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Bwire A, Sama DJ, Mirano J, Nyachae P, Owino K, Nabukeera J, Tumuhairwe J, Malik M, Salas I, Mitchell V, Bose K. Boosting Contraceptive Uptake in Urban Uganda: Older Women Benefit When Layering Adolescent and Youth Interventions Onto Existing Family Planning Programming. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200308. [PMID: 38641402 PMCID: PMC11111102 DOI: 10.9745/ghsp-d-22-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Uganda has a large young population with a high unmet need for family planning (FP). Although there have been many efforts to improve access to and uptake of contraception, improvements have been slow. The Ministry of Health Uganda partnered with The Challenge Initiative (TCI) to implement a novel multipronged approach layering adolescent and youth sexual reproductive health (AYSRH) onto a functioning general FP program for women of reproductive age in 3 local governments of Buikwe, Mukono, and Iganga. We describe the approach and aim to determine whether layering AYSRH interventions onto an existing program resulted in increased contraceptive uptake among adolescents and youth aged 10-24 years and among women aged 25-49 years. METHODS We analyzed service statistics from the Uganda Health Management Information System to assess contraceptive uptake for adolescents and youth (aged 10-24 years) and older women (aged 25-49 years) before and after the implementation of the AYSRH approach in 3 areas (Buikwe, Iganga, and Mukono) compared to 11 areas where only the general FP program was implemented and the Uganda country total. RESULTS This analysis showed that before the start of TCI's support, levels of contraceptive uptake were similar in all local governments. However, after implementation, there was an increase in uptake for general FP program only areas (1.7-point advantage over country total) and an even greater increase in general FP+AYSRH areas (2.4-point advantage over FP only programming). This was observed in both adolescents and youth aged 10-24 years and among women aged 25-49 years. CONCLUSION The layering of TCI's AYSRH interventions onto a well-functioning FP platform not only increased contraceptive uptake among adolescents and youth aged 10-24 years but also boosted uptake among women older than age 25 years.
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Affiliation(s)
| | | | - Jessica Mirano
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | | | | | | | | | - Maheen Malik
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | - Ian Salas
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | - Vanessa Mitchell
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
| | - Krishna Bose
- William H. Gates Sr. Institute for Population and Reproductive Health, Baltimore, MD, USA
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Pradhan MR, Mondal S, Saikia D, Mudi PK. Dynamics of caste and early childbearing in India: a perspective of three decades. BMC Womens Health 2024; 24:231. [PMID: 38600481 PMCID: PMC11008017 DOI: 10.1186/s12905-024-03077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Early childbearing disrupts girls' otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing. METHOD This study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20-24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs). RESULTS Many women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04-1.11) than those from the General caste. CONCLUSION To decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women's reproductive rights.
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Affiliation(s)
- Manas Ranjan Pradhan
- Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India.
| | - Sourav Mondal
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Daisy Saikia
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Prasanna Kumar Mudi
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
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Koiwa Y, Shishido E, Horiuchi S. Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:288. [PMID: 38541288 PMCID: PMC10970290 DOI: 10.3390/ijerph21030288] [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: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Globally, about half of all induced abortions have been estimated to be unsafe, which results in 13% of maternal deaths yearly. Of these induced abortions, 41% of unsafe abortions have been reported in young women who are dependent on their parents for their livelihood. They are often left in a vulnerable position and may have difficulty in making a decision regarding abortion. This study aimed to (1) characterize and map factors that influence abortion decision-making of adolescents and young women, and (2) identify the care and support that they need in their decision-making process. METHODS We conducted a scoping review following the JBI method and PRISMA-ScR checklist. We comprehensively searched MEDLINE (PubMed), Embase, Cochrane Library, CINAHL, and PsycInfo, and hand searched publications in the Google Scholar database between November 2021 and October 2023. The search included all English language qualitative and mixed methods research articles published on the database up to October 2023 that included participants aged 10-24 years. The CASP checklist was used as a guide for the qualitative analysis. NVivo was used to synthesize the findings. RESULTS There were 18 studies from 14 countries (N = 1543 young women) that met the inclusion criteria. Three domains and eleven categories were included as follows: personal (desire for self-realization and unwanted pregnancy), interpersonal (parental impact, reaction of partner, roles of peers and friends, existence of own child, and lack of support), and social circumstances (sexual crime, financial problem, limitation of choice, and underutilized healthcare services). Decision-making factors regarding abortions were also found across all three domains. CONCLUSION The abortion decision-making of young women is influenced by various external factors regardless of country. Parents are especially influential and tend to force their daughters to make a decision. Young women experienced suffering, frustration, and lack of autonomy in making decisions based on their preference. This emphasizes the importance of autonomous decision-making. In this regard, healthcare services should be used. However, there are barriers to accessing these services. To improve such access, the following are required: staff training to provide adolescent and youth-friendly health services, counseling based on women's needs, counseling including the parents or guardians that is confidential and ethical, promotion of decision aids, and affordable accessible care.
