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Ferretti A, Adjei KK, Ali J, Atuire C, Ayuk BT, Banougnin BH, Cengiz N, Gichoya J, Jjingo D, Juma DO, Kotze W, Krubiner C, Littler K, McCradden MD, Moodley K, Naidoo M, Nair G, Obeng-Kyereh K, Oliver K, Ralefala D, Toska E, Wekesah FM, Wright J, Vayena E. Digital tools for youth health promotion: principles, policies and practices in sub-Saharan Africa. Health Promot Int 2024; 39:daae030. [PMID: 38558241 PMCID: PMC10983781 DOI: 10.1093/heapro/daae030] [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] [Indexed: 04/04/2024] Open
Abstract
Although digital health promotion (DHP) technologies for young people are increasingly available in low- and middle-income countries (LMICs), there has been insufficient research investigating whether existing ethical and policy frameworks are adequate to address the challenges and promote the technological opportunities in these settings. In an effort to fill this gap and as part of a larger research project, in November 2022, we conducted a workshop in Cape Town, South Africa, entitled 'Unlocking the Potential of Digital Health Promotion for Young People in Low- and Middle-Income Countries'. The workshop brought together 25 experts from the areas of digital health ethics, youth health and engagement, health policy and promotion and technology development, predominantly from sub-Saharan Africa (SSA), to explore their views on the ethics and governance and potential policy pathways of DHP for young people in LMICs. Using the World Café method, participants contributed their views on (i) the advantages and barriers associated with DHP for youth in LMICs, (ii) the availability and relevance of ethical and regulatory frameworks for DHP and (iii) the translation of ethical principles into policies and implementation practices required by these policies, within the context of SSA. Our thematic analysis of the ensuing discussion revealed a willingness to foster such technologies if they prove safe, do not exacerbate inequalities, put youth at the center and are subject to appropriate oversight. In addition, our work has led to the potential translation of fundamental ethical principles into the form of a policy roadmap for ethically aligned DHP for youth in SSA.
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Affiliation(s)
- Agata Ferretti
- Health Ethics and Policy Lab, ETH Zurich, Hottingerstrasse 10, 8092 Zurich, Switzerland
| | - Kwame K Adjei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Ghana
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD 21205, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Caesar Atuire
- Department of Philosophy and Classics, University of Ghana, MR26+9PV, W.E.B. Dubois Road, Accra, Ghana
- Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7BN, UK
| | - Betrand Tambe Ayuk
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, 574W+49W, Buea, Cameroon
| | - Boladé Hamed Banougnin
- United Nations Population Fund, West and Central Africa Regional Office, PFQM+RVF, Route des Almadies, Dakar, Senegal
- Centre for Social Science Research, University of Cape Town, 12 University Avenue South, Rondebosch, Cape Town 7700, South Africa
| | - Nezerith Cengiz
- Department of Medicine, Faculty of Medicine and Health Sciences, Division for Medical Ethics and Law, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Judy Gichoya
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, 8HMC+PF5, Kampala, Uganda
| | | | - Wiaan Kotze
- Faculty of Medicine and Health Science, Stellenbosch University, Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
| | | | - Katherine Littler
- Health Ethics & Governance Unit, Research for Health Department, Science Division, WHO, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Melissa D McCradden
- Department of Bioethics, Genetics & Genome Biology, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Keymanthri Moodley
- Department of Medicine, Faculty of Medicine and Health Sciences, Division for Medical Ethics and Law, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Meshandren Naidoo
- Howard College, School of Law, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
| | - Gonasagrie Nair
- Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town 7915, South Africa
| | - Kingsley Obeng-Kyereh
- Children and Youth in Broadcasting—Curious Minds, 3 Damba Close, Chaban-Sakaman, Accra, Ghana
| | - Kedebone Oliver
- Genesis Analytics, Health Practice Area, 50 6th Road, Hyde Park, Johannesburg 2196, South Africa
| | - Dimpho Ralefala
- Office of Research and Development, University of Botswana, 4775 Notwane Road, Gaborone, Botswana
| | - Elona Toska
- Faculty of Humanities, Centre for Social Science Research, University of Cape Town, 12 University Avenue, Rondebosch, Cape Town 7700, South Africa
| | - Frederick M Wekesah
- African Population and Health Research Center, APHRC Headquarters, Kitisuru, Nairobi, Kenya
| | - Jonty Wright
- Faculty of Medicine and Health Science, Stellenbosch University, Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
| | - Effy Vayena
- Health Ethics and Policy Lab, ETH Zurich, Hottingerstrasse 10, 8092 Zurich, Switzerland
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Onono MA, Frongillo EA, Sheira LA, Odhiambo G, Wekesa P, Conroy AA, Cohen CR, Bukusi EA, Weiser SD. Links between Household-Level Income-Generating Agricultural Intervention and the Psychological Well-Being of Adolescent Girls in Human Immunodeficiency Virus-Affected Households in Southwestern Kenya: A Qualitative Inquiry. J Nutr 2023; 153:3595-3603. [PMID: 37863268 PMCID: PMC10739770 DOI: 10.1016/j.tjnut.2023.10.008] [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: 04/05/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Adolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity. OBJECTIVES This study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya. METHODS We conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose. RESULTS We found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm. CONCLUSIONS This study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically. This trial was registered at clinicaltrials.gov as NCT03741634.
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Affiliation(s)
- Maricianah A Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States.
| | - Lila A Sheira
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Amy A Conroy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States
| | - Craig R Cohen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
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Theron L, Höltge J, Ungar M. Multisystemic supports and adolescent resilience to depression over time: A South African mixed methods study. Dev Psychopathol 2023; 35:2365-2383. [PMID: 37144408 DOI: 10.1017/s0954579423000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In sub-Saharan countries, like South Africa, there is scant understanding of adolescent resilience to depression over time; the multisystemic resource combinations that support such resilience; and whether more diverse resource combinations yield better mental health dividends. In response, we conducted a longitudinal concurrent nested mixed methods study with 223 South African adolescents (mean age: 17.16 years, SD = 1.73; 64.60% girls; 81.60% Black). Using longitudinal mixture modeling, the quantitative study identified trajectories of depression and associations between trajectory membership and resource diversity. Using a draw-and-write methodology and reflexive thematic analyses, the qualitative study explored the resource diversity associated with each trajectory. Taken together, these studies identified four depression trajectories (Stable Low; Declining; Worsening; Chronic High) with varying resource diversity at baseline and over time. Resource diversity was inclusive of personal, relational, contextual, and culturally valued resources in both the Stable Low and Declining trajectories, with emphasis on relational supports. Personal resources were emphasized in the Worsening and Chronic High trajectories, and culturally valued and contextual resources de-emphasized. In summary, resource constellations characterized by within and across system diversity and cultural responsiveness are more protective and will be key to advancing sub-Saharan adolescent mental health.
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Affiliation(s)
- Linda Theron
- Department of Educational Psychology, University of Pretoria, Pretoria, South Africa
| | - Jan Höltge
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Michael Ungar
- Resilience Research Centre, Dalhousie University, Halifax, Canada
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Bandeira M, Graham MA, Ebersöhn L. The significance of feeling safe for resilience of adolescents in sub-Saharan Africa. Front Psychol 2023; 14:1183748. [PMID: 37663363 PMCID: PMC10469746 DOI: 10.3389/fpsyg.2023.1183748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Adolescents in sub-Saharan Africa (SSA) are exposed to several challenges and risk factors, linked to historical legacies. Sub-Saharan Africa has one of the highest rates of poverty and inequality in the world, is one of the regions most negatively affected by climate change, performs poorly on many health measures, and has high rates of different forms of violence, especially gender-based violence. These contextual challenges impact adolescent mental health outcomes, preventing them to access resilience-enabling pathways that support positive outcomes despite adversity. This study aimed to contribute to knowledge generation on resilience of young people in the understudied SSA region by investigating which variables directly (or indirectly) affect the resilience of adolescents. Methods Purposive sampling was used to collect quantitative survey data from 3,312 adolescents (females = 1,818; males = 1,494) between the ages of 12 and 20 years, participating in interventions implemented by a non-governmental organization, the Regional Psychosocial Support Initiative. Data were collected in Angola (385, 11.6%), Eswatini (128, 3.9%), Kenya (390, 11.8%), Lesotho (349, 10.5%), Mozambique (478, 14.4%), Namibia (296, 8.9%), South Africa (771, 23.3%), Uganda (201, 6.1%), and Zambia (314, 9.5%). The survey collected data on socio-demographic status, resilience (CYRM-R), depression (PHQ-9), self-esteem (Rosenberg Self-Esteem Scale) and feelings of safety (self-developed scale). Mental health was defined as lower levels of depression, higher levels of self-esteem and higher levels of feeling safe. A mediation analysis was conducted to investigate the relationship between the predictors (the socio-demographic variables) and the output (resilience), with the mediators being depression, self-esteem and feeling safe (which all link to mental health). Results This study contributes to a gap in knowledge on country-level comparative evidence on significant predictors that impact resilience outcomes (directly or indirectly) for adolescents in sub-Saharan African countries. The results indicate that, when considering all countries collectively, feeling safe is the only predictor that has a significant direct effect on overall resilience and personal resilience, but not on caregiver resilience. When considering each country separately, feeling safe has a direct effect on overall, personal and caregiver resilience for all countries; but not for South Africa and Mozambique. Discussion The results provide evidence on which to craft youth development interventions by measuring mediators (depression, self-esteem and feeling safe) and resilience for adolescents in sub-Saharan Africa. The overall results of the present paper point toward a contextually relevant pathway to supporting their resilience, namely, the need to systemically target the creation and/or strengthening of structures that enable adolescents to feel safe.
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Affiliation(s)
- Monica Bandeira
- Centre for the Study of Resilience and Department of Educational Psychology University of Pretoria, Pretoria, South Africa
| | - Marien A. Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, Pretoria, South Africa
| | - Liesel Ebersöhn
- Centre for the Study of Resilience and Department of Educational Psychology University of Pretoria, Pretoria, South Africa
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Chamdimba E, Kabiru CW, Ushie BA, Munthali A, Thakwalakwa C, Ajayi AI. Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi. Reprod Health 2023; 20:114. [PMID: 37544984 PMCID: PMC10404372 DOI: 10.1186/s12978-023-01655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Pregnancy and childbearing in adolescence could negatively affect girls' health and socio-economic wellbeing across the life course. Previous studies on drivers of adolescent pregnancy in Africa have not fully considered the perspectives of parents/guardians vis-à-vis pregnant and parenting adolescents. Our study addresses this gap by examining pregnant and parenting adolescents' and parents/guardians' narratives about factors associated with early and unintended pregnancy. METHODOLOGY The descriptive study draws on qualitative data collected as part of a larger mixed-methods cross-sectional survey on the lived experiences of pregnant and parenting adolescents. Data were collected between March and May 2021 in Blantyre, Malawi, using semi-structured interview guides. We interviewed 18 pregnant and parenting adolescent girls, 10 parenting adolescent boys, and 16 parents/guardians of pregnant and parenting adolescents. Recorded interviews were transcribed verbatim into the English language by bilingual transcribers. We used the inductive-thematic analytical approach to summarize the data. FINDINGS The data revealed several interconnected and structural reasons for adolescents' vulnerability to early and unintended pregnancy. These include adolescents' limited knowledge and access to contraceptives, poverty, sexual violence, school dropout, COVID-19 school closures, and being young and naively engaging in unprotected sex. While some parents agreed that poverty and school dropout or COVID-19 related school closure could lead to early pregnancies, most considered stubbornness, failure to adhere to abstinence advice and peer influence as responsible for adolescent pregnancies. CONCLUSION Our findings contribute to the evidence on the continued vulnerability of girls to unintended pregnancy. It highlights how parents and adolescents hold different views on reasons for early and unintended pregnancy, and documents how divergent views between girls and their parents may contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unintended pregnancies will require altering community attitudes about young people's use of contraceptives and engaging parents, education sector, civil society organizations and community and religious leaders to develop comprehensive sexuality education programs to empower in- and out-of school adolescents.
