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Agu CI, Nwankpa O, Ekwueme CN, Agu IC, Mbachu CO, Ezumah N, Onwujekwe O. Intersectionality analysis of young people's experiences and perceptions of discrimination in primary health centers in Ebonyi State, Southeast Nigeria. Int J Equity Health 2024; 23:100. [PMID: 38760811 PMCID: PMC11100186 DOI: 10.1186/s12939-024-02192-6] [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: 10/13/2023] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Young people (aged 10 to 24 years) in sub-Saharan Africa bear a huge and disproportionate burden of poor sexual and reproductive health (SRH) outcomes due to inequalities and discrimination in accessing sexual and reproductive health services (SRHS). This study assessed the experiences and perceptions of discrimination among young people seeking SRH services in Primary Health Centers (PHCs) using an intersectionality lens. METHODS A cross-sectional mixed-methods study was undertaken in six local government areas (LGAs) in Ebonyi State, southeast Nigeria. The LGAs comprise both urban and rural locations. The study population for the quantitative survey consisted of 1025 randomly selected young boys and girls aged 15-24 years. Eleven focus group discussions (FGDs) were conducted with the young people. Descriptive and inferential analyses were performed for quantitative data, while thematic analysis was performed for the qualitative data, using NVivo. RESULTS A total of 16.68% participants in the survey reported that young girls/women were treated badly/unfairly compared to young boys/men when seeking SRH services in PHCs; 15.22% reported that young clients get treated badly/unfairly from adults; and 12.49% reported that young clients with poor economic status were treated unfairly. Respondents also reported that young clients with disability (12.12%), and those who are poorly educated or uneducated (10.63%) are treated badly by healthcare providers when they access SRH services. Young people in urban areas were about 7 times more likely to believe that girls/young women are treated badly than boys/young men when seeking SRH services in PHCs compared to those who live in rural areas (p < 0.001). Among the young girls/women, residing in urban areas, being poor and in school increased the likelihood of getting treated badly/unfairly when receiving SRH services by 4 times (p < 0.001). The qualitative results revealed that health workers were generally harsh to young people seeking SRH services and the level of harshness or unfriendliness of the health workers varied depending on the young person's social identity. CONCLUSION There are varieties of intersecting factors that contribute to the discrimination of young clients in PHCs. This underscores the urgent need to prioritize intersectional perspectives in the design and implementation of interventions that will improve access and use of SRH services by young people.
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Affiliation(s)
- Chibuike Innocent Agu
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Department of Community Medicine, Alex-Ekwueme Federal University, Ndufu-Alike, Ebonyi State, Nigeria
| | - Ozioma Nwankpa
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
| | - Chinazom N Ekwueme
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
| | - Ifunanya Clara Agu
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria.
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Department of Health Administration and Management, College of Medicine, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
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Ramalepa TN, Netangaheni TR. A scoping review of strategies for adolescents' sexual and reproductive health role modelling. S Afr Fam Pract (2004) 2024; 66:e1-e9. [PMID: 38708753 PMCID: PMC11151353 DOI: 10.4102/safp.v66i1.5859] [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: 10/30/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Individuals strive to maintain their sexual and reproductive health (SRH) by being exposed to correct information, having access to contraceptives, and promoting safe sex practices. Adolescent SRH promotion efforts should consider the influence of role models. This review explored the availability and nature of strategies and programmes on adolescents' SRH role modelling and described them using a scoping review. METHODS Studies were retrieved from four databases and grey literature through a search of 223 studies. The databases included EBSCO-host, Medline, Sabinet, and Pubmed. Data extraction was guided by a data-extraction tool adapted from the JBI Manual for Evidence Synthesis. The characteristics of the selected studies were recorded in a Microsoft spreadsheet. Eleven studies published between 2014 and 2022 were included for the final review and analysed using thematic analysis. RESULTS Selected articles focused on adolescents' SRH; however, only two studies focused particularly on role modelling. Nonetheless, some aspects of the findings and recommendations presented could be extrapolated to adolescents' SRH role modelling. This includes adolescent-parent communication on SRH, community engagement, mentoring, positive role modelling, and information sharing through media campaigns. CONCLUSION There is a lack of literature on SRH role modelling because most studies did not focus on role modelling as an aspect of SRH. Therefore, research needs to be conducted on strategies and programmes focusing on SRH modelling.Contribution: The findings of this scoping review may encourage the development and implementation of strategies and programmes targeting adolescents' SRH throughout diverse communities to promote adolescent SRH.