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Affiliation(s)
- Yui Koiwa
- Makita General Hospital, Nishikamata, Ota-ku, Tokyo 144-8501, Japan;
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
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Kumah A, Aidoo LA, Amesawu VE, Issah AR, Nutakor HS. Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:1-8. [PMID: 38406655 PMCID: PMC10887489 DOI: 10.36401/jqsh-23-20] [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: 08/04/2023] [Revised: 09/19/2023] [Accepted: 10/16/2023] [Indexed: 02/27/2024]
Abstract
Introduction Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana. Methods A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables. Results The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes. Conclusions The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.
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Affiliation(s)
| | | | - Vera Edem Amesawu
- Department of Population and Reproductive Health, University of Ghana, Legon, Ghana
| | - Abdul-Razak Issah
- Department of Health Information Management, College of Health, Yamfo, Ghana
| | - Hillary Selassi Nutakor
- Department of Addiction, Recovery and Rehabilitation, Accra Psychiatric Hospital, Accra, Ghana
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Liga AD, Boyamo AE, Jabir YN, Tereda AB. Prevalence and correlates associated with early childbearing among teenage girls in Ethiopia: A multilevel analysis. PLoS One 2023; 18:e0289102. [PMID: 37552698 PMCID: PMC10409268 DOI: 10.1371/journal.pone.0289102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Teenage childbearing remains a significant global health concern, and in nations with limited resources, it is the major cause of newborn and maternal deaths. Early teenage childbearing is still Ethiopia's public health issue. Therefore, the goal of this study was to identify the prevalence and correlates of influencing early childbearing among teenage girls across Ethiopia. METHODS We conducted a secondary analysis of cross-sectional data from the 2016 Ethiopian Demographic and Health Survey. A multistage stratified cluster sampling strategy based on the community was used to include the 3,498 participants in total. To determine the significantly correlated factors that influence adolescent pregnancy, a multilevel binary logistic regression analysis was used. The factors that have a significant association with early childbearing were identified using the Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI). RESULTS This study demonstrated that 10.3% of teens across the country had children at an early age. The odds of early childbearing among teenage girls increased with first marriages occurring before the age of 18, non-formal education, being from a lower- or middle-class family, not using contraceptives, following Muslim or other religious beliefs, and being aware of the fertile window. Teenagers who had exposure to the media, however, had a reduced chance of becoming pregnant early. CONCLUSIONS The study indicates that early teenage childbearing is still Ethiopia's most significant public health problem. Therefore, the Ethiopian government should ban early marriage while also taking steps to reduce the risk through formal education, improved access to reproductive health education, and contraception, particularly for adolescent girls from low-income families and, by educating religious institutions about pregnancy dangers.
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Affiliation(s)
- Abebe Debu Liga
- Department of Statistics, College of Natural and Computational Sciences, Wolkite University, Wolkite, Ethiopia
| | - Adane Erango Boyamo
- Department of Statistics, College of Natural and Computational Sciences, Wachemo University, Hosaena, Ethiopia
| | - Yasin Negash Jabir
- Department of Statistics, College of Natural Science, Jimma University, Jimma, Ethiopia
| | - Akalu Banbeta Tereda
- Department of Statistics, College of Natural Science, Jimma University, Jimma, Ethiopia
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Hlongwa M, Mutambo C, Hlongwana K. 'In fact, that's when I stopped using contraception': a qualitative study exploring women's experiences of using contraceptive methods in KwaZulu-Natal, South Africa. BMJ Open 2023; 13:e063034. [PMID: 37080630 PMCID: PMC10124203 DOI: 10.1136/bmjopen-2022-063034] [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] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES This study explored women's experiences of using contraceptive methods in KwaZulu-Natal, South Africa. SETTING In October 2021, we conducted a qualitative study at Umlazi Township in KwaZulu-Natal province, South Africa, through face-to-face in-depth interviews. PARTICIPANTS Women from four primary healthcare facilities were recruited through a criterion-based sampling strategy. Using NVivo V.11, two skilled researchers independently conducted thematic data analysis, as a mechanism for quality assurance, before the results were collated and reconciled. RESULTS The study included 15 female participants, aged between 18 and 35 years, of whom two-thirds were aged 18-24 years. We found that women were concerned about unpleasant contraceptive methods side effects such as prolonged or irregular menstrual periods, bleeding, weight gain and/or severe pains, resulting in discontinuation of their use. In addition to contraceptive stockouts, women indicated that healthcare providers did not appropriately counsel or inform them about the available contraceptive methods, including how to use them. Key themes included the following: negative effects of contraceptive methods; stockouts of preferred contraceptive methods; inconsistent or incorrect use of contraceptive methods; lack of counselling regarding contracepive methods; and misconceptions about contraception. CONCLUSIONS Interventions aimed at reducing contraceptive stockouts are required to ensure that women are empowered to choose contraception based on their own preference, convenience and/or experience. It is imperative that counselling on contraceptive methods' side effects be improved, to ensure that women have freedom to make informed decisions about their preferred method, proper management of side effects and to assist them with method switching as needed, instead of discontinuation.