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Affiliation(s)
- Elita Chamdimba
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Alister Munthali
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | | | - Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Casale M, Somefun O, Haupt Ronnie G, Desmond C, Sherr L, Cluver L. A conceptual framework and exploratory model for health and social intervention acceptability among African adolescents and youth. Soc Sci Med 2023; 326:115899. [PMID: 37087974 DOI: 10.1016/j.socscimed.2023.115899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
Intervention acceptability has become an increasingly key consideration in the development, evaluation and implementation of health and social interventions. However, to date this area of investigation has been constrained by the absence of a consistent definition of acceptability, comprehensive conceptual frameworks disaggregating its components, and few reliable assessment measures. This paper aims to contribute to this gap, by proposing a conceptual framework and exploratory model for acceptability with a specific priority population for health and developmental interventions: adolescents and youth in Africa. We document our multi-staged approach to model development, comprising both inductive and deductive components, and both systematic and interpretative review methods. This included thematic analyses of respective acceptability definitions and findings, from 55 studies assessing acceptability of 60 interventions conducted with young people aged 10-24 in (mainly Southern and Eastern) Africa over a decade; a consideration of these findings in relation to Sekhon et al.'s Theoretical Framework of Acceptability (TFA); a cross-disciplinary review of acceptability definitions and models; a review of key health behavioural change models; and expert consultation with interdisciplinary researchers. Our proposed framework incorporates nine component constructs: affective attitude, intervention understanding, perceived positive effects, relevance, perceived social acceptability, burden, ethicality, perceived negative effects and self-efficacy. We discuss the rationale for the inclusion and definition of each component, highlighting key behavioural models that adopt similar constructs. We then extend this framework to develop an exploratory model for acceptability with young people, that links the framework components to each other and to intervention engagement. Acceptability is represented as an emergent property of a complex, adaptive system of interacting components, which can influence user engagement directly and indirectly, and in turn be influenced by user engagement. We discuss opportunities for applying and further refining or developing these models, and their value as a point of reference for the development of acceptability assessment tools.
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Affiliation(s)
- Marisa Casale
- School of Public Health, University of the Western Cape, Cape Town, South Africa; Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford, United Kingdom.
| | - Oluwaseyi Somefun
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, South Africa
| | | | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford, United Kingdom; Dept of Psychiatry and Mental Health, University of Cape Town, South Africa
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Negash WD, Eshetu HB, Asmamaw DB. Intention to use contraceptives and its correlates among reproductive age women in selected high fertility sub-saharan Africa countries: a multilevel mixed effects analysis. BMC Public Health 2023; 23:257. [PMID: 36747157 PMCID: PMC9901088 DOI: 10.1186/s12889-023-15187-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Intention to use contraceptive methods has an overriding importance to better visualize the women's future needs and more likely to translate it to actual behavior. It is therefore important to identify the motivating correlates such as education, women empowerment, as well as deterring factors like fear of side effects, infertility after contraceptive use, lack of knowledge regarding family planning methods among married women in countries with high fertility rates in sub-Saharan Africa. This helps to control family size, unintended pregnancies, and poor health outcomes for infants and mothers. METHODS A secondary data analysis was performed using the recent Demographic and Health Surveys. A total weighted sample of 178,875 reproductive age women was included in this study. A multilevel mixed-effect binary logistic regression model was fitted. The odds ratios along with the 95% confidence interval were generated to identify the correlates of the intention to use contraceptives. A p-value less than 0.05 was declared as statistical significance. RESULTS Overall, the intention to use contraception was 37.66% (95% CI, 37.44, 37.88). Whereas, the proportion of women who intend to use contraception was 59.20%, 53.30%, 42.32%, 37.88%, 37.63%, 35.25%, 31.32%, 20.64%, 20.30% in Burkina Faso, Burundi, Niger, Mali, DR. Congo, Nigeria, Angola, Gambia, and Chad respectively. Age; 15-24 (AOR = 3.72, 95% CI, 3.58, 3.86) and 25 - 24 years (AOR = 2.81, 95% CI, 2.74, 2.89), education of women; primary (AOR = 1.16, 95% CI, 1.13, 1.20), and secondary (AOR = 1.32, 95% CI, 1.27, 1.37), wealth index; middle (AOR = 1.15, 95% CI, 1.12, 1.18), rich (AOR = 1.28, 95% CI, 1.24, 1.32), number of living children 1-2 (AOR = 1.42, 95% CI, 1.37, 1.48), 3 or more (AOR = 1.77, 95% CI, 1.69, 1.85), age at cohabitation ≥ 18years (AOR = 1.37, 95% CI, 1.33, 1.40), heard family planning messages in the media (AOR = 1.47, 95% CI, 1.43, 1.50), history of ever terminated pregnancy (AOR = 1.13, 95% CI, 1.09, 1.17) and perceived distance to the health facility as not big problem (AOR = 1.16, 95% CI, 1.13, 1.19) were the correlates of intention to use contraceptives. CONCLUSION The finding of the current study demonstrates that the intention of contraceptive use among reproductive age women in high fertility countries in SSA was relatively low as compared to previous studies. Thus, each national authority, especially in Chad and Gambia would be keen to know the level of contraceptive use intentions for their respective region, the drivers of contraceptive use intention and to map priorities for behavioral change. Any intervention strategy that promotes intention of contraceptive use should consider these factors for better success. Future researchers interested in the area should also address qualitative variables like socio-cultural factors, which might have an effect on intention of contraceptive use.
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Affiliation(s)
- Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, PO.Box.196, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, PO.Box.196, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ditshwane B, Mokgatle MM, Oguntibeju OO. Awareness, Utilization and Perception of Sexually Transmitted Infections Services Provided to Out-of-School-Youth in Primary Health Facilities in Tshwane, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031738. [PMID: 36767123 PMCID: PMC9913921 DOI: 10.3390/ijerph20031738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Despite the availability of different health care initiatives and interventions, young people are still faced with barriers in accessing reproductive health care services; thus, they are exposed to health-related issues such as sexually transmitted infections. AIM To determine the awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in primary health facilities in the Tshwane district, Gauteng Province, South Africa. METHODS The study employed a quantitative, cross-sectional descriptive survey with a sample size of 219 to determine the level of awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in Tshwane district. RESULTS Out-of-school-youth between the ages of 18-24 years participated in the study. Most of the participants (90.8%, n = 199) were female. Service utilization was high in females compared to their male counterparts. There is availability of youth-friendly services in primary health care facilities, however, the level of service utilization among young people is still a challenge evidenced by 12.1% (n = 74) of participants who never sought treatment for STIs, although they had STI symptoms. Furthermore, 52.0% reported that they were not happy with the health services they received when they had STIs. These findings clearly indicate a gap in service delivery for young people regarding reproductive health issues; thus, the low health care seeking behavior among the youth. Condom use was 69.1% and/or inconsistently used among the youth; about 80% of the participants had low perceptions of the risk of contracting STIs. The self-reported risks of HIV and AIDS was 46.8%. Approximately 20% reported that they would not refuse to have sex if their partner did not want to use condoms. These findings showed risky behavior among the participants, and shows that the level of awareness about the risk of contracting STIs is still poor. CONCLUSIONS Irrespective of facilities with youth-friendly services, out-of-school-youth still display poor perceptions about sexually transmitted infections services due to health care providers' attitudes, limited resources, and working hours. Furthermore, the level of awareness regarding sexually transmitted infections is poor, hence the display of risky sexual behaviors.
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Affiliation(s)
- Boitumelo Ditshwane
- School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Matilda M. Mokgatle
- School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Oluwafemi O. Oguntibeju
- Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 3575, South Africa
- Correspondence: ; Tel.: +27-219538495
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Phiri M, Odimegwu C, Kalinda C. Unmet need for family planning among married women in sub-Saharan Africa: a meta-analysis of DHS data (1995 - 2020). Contracept Reprod Med 2023; 8:3. [PMID: 36627720 PMCID: PMC9832678 DOI: 10.1186/s40834-022-00198-5] [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: 12/08/2021] [Accepted: 10/26/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Closing the gap of unmet needs for family planning (FP) in sub-Saharan Africa remains critical in improving maternal and child health outcomes. Determining the prevalence of unmet needs for family planning among married women in the reproductive age is vital for designing effective sexual reproductive health interventions and programmes. Here, we use nationally representative data drawn from sub-Saharan countries to estimate and examine heterogeneity of unmet needs for family planning among currently married women of reproductive age. METHODS This study used secondary data from Demographic and Health Surveys (DHS) conducted between January 1, 1995 to December 31, 2020 from 37 countries in sub-Saharan African. An Inverse Heterogeneity model (IVhet) in MetaXL application was used to estimate country and sub-regional level pooled estimates and confidence intervals of unmet needs for FP in SSA. RESULTS The overall prevalence of unmet need for family planning among married women of reproductive age in the sub-region for the period under study was 22.9% (95% CI: 20.9-25.0). The prevalence varied across countries from 10% (95% CI: 10-11%) in Zimbabwe to 38% (95% CI: 35-40) and 38 (95% CI: 37-39) (I2 = 99.8% and p-value < 0.0001) in Sao Tome and Principe and Angola, respectively. Unmet needs due to limiting ranged from 6%; (95% CI: 3-9) in Central Africa to 9%; (95% CI: 8-11) in East Africa. On the other hand, the prevalence of unmet needs due to spacing was highest in Central Africa (Prev: 18; 95% CI: 16-21) and lowest in Southern Africa (Prev: 12%; 95% CI: 8-16). Our study indicates that there was no publication bias because the Luis Furuya-Kanamori index (0.79) was within the symmetry range of -1 and + 1. CONCLUSION The prevalence of unmet need for FP remains high in sub-Saharan Africa suggesting the need for health policymakers to consider re-evaluating the current SRH policies and programmes with the view of redesigning the present successful strategies to address the problem.
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Affiliation(s)
- Million Phiri
- grid.11951.3d0000 0004 1937 1135Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa ,grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Clifford Odimegwu
- grid.11951.3d0000 0004 1937 1135Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chester Kalinda
- grid.507436.30000 0004 8340 5635University of Global Health Equity, Bill and Joyce Cummings Institute of Global Health, KG 7 Ave., Kigali Heights, 5Th Floor, PO Box 6955, Kigali, Rwanda ,grid.16463.360000 0001 0723 4123School of Nursing and Public Health, Department of Public Health, University of KwaZulu-Natal, Howard College Campus, George Campbell Building, Durban, 4001 South Africa
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10
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Diop ZB, Bernays S, Tumwesige E, Asiimwe A, Kawuma R, Seeley J. Youth migration and access to health services in a trading centre in southern Uganda: A qualitative exploration. Glob Public Health 2023; 18:2191689. [PMID: 36973188 DOI: 10.1080/17441692.2023.2191689] [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: 03/29/2023]
Abstract
Impeded access to health services is a major factor influencing migrant health. In Uganda, previous research has shown lower utilisation of health services for young rural-urban migrants compared to their non-migrant counterparts. However, access to health services does not start at utilisation, but can be hampered by being able to identify a need for care. Using qualitative methods, we aimed to explore young rural-urban migrants' perceptions of health and patterns of engagement with health services. We analysed, using thematic analysis, a purposive sample of 18 in-depth interviews with 10 young people who had recently migrated within Uganda. Our results are presented through a framework conceptualising access at the intersection between abilities of people and characteristics of services. Participants perceived a need for care mostly through serious crises. Their ability to obtain care was hindered by a lack of resources, as well as the relative social isolation brought by migration. Our study highlights other barriers to accessing care such as the role of social norms and HIV-related stigma in health issues prioritisation, and healthcare workers' attitudes. This knowledge can inform approaches to ensure that community-based services are able to support healthcare access and improved health outcomes for this vulnerable group.