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Affiliation(s)
- Tshiamo N Ramalepa
- Department of Nursing Science, School of Healthcare Sciences, Sefako Makgatho Health Sciences University, Tshwane.
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Moolla A, Constance M, Ngcobo N, Mngadi S, Govathson C, Long L, Pascoe SJ. "I want one nurse who is friendly to talk to me properly like a friend": Learner preferences for HIV and contraceptive service provision in Gauteng, South Africa. RESEARCH SQUARE 2023:rs.3.rs-3725260. [PMID: 38168214 PMCID: PMC10760307 DOI: 10.21203/rs.3.rs-3725260/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Research with adolescents indicates that youth aged 15-24 years, especially females, are at high risk for HIV infection. The overall HIV prevalence among youth in this age group was 6.2% estimated in 2022. In addition, > 800,000 adolescents are newly infected with HIV every year and 79% of these infections occur in sub-Saharan Africa. The health service provision preferences and needs of adolescents are critical to reaching this population. Methods This qualitative study was conducted with learners from three public secondary schools in Gauteng, South Africa. Using convenience sampling, 22 in-depth stakeholder interviews (KIIs) with stakeholders and 8 focus group discussions (FGDs) with 55 learners aged ≥ 15, were conducted between March and October 2018. Learners < 18 were given assent and parental consent forms, whilst those ≥ 18 could consent of their own accord. KIIs and FGDs were conducted in private venues in the preferred language by trained interviewers and audio-recorded. Audio files were transcribed verbatim and translated into English if needed. Data were analysed thematically using NVivo version 11. Results The findings from both stakeholders and learners indicate many critical accessibility barriers which include: negative healthcare staff attitudes from older judgemental staff; stigmatisation from healthcare workers, the community as well as family; a lack of private consulting spaces and no confidentiality of patient information at facilities; inconvenient clinic operating times; long queues and facility resource issues. Both groups of participants suggested that accessibility to healthcare could be improved through value-added services (including free Wi-Fi and food), social gatherings and educational information sessions, as well as being staffed by younger, friendlier, confidential and non-judgemental staff in a private healthcare setting. Conclusion It is clear that there are many critical barriers that deter learners from accessing HIV and contraceptive services. Provision of private rooms and trying to ensure information confidentiality for youth-friendly services at locations and times that can be easily accessed by learners is key. Greater emphasis on learner-parent-teacher communication around sexual health education at school is needed along with making this information being more readily available to learners.