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Affiliation(s)
- Mbuzeleni Hlongwa
- School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Public Health, Societies and Belonging programme, Human Sciences Research Council, Pretoria, South Africa
| | - Chipo Mutambo
- School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit, University of KwaZulu-Natal, Durban, South Africa
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Factors associated with pregnancy and induced abortion among street-involved female adolescents in two Nigerian urban cities: a mixed-method study. BMC Health Serv Res 2023; 23:25. [PMID: 36627625 PMCID: PMC9832642 DOI: 10.1186/s12913-022-09014-x] [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: 08/13/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study determined the correlates of unwanted pregnancy and induced abortion among sexually active female street-involved adolescents (SIAs) aged 10-19 years in two urban cities in South-west, Nigeria. METHODS The data for this study were extracted from a larger mixed-method survey dataset on the sexual and reproductive health (SRH) of 1505 street-involved young people aged 10 to 24 years. For the quantitative data, the explanatory variables were age, history of school attendance, employment status, religion, living arrangement and city of residence. The study outcomes were a history of pregnancy and a history of induced abortion of last pregnancy. Binomial regression analysis was performed to determine the association between the explanatory and outcome variables. For the qualitative data generated through focus group discussions and in-depth-interviews, inductive and deductive approaches were used in conducting a thematic analysis to explore the perspectives and experiences of SIA on pregnancy and induced abortion. RESULTS Of the 424 female SIAs, 270 (63.7%) reported having had sex. Sixty-four (23.7%) respondents had a history of pregnancy, of which 38 (59.4%) gave a history of induced abortion of the last pregnancy. A history of school attendance significantly reduced the likelihood of being pregnant (AOR: 0.42, 95% C.I: 0.19-0.91), while 15-19-years-old SIAs who were pregnant were significantly less likely to abort (AOR: 0.13, 95% C.I: 0.02-0.77). Qualitative reports indicated that unintended pregnancy and induced abortion was a common experience among the sexually active SIAs. Many participants were aware of the methods of, and places to induce abortion. CONCLUSION A large proportion of SIAs are sexually active with a high incidence of unintended pregnancy and a high rate of unsafe abortion. Access of female SIAs to education can reduce the risk of unintended pregnancy. Attention needs to be paid to how SIAs can have access to contraception.
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Chimwaza-Manda W, Kamndaya M, Pilgrim N, Mathur S, Chipeta EK, Sikweyiya Y. Social support and very young adolescent girl's knowledge on sexual relationships: A comparative qualitative study of Girl Only Clubs' participants and non-participants in rural Malawi. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001339. [PMID: 36962900 PMCID: PMC10022037 DOI: 10.1371/journal.pgph.0001339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/22/2022] [Indexed: 01/15/2023]
Abstract
Early sexual relationships are associated with an increased risk of acquiring sexually transmitted diseases including HIV/AIDs, teenage pregnancies, and unsafe abortions among other negative health outcomes. Understanding sexual relationships among very young adolescents (VYAs) is important to equip them to protect themselves from negative sexual health (SH) outcomes. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is an HIV prevention initiative that provided an evidence-based core package of interventions to VYAs to prevent HIV acquisition in 15 countries in sub-Saharan Africa. The Girl Only Club (GOC) was the primary context for the interventions. Our objective in this study was to explore if there was any difference in social support (SS) received concerning sexual relationships between the VYA girls who attended GOCs and those who did not. In-depth interviews were conducted with 43 VYA girls, aged 10-14 years, in two rural southern districts, Zomba and Machinga, in Malawi. Twenty-three VYA girls were participants in GOCs and 20 VYA girls did not participate. A thematic, descriptive approach that involved a constant comparative analysis guided the data analysis, and Nvivo 12 software was used. In both study sites available SS concerning sexual relationships is informational support including information from parents, older relatives, and friends. However, club participants differed from non-club participants in sexual and reproductive health (SRH) knowledge and use. Club participants reported consulting others on decision-making and information on sexual relationships; receiving detailed SH information from clubs; condom use due to education received from the clubs; quitting sexual relationships; and correcting misinformation with club information. GOC participants received more SS which made them more knowledgeable and better at handling sexual relationship issues than those not in clubs. Interventions that integrate SS including social asset building and safe spaces are critical for VYA SRH programming.