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Affiliation(s)
- Zeynab B Diop
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia
| | | | - Allen Asiimwe
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Rachel Kawuma
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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11
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El-Gammal MA, Elgendy A, Heidler P, Owais TA, Eltewacy NK, Hamza N. The psychological impact of COVID-19 on healthcare work force in the Middle East region C-S study. Front Psychiatry 2023; 14:1112501. [PMID: 36950256 PMCID: PMC10026837 DOI: 10.3389/fpsyt.2023.1112501] [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] [Received: 11/30/2022] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction COVID-19, is one of the biggest challenges facing humanity in the 21st century (1). The pandemic outbreak as affected all human activities, starting with healthcare and medical service passing with economy and social relationships, as well as political, religious and cultural enactments (2). The healthcare workers were the most affected fighting in the frontline working longer hours under a high risk of being infected (3). This study aims to assess the depression, anxiety and stress levels of the healthcare workforce (physicians, nurses, pharmacists and dentists) in the Middle East and North Africa-MENA-region. Methods We invited healthcare workers in the Middle East to participate in our cross-sectional survey by answering to the DASS-21 questionnaire. Results A total of 4,845 healthcare workers participated in the study. The participants were from 11 countries as follows: 436 from Egypt, 430 from Algeria, 458 from Iraq, 453 from Jordan, 473 from Libya, 428 from Palestine, 419 from Saudi Arabia, 452 from Sudan, 451 from Syria, 424 from Tunisia, and 421 from Yemen. The doctors among the healthcare workers were 51.7%, 19.0% were from the nursing staff, 16.8% were pharmacists, and 12.5% were from dentists. The depression level among the healthcare workers was as follows: 29.1% were normal, 13.7% were mildly depressed, 26.9% were moderately depressed, 14.4% were suffering from severe depression, and the depression state was extremely severe for the last 15.9%. At the same time, 29.1% were suffering from no anxiety, while 6.9% were at a mild level, 22.3% were at a moderate level, 13.4% were at a severe level, and 28.3% were at an extremely severe level. For the stress levels, 38.6% were normal, 14.9% were suffering from mild stress, 20.3% were moderate, 17.4% were severe, and the stress level was extremely severe for the other 8.9%. Discussion This study indicates that in the Middle East and North Africa-MENA-region, the prevalence of depression, anxiety, and stress among the healthcare workforce during the COVID-19 pandemic was 70.9, 70.9, 61.4, respectively.
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Affiliation(s)
- Marwa Ahmed El-Gammal
- Nanotechnology Program, The American University of Cairo, Cairo, Egypt
- *Correspondence: Marwa Ahmed El-Gammal,
| | - Amira Elgendy
- Medical Agency for Research and Statistics, Cairo, Egypt
| | - Petra Heidler
- Department of International Business and Export Management, IMC University of Applied Management Sciences Krems, Krems an der Donau, Austria
- Department of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Tarek A. Owais
- Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
| | - Nael Kamel Eltewacy
- Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
- Eltewacy Arab Research Group, Cairo, Egypt
| | - Nouran Hamza
- Medical Agency for Research and Statistics, Cairo, Egypt
- Clinical Research Key, Nairobi, Kenya
| | - the EARG groupAmir RaisMohammedAshrafRemankamal abdouEntesarSobhy KiddeesEreenAbdelrazek AbdellahArwaAbd El-MaksoudMostafa S. M.MitwallyAwadAseelHananiAhmadYousef SubohDuhaElkhaderSamaaHanaysheSalsabeelKiswaniGharamBen AmmarHanenHamdiGhadaBrahmi lLinamohamed AyadiMalekZitaniBayanKarkarNourothmanTasneemAssalyehTasnimAl SariBatoulAltweelBaraaElzahafRaga A.abdulrasoul HasanMoufiqAli MohammedAlmajdoubHasanWisam AAlkokhiya aldareHajarAkwaisahAyoubAhmed AwasAliFateh MohammedDaresAl-duaisHarethAl-subariKholood AhmedAlhaloolBadrAbdelrahim MusbahAhmedAbdelrahim MusbahElhusseiniSalih EisaHassanAltayeb BakheetKhiderMonje AmirMohammed AlRiyadh abdulabbasAliAl-DabaghJaafar D.AlnajjarKarrar H.Hameed AhmedMarebAdil TawfeeqDaniahAloweiwiWahidAlkayedZaidSughayerAbdullahThaer AlbaddaweAyaAbu-SirhanLina A.AbdAlla HamadHindOmer IbrahimOmniaabdulmonem AhmedAsmaaDMD, Algiers Department of Dental Medicine, Algeria: Faculty of Medicine, Al-Azhar University, Egypt: Faculty of Pharmacy, Damanhour University, Egypt: Faculty of Pharmacy, Sohag University, Sohag, Egypt: Faculty of Pharmacy (Boys), Al-Azhar University, Assiut Branch, Egypt: Faculty of Pharmacy Mansoura University, Egypt: Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine: Faculty of Medicine, Al-Quds University, Palestine: Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia: Faculty of Medicine of Monastir, Tunisia: Faculty of Medicine Sfax, Sfax University Tunisia, Sfax, Tunisia: Faculty of Medicine, Aleppo University, Syria: College of Medical Technology, Department of Public Health, Derna, Libya: Radiologist Almogarief Teaching Hospital, Libya: Internal Medicine Resident at Brega General Hospital BGH, Libya: Faculty of Medicine, Omar Al-Mukhtar University, Al-Bayda, Libya: Faculty of Medicine of Sabha University, Sabha, Libya: Benghazi Medical Center, Benghazi, Libya: Internal Medicine Department, University of Science and Technology Hospital, Yemen: Faculty of Medicine and Health Sciences, University of Science and Technology, Yemen: Faculty of Medicine and Health Science, University of Gadarif, Sudan: Faculty of Medicine, Gabir Ibin Hayyan Medical University, Iraq: Faculty of Medicine, University of Baghdad, Iraq: College of Medicine, Al-Nahrain University, Baghdad, Iraq: Alnoor University College, Mosul, Iraq: University of Mosul, Aljumhori Hospital, Iraq: School of Medicine, University of Jordan, Amman, Jordan: Faculty of Engineering and IT, British University in Dubai, United Arab Emirates: Albalqa Applied University, Jordan: Ribat University Hospital, National Ribat University, Khartoum, Sudan: Alsalam Health Medical Hospital, Saudi Arabia
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12
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Factors influencing healthcare-seeking behaviour of South African adolescents. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sodi T, Quarshie ENB, Oppong Asante K, Radzilani-Makatu M, Makgahlela M, Nkoana S, Mutambara J. Mental health literacy of school-going adolescents in sub-Saharan Africa: a regional systematic review protocol. BMJ Open 2022; 12:e063687. [PMID: 36127093 PMCID: PMC9490578 DOI: 10.1136/bmjopen-2022-063687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Assessing mental health literacy has implications for the identification and treatment of mental health problems. Adolescents have been identified as a particularly important target group for initiating and improving mental health literacy. However, much of what we know about adolescent mental health literacy comes from high-income countries. This proposed review seeks to synthesise the available published primary evidence from sub-Saharan Africa on the status and measurement of mental health literacy among school-going adolescents. METHODS AND ANALYSIS We will perform a systematic review reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020). We will systematically search selected global databases (EMBASE, PsycINFO, PubMed and MEDLINE) and regional electronic databases (African Index Medicus and African Journals OnLine) up to December 2021 for observational and qualitative studies published in English and French. The standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst criteria) will be used to appraise the methodological quality of the included studies. The Petticrew-Roberts 3-step approach to narrative synthesis will be applied to the included studies. ETHICS AND DISSEMINATION We will not seek ethical approval from an institutional review board, as this is a systematic review of available and accessible literature. When completed, the full report of this review will be submitted to a journal for peer-reviewed publication; the key findings will be presented at local and international conferences with-partial or full-focus on (adolescent) mental health (literacy). PROSPERO REGISTRATION NUMBER CRD42021229011.
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Affiliation(s)
- Tholene Sodi
- Psychology Department, University of Limpopo, Sovenga, South Africa
| | - Emmanuel Nii-Boye Quarshie
- Department of Psychology, College of Humanities, University of Ghana, Accra, Ghana
- School of Psychology, University of Leeds, Leeds, UK
| | - Kwaku Oppong Asante
- Department of Psychology, College of Humanities, University of Ghana, Accra, Ghana
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | | | | | - Shai Nkoana
- Psychology Department, University of Limpopo, Sovenga, South Africa
| | - Julia Mutambara
- Department of Psychiatry, Midlands State University, Gweru, Zimbabwe
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Simmons SS, Hagan JE, Schack T. Then and Now: Investigating Anthropometrics and Child Mortality among Females in Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106171. [PMID: 35627708 PMCID: PMC9140720 DOI: 10.3390/ijerph19106171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Information on the concentration of body mass index and child death among females in Malawi, where the epidemics of weight gain have been disconcerting and preventable deaths among children linger, is limited. Therefore, the study examined the polarity of body mass index and the death of children among females. Using data from the Malawian Demographic and Health Survey from 2000 to 2015–2016, the study applied for the first time the index of concentration at the extremes and indirect demographic techniques to estimate the polarity of body mass index and child mortality among 65,499 females aged 15 to 49 years. The preponderance of obesity more than doubled from 2000 to 2015–2016 and was highest among females who were older (35–49 years), urban dwellers, rich, and located in districts within the central and southern regions. In addition, child survival was low among underweight, overweight, and obese females. While national-, regional-, and individual-level statistics are in development, these findings provide helpful information for health experts and other stakeholders to initiate appropriate age-region specific programs and interventions in Malawi, including targeting females in the high socio-economic bracket.
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Affiliation(s)
- Sally Sonia Simmons
- Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE, UK;
- Institute of Demography, National Research University-Higher School of Economics, 101000 Moscow, Russia
| | - John Elvis Hagan
- Department of Health, Physical Education & Recreation, College of Education Studies, University of Cape Coast, Cape Coast PMB TF0494, Ghana
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
- Correspondence:
| | - Thomas Schack
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
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Mebrahtu H, Skeen S, Rudgard WE, Du Toit S, Haag K, Roberts KJ, Gordon SL, Orkin M, Cluver L, Tomlinson M, Sherr L. Can a combination of interventions accelerate outcomes to deliver on the Sustainable Development Goals for young children? Evidence from a longitudinal study in South Africa and Malawi. Child Care Health Dev 2022; 48:474-485. [PMID: 34907593 DOI: 10.1111/cch.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to identify possible entry points for interventions that can act as development accelerators for children and adolescents in South Africa and Malawi. METHODS This study was a secondary data analysis. Data were sourced from the Child Community Care longitudinal study which tracked child well-being outcomes among 989 children (4-13 years) and their caregivers affected by HIV and enrolled in community-based organizations in South Africa and Malawi. We examined associations between five hypothesized accelerating services/household provisions-measured as access at baseline and follow-up and 12 child outcomes that relate to indicators within the Sustainable Development Goals (SDGs) framework. We calculated the adjusted probabilities of experiencing each SDG aligned outcome conditional on receipt of single, combined or all identified accelerators. RESULTS The results show household food security is associated with positive child education and cognitive development outcomes. Cash grants were positively associated with nutrition and cognitive development outcomes. Living in a safe community was positively associated with all mental health outcomes. Experiencing a combination of two factors was associated with higher probability of positive child outcomes. However, experiencing all three accelerators was associated with better child outcomes, compared with any of the individual factors by themselves with substantial improvements noted in child education outcomes. CONCLUSIONS Combined delivery of specific interventions or services may yield greater improvements in child outcomes across different developmental domains. It is recommended that multiple support avenues in combination like improving food security and safe communities, as well as social protection grants, should be provided for vulnerable children to maximize the impact.