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Olorunmoteni OE, Fehintola FO, Seun-Fadipe C, Komolafe MA, Mosaku KS. Sleep quality and its relationship with school schedules and mental health of Nigerian secondary school adolescents. J Clin Sleep Med 2023; 19:1895-1904. [PMID: 37421328 PMCID: PMC10620664 DOI: 10.5664/jcsm.10708] [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: 12/15/2022] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVES This study aimed to determine the sleep quality of in-school Nigerian adolescents and its association with their schooling and mental health outcomes. METHODS The study was a descriptive cross-sectional study. It was conducted among adolescents attending public and private secondary schools within the Ife Central Local Government, Osun State, southwestern Nigeria. A multistage sampling technique was used to select study participants. The Pittsburgh Sleep Quality Index, 9-item Patient Health Questionnaire (PHQ-9), and 7-item General Anxiety Disorder questionnaires were used to determine sleep quality, depression, and anxiety, respectively. RESULTS We studied 448 adolescents aged between 10 and 19 years with a mean age of 15.0 ± 1.8 years. The majority of our respondents (85.0%) had poor sleep quality. More than half of the respondents (55.1%) had insufficient sleep during weekdays, while only 34.8% had insufficient sleep during weekends. The school closing time and school type showed a statistically significant association with sleep quality (P = .039 and .005, respectively). The odds of having poor sleep quality increased by 2-fold among adolescents in private schools when compared with those in public schools (adjusted odds ratio = 1.97, 95% confidence interval = 1.069-3.627). Using multiple linear regression, only depression showed a statistically significant association with sleep quality at 95% confidence interval (CI = 0.073 to 0.219, P < .001), such that for every unit change in depression scores (PHQ-9), there will be a corresponding increase of 0.103 in sleep quality. CONCLUSIONS Sleep quality is poor in adolescents and adversely associated with their mental health. This should also be addressed in the development of appropriate interventions. CITATION Olorunmoteni OE, Fehintola FO, Seun-Fadipe C, Komolafe MA, Mosaku KS. Sleep quality and its relationship with school schedules and mental health of Nigerian secondary school adolescents. J Clin Sleep Med. 2023;19(11):1895-1904.
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Affiliation(s)
| | - Funmito Omolola Fehintola
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Olorunmoteni OE, Gómez-Olivé FX, Popoola BO, Fatusi AO, Scheuermaier K. Adolescent sleep health in Africa: a scoping review protocol. BMJ Open 2023; 13:e067373. [PMID: 37591652 PMCID: PMC10441092 DOI: 10.1136/bmjopen-2022-067373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Problematic sleep is a major threat to health and quality of life among adolescents. Hence, to provide directions for research and interventions, there is a need to examine the literature on adolescent sleep health in Africa. However, available studies on adolescent sleep health in Africa have not been properly mapped. Thus, this scoping review aims to investigate the extent and type of available evidence concerning sleep health among adolescents in Africa and to highlight the relationship of adolescent sleep health with adverse mental health outcomes and cardiometabolic risk factors. The review will further highlight areas of agreement and controversies on adolescent sleep health, and identify evidence gaps that require research attention across the continent. METHODS AND ANALYSIS This scoping review will be conducted using Arksey and O'Malley's six-step procedure. Thus, we have prepared this protocol according to the framework for scoping reviews developed by the Joanna Briggs Institute. To identify eligible studies, we will search MEDLINE, Scopus, PsycINFO, AJOL, JSTOR, HINARI and Google Scholar. The review will include all published articles in English, French, Spanish, Portuguese and Italian languages on adolescent sleep health in Africa from the inception of the databases, while relevant information will be extracted from included studies using an adapted data extraction tool. The results will be presented using tables and charts as appropriate. ETHICS AND DISSEMINATION The scoping review does not require ethical approval because the publications to be used for the review are publicly available and the study does not involve contact with humans or other animals as research participants. Furthermore, clinical records will not be used for the study. Upon completion, findings from the study will be disseminated through presentations at scientific meetings and publication in a relevant peer-reviewed journal. SCOPING REVIEW REGISTRATION Open Science Framework (https://osf.io/5sjwq/).