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Affiliation(s)
- Wanangwa Chimwaza-Manda
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mphatso Kamndaya
- School of Applied Sciences, University of Malawi-The Polytechnic, Blantyre, Malawi
| | | | - Sanyukta Mathur
- Population Council, Washington, DC, United States of America
| | | | - Yandisa Sikweyiya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Whitton A, Swahn MH, Culbreth R, Kasirye R. Attitudes and risky sexual behavior among youth in Kampala, Uganda: Empirical analyses of risk factors by gender. PEC INNOVATION 2022; 1:100090. [PMID: 36532298 PMCID: PMC9757820 DOI: 10.1016/j.pecinn.2022.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study sought to examine gender differences and the influence of peer and parental perceptions on sexual risk behaviors among an at-risk sample of youth living in Kampala, Uganda. METHODS Using the cross-sectional Kampala Youth Survey (2014) based in Kampala, Uganda (n = 1134), bivariate and multivariable logistic regressions were conducted to determine the odds of sexual risk behaviors based on peer and parental influence variables and gender. RESULTS The perceptions of peer, adult, and parental opinions on sexual activity were significantly associated with varying levels across all risky sexual behaviors explored. When indexed and adjusted for other variables, females compared to males were at increased odds of participating in 3-4 risky sexual behaviors (OR: 0.63, 95% CI: 0.44, 0.90) and 5-6 risky sexual behaviors (OR: 0.38, 95% CI: 0.21, 0.68) compared to zero risky sexual behaviors. CONCLUSIONS Adolescent sexual risk behaviors are subject to peer and parental influence and vary between genders. INNOVATION This study emphasizes the importance of peer influences in adolescent sexual risk behaviors. Many of these youth are orphans, which may explain the lack of association between parental influences and sexual risk behavior. School-based and community-based interventions may be effective at preventing risky sexual behaviors for this vulnerable population.
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Affiliation(s)
- Alaina Whitton
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Rachel Culbreth
- Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA
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Preferences for accessing sexual and reproductive health services among adolescents and young adults living with HIV/AIDs in Western Kenya: A qualitative study. PLoS One 2022; 17:e0277467. [PMID: 36383570 PMCID: PMC9668131 DOI: 10.1371/journal.pone.0277467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the need, adolescents and young adults (AYAs) in resource-limited settings have limited access to sexual and reproductive health (SRH) care services for improved health outcomes. This is worse for AYAs living with HIV in resource-limited settings where much is unknown about contexts and issues inhibiting access to SRHs. We explored adolescents', healthcare workers, and caregivers' preferences for access to sexual and reproductive health services for adolescents and young adults living with HIV. We conducted 30 in-depth interviews and 8 focus group discussions among a subset of AYA aged 14-24 living with HIV, healthcare workers, and caregivers/parents. We recruited participants from Lumumba Sub-County Hospital (KLM) and Kisumu County Referral Hospitals in Kisumu County (KCH). Trained and experienced qualitative research assistants 5-10 years older than the adolescents conducted interviews and facilitated discussions using guides designed to elicit detailed views and perspectives on sex and sexuality, access to SRH services, challenges of AYA living with HIV, and potential interventions to improve access to SRH services. Audio files were transcribed verbatim and translated to English where necessary before coding and analysis. We applied constant comparative analysis for theme and content to arrive at our conclusions. Our analysis yielded two main themes: preferences for a venue for SRH services and choices for qualities of an SRH counsellor. We found that AYAs generally preferred receiving SRH services to be co-situated within clinical facilities. We also observed gender differences in the qualities of SRH providers, with male AYAs preferring older male service providers compared to females who preferred younger female providers close to their age. The study highlighted the preferences of AYAs for accessing SRH, which need to be considered when designing their health programs. Further, AYAs seem to endite health systems to individualize access to SRH for AYAs living with HIV by providing a combination of attributes that meet individual preferences.
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Manda WC, Sikweyiya Y, Kaunda-Khangamwa BN, Selemani A, Jimu S, Kamndaya M. Adolescent sexual health interventions that include very young adolescents in sub-Saharan Africa: a scoping review protocol. BMJ Open 2022; 12:e063343. [PMID: 36379647 PMCID: PMC9668002 DOI: 10.1136/bmjopen-2022-063343] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Targeting very young adolescents (VYAs) with sexual health (SH) interventions is increasingly being recognised as one of the strategies for addressing SH challenges in late adolescence. However, there is a dearth of literature regarding SH interventions implemented specifically for VYAs in sub-Saharan Africa (SSA). This scoping review aims to provide a summary of documented evidence on SH interventions that include VYAs in SSA, identify gaps in existing interventions and provide recommendations for further programmatic work on SH for VYAs. METHODS AND ANALYSIS The methods for this scoping review will be guided by the framework proposed by Arksey and O'Malley and further enhanced by Levac et al and the Joanna Briggs Institute. We will search electronic databases: Popline, EMBASE, PubMed, CINAHL, Dimensions, African Journals Online (AJOL) and specific summon country-specific search. We will include published studies from SSA and only adolescent SH interventions published from the year 2003-2022. Furthermore, we will include programmatic and intervention literature that has not been published in peer-reviewed articles. The data will be charted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review. The data will then be collated and summarised. ETHICS AND DISSEMINATION The scoping review methodology involves putting together information from articles or grey literature that is either publicly available or shared by the authors, this study does not require ethical approval. Findings of this scoping review will be published in a scientific journal and presented at relevant scientific fora and conferences. This scoping review will provide a comprehensive overview of the evidence base of adolescent SH interventions for VYAs in SSA and will highlight critical gaps in the existing interventions and areas where further programmatic work is needed for VYAs in SSA. REGISTRATION https://archive.org/details/osf-registrations-gn538-v1.