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Affiliation(s)
- Helen Mebrahtu
- Institute for Global Health, University College London, London, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - William E Rudgard
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK
| | - Stefani Du Toit
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Katharina Haag
- Institute for Global Health, University College London, London, UK
| | | | - Sarah L Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mark Orkin
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK.,MRC-NRF Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lucie Cluver
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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16
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Iwelunmor J, Ezechi O, Obiezu-Umeh C, Gbaja-Biamila T, Musa AZ, Nwaozuru U, Xian H, Oladele D, Airhihenbuwa CO, Muessig K, Rosenberg N, Conserve DF, Ong JJ, Nkengasong S, Day S, Tahlil KM, BeLue R, Mason S, Tang W, Ogedegbe G, Tucker JD. Enhancing HIV Self-Testing Among Nigerian Youth: Feasibility and Preliminary Efficacy of the 4 Youth by Youth Study Using Crowdsourced Youth-Led Strategies. AIDS Patient Care STDS 2022; 36:64-72. [PMID: 35147463 PMCID: PMC8861905 DOI: 10.1089/apc.2021.0202] [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: 12/19/2022] Open
Abstract
Although HIV self-testing (HIVST) has expanded in many regions, a few HIVST services have been tailored for and organized by youth. Innovative HIVST models are needed to differentiate testing services and generate local demand for HIVST among youth. The current pilot study aimed at examining the feasibility and efficacy of crowdsourced youth-led strategies to enhance HIVST as well as sexually transmitted infection (STI) testing. Teams of youth iteratively developed HIVST interventions using crowdsourcing approaches and apprenticeship training. Five interventions were selected and then evaluated among youth (ages 14–24) from September 2019 to March 2020. Given the similar outcomes and approaches, we present cumulative data from the completed interventions. We assessed HIVST uptake (self-report), STI uptake (facility reports for gonorrhea, syphilis, hepatitis B, and chlamydia testing), and quality of youth participation. Mixed-effect logistic regression models estimated intervention effects at baseline and 6 months. Of the 388 youths enrolled, 25.3% were aged 14–19, 58.0% were male, and 54.1% had completed secondary education. We observed a significant increase in HIVST from 3 months compared with 6 months (20% vs. 90%; p < 0.001). Among those who received an HIVST at 3 months, 324 out of 388 were re-tested at 6 months. We also observed significant increases in testing for all four STIs: syphilis (5–48%), gonorrhea (5–43%), chlamydia (1–45%), and hepatitis B testing (14–55%) from baseline to the 6-month follow-up. Youth participation in the intervention was robust. Youth-led HIVST intervention approaches were feasible and resulted in increased HIV/STI test uptake. Further research on the effectiveness of these HIVST services is needed.
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Affiliation(s)
- Juliet Iwelunmor
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Titilola Gbaja-Biamila
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, Missouri, USA
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Adesola Z. Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Division of Public Health Sciences, Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Hong Xian
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - David Oladele
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, Missouri, USA
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Collins O. Airhihenbuwa
- Heath Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Kathryn Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Rosenberg
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Donaldson F. Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan Nkengasong
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suzanne Day
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kadija M. Tahlil
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rhonda BeLue
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Stacey Mason
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Joseph D. Tucker
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cherewick M, Lebu S, Su C, Richards L, Njau PF, Dahl RE. Promoting gender equity in very young adolescents: targeting a window of opportunity for social emotional learning and identity development. BMC Public Health 2021; 21:2299. [PMID: 34923962 PMCID: PMC8684613 DOI: 10.1186/s12889-021-12278-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background The transition from childhood to adolescence is a uniquely sensitive period for social and emotional learning in the trajectory of human development. This transition is characterized by rapid physical growth, sexual maturation, cognitive and behavioral changes and dynamic changes in social relationships. This pivotal transition provides a window of opportunity for social emotional learning that can shape early adolescent identity formation and gender norms, beliefs and behaviors. The objective of this study is to evaluate the potential of a social emotional learning intervention for very young adolescents (VYAs) to improve social emotional mindsets and skills. Methods Discover Learning is a social emotional learning intervention designed for VYAs (10-11 years of age) to support development of social emotional mindsets and skills from four primary schools in Dar es Salaam, Tanzania. The intervention delivered three different packages of learning experiences to three arms of the study. 528 VYAs were randomized to each of the three study arms (A-Content learning, B-Content learning and reflection, and C-Content learning, reflection and experiential practice). A quantitative survey was administered to all participants before and after the intervention to capture changes in social emotional mindsets and skills. A discrete choice experiment measured changes in gender norms, beliefs and behaviors. Results 528 VYAs were included in the analysis. Participants in all three arms of the study demonstrated significant improvements in social emotional mindsets and skills outcomes (generosity, curiosity, growth mindset, persistence, purpose and teamwork). However, Group C (who received experiential social learning opportunities in small, mixed-gender groups and a parent and community learning components demonstrated larger treatment effects on key outcomes in comparison to Groups A and B. Results indicate Group C participants had greater change in gender equity outcomes (OR = 1.69, p = <0.001) compared to Group A (OR = 1.30, p = <0.001) and Group B (OR = 1.23, p = 0.004). Conclusion These findings provide evidence that social emotional learning interventions targeting VYAs can improve social emotional mindsets and skills and gender equity outcomes. The findings indicate the importance of experiential learning activities in mixed-gender groups during the unique developmental window of early adolescence. The study also provides support for the inclusion of parental/caregiver and community engagement in programs designed for VYAs. Trial registration Retrospectively registered on July 7th, 2020. NCT0445807 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12278-3.
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Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, 13001 E 17th Pl, Room B119, Aurora, CO, 80045, USA.
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
| | - Christine Su
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
| | - Lisa Richards
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Prosper F Njau
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Ronald E Dahl
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
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Salawu MM, Okedare OO, Reed E, Kiene SM, Fawole OI. Money, Power, and Relationships: Economic Vulnerability in Girls' Lives and Risk for Partner Violence Among Girls in Ibadan, Nigeria. Violence Against Women 2021; 28:2805-2824. [PMID: 34860615 DOI: 10.1177/10778012211058223] [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: 11/16/2022]
Abstract
This study explored the experience of economic vulnerability and its effect on girls' future aspirations, relationships, and financial reliance on male partners, as well as risk for intimate partner violence (IPV) and related health consequences. Thirteen Focus Group Discussions (FGDs) were conducted among 122 female adolescents aged 15-19 years. Participants reported that lack of economic resources limits girls' ability to be economically independent by reducing opportunities to receive education or enter into a trade. Economic vulnerability decreases girls' ability to become economically independent, increasing financial reliance on male partners, and in turn, increasing risk for IPV, sexually transmitted infections, and unintended pregnancy.
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Affiliation(s)
- Mobolaji M Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Omowumi O Okedare
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, 229220School of Public Health, San Diego State University, San Diego, CA, USA.,Center on Gender Equity and Health, University of California San Diego, Division of Infectious Disease and Global Public Health, La Jolla, CA, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, 7117San Diego State University, San Diego, CA, USA
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
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Belay HG, Arage G, Degu A, Getnet B, Necho W, Dagnew E, Melkie A, Seid T, Bezie M, Nibret G, Worke MD. Youth-friendly sexual and reproductive health services utilization and its determinants in Ethiopia: A systematic review and meta-analysis. Heliyon 2021; 7:e08526. [PMID: 34934842 PMCID: PMC8661021 DOI: 10.1016/j.heliyon.2021.e08526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In most developing countries, meeting young people's sexual and reproductive health (SRH) needs remains a problem. Despite policy initiatives and strategic measures aimed at increasing youth utilization of sexual and reproductive health services in Ethiopia, its utilization remains very low. Therefore, this study aimed to assess Ethiopia's youth-friendly sexual and reproductive health services' utilisation and determinants. METHODS Scopus, Medline, Google Scholar, and CINAHL databases were searched for articles published until March 2021. The pooled prevalence and effect size of youth-friendly sexual and reproductive health service use and associated factors were estimated using a weighted DerSimonian-laird random effect model. The I2 statistics were used to determine the degree of heterogeneity. The funnel plot and Egger's regression test were used to examine publication bias. Subgroup analyses were performed to reduce underlying heterogeneity. RESULTS One thousand one hundred and ninety-one articles were generated from various databases, and a final 26 articles were included in the review, including 16246 participants. Ethiopia's pooled prevalence of youth-friendly sexual and reproductive health service utilization was 42.73 % (95% CI: 35.38-50.09). The findings of this study showed that grade level 11-12, grade level 9-10, close to home sexual and reproductive health services, male sex, and discussion of sexual and reproductive health service with family, friends, and groups, ever experience sexual activity were associated with utilization of youth-friendly sexual and reproductive health services. Maternal educational status secondary school and above, age 15-19 years, age 20-24 years, having ever experienced reproductive problems, living with a partner, living alone, knowing about sexual and reproductive health, having a convenient working hour for youth-friendly service, and participation in a school clubs were also associated with the utilization of youth-friendly sexual and reproductive health services. CONCLUSION We found several determinant factors for adolescent and youth utilization of sexual and reproductive health services. The review highlights the importance of improving service usage through youth education and promotion and the scaling up and institutionalizing of youth-friendly services through extensive capacity building.
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Affiliation(s)
- Habtamu Gebrehana Belay
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemu Degu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekalu Getnet
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Enyew Dagnew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abenezer Melkie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigist Seid
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Minale Bezie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Chen J, Farah N, Dong RK, Chen RZ, Xu W, Yin J, Chen BZ, Delios AY, Miller S, Wan X, Ye W, Zhang SX. Mental Health during the COVID-19 Crisis in Africa: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010604. [PMID: 34682357 DOI: 10.1101/2021.04.19.21255755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 05/27/2023]
Abstract
We aim to provide a systematic review and meta-analysis of the prevalence rates of mental health symptoms among major African populations during the COVID-19 pandemic. We include articles from PubMed, Embase, Web of Science, PsycINFO, and medRxiv between 1 February 2020 and 6 February 2021, and pooled data using random-effects meta-analyses. We identify 28 studies and 32 independent samples from 12 African countries with a total of 15,071 participants. The pooled prevalence of anxiety was 37% in 27 studies, of depression was 45% in 24 studies, and of insomnia was 28% in 9 studies. The pooled prevalence rates of anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%, respectively) are higher than those in Sub-Saharan Africa (31%, 30%, and 24%, respectively). We find (a) a scarcity of studies in several African countries with a high number of COVID-19 cases; (b) high heterogeneity among the studies; (c) the extent and pattern of prevalence of mental health symptoms in Africa is high and differs from elsewhere-more African adults suffer from depression rather than anxiety and insomnia during COVID 19 compared to adult populations in other countries/regions. Hence, our findings carry crucial implications and impact future research to enable evidence-based medicine in Africa.
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Affiliation(s)
- Jiyao Chen
- College of Business, Oregon State University, Corvallis, OR 97330, USA
| | - Nusrat Farah
- College of Business and Analytics, Southern Illinois University Carbondale, Carbondale, IL 62901, USA
| | - Rebecca Kechen Dong
- Business School, University of South Australia, Adelaide, SA 5001, Australia
| | | | - Wen Xu
- International Business and Management Department, Nottingham University Business School China, University of Nottingham Ningbo China, Ningbo 315100, China
| | - Jin Yin
- School of Humanities, Southeast University, Nanjing 211189, China
| | - Bryan Z Chen
- Crescent Valley High School, Corvallis, OR 97330, USA
| | | | - Saylor Miller
- College of Business, Oregon State University, Corvallis, OR 97330, USA
| | - Xue Wan
- School of Economics and Management, Tongji University, Shanghai 200092, China
| | - Wenping Ye
- Department of Business Administration, School of Management, Jinan University, Guangzhou 510632, China
| | - Stephen X Zhang
- Department of Psychology, University of Adelaide, Adelaide, SA 5001, Australia
- Faculty of Professions, Entrepreneurship, Commercialization and Innovation Center, University of Adelaide, Adelaide, SA 5005, Australia
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21
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Mental Health during the COVID-19 Crisis in Africa: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010604. [PMID: 34682357 PMCID: PMC8536091 DOI: 10.3390/ijerph182010604] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/19/2022]
Abstract
We aim to provide a systematic review and meta-analysis of the prevalence rates of mental health symptoms among major African populations during the COVID-19 pandemic. We include articles from PubMed, Embase, Web of Science, PsycINFO, and medRxiv between 1 February 2020 and 6 February 2021, and pooled data using random-effects meta-analyses. We identify 28 studies and 32 independent samples from 12 African countries with a total of 15,071 participants. The pooled prevalence of anxiety was 37% in 27 studies, of depression was 45% in 24 studies, and of insomnia was 28% in 9 studies. The pooled prevalence rates of anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%, respectively) are higher than those in Sub-Saharan Africa (31%, 30%, and 24%, respectively). We find (a) a scarcity of studies in several African countries with a high number of COVID-19 cases; (b) high heterogeneity among the studies; (c) the extent and pattern of prevalence of mental health symptoms in Africa is high and differs from elsewhere-more African adults suffer from depression rather than anxiety and insomnia during COVID 19 compared to adult populations in other countries/regions. Hence, our findings carry crucial implications and impact future research to enable evidence-based medicine in Africa.
