10 years (PR 1.34, 95% CI: 1.02-1.75) and chewing khat in the last 30 days (PR 1.93, 95% CI: 1.10-3.40). CONCLUSION Multiple sexual partnerships are highly prevalent among young psychoactive-substance-users, irrespective of the socio-demographic strata. Being female, having lived in the informal settlement for 6-10 years, and chewing khat were significantly associated with having multiple sexual partners in the last 30 days. In tackling this high-risk sexual behaviour, it is recommended that risk-reduction interventions are considered for the different socio-demographic strata identified in this study, i.e. females, those who have lived in the informal settlement for about 6-10 years, and those who chew khat.
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18
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Bukenya JN, Canavan CR, Bärnighausen T, Fawzi WW. Strengthening our knowledge base and research capacity for improved adolescent health in sub-Saharan Africa: a South-South-North collaboration. Trop Med Int Health 2019; 25:2-4. [PMID: 31777153 DOI: 10.1111/tmi.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Africa Health Research Institute, Somkhele, South Africa
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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