1
|
Monteiro DLM, Miranda FRD, Bruno ZV, Cavalcante MB, Lacerda IMS, Ramos JAS, Rodrigues NCP. Repeated adolescent pregnancy in Brazil from 2015 to 2019. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221513. [PMID: 37222326 DOI: 10.1590/1806-9282.20221513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/02/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38). CONCLUSION Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.
Collapse
Affiliation(s)
- Denise Leite Maia Monteiro
- Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
- Centro Universitário Serra dos Órgãos - Teresópolis (RJ), Brazil
| | - Fátima Regina Dias Miranda
- Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
- Universidade do Grande Rio - Rio de Janeiro (RJ), Brazil
| | | | | | | | | | - Nádia Cristina Pinheiro Rodrigues
- Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| |
Collapse
|
2
|
D'Souza P, Phagdol T, D'Souza SRB, D S A, Nayak BS, Velayudhan B, Bailey JV, Stephenson J, Oliver S. Interventions to support contraceptive choice and use: a global systematic map of systematic reviews. EUR J CONTRACEP REPR 2023; 28:83-91. [PMID: 36802955 DOI: 10.1080/13625187.2022.2162337] [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: 02/22/2023]
Abstract
BACKGROUND To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.
Collapse
Affiliation(s)
- Preethy D'Souza
- UCL Social Research Institute, University College London, London, UK
| | - Tenzin Phagdol
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D'Souza
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anupama D S
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | | | - Sandy Oliver
- UCL Social Research Institute, University College London, London, UK.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
3
|
Boateng AA, Botchwey COA, Adatorvor BA, Baidoo MA, Boakye DS, Boateng R. A phenomenological study on recurrent teenage pregnancies in effutu municipality- Ghana.the experiences of teenage mothers. BMC Public Health 2023; 23:218. [PMID: 36726092 PMCID: PMC9890793 DOI: 10.1186/s12889-023-15074-3] [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: 05/13/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Generally, recurrent teenage pregnancies are public health menaces that impede the quality of life of teenage mothers, their offspring, and society as a whole. However, there is paucity of information regarding factors influencing this social issue especially, in developing countries where Ghana is no exception. Moreover, this menace has been least investigated from the perspective of the teenager with multiple pregnancies. Hence, this study aimed at identifying the factors influencing recurrent teenage pregnancies and the challenges confronted by these teenage mothers. METHOD This study is a phenomenological qualitative study that was conducted in the Effutu Municipality in the Central Region of Ghana. Employing convenience and snowball sampling, 40 participants who were residents of the study area, had a child each, and were pregnant at the time of the study were included. Other participants included teenage mothers who had at least two (2) children. A face-to-face in-depth interview with the help of an interview guide was conducted. Proceedings were recorded, transcribed, and analysed using thematic analysis. Quotations were used in the result presentation. RESULTS The results of the study revealed that factors influencing recurrent teenage pregnancies are multifactorial. It includes peer pressure, parental neglect, poverty, living with a partner, and inadequate knowledge of family planning. The teenager with recurrent pregnancy is confronted with financial difficulties and is faced with stigmatisation in the society where she finds herself. CONCLUSION To this effect, it is important to intensify education on family planning and good parental practices among parents with teenage mothers while providing a similar form of sensitization for members of the society about the harmful effects of stigmatisation on the teenage mother and her children. Again, a social support network for teenagers with recurrent pregnancies could be formed to help curb this public health menace.
Collapse
Affiliation(s)
- Agartha Afful Boateng
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region, Winneba, Ghana.
| | - Charles Owusu-Aduomi Botchwey
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | | | - Michael Afari Baidoo
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | - Dorothy Serwaa Boakye
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | - Richard Boateng
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
McCarey C, Viviano M, Yaron M. FertiSTAT: A Potential Tool for Adolescent Sexual Health. J Pediatr Adolesc Gynecol 2021; 34:805-810. [PMID: 33989802 DOI: 10.1016/j.jpag.2021.04.007] [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: 10/16/2020] [Revised: 04/16/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE The FertiSTAT (fertility status awareness) tool provides personalized advice on reducing risk factors for infertility and seeking medical advice on the basis of lifestyle and reproductive profile. The aim of our research was to test the FertiSTAT tool in younger patients (14-24 years). A secondary objective was to screen for and evaluate knowledge of risk factors that affect fertility. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Patients aged 14-24 years attending consultations at Geneva University Hospitals received a quantitative questionnaire before consultations. Questions covered lifestyle, gynecological history, perception of fertility, and pregnancy intent. We investigated respondents' beliefs with regard to risk factors for infertility through "true/false" questions. We selected questions relevant to our population from the original FertiSTAT questionnaire to calculate each respondent's FertiSTAT score. Scores ranged from "blue" (low risk, score 1) to "red" (risk of infertility, score 4). RESULTS A total of 279 women aged 14-24 years were included. Nonpregnant patients had overall higher FertiSTAT scores (2.7 ± 0.8). Upon logistic regression analysis, with every additional FertiSTAT point, the odds of being pregnant at the time of survey decreased by 0.48. Risk factors for infertility and knowledge of these risk factors were equally distributed between pregnant and nonpregnant women. CONCLUSION Our findings suggest FertiSTAT might be a useful tool in the younger population to whom we extended it, and highlight gaps in knowledge on risk factors for infertility. These findings are of interest when considering FertiSTAT as a starting point to discuss contraception and risk factors for infertility at an age at which risk mitigation would prove most effective in preserving future fertility.