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Simpson N, Kydd A, Phiri M, Mbewe M, Sigande L, Gachie T, Ngobeni M, Monese T, Figerova Z, Schlesinger H, Bond V, Belemu S, Simwinga M, Schaap A, Biriotti M, Fidler S, Ayles H. Insaka: mobile phone support groups for adolescent pregnant women living with HIV. BMC Pregnancy Childbirth 2021; 21:663. [PMID: 34592959 PMCID: PMC8482634 DOI: 10.1186/s12884-021-04140-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile phone-based interventions have been demonstrated in different settings to overcome barriers to accessing critical psychosocial support. In this study, we aimed to assess the acceptability and feasibility of a phone-based, peer-to-peer support group intervention for adolescent pregnant women aged 15-24 years living with HIV in Zambia. METHODS Sixty-one consenting participants were recruited from Antenatal Clinics of two large urban communities in Lusaka. They were invited to participate in the mobile phone-based intervention that allowed them to anonymously communicate in a small group led by a facilitator for 4 months. A mixed methods approach was used to assess acceptability and feasibility, including a focus group discussion, pre- and post-intervention interview and analysis of the content of the text message data generated. RESULTS Participants reported finding the platform "not hard to use" and enjoyed the anonymity of the groups. Seventy-one percent of participants (n = 43) participated in the groups, meaning they sent text messages to their groups. Approximately 12,000 text messages were sent by participants (an average of 169 messages/user and 6 mentors in 6 groups. Topics discussed were related to social support and relationships, stigma, HIV knowledge and medication adherence. CONCLUSION The study showed that the intervention was acceptable and feasible, and highlighted the potential of the model for overcoming existing barriers to provision of psychosocial support to this population.
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Affiliation(s)
- Nikita Simpson
- Department of Anthropology, London School of Economics and Political Science, London, UK.
- SHM Foundation, 20-22 Bedford Row, London, UK.
| | - Anna Kydd
- SHM Foundation, 20-22 Bedford Row, London, UK
| | | | | | | | | | | | | | | | | | - Virginia Bond
- Zambart, Lusaka, Zambia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Sarah Fidler
- Department of Infectious Diseases, Imperial College, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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Hensen B, Phiri M, Schaap A, Floyd S, Simuyaba M, Mwenge L, Sigande L, Belemu S, Shanaube K, Simwinga M, Fidler S, Hayes R, Ayles H. Yathu Yathu ("For us, by us"): Design of a cluster-randomised trial of the impact of community-based, peer-led comprehensive sexual and reproductive health services for adolescents and young people aged 15 to 24 in Lusaka, Zambia. Contemp Clin Trials 2021; 110:106568. [PMID: 34543725 DOI: 10.1016/j.cct.2021.106568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In sub-Saharan Africa, the growing population of adolescents and young people aged 15 to 24 face a high burden of HIV, and other preventable and treatable sexually transmitted infections. Despite this burden, adolescents and young people are the population least served by available sexual and reproductive (SRH) services. This trial aims to evaluate the impact of community-based peer-led SRH services, combined with a novel incentivised "loyalty card" system, on knowledge of HIV status and coverage of SRH services. METHODS A cluster-randomised trial (CRT) with embedded process and economic evaluation. DISCUSSION With little available evidence of the impact of community-based, peer-led services on coverage of SRH services, our study will provide evidence critical to expanding our knowledge of how to reach adolescents and young people. The "loyalty card" system is also a novel approach to providing SRH services. The delivery of community-based services supported by incentives in the form of loyalty cards is innovative, and may prove a simple strategy to improve access to SRH services. Adolescents and young people remain underserved by available SRH services; there remains a critical need to identify ways to provide adolescents and young people with access to SRH services. Rigorous evidence of whether this innovative strategy, with strong links to the local health facility, increases coverage of critical SRH services would add to the evidence-base of how to reach adolescents and young people.
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Affiliation(s)
- B Hensen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - A Schaap
- Zambart, Lusaka, Zambia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | | | - S Fidler
- Imperial College and Imperial College NIHR BRC, London, United Kingdom
| | - R Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - H Ayles
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Zambart, Lusaka, Zambia
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Neighborhood-Level Influences and Adolescent Health Risk Behaviors in Rural and Urban Sub-Saharan Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147637. [PMID: 34300089 PMCID: PMC8305046 DOI: 10.3390/ijerph18147637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
The impact of neighborhoods on adolescent engagement in health-risk behaviors (HRBs), such as substance use and sexual activity, has been well documented in high-income countries; however, evidence from low and middle-income country settings is limited, particularly in sub-Saharan African (SSA) countries. Neighborhoods and communities in SSA continue to experience urbanization, epidemiologic transition, and the simultaneous presence of large populations living in rurality and urbanicity. This is a dynamic context for exploring adolescent health challenges. This review seeks to identify and summarize existing literature that investigates adolescent engagement in HRBs when compared across rural and urban neighborhoods across SSA. We performed searches using three electronic databases, targeted grey literature searches and scanned reference lists of included studies. Following dual-screening, our search yielded 23 relevant studies that met all inclusion criteria. These were categorized into six broad themes including studies on: (1) sexual risk taking, (2) injury-related, (3) violence, (4) eating and/or exercise-related, (5) substance use, and (6) personal hygiene. We found that neighborhood factors relating to accessibility and availability of health information and care impacted adolescent engagement in HRBs in rural and urban areas. Urbanization of areas of SSA plays a role in differences in engagement in HRBs between rural and urban dwelling adolescents.
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Ajayi AI, Otukpa EO, Mwoka M, Kabiru CW, Ushie BA. Adolescent sexual and reproductive health research in sub-Saharan Africa: a scoping review of substantive focus, research volume, geographic distribution and Africa-led inquiry. BMJ Glob Health 2021; 6:bmjgh-2020-004129. [PMID: 33568395 PMCID: PMC7878134 DOI: 10.1136/bmjgh-2020-004129] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Previous review studies have not systematically mapped the existing body of knowledge on adolescent sexual and reproductive health (ASRH) in sub-Saharan Africa (SSA). Our scoping review addresses this gap by examining how the body of research on ASRH in SSA has evolved over the past decade, and its present profile, in terms of trends in volume, geographic and substantive focus, and Africa-led inquiry. METHODS We used a three-step search strategy to identify English and French peer-reviewed publications and relevant grey literature on ASRH in SSA published between January 2010 and December 2019. Two reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. RESULTS A total of 1302 articles were published over the period, rising from 91 in 2010 to 183 in 2015. However, the bulk of the studies (63.9%) focused on six (South Africa, Kenya, Nigeria, Tanzania, Uganda and Ethiopia) of the 46 SSA countries. Ten countries had no ASRH papers, while five others each had only one publication. While issues like HIV (17.2%), sexual behaviours (17.4%) and access to sexual and reproductive health services (13.0%) received substantial attention, only a few studies focused on early adolescence (10-14 years), programme interventions, scaling up of interventions and policy evaluation. Just over half of publications had authors with African institutional affiliations as first authors (51.1%) or last author (53.0%). Sixteen per cent of papers did not include any authors from institutions in Africa. CONCLUSIONS Our review demonstrated that research on ASRH is limited in focus and is unevenly distributed across SSA countries. The identified gaps can guide future research and funding to advance ASRH policies and programmes. It is also vital for stakeholders in the research enterprise, including researchers, donors, ethical review boards, and journal editors and reviewers, to implement measures that foster national investigators' inclusion.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Emmanuel Oloche Otukpa
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Meggie Mwoka
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
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Maina BW, Juma K, Igonya EK, Osindo J, Wao H, Kabiru CW. Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044398. [PMID: 34020975 PMCID: PMC8144038 DOI: 10.1136/bmjopen-2020-044398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/12/2021] [Accepted: 04/23/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Early sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10-19 years. METHODS AND ANALYSIS We will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independently screen all retrieved records and relevant data on sexual debut extracted.Data will be pooled using the random effects model. Dichotomous outcomes will be reported as risk ratios and continuous data as mean difference at 95% CI. Heterogeneity will be assessed using the I² statistic. Findings will be presented in tables and charts, while providing a description of all included studies, themes and concepts drawn from literature. ETHICS AND DISSEMINATION Ethical approval is not required. The findings will be disseminated through peer-reviewed publications, presentations at relevant conferences and other convening focusing on adolescent sexual and reproductive health.
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Affiliation(s)
- Beatrice W Maina
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Kenneth Juma
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Emmy Kageha Igonya
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Osindo
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
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Folayan MO, Tantawi ME, Oginni O, Oziegbe E, Mapayi B, Arowolo O, Adeniyi AA, Sam-Agudu NA. Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria. PLoS One 2021; 16:e0247073. [PMID: 33630858 PMCID: PMC7906320 DOI: 10.1371/journal.pone.0247073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Oral health is a less-recognized correlate of overall and mental wellbeing. This study aimed to assess the relationship between suicidal behavior (ideation and attempt) and oral health practices and status, and to determine the effect of sex on these associations among Nigerian adolescents. Methods Household survey data were collected from 10 to 19-year-old adolescents in southwestern Nigeria. Dependent variables were daily tooth brushing, daily consumption of refined carbohydrates between meals, and oral hygiene status (measured by plaque index). The independent variable was lifetime suicidal ideation/attempt, dichotomized into ‘yes’ and ‘never’. ‘Daily tooth brushing’ and ‘daily consumption of refined carbohydrates between meals’ were included in two separate logistic regression models, and ‘oral hygiene status’ was included in a linear regression model. The models were adjusted for sex, age, and socioeconomic status. The linear regression model was also adjusted for frequency of daily tooth-brushing and of consumption of refined carbohydrates between meals. Interactions between sex and suicidal ideation/suicide attempt in association with dependent variables were assessed. Significance was set at 5%. Results We recruited 1,472 participants with mean age (standard deviation) of 14.6 (2.6) years. The mean plaque index was 0.84 (0.56), and 66 (4.5%) adolescents reported ever having suicidal ideation/attempt. Suicidal ideation/attempt was associated with significantly lower likelihood of tooth brushing (OR = 0.48, 95% CI: 0.26, 0.91), higher likelihood of consuming refined carbohydrates between meals (OR = 2.30, 95% CI: 1.29, 4.10), and having poor oral hygiene (B = 0.18, 95% CI: 0.05, 0.32). Among males, suicidal ideation/attempt was associated with less likelihood of eating refined carbohydrates between meals (OR = 0.96, 95% CI: 0.35, 2.61). Conversely, it was associated with a significantly higher likelihood of this outcome (OR = 4.85, 95% CI: 2.23, 10.55) among females. Conclusion The study findings suggest that poor tooth brushing habits and poor oral hygiene are indicators for risk of suicidal behavior for adolescents in Nigeria, while high sugar consumption may be an additional risk factor for adolescent females. These findings support the role of dental practitioners as members of healthcare teams responsible for screening, identifying and referring patients at risk for suicidal ideation/attempt.
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Affiliation(s)
| | - Maha El Tantawi
- Faculty of Dentistry, Alexandria University, Alexandria, Alexandria Governorate, Egypt
| | - Olakunle Oginni
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Elizabeth Oziegbe
- Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Olaniyi Arowolo
- Obafemi Awolowo University Teaching Hospitals’ Complex, Ile-Ife, Osun State, Nigeria
| | | | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Suicidal ideation and associated factors among school-going adolescents in rural Ghana. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractSuicidal ideation is a critical risk for attempted suicide and eventual suicide. Little is known about suicidal ideation among rural adolescents in most sub-Saharan African countries. We aimed to estimate the 12-month prevalence of suicidal ideation and to describe some of the common and gender-specific associated factors among in-school adolescents in rural Ghana. We conducted a cross-sectional survey involving a random sample of 1101 in-school adolescents aged 10–19 years in a rural district in Eastern Ghana. The Suicidal Behavior Questionnaire-Revised was used to assess suicidal ideation. Overall, 25.1% participants (95% CI = 22.5–27.7), representing 28.3% females (95% CI = 24.7–32.2) and 21.5% males (95% CI = 18.0–25.2) reported suicidal ideation during the previous 12 months. Females who experienced personal and interpersonal adversities mainly outside the family context were likely to report suicidal ideation, while suicidal ideation among males was associated with conflict with parents. Regardless of gender, adolescents who reported exposure to a friend’s attempted suicide were about two times more likely to report suicidal ideation. The prevalence of suicidal ideation among adolescents in rural Ghana compares with in-school estimates from other countries within sub-Saharan Africa, but also underscores the need for targeted and universal prevention programmes and intervention efforts to mitigate the potential transition from suicidal ideations to suicidal attempts and eventual deaths by suicide among rural adolescents.