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Affiliation(s)
- Oluwatosin Eunice Olorunmoteni
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Health and Health Transitions Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Adesegun Olayiwola Fatusi
- Department of Community Medicine, University of Medical Sciences, Ondo, Nigeria
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Karine Scheuermaier
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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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Hirose N, Sanmei C, Okamoto M, Madeni FE, Madeni N, Teshima A, Ando Y, Takahama K, Yoshikawa M, Kunimoto Y, Shimpuku Y. Associated factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy among early and late adolescents in Tanzania: a cross-sectional study. Reprod Health 2023; 20:44. [PMID: 36918903 PMCID: PMC10012580 DOI: 10.1186/s12978-023-01583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Adolescent pregnancy is a serious reproductive health problem in Tanzania. However, the risk factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy in Tanzanian adolescents remain unexplored. METHODS We collected baseline characteristics and information on attitudes and behaviors of reproductive health from 4161 Tanzanian adolescents in all 54 primary and secondary schools in the Korogwe district. We applied mixed effect multiple regression analyses stratified by sex to find the factors related to reproductive health attitudes and behaviors toward pregnancy. RESULTS In female students, regarding the attitudes of reproductive health, higher age, hope for marriage in the future, a talk with a parent about sex or pregnancy, and a higher hope score were significantly associated with a lower score. For the behaviors of reproductive health, higher age, a talk with a parent about sex or pregnancy, time to talk with a parent about daily life, and a higher hope score were significantly associated with a lower score. In male students, regarding the attitudes of reproductive health, a higher hope score was significantly associated with a lower score. For the behaviors of reproductive health, higher age, time to talk with a parent about daily life, and a higher hope score was significantly associated with a lower score. CONCLUSIONS The heterogeneous factor-outcomes association between female and male students suggested that sex-specialized interventions may be required to change their risky attitudes or behaviors of reproductive health. Although we cannot conclude as points of intervention, our study suggested that it may be practical to improve parent-adolescents communication about sex or reproductive health and change adolescents' views of pregnancy or marriage for gaining financial or social status.
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Affiliation(s)
- Naoki Hirose
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan.
| | - Chen Sanmei
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | | | | | | | - Ayaka Teshima
- Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Yasunobu Ando
- National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | | | | | - Yu Kunimoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Yoko Shimpuku
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan
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Musindo O, Jafry S, Nyamiobo J, Becker KD, Gellatly R, Maloy C, Lozano-Ruiz A, Romero-Gonzalez B, Kola L, Merali Z, Chorpita BF, Kumar M. Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10-24 years) in sub-Saharan Africa: a systematic scoping review. EClinicalMedicine 2023; 57:101835. [PMID: 36874395 PMCID: PMC9981905 DOI: 10.1016/j.eclinm.2023.101835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023] Open
Abstract
Background Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature. Methods We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627. Findings Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review. Interpretation Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population. Funding MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.
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Affiliation(s)
- Otsetswe Musindo
- Department of Clinical, Neuro- & Developmental Psychology, Vrije University, Amsterdam, Netherlands
| | - Sheharbano Jafry
- Department of Global Health, University of Washington Seattle, USA
| | - Joseph Nyamiobo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Kimberly D. Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Caitlin Maloy
- Health Sciences Library, University of Washington Seattle, USA
| | - Alvaro Lozano-Ruiz
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Borja Romero-Gonzalez
- Department of Psychology, Faculty of Education, University of Valladolid, Valladolid, Spain
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Grosso A, Berg L, Rucinski K, Rao A, Djaló MA, Diouf D, Baral S. Sexual and Reproductive Health Service Needs Associated with Underage Initiation of Selling Sex among Adult Female Sex Workers in Guinea-Bissau. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12715. [PMID: 36232014 PMCID: PMC9566000 DOI: 10.3390/ijerph191912715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To assess the prevalence and predictors of underage initiation of selling sex among female sex workers (FSW) in Guinea-Bissau. METHODS 505 adult FSW recruited using respondent-driven sampling were surveyed in 2017. Multivariable logistic regression was used to identify demographic, behavioral, and psychosocial characteristics associated with initiation of selling sex while underage (<18 years). RESULTS A total of 26.3% (133/505) of FSW started selling sex before age 18. Underage initiation of selling sex was associated with experiencing forced sex before age 18 (adjusted odds ratio (aOR): 6.74; 95% confidence interval (CI): 2.05-22.13), and never being tested for HIV (aOR: 0.43; 95% CI: 0.20-0.91). Despite having lower odds of wanting to have children or more children (aOR: 0.31; 95% CI: 0.17-0.56), FSW who started selling sex while underage had lower odds of using highly effective contraception such as implants (aOR: 0.43; 95% CI: 0.24-0.77). Among those who were ever pregnant, a lower percentage of FSW who started selling sex while underage accessed antenatal care (56.6% vs. 74.7%, p = 0.008). CONCLUSIONS These data suggest that early initiation of selling sex among adult FSW in Guinea-Bissau is common. Social services for youth and integrated HIV and reproductive health services are critical to address the persisting sexual and reproductive health needs of FSW who started selling sex while underage.