Collapse
Affiliation(s)
- Catherine McCarey
- Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland.
| | - Manuela Viviano
- Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Michal Yaron
- Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
6
|
Farrar N, Elliott D, Jepson M, Houghton C, Young B, Donovan J, Rooshenas L. Recruiters' perspectives and experiences of trial recruitment processes: a qualitative evidence synthesis protocol. BMJ Open 2021; 11:e045233. [PMID: 34686547 PMCID: PMC8543629 DOI: 10.1136/bmjopen-2020-045233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Recruitment to randomised trials (RCTs) is often challenging. Reviews of interventions to improve recruitment have highlighted a paucity of effective interventions aimed at recruiters and the need for further research in this area. Understanding the perspectives and experiences of those involved in RCT recruitment can help to identify barriers and facilitators to recruitment, and subsequently inform future interventions to support recruitment. This protocol describes methods for a proposed qualitative evidence synthesis (QES) of recruiters' perspectives and experiences relating to RCT recruitment. METHODS AND ANALYSIS The proposed review will synthesise studies reporting clinical and non-clinical recruiters' perspectives and experiences of recruiting to RCTs. The following databases will be searched: Ovid MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, ORRCA and Web of Science. A thematic synthesis approach to analysing the data will be used. An assessment of methodological limitations of each study will be performed using the Critical Appraisal Skills Programme tool. Assessing the confidence in the review findings will be evaluated using the GRADE Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) tool. ETHICS AND DISSEMINATION The proposed QES will not require ethical approval as it includes only published literature. The results of the synthesis will be published in a peer-reviewed journal and publicised using social media. The results will be considered alongside other work addressing factors affecting recruitment in order to inform future development and refinement of recruitment interventions. PROSPERO REGISTRATION NUMBER CRD42020141297.
Collapse
Affiliation(s)
- Nicola Farrar
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Marcus Jepson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Galway, Ireland
| | - Bridget Young
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Jenny Donovan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
7
|
Boyle JA, Yimer NB, Hall J, Walker R, Jack B, Black K. Reproductive Life Planning in Adolescents. Semin Reprod Med 2021; 40:124-130. [PMID: 34687031 DOI: 10.1055/s-0041-1735210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Unplanned pregnancy in adolescents contributes to the burden of disease, mortality, and health and educational disparities experienced by young people during this vulnerable period between childhood and adulthood. Reproductive life planning (RLP) is an approach that has been endorsed and adopted internationally, which prompts individuals and couples to set personal goals regarding if and when to have children based on their own personal priorities. This review discusses RLP tools, their acceptability, effectiveness, and issues in implementation across different contexts, with a specific focus on how RLP has been applied for adolescents. While a range of RLP tools are available and considered acceptable in adult populations, there is minimal evidence of their potential benefits for adolescent populations. Online platforms and information technology are likely to promote reach and implementation of RLP interventions in adolescents. Consideration of the socioecological contexts where adolescent pregnancies are more common should be integral to much needed future work that explores RLP interventions in adolescents.
Collapse
Affiliation(s)
- Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia.,Obstetrics, Gynaecology and Neonatology, The University of Sydney Central Clinical School, University of Sydney, Australia
| | - Nigus Bililigin Yimer
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jennifer Hall
- College of Health Sciences, Woldia University, Ethiopia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Brian Jack
- EGA Institute for Women's Health, University College London, United Kingdom
| | | |
Collapse
|
8
|
Amongin D, Kaharuza F, Hanson C, Nakimuli A, Mutesi S, Benova L, Atuyambe L. "… I would have left that man long time ago but, …" exploring circumstances of and motivators for repeat adolescent birth in Eastern Uganda. ACTA ACUST UNITED AC 2021; 79:142. [PMID: 34362439 PMCID: PMC8344224 DOI: 10.1186/s13690-021-00662-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND First birth before 18 years has declined in Uganda unlike repeat adolescent birth (=second or more births before age 20 years). We explored the circumstances of and motivators for repeat adolescent birth in Eastern Uganda. METHODS Between January and March 2020, we conducted a qualitative study involving 70 individual in-depth interviews with purposively selected respondents - 20-25-year-old women with and without repeat adolescent birth, their partners, and parents, in the communities of Teso sub-region. We conducted latent content analysis. RESULTS Four major themes emerged: poverty, vulnerability, domestic violence, and demotivators. Sub-themes identified under poverty were: "limited provisions", "peasantry", "large families", "dropping out of school", "alcohol abuse", and "broken family structure". Vulnerability included "marital entrapment" and "partner coercion". Demotivators included: "abandonment", "stern warning", "objection to marriage", and "empowerment". Extreme poverty resulted in inadequate provision of basic needs leading to unprotected sexual activity in a bid to secure financial support. Following the first birth, more than three quarters of the women with repeat adolescent birth reported increased economic distress that forced them to remain in unwanted marriage/union, often characterized by partner coercion, despite wanting to delay that repeat birth. Women without repeat adolescent birth avoided a second birth by empowerment through: an economic activity, contraception use, and resumption of schooling. CONCLUSION Repeat adolescent birth in Uganda is premised around attempts to address the economic distress precipitated by first birth. Many women want to delay that repeat birth but the challenges robbed them of their reproductive autonomy. Beyond efforts to prevent first birth, programs need to address economic empowerment, ensure contraceptive access, and school re-integration for adolescent mothers in order to prevent shortly-spaced repeat births.