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Affiliation(s)
- Wanangwa Chimwaza Manda
- Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Yandisa Sikweyiya
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Apatsa Selemani
- Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | | | - Mphatso Kamndaya
- Applied Sciences, Malawi University of Business and Applied Sciences, Blantyre, Malawi
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Serván-Mori E, Cerecero-García D, Morales-Vazquez M, Sosa-Rubí S, Heredia-Pi I, Hernández-Serrato M. The Role of Effective Knowledge on Contraceptive Methods Use in the Replication of Mother-Daughter Adolescent Pregnancy in Mexico. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:4035-4046. [PMID: 36036869 DOI: 10.1007/s10508-021-02272-6] [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: 08/26/2020] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
An important gap in the literature is the analysis of the role of effective knowledge concerning use of contraceptive methods in the intergenerational reproduction of adolescent pregnancy in low- and middle-income countries. Using data from the 2014 Mexico National Survey of Demographic Dynamics, we conducted a retrospective cohort and complete case analysis of women aged ≤ 19 years cohabitating with their mothers and who self-reported having had sexual intercourse at the moment of the survey (n = 5143). We estimated instrumental variable probit models (IV-probit) to assess the association between effective knowledge concerning the use of contraceptive methods and adolescent pregnancy. We stratified our models according to parental history of adolescent pregnancy. Adolescent pregnancy prevalence in our sample was 58.7%. The IV-probit model showed that mothers with a history of adolescent pregnancy were 12.1 percentage points more likely to have daughters who experience adolescent pregnancy. In addition, daughters with effective knowledge concerning the use of contraceptive methods were 1.3 percentage points less likely to experience an adolescent pregnancy. Our findings carry relevant implications for policies seeking to reduce adolescent pregnancy. They highlight the need for policies and programs that tackle the intergenerational transmission of sexual and reproductive behaviors by increasing the information available to adolescents and enhancing their effective knowledge about the use of contraceptive methods. Identifying population groups at higher risk of adolescent pregnancy can contribute to the design of successful reproductive health policies in Mexico and other low- and middle-income countries.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, 62100, Cuernavaca, Morelos, México
| | - Diego Cerecero-García
- Center for Health Systems Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, 62100, Cuernavaca, Morelos, México.
| | - Mariana Morales-Vazquez
- Center for Health Systems Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, 62100, Cuernavaca, Morelos, México
| | - Sandra Sosa-Rubí
- Center for Health Systems Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, 62100, Cuernavaca, Morelos, México
| | - Ileana Heredia-Pi
- Center for Health Systems Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, 62100, Cuernavaca, Morelos, México
| | - María Hernández-Serrato
- Center of Information for Public Health Decisions, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa Maria Ahuacatitlan, Cerrada Los Pinos y Caminera, 62100, Cuernavaca, Morelos, México
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13
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Chidwick H, Baumann A, Ogba P, Banfield L, DiLiberto DD. Exploring adolescent engagement in sexual and reproductive health research in Kenya, Rwanda, Tanzania, and Uganda: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000208. [PMID: 36962492 PMCID: PMC10022240 DOI: 10.1371/journal.pgph.0000208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/23/2022] [Indexed: 06/18/2023]
Abstract
Adolescent sexual and reproductive health (ASRH) in East Africa has prioritized research on the barriers to care, communication, and ASRH knowledge, attitudes, and practices. However, there is little research examining the extent to which meaningful adolescent engagement in research is achieved in practice and how this influences the evidence available to inform ASRH services. This review offers a critical step towards understanding current approaches to adolescent engagement in ASRH research and identifying opportunities to build a strengthened evidence base with adolescent voices at the centre. This scoping review is based on Arksey and O'Malley's (2005) framework, employing a keyword search of four databases via OVID: Medline, Global Health, Embase and PsycINFO. Two reviewers screened title, abstract and full text to select articles examining ASRH in Tanzania, Rwanda, Kenya, and Uganda, published between 2000 and 2020. After articles were selected, data was extracted, synthesized, and thematically organized to highlight emerging themes and potential opportunities for further research. The search yielded 1201 results, 34 of which were included in the final review. Results highlight the methods used to gather adolescent perspectives of ASRH (qualitative), the content of those perspectives (knowledge, sources of information, gaps in information and adolescent friendly services), and the overall narratives that frame discussions of ASRH (risky sexual behaviour, stigma, and gender norms). Findings indicate the extent of adolescent engagement in ASRH research is limited, resulting in a lack of comprehensive evidence, consistent challenges with stigma, little information on holistic concepts and a narrow framing of ASRH. In conclusion, there is opportunity for more meaningful engagement of adolescents in ASRH research. This engagement can be achieved by involving adolescents more comprehensively throughout the research cycle and by expanding the range of ASRH topics explored, as identified by adolescents.