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Affiliation(s)
- Ashley Grosso
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ 07102, USA
- Center for Population Behavioral Health, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ 08901, USA
| | - Lindsay Berg
- Center for Population Behavioral Health, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ 08901, USA
| | - Katherine Rucinski
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Atwijukiire H, Nakidde G, Otwine AT, Kabami J. Experiences of HIV Positive Serostatus Disclosure to Sexual Partner Among Individuals in Discordant Couples in Mbarara City, Southwestern Uganda. HIV AIDS (Auckl) 2022; 14:231-242. [PMID: 35615114 PMCID: PMC9124813 DOI: 10.2147/hiv.s361898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Disclosure of HIV status is key in HIV management. Despite many studies on serostatus disclosure, there is a gap in experiences regarding HIV status disclosure among discordant couples. The current study addressed this research gap, and explored the lived experiences of serostatus disclosure among discordant couples in Mbarara City, South Western Uganda. Participants and Methods We conducted 12 in-depth interviews with the help of a translated interview guide, and they were audio recorded. Participants were purposively enrolled in the study, which employed a phenomenological qualitative design. The study was conducted at three public health facilities in Mbarara City. The data was analyzed using thematic content analysis. Approval for this research was obtained from the Mbarara University Research Ethics Committee (MUST-REC) and administrative clearance from the city clerk of Mbarara City. Results The mean age of the participants was 38 years old, ranging from 20 to 67 years. An equal number of males (six) and females participated in this study. Most of them had at least secondary level education, and only three had primary education. Half of the participants disclosed their serostatus to partners immediately after testing HIV positive. Key emerging themes as experienced benefits of HIV serostatus disclosure included: 1) social support and care; 2) decisions regarding health, fertility, and child bearing; 3) sharing information on HIV prevention and protection measures; 4) positive living; and 5) ease of HIV serostatus disclosure. The challenges associated with serostatus disclosure were summarized as one theme: misunderstandings in the families of the discordant couples. Conclusion Socially, psychologically and financially HIV positive individuals have benefited from their negative partners. Healthwise, they have been supported, and cared for after disclosing their positive status, but some have faced challenges, such as family misunderstandings. Couple HIV counseling and testing by a trained health worker is beneficial in HIV care and could mitigate the challenges related HIV serostatus disclosure.
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Affiliation(s)
- Humphrey Atwijukiire
- Nursing Department, Bishop Stuart University, Mbarara, Uganda
- Correspondence: Humphrey Atwijukiire, Email
| | - Gladys Nakidde
- Nursing Department, Bishop Stuart University, Mbarara, Uganda
| | | | - Jane Kabami
- Department of Nursing and Midwifery, Kabale University, Kabale, Uganda
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Okonji EF, Wyk BV, Mukumbang FC. Two-year retention in care for adolescents on antiretroviral therapy in Ehlanzeni district, South Africa: a baseline cohort analysis. AIDS Care 2022; 35:374-384. [PMID: 35357245 DOI: 10.1080/09540121.2022.2057409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescents living with HIV (ALHIV) struggle to remain engaged in HIV-related care and adhere to antiretroviral treatment (ART) due to a myriad of physical, psychological and cognitive-developmental challenges. We report on the profile of ALHIV aged 10-19 years on ART and the clinical factors associated with their retention in care. A retrospective cohort analysis was conducted with 16,108 ALHIV, aged 10-19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Anonymised data were obtained from electronic medical records (Tier.net). Trends in retention in care among adolescents on ART was described using Kaplan-Meier survival estimates. Cox proportional analysis was performed to identify factors associated with retention in care over 2 years. More than half (53%) were females, and median duration on ART was 8 months. Retention in care among adolescents at months 6, 12, 18 and 24 was 90.5%, 85.4%, 80.8% and 76.2%, respectively. After controlling for confounders, risk of dying or lost to follow up increased for female adolescents (aHR = 1.28, 95% CI 1.10-1.49); being initiated on ART while pregnant (aHR = 2.72, 95% CI 1.99-3.69); history of TB infection (aHR = 1.71, 95% CI 1.10-2.65); and started ART at age 10-14 years (aHR = 2.45, 95% CI 1.96-3.05), and 15-19 years (aHR = 9.67, 95% CI 7.25-12.89). Retention in care among adolescents on ART over two-year period was considerably lower than the UNAIDS 2030 target of 95%. Of particular concern for intervention is the lower rates of retention in care among females and pregnant adolescents and starting ART between the ages of 10 and 19 years. Family or caregivers and peer support groups centred interventions designed to promote early initiation and retention in care through early case identification are needed.