Collapse
Affiliation(s)
- Dinah Amongin
- Department of Health Policy Planning and Management, Makerere University College of Health Sceinces, Kampala, Uganda. .,Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Frank Kaharuza
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Mutesi
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
9
|
DeVille NV, Khalili R, Levy JI, Korrick SA, Vieira VM. Prenatal environmental exposures and associations with teen births. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:197-210. [PMID: 32913222 PMCID: PMC7943647 DOI: 10.1038/s41370-020-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children's prenatal exposure to multiple environmental chemicals may contribute to subsequent deficits in impulse control, predisposing them to risk-taking. OBJECTIVE Our goal was to investigate associations between prenatal exposure mixtures and risk of teen birth, a manifestation of high-risk sexual activity, among 5865 girls (1st generation) born in southeast Massachusetts from 1992-1998. METHODS Exposures included prenatal modeled polychlorinated biphenyls (PCBs), ρ,ρ'-dichlorodiphenyl dichloroethylene (DDE), hexachlorobenzene (HCB), lead (Pb), and mercury (Hg). We fit adjusted generalized additive models with multivariable smooths of exposure mixtures, 1st generation infant's birth year, and maternal age at 1st generation birth. Predicted odds ratios (ORs) for teen birth were mapped as a function of joint exposures. We also conducted sensitivity analyses among 1st generation girls with measured exposure biomarkers (n = 371). RESULTS The highest teen birth risk was associated with a mixture of high prenatal HCB, Hg, Pb, and PCB, but low DDE exposure, with similar associations in sensitivity analyses. The highest OR predicted for girls born in 1995 to mothers of median age (26 years) was at the 95th percentile of the HCB and PCB exposure distributions (OR = 3.09; 95% confidence interval: 0.29, 32.4). Additionally, girls born earlier in the study period or to teen mothers were at increased risk of teen birth. SIGNIFICANCE Prenatal environmental chemical exposures and sociodemographic characteristics may interact to substantially increase risk of teen births.
Collapse
Affiliation(s)
- Nicole V DeVille
- Program in Public Health, College of Health Sciences, University of California, Irvine, Irvine, CA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Roxana Khalili
- Program in Environmental Health Sciences, College of Health Sciences, University of California, Irvine, Irvine, CA, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Susan A Korrick
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Verónica M Vieira
- Program in Public Health, College of Health Sciences, University of California, Irvine, Irvine, CA, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Ghaffari R, Taghizadieh A, Behshid M, Somi MH, Mirzazadeh A, Baradaran HR, Huntington M, Emami Razavi SH, Baghban Rezvan F, Salek Ranjbarzadeh F. Accountability in medical education from theory to practice Tabriz 2018 statement: A step towards the implementation of this social necessity. Med J Islam Repub Iran 2020; 34:93. [PMID: 33315967 PMCID: PMC7722974 DOI: 10.34171/mjiri.34.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background: To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference.
Methods: For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Results: Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Conclusion: Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.