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Affiliation(s)
- Hanna Chidwick
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Baumann
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Ogba
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Deborah D. DiLiberto
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
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Khan S, Kemigisha E, Turyakira E, Chaput K, Kabakyenga J, Kyomuhangi T, Manalili K, Brenner JL. Effets dramatiques des mesures de santé publique liées à la COVID-19 et de la migration inverse de masse sur la santé sexuelle et reproductive des jeunes des régions rurales de l’Ouganda. Paediatr Child Health 2022; 27:S123-S129. [PMID: 36092289 PMCID: PMC9455642 DOI: 10.1093/pch/pxab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Les jeunes (de 10-24 ans) comptent pour presque le tiers de la population ougandaise et il est fréquemment difficile pour eux de se prévaloir de services de santé sexuelle et reproductive (SSR), l’incidence d’issues négatives en matière de SSR est en effet disproportionnellement élevée. En réponse à la COVID-19, l’Ouganda a mis en place de strictes mesures de santé publique, y compris la fermeture générale des transports collectifs, des écoles et des entreprises, ce qui a poussé les jeunes qui étudiaient et travaillaient en milieu urbain à retourner dans leur village rural. Notre étude visait à décrire qualitativement l’impact non intentionnel perçu des mesures de santé liées à la COVID-19 sur la SSR des jeunes dans deux districts ruraux. Méthodes Des groupes de consultation semi-structurée et entrevues avec intervenants clés auprès de jeunes, de parents, de leaders communautaires, de travailleurs, coordonnateurs et superviseurs de santé communautaire (TSC), de professionnels de la santé, de gestionnaires de la santé des districts et des établissements de santé et de médecins-hygiénistes expressément sélectionnés ont eu lieu afin d’examiner l’impact vécu et perçu qu’ont eues les mesures liées à la COVID-19 sur la SSR des jeunes. Les entrevues ont été enregistrées, transcrites et codées à l’aide d’une analyse thématique déductive. Résultats Quatre thèmes liés à la COVID-19 et trois sous-thèmes sont ressortis des 15 groupes de consultation et deux entrevues avec intervenants clés (n = 94). La fermeture des transports collectifs et le port obligatoire du masque ont empêché les jeunes d’obtenir des soins de SSR. La fermeture des écoles et des lieux de travail et la migration subséquente des jeunes des milieux urbains vers leur village rural ont fait exploser la demande auprès des établissements ruraux de santé mal préparés, ce qui a entravé davantage la quête de soins. Les jeunes ont rapporté craindre que leurs parents découvrent leur quête de soins de SSR, ce qui les a empêchés de le faire. Le confinement a causé des difficultés financières, l’isolement et l’entassement des familles; le mauvais traitement des jeunes, la violence sexiste et les mariages forcés ont suivi, et certains jeunes ont rapporté avoir accepté ces mariages comme un moyen d’échapper à la violence. L’inactivité et la multiplication des contacts sociaux étaient perçues comme favorisant l’activité sexuelle précoce. L’impact rapporté sur la SSR était des infections plus graves et des complications causées par le retard des soins, et une flambée des infections transmises sexuellement et des avortements. Conclusion Les mesures de santé publique liées à la COVID-19 ont fait reculer la quête de soins par les jeunes tout en augmentant les comportements risqués et les issues négatives de SSR. Il est essentiel d’investir dans la programmation en SSR auprès des jeunes afin d’inverser les effets non intentionnels de la pandémie et de reprendre notre élan vers les cibles de SSR chez les jeunes. La gestion future des pandémies doit tenir compte des disparités sociales et sanitaires et réduire les risques non intentionnels sur la SSR des jeunes présentés par les mesures de santé publique.