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Affiliation(s)
- Emeka F Okonji
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Brian Van Wyk
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.,Department of global Health, School of Medicine, University of Washington, Seattle, WA, USA
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12
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Cockcroft A, Omer K, Gidado Y, Mohammed R, Belaid L, Ansari U, Mitchell C, Andersson N. Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e36060. [PMID: 35289762 PMCID: PMC8965671 DOI: 10.2196/36060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adolescents (10-19 years) are a big segment of the Nigerian population, and they face serious risks to their health and well-being. Maternal mortality is very high in Nigeria, and rates of pregnancy and maternal deaths are high among female adolescents. Rates of HIV infection are rising among adolescents, gender violence and sexual abuse are common, and knowledge about sexual and reproductive health risks is low. Adolescent sexual and reproductive health (ASRH) indicators are worse in the north of the country. Objective In Bauchi State, northern Nigeria, the project will document the nature and extent of ASRH outcomes and risks, discuss the findings and codesign solutions with local stakeholders, and measure the short-term impact of the discussions and proposed solutions. Methods The participatory research project is a sequential mixed-methods codesign of a pragmatic cluster randomized controlled trial. Focus groups of local stakeholders (female and male adolescents, parents, traditional and religious leaders, service providers, and planners) will identify local priority ASRH concerns. The same stakeholder groups will map their knowledge of factors causing these concerns using the fuzzy cognitive mapping (FCM) technique. Findings from the maps and a scoping review will inform the contextualization of survey instruments to collect information about ASRH from female and male adolescents and parents in households and from local service providers. The survey will take place in 60 Bauchi communities. Adolescents will cocreate materials to share the findings from the maps and survey. In 30 communities, randomly allocated, the project will engage adolescents and other stakeholders in households, communities, and services to discuss the evidence and to design and implement culturally acceptable actions to improve ASRH. A follow-up survey in communities with and without the intervention will measure the short-term impact of these discussions and actions. We will also evaluate the intervention process and use narrative techniques to assess its impact qualitatively. Results Focus groups to explore ASRH concerns of stakeholders began in October 2021. Baseline data collection in the household survey is expected to take place in mid-2022. The study was approved by the Bauchi State Health Research Ethics Committee, approval number NREC/03/11/19B/2021/03 (March 1, 2021), and by the Faculty of Medicine and Health Sciences Institutional Review Board McGill University (September 13, 2021). Conclusions Evidence about factors related to ASRH outcomes in Nigeria and implementation and testing of a dialogic intervention to improve these outcomes will fill a gap in the literature. The project will document and test the effectiveness of a participatory approach to ASRH intervention research. Trial Registration ISRCTN Registry ISRCTN18295275; https://www.isrctn.com/ISRCTN18295275 International Registered Report Identifier (IRRID) DERR1-10.2196/36060
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Affiliation(s)
- Anne Cockcroft
- Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
| | - Khalid Omer
- Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women's Associations of Nigeria, Bauchi, Nigeria
| | - Rilwanu Mohammed
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Loubna Belaid
- Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Umaira Ansari
- Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
| | - Claudia Mitchell
- Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Neil Andersson
- Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