Collapse
Affiliation(s)
- Reza Ghaffari
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Taghizadieh
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mozhgan Behshid
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Husein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azim Mirzazadeh
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mark Huntington
- Department of Family Medicine, School of Medicine, University of South Dakota Sanford, 414 E. Clark Street, Vermillion, SD 57069, United States
| | - Seyed Hasan Emami Razavi
- Neuroscience Institute, Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Flora Baghban Rezvan
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Salek Ranjbarzadeh
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
12
|
Houghton C, Dowling M, Meskell P, Hunter A, Gardner H, Conway A, Treweek S, Sutcliffe K, Noyes J, Devane D, Nicholas JR, Biesty LM. Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 10:MR000045. [PMID: 33026107 PMCID: PMC8078544 DOI: 10.1002/14651858.mr000045.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Randomised trials (also referred to as 'randomised controlled trials' or 'trials') are the optimal way to minimise bias in evaluating the effects of competing treatments, therapies and innovations in health care. It is important to achieve the required sample size for a trial, otherwise trialists may not be able to draw conclusive results leading to research waste and raising ethical questions about trial participation. The reasons why potential participants may accept or decline participation are multifaceted. Yet, the evidence of effectiveness of interventions to improve recruitment to trials is not substantial and fails to recognise these individual decision-making processes. It is important to synthesise the experiences and perceptions of those invited to participate in randomised trials to better inform recruitment strategies. OBJECTIVES To explore potential trial participants' views and experiences of the recruitment process for participation. The specific objectives are to describe potential participants' perceptions and experiences of accepting or declining to participate in trials, to explore barriers and facilitators to trial participation, and to explore to what extent barriers and facilitators identified are addressed by strategies to improve recruitment evaluated in previous reviews of the effects of interventions including a Cochrane Methodology Review. SEARCH METHODS We searched the Cochrane Library, Medline, Embase, CINAHL, Epistemonikos, LILACS, PsycINFO, ORRCA, and grey literature sources. We ran the most recent set of searches for which the results were incorporated into the review in July 2017. SELECTION CRITERIA We included qualitative and mixed-methods studies (with an identifiable qualitative component) that explored potential trial participants' experiences and perceptions of being invited to participate in a trial. We excluded studies that focused only on recruiters' perspectives, and trials solely involving children under 18 years, or adults who were assessed as having impaired mental capacity. DATA COLLECTION AND ANALYSIS Five review authors independently assessed the titles, abstracts and full texts identified by the search. We used the CART (completeness, accuracy, relevance, timeliness) criteria to exclude studies that had limited focus on the phenomenon of interest. We used QSR NVivo to extract and manage the data. We assessed methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We used thematic synthesis to analyse and synthesise the evidence. This provided analytical themes and a conceptual model. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. Our findings were integrated with two previous intervention effectiveness reviews by juxtaposing the quantitative and qualitative findings in a matrix. MAIN RESULTS We included 29 studies (published in 30 papers) in our synthesis. Twenty-two key findings were produced under three broad themes (with six subthemes) to capture the experience of being invited to participate in a trial and making the decision whether to participate. Most of these findings had moderate to high confidence. We identified factors from the trial itself that influenced participation. These included how trial information was communicated, and elements of the trial such as the time commitment that might be considered burdensome. The second theme related to personal factors such as how other people can influence the individual's decision; and how a personal understanding of potential harms and benefits could impact on the decision. Finally, the potential benefits of participation were found to be key to the decision to participate, namely personal benefits such as access to new treatments, but also the chance to make a difference and help others. The conceptual model we developed presents the decision-making process as a gauge and the factors that influence whether the person will, or will not, take part. AUTHORS' CONCLUSIONS This qualitative evidence synthesis has provided comprehensive insight into the complexity of factors that influence a person's decision whether to participate in a trial. We developed key questions that trialists can ask when developing their recruitment strategy. In addition, our conceptual model emphasises the need for participant-centred approaches to recruitment. We demonstrated moderate to high level confidence in our findings, which in some way can be attributed to the large volume of highly relevant studies in this field. We recommend that these insights be used to direct or influence or underpin future recruitment strategies that are developed in a participant-driven way that ultimately improves trial conduct and reduces research waste.
Collapse
Affiliation(s)
- Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aislinn Conway
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katy Sutcliffe
- Department of Social Science, Social Science Research Unit, UCL Institute of Education, London, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jane R Nicholas
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
13
|
Maravilla JC, Betts K, Adair L, Alati R. Stunting of children under two from repeated pregnancy among young mothers. Sci Rep 2020; 10:14265. [PMID: 32868833 PMCID: PMC7459341 DOI: 10.1038/s41598-020-71106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/05/2020] [Indexed: 11/08/2022] Open
Abstract
Repeated pregnancy leaves young mothers nutritionally deprived which may in turn lead to poor infant growth. We measure the occurrence and persistence of stunting among offspring of young mothers who experienced repeated pregnancies using data from the Cebu Longitudinal Health and Nutrition Survey. We selected mothers aged 14-24 years (n = 1,033) with singleton birth. We determined the length-for-age z scores (LAZ) at 12 and 24 months of the index child using the World Health Organisation 2007 growth standard. We fitted LAZ, stunting occurrence (i.e. LAZ < - 2) and persistence from 12 to 24 months into regression models and tested for the mediating effect of low birthweight and feeding practices. In these models, repeated pregnancy was analysed in an ordinal approach using number of past pregnancies of young mothers at birth of the index child. Compared to infants born to young mothers aged 14-24 years who had no previous pregnancies, those born to young mothers with repeated pregnancies have at least 0.15 (95% CI - 0.23, - 0.08) LAZ lower and are at higher chance of stunting by at least 40% (95% CI 1.19, 1.67) at 12 and 24 months. Similar cohorts of infants showed an elevated risk of persistent stunting from 12 through 24 months with a relative risk ratio of 1.51 (95% CI 1.21, 1.88). Optimal feeding practices substantially mediated stunting outcomes by further reducing the effects of repeated pregnancy to stunting occurrence and persistence by 19.95% and 18.09% respectively. Mediation tests also showed low birthweight in the causal pathway between repeated pregnancy and stunting. Repeated pregnancy in young mothers is a predictor of stunting among children under 2 years. Secondary pregnancy prevention measures and addressing suboptimal feeding practices are beneficial to mitigate the negative impact of repeated adolescent pregnancy on children.