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Affiliation(s)
- Sundus Khan
- Bureau de santé autochtone, locale et mondiale, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
| | - Elizabeth Kemigisha
- Faculté d'études interdisciplinaires, faculté de médecine, Université de science et technologie Mbarara, Mbarara, Ouganda.,Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Eleanor Turyakira
- Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda.,Département de santé communautaire, faculté de médecine, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Kathleen Chaput
- Département d'obstétriques et de gynécologie, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada.,Département de sciences de santé communautaire, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
| | - Jerome Kabakyenga
- Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda.,Département de santé communautaire, faculté de médecine, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Teddy Kyomuhangi
- Institut de santé de la mère, du nouveau-né et de l'enfant, Université de science et technologie Mbarara, Mbarara, Ouganda
| | - Kimberly Manalili
- Département de sciences de santé communautaire, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
| | - Jennifer L Brenner
- Bureau de santé autochtone, locale et mondiale, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada.,Département de sciences de santé communautaire, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada.,Département de pédiatrie, école de médecine Cumming, Université de Calgary, Calgary, Alberta, Canada
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15
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Kakal T, Nalwadda C, van Reeuwijk M, van Veen M, Kusters L, Chatterjee O, Owekmeno C, Kok M. Young people's choice and voice concerning sex and relationships: effects of the multicomponent Get Up Speak Out! Programme in Iganga, Uganda. BMC Public Health 2022; 22:1603. [PMID: 35999598 PMCID: PMC9396562 DOI: 10.1186/s12889-022-13919-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background Young people in Uganda face challenges in achieving their sexual and reproductive health and rights (SRHR), such as lack of information, limited access to services, teenage pregnancy and sexually transmitted infections. To address this, their empowerment – including their ability to express themselves and make decisions, is a key strategy. This study assessed how young people’s voice and choice concerning sex and relationships changed over the period of 3 years of implementation of the Get Up Speak Out! programme. Methods Data were collected through a household survey with young people (15-24 years) and through focus group discussions, in-depth interviews and key informant interviews with youth and community stakeholders in 2017 for the baseline and 2020 for the end-line. Using the difference-in-difference technique and thematic analysis, changes in key outcomes were assessed over time between intervention and control area. Results There were limited changes over time in the intervention area, which did not differ from changes in the control area. Young people were able to express themselves and expand their decision-making space on sex and relationships, in particular if they were older, male and in a relationship. Young women negotiated their agency, often by engaging in transactional sex. However, youth were still restricted in their self-expression and their choices as speaking about sexuality was taboo, particularly with adults. This was influenced by the political and religious climate around SRHR in Uganda, which emphasised abstinence as the best option for young people to prevent SRHR-related problems. Conclusions Young people’s SRHR remains a challenge in Uganda in the context of a conservative political and religious environment that reinforces social and gender norms around youth and young women’s sexuality. The limited effect of the programme on increasing young people’s voice and choice concerning relationships in Uganda can be understood in the context of a ban on comprehensive sexuality education (CSE) and the COVID-19 pandemic. These structural and emerging contextual factors enforce the taboo around youth sexuality and hinder their access to SRHR information and services. Multi-component and targeted programmes are needed to influence changes at the structural, community and individual level. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13919-x.
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Affiliation(s)
- Tasneem Kakal
- KIT Royal Tropical Institute, Amsterdam, The Netherlands.
| | | | | | | | - Lincie Kusters
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | | | | | - Maryse Kok
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
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16
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Adane M, Cherie N, Damtie Y, Malde M, Chanie MG. Sexual and reproductive health service needs among youths attending preparatory school in Debre Tabor Town, Northwest Ethiopia. SAGE Open Med 2022; 10:20503121221113667. [PMID: 35910818 PMCID: PMC9326834 DOI: 10.1177/20503121221113667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Despite the reproductive health needs of youth having been supported by different organizations, youths continue to fall victim to sexual and reproductive health problems, and utilization of those services remains low. All efforts have not been felt across the Ethiopian learning institutions as is evidenced by persistent reproductive health problems. This study was aimed to determine sexual and reproductive health service needs among preparatory school youths of Debre Tabor town, Ethiopia. Methods: Facility-based cross-sectional study design was conducted in Debre Tabor town from 15 to 30 February 2020. A simple random sampling technique was used to access a total of 850 preparatory school students. The data were collected using pre-tested, structured, and self-administered questionnaires. Data were entered into EpiData v. 4.6 and exported to SPSS version 25 software for analysis. Binary logistics regression was used for analysis. Adjusted odds ratio along with 95% confidence interval was estimated to measure the strength of the association. The level of statistical significance was declared at a p value of 0.05. Results: The overall magnitude of sexual and reproductive health service needs was found 61.5% at 95% confidence interval (58.2%, 64.8 %). Being married (adjusted odds ratio = 2.24; 95% confidence interval: 1.10, 4.55), having information about sexual and reproductive health (adjusted odds ratio = 2.56; 95% confidence interval: 1.85, 3.55), youth discussion with families on sexual and reproductive health (adjusted odds ratio = 1.52, 95% confidence interval: 1.11, 2.10), and having a history of sexual intercourse (adjusted odds ratio = 2.19; 95% confidence interval: 1.53, 3.13) were found significantly associated with sexual and reproductive health service needs of youths. Conclusion: the overall need for sexual and reproductive health services among youths was found high. Therefore, managers and health workers need to prioritize an intervention that can improve youth-friendly service, information dissemination, and counseling, promoting discussion among family members on the sexual and reproductive health needs of the youths.