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Cherewick M, Lebu S, Su C, Richards L, Njau PF, Dahl RE. Adolescent, caregiver and community experiences with a gender transformative, social emotional learning intervention. Int J Equity Health 2021; 20:55. [PMID: 33536044 PMCID: PMC7860221 DOI: 10.1186/s12939-021-01395-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Inequitable gender norms, beliefs and behaviors, are shaped by learning experiences during key developmental stages in an individual's life course, and can have negative impacts on health and well-being outcomes. Very early adolescence represents one stage when formative learning experiences about gender inequity can have the potential to support or hinder more equitable gender norms, beliefs and behaviors. The aim of this qualitative study was to evaluate the effect of a gender transformative, social emotional learning intervention for very young adolescents (VYAs) that included experiential learning with peers, parents/caregivers and community members. METHODS This study examined the effects of an intervention designed to provide social emotional learning opportunities for adolescents ages 10-11 in Dar es Salaam, Tanzania. The qualitative sample included 279 participants. Qualitative methods included 102 in-depth interviews with VYAs, 22 focus groups with 117 VYAs, 60 in-depth interviews with parents/caregivers and 54 participant observations. A grounded theory approach was used to identify emergent themes. RESULTS Participants reported growth in targeted areas of social emotional mindsets and skills, including a shift in gender norms, beliefs and behaviors. VYAs reported that experiential learning in mixed gender teams provided opportunities to actively practice and reflect on gender norms, beliefs and behaviors. VYAs also reported active practice of social emotional mindsets and skills with peers, parents/caregivers and the community. Parents/caregivers reported changes in VYAs' social emotional mindsets and skills within the home, with the community and with siblings and peers. Both adolescents and parent/caregivers reported positive change towards more equitable gender norms, beliefs and behaviors through participation in experiential learning activities and reflective discussions. CONCLUSIONS These findings suggest that an intervention providing social and emotional experiential learning opportunities during the developmental window of very young adolescence can be effective in transforming gender norms, beliefs and behaviors. Involvement of peers, parents/caregivers and community members was effective at supporting learning social emotional mindsets and skills in VYAs. Findings encourage local and global adolescent programming to include gender transformative content paired with social emotional experiential learning with peers, family and the community and can stimulate positive change in gender norms, beliefs and behaviors to promote gender equity.
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Affiliation(s)
- Megan Cherewick
- Department of Health Sciences, California State University East Bay, 25800 Carlos Bee Blvd, Hayward, CA 94542 USA
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720 USA
| | - Christine Su
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720 USA
| | - Lisa Richards
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Prosper F. Njau
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720 USA
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Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys. PLoS One 2021; 16:e0246309. [PMID: 33529246 PMCID: PMC7853509 DOI: 10.1371/journal.pone.0246309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
Context Nigeria is a high-burden country in terms of young people’s health. Understanding changes in young people’s sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions. Objective This study assessed changes in SRH behaviours of unmarried young people aged 15–24 and associated factors over a ten-year period in Nigeria. Data and method We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours. Results Over four-fifths of unmarried young people (15–24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20–24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves. Conclusion Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.
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Cherewick M, Lebu S, Su C, Richards L, Njau PF, Dahl RE. Study Protocol of a Distance Learning Intervention to Support Social Emotional Learning and Identity Development for Adolescents Using Interactive Mobile Technology. Front Public Health 2021; 9:623283. [PMID: 33585394 PMCID: PMC7879395 DOI: 10.3389/fpubh.2021.623283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The maturational period from age 10 to 14-often referred to as very young adolescents (VYAs)-represents a dynamic period of learning and neurobehavioral development as individuals transition from childhood to adolescence. This developmental period presents a window of opportunity for strategic investment to improve trajectories of health, education and well-being among young people. More specifically, neurodevelopmental changes during pubertal maturation influence neural circuitry involved in processing emotions, risks, rewards and social relationships. Technology can be leveraged to create social emotional learning experiences for VYAs and provide opportunities for flexible, distance learning in low-income countries. The aim of this study protocol is to detail how insights from developmental science can be used to inform the intervention design, implementation and evaluation of a distance learning, social emotional learning intervention for VYAs. Methods: This study will be delivered to 500 VYAs in Temeke District, Dar es salaam. Study participants will watch culturally-relevant, animated videos on social emotional mindsets and skills and content will be paired with experiential learning activities over a period of 10 weeks. A nested smart-phone based study will practice learning social emotional skills and mindsets through engagement with multi-media material via the WhatsApp messenger application. Surveys and in-depth interviews will be administered to adolescents, their parents/caregivers and teachers before and after the intervention to evaluate the effect of the intervention on study outcomes. Discussion: This study is among the first to provide results on how to effectively design a distance-learning intervention to promote social emotional learning and identity development within a low-resource context. The findings will provide substantial evidence to inform new intervention approaches that are effective in low-resource contexts and strategies to reach scale among similar programs invested in leveraging technology to support adolescent health and development. Clinical Trial registration: Study registered with ClinicalTrials.gov. Identifier number NCT0445807.
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Affiliation(s)
- Megan Cherewick
- Department of Health Sciences, California State University East Bay, Hayward, CA, United States
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Christine Su
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Lisa Richards
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | | | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
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Cherewick M, Lebu S, Su C, Dahl RE. An Intervention to Enhance Social, Emotional, and Identity Learning for Very Young Adolescents and Support Gender Equity: Protocol for a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e23071. [PMID: 33206624 PMCID: PMC7808886 DOI: 10.2196/23071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The onset of puberty is a pivotal period of human development that is associated with significant changes in cognitive, social, emotional, psychological, and behavioral processes that shape identity formation. Very early adolescence provides a critical opportunity to shape identity formation around gender norms, attitudes, and beliefs before inequitable gender norms are amplified during and after puberty. OBJECTIVE The aim of the Discover Learning Project is to integrate strategic insights from developmental science to promote positive transformation in social, emotional, and gender identity learning among 10- to 11-year-olds in Tanzania. Through a pragmatic randomized controlled trial, the intervention scaffolds the development of critical social and emotional mindsets and skills (curiosity, generosity, persistence, purpose, growth mindset, and teamwork) delivered by conducting 18 after-school, technology-driven, experiential learning sessions in small, mixed-gender groups. METHODS The Discover Learning Intervention is a 3-arm randomized controlled trial that will be delivered to 579 participants selected from four public primary schools in Temeke District, Dar es Salaam, Tanzania. Randomization will be done at the individual level into 3 treatment groups receiving incremental intervention components. The treatment components include Discover Learning content curated into child-friendly videos, facilitated discussions, and a parent-child workbook, to be implemented over two phases, each 6 weeks long. A baseline survey will be administered to participants and their parents prior to the intervention. The process will be observed systematically, and data will be collected using surveys, in-depth interviews, observations, and focus group discussions with adolescents, parents, teachers, and facilitators conducted prior, during, and after each implementation phase. RESULTS This study builds on formative and pilot studies conducted with the target population to inform the design of the intervention. The results will generate new evidence that will inform strategies for achieving scale in Tanzania and provide insights for replication of similar programs that are invested in gender-transformative interventions in peri-urban, low-resource settings. CONCLUSIONS The Discover Learning Intervention makes an important contribution to the field of adolescent developmental science as an intervention designed for very young adolescents in a low-resource setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04458077; https://clinicaltrials.gov/ct2/show/NCT04458077. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23071.
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Affiliation(s)
- Megan Cherewick
- Department of Health Sciences, California State University East Bay, Hayward, CA, United States
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Christine Su
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Ronald E Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
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Health Care Experiences of Youth Living With HIV Who Were Lost to Follow-up in Western Kenya. J Assoc Nurses AIDS Care 2020; 30:539-547. [PMID: 31461737 DOI: 10.1097/jnc.0000000000000044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV is the leading cause of mortality for youth in sub-Saharan Africa. Youth are more likely than any other age group to be lost to follow-up (LTFU) from care. We investigated the health care-related experiences of youth living with HIV (YLWH) who were LTFU (i.e., had not returned to care for at least 4 months), as well as the perceptions of the community health workers who supported them. Data were collected from two focus group discussions with community health workers (n = 18) who worked with YLWH and 27 semistructured interviews with YLWH (ages 15-21 years) who were LTFU. Attitudes toward health care were presented in the context of a social-ecological model. Respondents highlighted the need for improved youth-oriented services, including youth-friendly clinics and training for care providers about specific needs of YLWH. Researchers should develop and test the impact of these interventions to improve retention of YLWH in care.
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Ahinkorah BO. Predictors of unmet need for contraception among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis. PLoS One 2020; 15:e0236352. [PMID: 32760153 PMCID: PMC7410238 DOI: 10.1371/journal.pone.0236352] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/03/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Despite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA. MATERIALS AND METHODS Data from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval. RESULTS The prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p < 0.001], cohabiting AGYW [aOR = 1.52; 95% CI = 1.42-1.63] and AGYW with three or more births [aOR = 3.41; 95% CI = 3.02-3.85]. At the household/community level, the odds of unmet need for contraception was highest among poorer AGYW [aOR = 1.36; 95% CI = 1.21-1.53], AGYW in female-headed households [aOR = 1.22; 95% CI = 1.13-1.33], urban AGYW [aOR = 1.21; 95% CI = 1.11-1.32] and AGYW who took healthcare decisions alone [aOR = 1.10; 95% CI = 1.01-1.21]. CONCLUSION This study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended.
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Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Population and Public Health Research [ACPPHR], Faculty of Health, University of Technology Sydney, Liverpool, Australia
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Adolescent nutrition and physical activity in low-income suburbs of Abidjan, Côte d'lvoire: the gap between knowledge, aspirations and possibilities. Public Health Nutr 2020; 24:5227-5237. [PMID: 32698915 DOI: 10.1017/s1368980020001809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore adolescents' perceptions, knowledge and behaviours regarding nutrition and physical activity in low-income districts of Abidjan, Côte d'Ivoire, taking into consideration their caregivers' perspectives. DESIGN Two investigators conducted six focus group discussions. SETTING The study was carried out in two low-income suburbs, Yopougon and Port-Bouët, in Abidjan, Côte d'Ivoire. PARTICIPANTS Adolescents and their caregivers were recruited into the study via local head teachers and heads of settlement. RESULTS Overall, seventy-two participants, including forty-six adolescents and twenty-six caregivers, took part. Participants demonstrated good nutrition knowledge, relating nutritional health to a balanced diet and hygiene. Sustained physical activity was reported. However, adopting good practices was challenging due to participant's economic circumstances. Their environment was a barrier to improving health due to dirtiness and violence, with a lack of space limiting the possibility to practice sport. Adolescents and their caregivers differed in their response to these constraints. Many caregivers felt powerless and suggested that a political response was the solution. Alternatively, adolescents were more likely to suggest new creative solutions such as youth-friendly centres within their community. CONCLUSIONS Participants were aware that their nutritional habits were not in line with what they had learnt to be good nutritional practices due to socio-economic constraints. Physical activity was part of adolescent life, but opportunities to exercise were restricted by their environment. Strategies for improving adolescent health in these settings need to be developed in collaboration with adolescents in a manner that accommodates their opinions and solutions.
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Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review. BMC Psychiatry 2020; 20:234. [PMID: 32408896 PMCID: PMC7222461 DOI: 10.1186/s12888-020-02587-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/05/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa. METHOD We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence. RESULTS Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm. CONCLUSION Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.