Collapse
Affiliation(s)
- Joemer Calderon Maravilla
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia.
- Life Course Centre, Australian Research Council Centre of Excellence for Children and Families Over the Life Course, Brisbane, Australia.
- Institute of Nursing, Far Eastern University, Manila, Philippines.
| | - Kim Betts
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - Linda Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rosa Alati
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
- Life Course Centre, Australian Research Council Centre of Excellence for Children and Families Over the Life Course, Brisbane, Australia
- School of Public Health, Curtin University, Perth, Australia
| |
Collapse
|
14
|
Vallejo-Medina P, Correa JC, Gómez-Lugo M, Saavedra-Roa DA, García-Montaño E, Pérez-Pedraza D, Niebles-Charris J, García-Roncallo P, Abello-Luque D, Espada JP, Morales A. A text mining approach for adapting a school-based sexual health promotion program in Colombia. Prev Med Rep 2020; 18:101090. [PMID: 32322460 PMCID: PMC7160447 DOI: 10.1016/j.pmedr.2020.101090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/08/2020] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
A common practice among clinical psychologists and other health professionals is the use of school-based sexual health promotion programs as a means for preventing sexually transmitted infections. A fundamental criterion for the designing and adaptation of these programs is the age of their target populations because limited education and language are the most relevant factors that limit the efficacy of these programs. The contribution of this paper consists of assessing both the readability of the written materials that accompany the contents of a Spanish-written school-based sexual health promotion program used in Colombia, as well as the words co-occurrence network structure of its contents. The readability of the evaluated program corresponded to its intended target population aged between 14 and 19, with the schooling of 9-13 years of education. The resulting words co-occurrence network structure of the COMPAS program also mirrored its theoretical content. These results all together are deemed as empirical evidence of the adequacy of the program.
Collapse
Affiliation(s)
| | - Juan C. Correa
- Fundación Universitaria Konrad Lorenz, School of Psychology, Bogotá, Colombia
| | - Mayra Gómez-Lugo
- Fundación Universitaria Konrad Lorenz, School of Psychology, Bogotá, Colombia
| | | | | | | | | | | | | | - José Pedro Espada
- Universidad Miguel Hernandez de Elche, Health Psychology Department, Elche, Spain
| | - Alexandra Morales
- Universidad Miguel Hernandez de Elche, Health Psychology Department, Elche, Spain
| |
Collapse
|
15
|
Field S, Abrahams Z, Honikman S. Adolescent mothers: A qualitative study on barriers and facilitators to mental health in a low-resource setting in Cape Town, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e9. [PMID: 32501029 PMCID: PMC7300943 DOI: 10.4102/phcfm.v12i1.2279] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/14/2020] [Accepted: 02/22/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pregnant and postnatal adolescent women are a high-risk group for common mental disorders (CMDs); however, they have low levels of engagement and retention with mental health services. Negative consequences of CMDs have been documented for both mother and child. AIM The study aimed to explore the barriers and facilitators to service access for adolescents in low-resource settings. SETTING We interviewed 12 adolescents, aged 15-19 years, from low-resource settings in Cape Town, South Africa. Participants had previously engaged with a mental health service, integrated into maternity care. METHODS Twelve semi-structured, individual interviews were used for this qualitative study. Interviews were recorded, transcribed and coded. A framework analysis was employed for data analysis. RESULTS Adolescents perceived considerable stigma around both teenage pregnancy and mental illness, which inhibited use of mental health services. Other barriers included fearing a lack of confidentiality as well as logistical and environmental obstacles. Service uptake was facilitated by support from other adults and flexible appointment times. Face-to-face individual counselling was their preferred format for a mental health intervention. CONCLUSION Several key components for adolescent-friendly mental health services emerged from our findings: integrate routine mental health screening into existing obstetric services to de-stigmatise mental health problems and optimise screening coverage; coordinate obstetric and counselling appointment times to rationalise the use of limited resources; and sensitise care providers to the needs of adolescents to reduce stigma around adolescent sexual activity and mental illness. A non-judgemental, caring and confidential relationship between counsellors and clients is crucial for successful interactions.