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Obiezu-Umeh C, Nwaozuru U, Mason S, Gbaja-Biamila T, Oladele D, Ezechi O, Iwelunmor J. Implementation Strategies to Enhance Youth-Friendly Sexual and Reproductive Health Services in Sub-Saharan Africa: A Systematic Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684081. [PMID: 36304027 PMCID: PMC9580831 DOI: 10.3389/frph.2021.684081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Youth-friendly health service (YFHS) interventions are a promising, cost-effective approaches to delivering sexual and reproductive services that cater to the developmental needs of young people. Despite a growing evidence-base, implementation of such interventions into practice have proven to be challenging in sub-Saharan Africa (SSA). Thus, the purpose of this review is to synthesize existing evidence on YFHS implementation in SSA and understand which implementation strategies were used, in what context, how they were used, and leading to which implementation outcomes. Methods: A comprehensive literature search in PubMed, Embase, Scopus, and CINAHL, was conducted to identify peer-reviewed research articles published from database inception up until August 2020. Eligible studies were required to include young people (ages 10–24 years) in sub-Saharan Africa. Studies that described implementation strategies, as conceptualized by the Expert Recommendations for Implementing Change (ERIC) project, used to enhance the implementation of YFHS were included. Implementation outcomes were extracted using Proctor and colleagues' 8 taxonomy of implementation outcomes. Results: We identified 18 unique interventions (reported in 23 articles) from an initial search of 630 articles, including seven from East Africa, seven from South Africa, and four from West Africa. In most studies (n = 15), youth-friendly health services were delivered within the context of a health facility or clinic setting. The most frequently reported categories of implementation strategies were to train and educate stakeholders (n = 16) followed by infrastructure change (n = 10), to engage consumers (n = 9), the use of evaluative and iterative strategies (n = 8), support clinicians (n = 8), and providing interactive assistance (n = 6). The effectiveness of the strategies to enhance YFHS implementation was commonly measured using adoption (n = 15), fidelity (n = 7), acceptability (n = 5), and penetration (n = 5). Few studies reported on sustainability (n = 2), appropriateness (n = 1), implementation cost (n = 1) and feasibility (n = 0). Conclusion: Results of the review emphasize the need for further research to evaluate and optimize implementation strategies for promoting the scale-up and sustainability of evidence-based, YFHS interventions in resource-constrained settings. This review also highlights the need to design robust studies to better understand which, in what combination, and in what context, can implementation strategies be used to effectively enhance the implementation of YFHS interventions.
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Affiliation(s)
- Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Stacey Mason
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Titilola Gbaja-Biamila
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - David Oladele
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- *Correspondence: Juliet Iwelunmor
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Mwoka M, Ajayi AI, Kibunja G, Cheruiyot C, Ouedraogo R, Juma K, Igonya EK, Opondo W, Otukpa E, Kabiru C, Ushie BA. Cocreated regional research agenda for evidence-informed policy and advocacy to improve adolescent sexual and reproductive health and rights in sub-Saharan Africa. BMJ Glob Health 2021; 6:bmjgh-2021-005571. [PMID: 33811099 PMCID: PMC8023722 DOI: 10.1136/bmjgh-2021-005571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Meggie Mwoka
- Policy Engagement and Communications, African Population and Health Research Center, Nairobi, Kenya
| | - Anthony Idowu Ajayi
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Grace Kibunja
- Policy Engagement and Communications, African Population and Health Research Center, Nairobi, Kenya
| | - Collins Cheruiyot
- Policy Engagement and Communications, African Population and Health Research Center, Nairobi, Kenya
| | - Ramatou Ouedraogo
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Juma
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Emmy Kageha Igonya
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Winnie Opondo
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Emmanuel Otukpa
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline Kabiru
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics & Sexual and Reproductive Health and Rights, African Population and Health Research Center, Nairobi, Kenya
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