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Glass N, Remy MM, Mayo-Wilson LJ, Kohli A, Sommer M, Turner R, Perrin N. Comparative effectiveness of an economic empowerment program on adolescent economic assets, education and health in a humanitarian setting. BMC Public Health 2020; 20:170. [PMID: 32019539 PMCID: PMC7001195 DOI: 10.1186/s12889-020-8219-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence is a critical period of human development, however, limited research on programs to improve health and well-being among younger adolescents living in conflict-affected and humanitarian settings exists. The purpose of this study was to assess the comparative effectiveness of an economic empowerment program on young adolescent outcomes in a complex humanitarian setting. METHODS This longitudinal, mixed methods study examined the relative effectiveness of an integrated parent (Pigs for Peace, PFP) and young adolescent (Rabbits for Resilience, RFR) animal microfinance/asset transfer program (RFR + PFP) on adolescent outcomes of asset building, school attendance, mental health, experienced stigma, and food security compared to RFR only and PFP only over 24 months. A sub-sample of young adolescents completed in-depth qualitative interviews on the benefits and challenges of participating in RFR. RESULTS Five hundred forty-two young adolescents (10-15 years) participated in three groups: RFR + PFP (N = 178), RFR only (N = 187), PFP only (N = 177). 501 (92.4%) completed baseline surveys, with 81.7% (n = 442) retention at endline. The group by time interaction (24 months) was significant for adolescent asset building (X2 = 16.54, p = .002), school attendance (X2 = 12.33, p = .015), and prosocial behavior (X2 = 10.56, p = .032). RFR + PFP (ES = 0.31, ES = 0.38) and RFR only (ES-0.39, ES = 0.14) adolescents had greater improvement in asset building and prosocial behavior compared to PFP only, respectively. The odds of missing two or more days of school in the past month were 78.4% lower in RFR only and 45.1% lower in RFR + PFP compared to PFP only. No differences between groups in change over time were found for internalizing behaviors, experienced stigma, or food security. Differences by age and gender were observed in asset building, prosocial behavior, school attendance, experienced stigma, and food security. The voices of young adolescents identified the benefits of the RFR program through their ability to pay for school fees, help their families meet basic needs, and the respect they gained from family and community. Challenges included death of rabbits and potential conflict within the household on how to use the rabbit asset. CONCLUSION These findings underscore the potential for integrating economic empowerment programs with both parents and young adolescents to improve economic, educational, and health outcomes for young adolescents growing up in rural and complex humanitarian settings. TRIAL REGISTRATION NCT02008695. Retrospectively registered 11 December 2013.
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Affiliation(s)
- Nancy Glass
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Mitima Mpanano Remy
- Programme d'Appui aux Initiatives Economiques (PAIDEK), Bukavu, Democratic Republic of Congo
| | - Larissa Jennings Mayo-Wilson
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Anjalee Kohli
- Institute of Reproductive Health, Georgetown University, Washington, District of Columbia, USA
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rachael Turner
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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Nyundo A, Manu A, Regan M, Ismail A, Chukwu A, Dessie Y, Njau T, Kaaya SF, Smith Fawzi MC. Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10-19 years: cross-sectional study. Trop Med Int Health 2019; 25:54-69. [PMID: 31698526 DOI: 10.1111/tmi.13336] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to determine the burden of depression, suicidal ideation and suicidal behaviour amongst adolescents at sites in six sub-Saharan African countries and examine associated risk and protective factors. METHODS Household-based cross-sectional study involving male and female adolescents ages 10-19 years. A total of 7,662 adolescents from eight sites in six countries participated in the survey. Three sites were urban: Dar es Salaam (Tanzania), Harar (Ethiopia) and Ibadan (Nigeria); five were rural: Dodoma (Tanzania), Iganga/Mayuge (Uganda), Kersa (Ethiopia), Ningo Prampram (Ghana) and Nouna (Burkina Faso). Log-binomials models were used to estimate relative risks and confidence intervals for factors associated with depression and suicidal behaviour. This was supplemented using log-Poisson models as needed. RESULTS The prevalence of suicidal behaviour over the last 12 months ranged between 1.2% and 12.4% in the eight sites. Depressive symptoms and suicidal ideation/behaviours were associated with older age, female sex, food insecurity, poor access to health care and substance use. Depression was strongly associated with increased risk of suicidal behaviour at two sites where the multivariate model converged: Harar, Ethiopia (RR = 3.5, 95% CI 1.8, 7.0, P < 0.05) and Ibadan, Nigeria (RR = 3.7, 95% CI 2.2, 6.3, P < 0.0001). CONCLUSIONS Depressive symptoms and suicidal behaviour are common amongst sub-Saharan African adolescents at these 8 sites. Most factors associated with depressive symptoms are modifiable and preventable. Routine screening for depressive symptoms in services frequented by adolescents in these and similar communities would be crucial in early detection and prompt intervention.
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Affiliation(s)
- Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine, University of Dodoma, Dodoma, Tanzania
| | - Adom Manu
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Mathilda Regan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Abbas Ismail
- Department of Statistics, University of Dodoma, Dodoma, Tanzania
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Tasiana Njau
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia F Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Adeleke O, Balogun F. PERCEPTION OF IN-SCHOOL ADOLESCENTS ABOUT ADOLESCENTFRIENDLY CHARACTERISTICS OF HEALTHCARE SERVICES RECEIVED IN IBADAN METROPOLIS, NIGERIA. Ann Ib Postgrad Med 2019; 17:162-172. [PMID: 32669994 PMCID: PMC7358805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Adolescence was previously assumed to be a diseases free stage of life. It is however now known that adolescents are not only involved in risky health behaviours but they also have their own share of health problems that other age groups face. The adolescent-friendly model helps to create adolescent-responsive health systems, Nigeria currently has no country-specific report on the adolescent-friendly characteristics of the health services rendered to her adolescents. This study identified various health problems for which in-school adolescents in Ibadan North- East Local Government Area sought healthcare and determined their perception of received healthcare services with regards to its "adolescent-friendliness". METHODS This was a school-based cross-sectional study that utilized quantitative method of data collection. A multi-stage systematic random sampling technique was employed to select 500 students for school survey. Self-administered, semistructured questionnaire was used to collect data. Descriptive statistics and Chisquare test at α=0.05 were used for data analysis. RESULTS Perceived malaria (52.4%), acne (36.2%), menstrual pain (17.0%) and depression (3.0%) were the common health problems adolescents sought health care for. Majority of the adolescents perceived the health services received as being adolescent-friendly. These health services were perceived to be accessible by (87%), acceptable by (93.2%), appropriate by (81.4%), effective by (91.4%), and equitable by (82.2%) of the respondents. Adolescents who sought mental care perceived least adolescent-friendliness of received healthcare services. CONCLUSION Adolescents in Ibadan currently view received health services as adolescent-friendly. However, the management of mental health problems in adolescents should incorporate adolescent friendly elements entrenched at every level of the health system.
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Affiliation(s)
- O. Adeleke
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - F.M. Balogun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
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Donahue C, Robinson J, Granato SA, Tirera F, Billy DA, Koné A, Pfeiffer J. Adolescent access to and utilisation of health services in two regions of Côte d'Ivoire: A qualitative study. Glob Public Health 2019; 14:1302-1315. [PMID: 30821598 DOI: 10.1080/17441692.2019.1584229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adolescence is a critical time for physical, cognitive, social and emotional development, yet adolescents are prone to unique barriers and unmet needs for receiving proper health care services and information. This study explored barriers and facilitators to adolescent (15-19 years) access to and utilisation of health services in two regions of Côte d'Ivoire. Focus group discussions were conducted with adolescent females and males, caregivers, and health care workers at eight health facilities. Barriers and facilitators emerged within three themes: cultural, structural, and 'accueil', a French term encompassing overall feelings and experiences of a situation. Cultural barriers included community beliefs and stigma, and adolescent knowledge, while caregiver support and medical preference were both barriers and facilitators. Structural barriers included financial costs, distance to health facilities, waiting times, and lack of supplies and medications. Feelings of fear, shame and discomfort were barriers related to 'accueil' while interactions with health care workers were both barriers and facilitators. Similarities and differences in perspectives arose between groups. Future work to increase adolescent access to and utilisation of health services should take into consideration both participant recommendations and the interconnectedness of the barriers faced to create multidimensional approaches that improve health outcomes for this priority population.
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Affiliation(s)
- Chantal Donahue
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Julia Robinson
- a Department of Global Health , University of Washington , Seattle , WA , USA.,b Health Alliance International , Seattle , WA , USA
| | - Samuel Adam Granato
- a Department of Global Health , University of Washington , Seattle , WA , USA.,b Health Alliance International , Seattle , WA , USA
| | | | - Doroux Aristide Billy
- a Department of Global Health , University of Washington , Seattle , WA , USA.,c Health Alliance International , Bouaké , Côte d'Ivoire
| | - Ahoua Koné
- a Department of Global Health , University of Washington , Seattle , WA , USA.,b Health Alliance International , Seattle , WA , USA
| | - James Pfeiffer
- a Department of Global Health , University of Washington , Seattle , WA , USA.,b Health Alliance International , Seattle , WA , USA
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Developmental Assets and Academic Performance of Adolescents in Ghana, Kenya, and South Africa. CHILD & YOUTH CARE FORUM 2018. [DOI: 10.1007/s10566-018-9480-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kugbey N, Ayanore MA, Amu H, Oppong Asante K, Adam A. International note: Analysis of risk and protective factors for risky sexual behaviours among school-aged adolescents. J Adolesc 2018; 68:66-69. [PMID: 30041055 DOI: 10.1016/j.adolescence.2018.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/11/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
This study examined the prevalence and associated factors of risky sexual behaviours among 1648 school-going adolescents using the 2012 Ghana Global School-based Student Health Survey. Our findings showed 33.5% of the participants had ever had sex 32.5% had multiple sexual partners and only 26.2% reported using condom during their last sexual intercourse. Being male, older age, anxiety, loneliness, suicidal ideation, being bullied, food insecurity (hunger), current alcohol and marijuana use were significant risk factors for being sexually experienced, multiple partners, but not condom use. Parental knowledge of activity was a significant protective factor against adolescents' sexual experience. These findings underscore the need to develop school-based interventions that would help reduce risky sexual behaviours among school-going adolescents.
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Affiliation(s)
- Nuworza Kugbey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana; Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa.
| | - Martin Amogre Ayanore
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Kwaku Oppong Asante
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa; Department of Psychology, University of Ghana, Legon, Ghana
| | - Awolu Adam
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Kyilleh JM, Tabong PTN, Konlaan BB. Adolescents' reproductive health knowledge, choices and factors affecting reproductive health choices: a qualitative study in the West Gonja District in Northern region, Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:6. [PMID: 29361947 PMCID: PMC5782392 DOI: 10.1186/s12914-018-0147-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Ghana, adolescents constitute about a quarter of the total population. These adolescents make reproductive health decisions and choices based on their knowledge and the availability of such choices. These reproductive health decisions and choices can either negatively or positively affect their lives. This study therefore explored adolescents' reproductive health knowledge and choices, the type of choices they make and the factors that affect these choices. METHODS This qualitative study adopted a narrative approach to qualitative enquiry. Eight focus group discussions (N = 80) were conducted among both in-school and out-of-school adolescents aged 10-19 years. The discussions were stratified by sex and studentship. In addition, nine in-depth interviews were conducted with various stakeholders in reproductive health services and community opinion leaders. Both the focus group discussions and in-depth interviews were recorded, transcribed and analysed using NVivo 11. Thematic analysis was employed in analysing data. RESULTS The study found that knowledge on reproductive health choices was low among respondents with majority of them relying on their peers for information on sexual and reproductive health. Having a sexual partner(s) and engaging in premarital sex was common and viewed as normal. Adolescents engaged in unprotected sexual practices as a way of testing their fertility, assurance of love, bait for marriage and for livelihood. Inserting herbs into the vagina, drinking concoctions and boiled pawpaw leaves were identified as local methods employed by adolescents to induce abortion. Reproductive health services were available in the community but received low utilization because of perceived negative attitude of health workers, confidentiality and social norms. CONCLUSIONS Adolescents in this study generally engaged in risky reproductive health choices that can negatively affect their reproductive health. Adolescents in this part of Ghana have challenges utilizing available reproductive health services because of socio-cultural and health system barriers.