Collapse
Affiliation(s)
- Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town.
| | | | | |
Collapse
|
16
|
Yibrehu MS, Mbwele B. Parent - adolescent communication on sexual and reproductive health: the qualitative evidences from parents and students of Addis Ababa, Ethiopia. Reprod Health 2020; 17:78. [PMID: 32460783 PMCID: PMC7254664 DOI: 10.1186/s12978-020-00927-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Repeatedly adolescents in Africa have been experiencing early pregnancy by more than 50%, early parenthood by 30% and new HIV infections by more than 80%. Parent - Adolescent communication as an effective strategy on sexual and reproductive health has not been taken up in most of African countries including Ethiopia. The aim of the study was to assess the challenges of Parent - Adolescent communication on sexual and reproductive health practices in Addis Ababa, Ethiopia. METHODS A qualitative cross-sectional study exploring Parent - Adolescent communication practices was conducted in two high schools Yeka sub-city, Addis Ababa, Ethiopia. Students aged 15-19 years were recruited for in-depth interviews and focused group discussions (FGD) as well as respective parents for in-depth interviews and parents' FGD. RESULTS Twenty students were available for in-depth interviews and all of them for FDG. Sixteen parents were available for in-depth interviews and nine of them for parent's FGD. Parent - Adolescent communication on sexual and reproductive was reported to be important by both adolescents and parents. The parental initiation is rare. The initial sexual activity by the adolescents triggers initiation by parents. The communications are gender dependent, not planned and not continuous and inhibited by intergenerational cultural taboo. A gap exists in parental knowledge on such communications. Parents deny responsibilities to communicate with adolescent as they fear it will perpetuate early sex practices, adolescents are too young it's an embarrassment, often being busy for household income retards their wills to communicate. CONCLUSIONS Parent-Adolescent communications on sexual and reproductive health is not a common practice in Addis Ababa, Ethiopia due to taboo, cultural structures, gender domains and parental knowledge. These findings alarm the risk of adolescent exposure towards unwanted pregnancies, transmissions of HIV/AIDS and Sexually Transmitted Infections in Addis Ababa.
Collapse
Affiliation(s)
- Meseret Shiferaw Yibrehu
- School of Public Health, Gondar University, P.O Box 196, Gondar, Amhara Ethiopia
- RN, Midwife Nurse, Public Health Consultant, P.O. Box 30995, Addis Ababa, Ethiopia
| | - Bernard Mbwele
- Department of Epidemiology and Biostatistics, University of Dares Salaam, Mbeya College of Health and Allied Sciences UDSM-MCHAS, PO Box 608, Mbeya, Tanzania
- Vijiji International, Mawenzi Road, P.O Box 7823, Moshi, Tanzania
| |
Collapse
|
17
|
Amongin D, Nakimuli A, Hanson C, Nakafeero M, Kaharuza F, Atuyambe L, Benova L. Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys. PLoS One 2020; 15:e0231557. [PMID: 32287303 PMCID: PMC7156070 DOI: 10.1371/journal.pone.0231557] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background Information on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors. Methods We analyzed Uganda Demographic and Health Survey data of women age 20–24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the second order birth and the prevalence of short birth intervals birth (<13 months) between the first and second such birth. On the 2016 survey, we examined factors associated with repeat adolescent birth using bivariate and multivariate modified Poisson regression. Results At the 1988/89 survey, 58.9% of women with first birth <18 years reported a repeat adolescent birth. This percentage increased to 66.8% in 2006 (+7.9 percentage points [pp], p = 0.010) and thereafter declined to 55.6% by 2016 (-11.2 pp, p<0.001), nevertheless, no change occurred between 1988/89 and 2016 (-3.3pp, p = 0.251). Among women with repeat adolescent births, the mean number of live births by exact age 20 years (2.2 births) and prevalence of short birth intervals (3.5% in 1988/89, 5.4% in 2016) (+1.9pp, p = 0.245) did not change. Increasingly more women with repeat adolescent births preferred to have had the second child later, 22.5% in 1995 and 43.1% in 2016 (+20.6pp, p = <0.001). On the 2016 survey, women from poorer households and those of younger age at first birth were significantly more likely to report repeat adolescent birth. Conclusion Following a first birth <18 years, more than half of the women report a repeat adolescent birth (<20 years), with no decline observed in 30 years. Increasingly more women wanted the second adolescent pregnancy later, highlighting the need to support adolescents with improved family planning services at each contact.
Collapse
Affiliation(s)
- Dinah Amongin
- Department of Obstetrics and Gynaecology School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- * E-mail:
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, England
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mary Nakafeero
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Frank Kaharuza
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England
- Department of Public Health, Institute of Tropical Medicine, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
18
|
Mantzourani E, Hodson K, Evans A, Alzetani S, Hayward R, Deslandes R, Hughes ML, Holyfield G, Way C. A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200236. [PMID: 31395752 DOI: 10.1136/bmjsrh-2018-200236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 07/03/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Access to emergency contraception (EC) has been a core component of attempts to address high teenage pregnancy rates in Wales. A national service was commissioned in 2011, allowing supply of EC free of charge from community pharmacies (CPs). This study investigated 5 years of the EC service, to describe its use and investigate changes in the pattern of use over time. METHODS Secondary analyses of data from all National Health Service funded CP EC consultations in Wales between 1 August 2012 and 31 July 2017 (n=181 359). Data comprised standardised clinical and demographic information, in the form of predefined service user responses, submitted for reimbursement by CPs. RESULTS Overall service provision remained relatively consistent over the study period, with women aged between 13 and 59 years accessing the service. An association was observed between the time since unprotected sexual intercourse and the day on which the service was accessed (Χ2(18)=16 292.327, p<0.001). Almost half (47.9%) of requests were because no contraception had been used, with a strong and positive association for teenagers and women aged 40+ years. A statistically significant and increasing percentage of consultations were accompanied by further sexual health advice (r=0.7, p<0.01). CONCLUSIONS Access to EC through CPs is contributing to reducing teenage conceptions and termination rates. However, action is needed to increase contraception use in all age groups. Reduced availability of CP services on Sundays is a barrier to timely EC access. Findings support an expanded role for community pharmacists in provision of regular contraception.