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Affiliation(s)
| | | | - Benson Boinkum Konlaan
- Department of Community Health and Family Medicine, University for Development Studies, Tamale, Ghana
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The relationship between parent mental health and intimate partner violence on adolescent behavior, stigma and school attendance in families in rural Democratic Republic of Congo. Glob Ment Health (Camb) 2018; 5:e20. [PMID: 29868240 PMCID: PMC5981659 DOI: 10.1017/gmh.2018.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 01/02/2018] [Accepted: 02/06/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Prolonged conflict and economic instability challenge the existing support networks in families and society places significant stress on both adults and adolescents. Exploring individual, family and social factors that increase the likelihood of or protect adolescents from negative outcomes are important to the development of evidence-based prevention and response programing in global settings. OBJECTIVE Examine the relationship between parent mental health and experience/perpetration of intimate partner violence (IPV) and adolescent behaviors, stigma, and school attendance. The relationship is further examined for differences by gender. METHODS Secondary analysis of data from an ongoing comparative effectiveness trial of a productive asset transfer program in eastern Democratic Republic of Congo (DRC). RESULTS Three hundred and eighty-eight adolescent and parent dyads were included in the analysis. The analysis demonstrated that parent mental health and IPV can have a negative impact their children's well-being and the impact is different for boys and girls, likely linked to gender roles and responsibilities in the home and community. Social relationships of adolescents, as reported through experienced stigma, were negatively impacted for both boys and girls. Parent report of symptoms of PTSD and depression had a stronger negative effect on girls' outcomes, including experienced stigma, externalizing behaviors, and missed days of school than boys. For adolescent boys, their parent's report of IPV victimization/perpetration was associated with more negative behaviors at the 8-month follow-up assessment. CONCLUSION The findings reinforce the critical importance of interventions that engage parents and their children in activities that advance health and improve relationships within the family.
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Key Words
- AYPA, African Youth Psychosocial Assessment
- CPT, cognitive processing therapy
- DRC, Democratic Republic of Congo
- HDDS, Household Dietary Diversity Scale
- HSCL, Hopkins Symptom Checklist
- HTQ, Harvard Trauma Questionnaire
- IPV, intimate partner violence
- IRB, Internal Review Board
- Intimate partner violence
- NICHD, National Institute of Child Health and Human Development
- NIH, National Institute of Health
- PFP, pigs for peace
- PTSD, post-traumatic stress disorder
- RA, research assistant
- RFR, rabbits for resilience
- mental health
- post-conflict
- stigma
- young adolescents
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Lusey H, San Sebastian M, Christianson M, Edin KE. Factors associated with gender equality among church-going young men in Kinshasa, Democratic Republic of Congo: a cross-sectional study. Int J Equity Health 2017; 16:213. [PMID: 29228996 PMCID: PMC5725947 DOI: 10.1186/s12939-017-0707-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022] Open
Abstract
Background While women and girls are made vulnerable by inequitable and violent versions of masculinities, there is increasing evidence that gender equality will not be achieved without partnering with men. The aim of this study was to assess gender-equitable norms and their determinants among church-going young men in Kinshasa, the Democratic Republic of Congo. Method A cross-sectional study was carried out among 289 church-going young men, aged 18–24 years, residing in three disadvantaged communes of Kinshasa. Variables included sociodemographic characteristics, attitudes towards gender equality and responses to issues related to the Gender-Equitable Men (GEM) scale. Logistic regression was applied to identify the associations between sociodemographic characteristics, attitudes and the GEM scale. Results The findings provide evidence of attitudes and beliefs that act as barriers to gender equality. For instance, the majority of church-going young men (83.74%) agreed that a man is the only decision maker in the home and about half (50.87%) of the respondents supported the statement “There are times a woman deserves to be beaten”. Similarly, around half of the participants agreed with the idea of men’s uncontrollable sex drive (50.87%) and men’s toughness (50.17%). Close to half of the participants (44.29%) agreed that it is women’s responsibility to prevent pregnancy. These attitudes co-existed with a few gender-equitable norms as 82.70% agreed on the importance of joint decisions concerning family planning. An association between education, certain places of residence, being single or separated, and supportive attitudes towards gender equality was found with higher scores for the GEM. Conclusion Our study findings indicate that a high proportion of church-going young men do not endorse gender-equitable norms. Therefore, churches urgently need comprehensive gender equality and masculinity policies and programmes to influence young men’s attitudes and behaviours. The promotion of gender equality in schools and the wider community also need to be encouraged.
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Affiliation(s)
- Hendrew Lusey
- World Council of Churches, Central Africa Regional Coordinator of the Ecumenical HIV and AIDS Initiative in Africa (EHAIA), C/o Salvation Army Headquarter, Avenue Colonel Ebeya no 23, B.P. 8636, Kinshasa Gombe, Democratic Republic of Congo. .,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden. .,Department of Nursing, Sexual and Reproductive Health, Umeå University, Umeå, Sweden.
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Monica Christianson
- Department of Nursing, Sexual and Reproductive Health, Umeå University, Umeå, Sweden
| | - Kerstin E Edin
- Department of Nursing, Sexual and Reproductive Health, Umeå University, Umeå, Sweden
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Izugbara CO, Egesa CP, Kabiru CW, Sidze EM. Providers, Unmarried Young Women, and Post-Abortion Care in Kenya. Stud Fam Plann 2017; 48:343-358. [PMID: 28940208 PMCID: PMC6681013 DOI: 10.1111/sifp.12035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Young women and girls in Kenya face challenges in access to abortion care services. Using in‐depth and focus group interviews, we explored providers’ constructions of these challenges. In general, providers considered abortion to be commonplace in Kenya; reported being regularly approached to offer abortion‐related care and services; and articulated the structural, contextual, and personal challenges they faced in serving young post‐abortion care (PAC) patients. They also considered induced abortion among young unmarried girls to be especially objectionable; stressed premarital fertility and out‐of‐union sexual activity among unmarried young girls as transgressive of respectable femininity and proper adolescence; blamed young women and girls for the challenges they reported in obtaining PAC services; and linked these challenges to young women's efforts to conceal their failures related to gender and adolescence, exemplified by pre‐marital pregnancy and abortion. This study shows how providers’ distinctive emphasis that young abortion care‐seekers are to blame for their own difficulties in accessing PAC may add to the ongoing crisis of post‐abortion care for young women and adolescent girls in Kenya.
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47
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Kohli A, Remy MM, Binkurhorhwa AK, Mitima CM, Mirindi AB, Mwinja NB, Banyewesize JH, Ntakwinja GM, Perrin NA, Glass N. Preventing risky behaviours among young adolescents in eastern Democratic Republic of Congo: A qualitative study. Glob Public Health 2017; 13:1241-1253. [PMID: 28443367 DOI: 10.1080/17441692.2017.1317009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This qualitative study explores and describes adolescent risk behaviours, specifically consumption of alcohol and use of violence; the perceived consequences of these behaviours on future well-being and relationships; and collaboratively identifies the essential components of a prevention intervention for risk behaviours (alcohol use, violence) among young adolescents while strengthening the protective individual and relationship factors in post-conflict Democratic Republic of Congo. One-on-one in-depth interviews were conducted with 28 male and female youth, 20 parents/guardians and 20 stakeholders in three rural villages of South Kivu Province. Trained interviewers conducted interviews and participated in daily debriefing. Descriptive qualitative analysis was used to analyse the data. Youth use of violence and alcohol was associated with a range of factors including peer influence, parent behaviours, school enrolment and poverty. The consequences of risk behaviour include damaged family and social bonds, reduced economic and educational productivity and promise. Community-based, multilevel prevention interventions that promote protective factors and reduce youth exposure and vulnerability to risk factors may have immediate and long-term impact on youth health and behaviour. Such a programme could engage youth, adults and local stakeholders in a range of social, educational and economic activities.
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Affiliation(s)
- Anjalee Kohli
- a Johns Hopkins University School of Nursing , Baltimore , MD , USA
| | - Mitima Mpanano Remy
- b Programme d'Appui aux Initiatives Economiques (PAIDEK) , Bukavu , Democratic Republic of Congo
| | | | | | | | | | | | | | | | - Nancy Glass
- a Johns Hopkins University School of Nursing , Baltimore , MD , USA
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Adjiwanou V, Engdaw AW. Household environmental health hazards’ effect on under-five mortality in sub-Saharan Africa: What can we learn from the Demographic and Health Survey? Glob Public Health 2017; 12:780-794. [DOI: 10.1080/17441692.2017.1281327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Vissého Adjiwanou
- Centre for Actuarial Research (CARe), University of Cape Town, Cape Town, South Africa
- Département de Démographie, Université de Montréal, Montréal, Canada
| | - Alehegn Worku Engdaw
- Centre for Actuarial Research (CARe), University of Cape Town, Cape Town, South Africa
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Kinsman J, Norris SA, Kahn K, Twine R, Riggle K, Edin K, Mathebula J, Ngobeni S, Monareng N, Micklesfield LK. A model for promoting physical activity among rural South African adolescent girls. Glob Health Action 2015; 8:28790. [PMID: 26685095 PMCID: PMC4684577 DOI: 10.3402/gha.v8.28790] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/07/2015] [Accepted: 11/17/2015] [Indexed: 12/02/2022] Open
Abstract
Background In South Africa, the expanding epidemic of non-communicable diseases is partly fuelled by high levels of physical inactivity and sedentary behaviour. Women especially are at high risk, and interventions promoting physical activity are urgently needed for girls in their adolescence, as this is the time when many girls adopt unhealthy lifestyles. Objective This qualitative study aimed to identify and describe facilitating factors and barriers that are associated with physical activity among adolescent girls in rural, north-eastern South Africa and, based on these, to develop a model for promoting leisure-time physical activity within this population. Design The study was conducted in and around three secondary schools. Six focus group discussions were conducted with adolescent girls from the schools, and seven qualitative interviews were held with sports teachers and youth leaders. The data were subjected to thematic analysis. Results Seven thematic areas were identified, each of which was associated with the girls’ self-reported levels of physical activity. The thematic areas are 1) poverty, 2) body image ideals, 3) gender, 4) parents and home life, 5) demographic factors, 6) perceived health effects of physical activity, and 7) human and infrastructural resources. More barriers to physical activity were reported than facilitating factors. Conclusions Analysis of the barriers found in the different themes indicated potential remedial actions that could be taken, and these were synthesised into a model for promoting physical activity among South African adolescent girls in resource-poor environments. The model presents a series of action points, seen both from the ‘supply-side’ perspective (such as the provision of resources and training for the individuals, schools, and organisations which facilitate the activities) and from the ‘demand-side’ perspective (such as the development of empowering messages about body image for teenage girls, and encouraging more parental involvement). The development of physical activity interventions that incorporate this supply- and demand-side model would represent an additional tool for ongoing efforts aimed at tackling the expanding non-communicable disease epidemic in South Africa, and in other resource-constrained settings undergoing rapid health transitions.
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Affiliation(s)
- John Kinsman
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Kari Riggle
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Edin
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Jennifer Mathebula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sizzy Ngobeni
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nester Monareng
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Suarez EB, Logie C, Arocha JF. An open debate about the object and purpose of global health knowledge in the context of an interdisciplinary research partnership on HIV/STI prevention priorities in Peru. Global Health 2014; 10:40. [PMID: 24886493 PMCID: PMC4033682 DOI: 10.1186/1744-8603-10-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 05/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background With the failure of the latest vaccine trial, HVTN-505, HIV prevention efforts remain critical. Social and structural factors contributing to HIV and STI transmission include stigma regarding sexual violence, HIV infection and sexual orientation. For instance, HIV prevention and overall sexual health programs in Peru have been implemented yet key populations of youth (sex workers, male and transgender youth) continue to be overrepresented in new cases of HIV and STI. This suggests that interventions must take new directions and highlights the need for additional research. Discussion While interdisciplinary, international research collaborations often are indicated as best practice in developing new knowledge in global health and an important component of the leadership in health systems, this does not mean they are free of challenges. In this debate we document our reflections on some of the challenges in developing an interdisciplinary and international research team to understand HIV and STI prevention priorities among youth in two culturally diverse cities in Peru: Lima, the capital city, and Ayacucho, in the Andean region. Summary Rather than offering solutions we aim to contribute to the debate about the object and purpose of global health research in the context of developing international research partnerships that genuinely promote a reciprocal and bidirectional flow of knowledge between the Global South and the Global North, and researchers at intersections of these locations.
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Affiliation(s)
- Eliana Barrios Suarez
- Lyle S, Hallman Faculty of Social Work, Wilfrid Laurier University, 120 Duke Street West, N2H 3W8 Kitchener, ON, Canada.
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