Collapse
Affiliation(s)
- Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | | | - Sarah Alzetani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Hayward
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Rhian Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Mary Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | | | - Cheryl Way
- National Health Service Wales Informatics Service, Cardiff, UK
| |
Collapse
|
19
|
Lin CJ, Nowalk MP, Ncube CN, Aaraj YA, Warshel M, South-Paul JE. Long-term Outcomes for Teen Mothers Who Participated in a Mentoring Program to Prevent Repeat Teen Pregnancy. J Natl Med Assoc 2018; 111:296-301. [PMID: 30449542 DOI: 10.1016/j.jnma.2018.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Each year in the United States (US), one million adolescents are pregnant, of which approximately 20% are repeat pregnancies. Adolescent motherhood is associated with lower educational attainment, socioeconomic status and poorer health outcomes. A mentoring program called the Maikuru Program conducted from 2011 to 2015, was designed to teach young mothers under 20 years old how to face daily life challenges, to support them by pairing them with an adult mentor, and prevent a subsequent pregnancy during their teens. The goal of the present study was to examine educational attainment, employment and pregnancies of these adolescent mothers 1-5 years post program. METHODS Former participants of the Maikuru Program were contacted by telephone and/or Facebook in 2016 to conduct a survey about education attainment, employment status, number of subsequent children delivered, and satisfaction with the program. RESULTS Nineteen of 51 participants (37%) were reached to complete the survey. Of those who responded, all were in high school or had graduated, nearly half were pursuing some form of higher education and 12 (63%) were currently employed. Nine mothers had given birth to another child; only two (10.5%) were known to be less than 20 years old at the time. All participants reported positive perceptions of the program and would recommend it to other adolescent mothers. CONCLUSION Educational achievement and employment were high among a modest proportion of adolescent mothers who had participated in a culturally tailored, teen mother-adult mentoring program. Repeat teen pregnancy was infrequent and the mentoring program was perceived as contributing to the success of those who responded to the follow-up. A future randomized trial based on this model may confirm these findings.
Collapse
Affiliation(s)
- Chyongchiou Jeng Lin
- University of Pittsburgh School of Medicine, Department of Family Medicine, 4420 Bayard Street, Suite 520, Pittsburgh, PA 15260, USA.
| | - Mary Patricia Nowalk
- University of Pittsburgh School of Medicine, Department of Family Medicine, 4420 Bayard Street, Suite 520, Pittsburgh, PA 15260, USA
| | - Collette N Ncube
- Department of Health Sciences, Bouvé College of Health Sciences, Institute for Health Equity and Social Justice Research, 332 INV, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Yassmin Al Aaraj
- University of Pittsburgh School of Medicine, Department of Family Medicine, 4420 Bayard Street, Suite 520, Pittsburgh, PA 15260, USA
| | - McKenzie Warshel
- University of Pittsburgh School of Medicine, Department of Family Medicine, 4420 Bayard Street, Suite 520, Pittsburgh, PA 15260, USA
| | - Jeannette E South-Paul
- University of Pittsburgh School of Medicine, Department of Family Medicine, 4420 Bayard Street, Suite 520, Pittsburgh, PA 15260, USA
| |
Collapse
|
20
|
Frederiksen BN, Rivera MI, Ahrens KA, Malcolm NM, Brittain AW, Rollison JM, Moskosky SB. Clinic-Based Programs to Prevent Repeat Teen Pregnancy: A Systematic Review. Am J Prev Med 2018; 55:736-746. [PMID: 30342636 PMCID: PMC10411458 DOI: 10.1016/j.amepre.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT The purpose of this paper is to synthesize and evaluate the evidence on the effectiveness of repeat teen pregnancy prevention programs offered in clinical settings. EVIDENCE ACQUISITION Multiple databases were searched for peer-reviewed articles published from January 1985 to April 2016 that included key terms related to adolescent reproductive health services. Analysis of these studies occurred in 2017. Studies were excluded if they focused solely on sexually transmitted disease/HIV prevention services, or occurred outside of a clinic setting or the U.S., Canada, Europe, Australia, or New Zealand. Inclusion and exclusion criteria further narrowed the studies to those that included information on at least one short-term (e.g., increased knowledge); medium-term (e.g., increased contraceptive use); or long-term (e.g., decreased repeat teen pregnancy) outcome, or identified contextual barriers or facilitators for providing adolescent-focused family planning services. Standardized abstraction methods and tools were used to synthesize the evidence and assess its quality. Only studies of clinic-based programs focused on repeat teen pregnancy prevention were included in this review. EVIDENCE SYNTHESIS The search strategy identified 27,104 citations, 940 underwent full-text review, and 120 met the adolescent-focused family planning services inclusion criteria. Only five papers described clinic-based programs focused on repeat teen pregnancy prevention. Four studies found positive (n=2) or null (n=2) effects on repeat teen pregnancy prevention; an additional study described facilitators for helping teen mothers remain linked to services. CONCLUSIONS This review identified clinic-based repeat teen pregnancy prevention programs and few positively affect factors that may reduce repeat teen pregnancy. Access to immediate postpartum contraception or home visiting programs may be opportunities to meet adolescents where they are and reduce repeat teen pregnancy. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
Collapse
Affiliation(s)
- Brittni N Frederiksen
- Office of the Assistant Secretary for Health, Office of Population Affairs, HHS, Rockville, Maryland.
| | - Maria I Rivera
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katherine A Ahrens
- Office of the Assistant Secretary for Health, Office of Population Affairs, HHS, Rockville, Maryland
| | | | - Anna W Brittain
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan B Moskosky
- Office of the Assistant Secretary for Health, Office of Population Affairs, HHS, Rockville, Maryland
| |
Collapse
|
21
|
Hennelly N, Cooney A, Houghton C, O'Shea E. The experiences and perceptions of personhood for people living with dementia: A qualitative evidence synthesis protocol. HRB Open Res 2018; 1:18. [PMID: 32490349 PMCID: PMC7219284 DOI: 10.12688/hrbopenres.12845.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Personhood in dementia is concerned with treating people living with dementia with dignity and respect, in a manner that supports their sense of self. It focuses on treating the person living with dementia as a person first and foremost. Supporting personhood in dementia is the key goal of person-centred care. Existing qualitative research examines what personhood means to the person living with dementia and explores what is important to their personhood and sense of self. However, to date little work has focused on synthesising these studies. Methods: This is a protocol for a qualitative evidence synthesis of personhood in dementia. The review examines qualitative peer-reviewed research of the perspectives and experiences of personhood for people living with dementia. A systematic search will be carried out on eight electronic databases and supplemented by other purposeful literature search methods. Title and abstract screening, and full text screening will be carried out by two authors independently. Included studies will be critically appraised. Thematic synthesis will be conducted on all of the included studies. Confidence in the review findings will be assessed using GRADE CERQual. Discussion: The findings from this synthesis will be useful to health care providers and policy makers seeking to understand what personhood means for people living with dementia. The findings will also inform optimal service provision, as well as outcome measures in dementia. PROSPERO registration:
CRD42017076114 (21/11/2017)
Collapse
Affiliation(s)
- Niamh Hennelly
- Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Ireland
| | - Adeline Cooney
- Centre for Teaching & Learning, Maynooth University , Maynooth, Ireland
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Ireland
| |
Collapse
|
22
|
Walpole G, Clark H, Dowling M. Myeloma patients' experiences of haematopoietic stem cell transplant: A qualitative thematic synthesis. Eur J Oncol Nurs 2018; 35:15-21. [PMID: 30057079 DOI: 10.1016/j.ejon.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/16/2018] [Accepted: 05/08/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to synthesise all qualitative evidence on the experiences of myeloma patients undergoing haematopoietic stem cell transplant (HSCT). METHOD A systematic search strategy was developed and a rigorous search of the literature was undertaken searching six databases (CINAHL, Embase, Medline, Psych Info, Ethos and Proquest). The software for systematic reviews www.covidence.org was used to blind screen for eligible papers. Quality appraisal of each study was undertaken using the Critical Appraisal Skills Programme (CASP). Confidence in each finding was assessed using Confidence in the Evidence from Reviews of Qualitative research (CERQual). RESULTS Eight qualitative studies (reported in eleven papers and including seventy six myeloma patients) were selected in the final sample for evidence synthesis. Four themes were identified relating to patients' feeling 'dead', disconnecting and isolating themselves, cognitive impairment and engagement with exercise and its benefits in recovery. CONCLUSIONS The burden of cognitive functioning among myeloma patients was often under detected. Nurses should ask patients regularly about their memory and any challenges they may be experiencing to their concentration and recall, Exercise during the transplant process can help improve patients' recovery, both physically and psychologically. A structured exercise programme developed by a physiotherapist to suit the needs of each patient should be standard practice in the transplant process.
Collapse
Affiliation(s)
| | - Helen Clark
- Library and Information Services, Sligo University Hospital, Sligo, Ireland.
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| |
Collapse
|