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Affiliation(s)
- Metages Adane
- Outpatient Department, Debre Tabor General Hospital, Debre Tabor, Ethiopia
| | - Niguss Cherie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Muluken Genetu Chanie
- Department of Health System and Policy, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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17
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Ooms GI, van Oirschot J, Okemo D, Reed T, van den Ham HA, Mantel-Teeuwisse AK. Healthcare workers' perspectives on access to sexual and reproductive health services in the public, private and private not-for-profit sectors: insights from Kenya, Tanzania, Uganda and Zambia. BMC Health Serv Res 2022; 22:873. [PMID: 35794551 PMCID: PMC9261038 DOI: 10.1186/s12913-022-08249-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Access to sexual and reproductive health services remains a challenge for many in Kenya, Tanzania, Uganda and Zambia. Health service delivery in the four countries is decentralised and provided by the public, private and private not-for-profit sectors. When accessing sexual and reproductive health services, clients encounter numerous challenges, which might differ per sector. Healthcare workers have first-hand insight into what impediments to access exist at their health facility. The aim of this study was to identify differences and commonalities in barriers to access to sexual and reproductive health services across the public, private and private not-for-profit sectors. Methods A cross-sectional survey was conducted among healthcare workers working in health facilities offering sexual and reproductive health services in Kenya (n = 212), Tanzania (n = 371), Uganda (n = 145) and Zambia (n = 243). Data were collected in July 2019. Descriptive statistics were used to describe the data, while binary logistic regression analyses were used to test for significant differences in access barriers and recommendations between sectors. Results According to healthcare workers, the most common barrier to accessing sexual and reproductive health services was poor patient knowledge (37.1%). Following, issues with supply of commodities (42.5%) and frequent stockouts (36.0%) were most often raised in the public sector; in the other sectors these were also raised as an issue. Patient costs were a more significant barrier in the private (33.3%) and private not-for-profit sectors (21.1%) compared to the public sector (4.6%), and religious beliefs were a significant barrier in the private not-for-profit sector compared to the public sector (odds ratio = 2.46, 95% confidence interval = 1.69–3.56). In all sectors delays in the delivery of supplies (37.4-63.9%) was given as main stockout cause. Healthcare workers further believed that it was common that clients were reluctant to access sexual and reproductive health services, due to fear of stigmatisation, their lack of knowledge, myths/superstitions, religious beliefs, and fear of side effects. Healthcare workers recommended client education to tackle this. Conclusions Demand and supply side barriers were manifold across the public, private and private not-for-profit sectors, with some sector-specific, but mostly cross-cutting barriers. To improve access to sexual and reproductive health services, a multi-pronged approach is needed, targeting client knowledge, the weak supply chain system, high costs in the private and private not-for-profit sectors, and religious beliefs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08249-y.
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Affiliation(s)
- Gaby I Ooms
- Health Action International, Overtoom 60-2, 1054 HK, Amsterdam, The Netherlands. .,Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
| | | | | | - Tim Reed
- Health Action International, Overtoom 60-2, 1054 HK, Amsterdam, The Netherlands
| | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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18
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Okeke CC, Mbachu CO, Agu IC, Ezenwaka U, Arize I, Agu C, Obayi C, Onwujekwe O. Stakeholders' perceptions of adolescents' sexual and reproductive health needs in Southeast Nigeria: a qualitative study. BMJ Open 2022; 12:e051389. [PMID: 35676003 PMCID: PMC9185505 DOI: 10.1136/bmjopen-2021-051389] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study explored the perceptions of adult stakeholders on adolescents sexual and reproductive health (SRH) needs, variations of perceived needs by different social stratifiers and adolescent's perceived interventions to address these needs. This will provide evidence that could be useful for policy and programme reviews for improving access and use of services in to meet the SRH needs of adolescents. DESIGN A qualitative cross-sectional study was conducted in Ebonyi state, Southeast, Nigeria. Data were analysed using thematic framework and content analysis approaches. SETTING AND PARTICIPANTS This qualitative study was conducted in six selected local government areas in Ebonyi state, Nigeria. The study participants comprised of adult stakeholders including community leaders, adolescent boys and girls aged 13-18 years. Adolescents were purposively selected from schools, skill acquisition centres and workplaces. A total of 77 in-depth interviews, 6 (with community leaders) and 12 (with adolescents) focus group discussions were conducted using pretested question guides. RESULTS Adolescent SRH needs were perceived to be unique and special due to their vulnerability, fragility and predisposition to explore new experiences. Recurring adolescent SRH needs were: SRH education and counselling; access to contraceptive services and information. These needs were perceived to vary based on sex, schooling and marital status. Adolescent girls were perceived to have more psychological needs, and more prone to negative health outcomes. Out-of-school adolescents were described as more vulnerable, less controlled, less supervised and more prone to sexual abuse. Unmarried adolescents were perceived more vulnerable to sexual exploitation and risks, while married were perceived to have more maternal health service needs. CONCLUSIONS Perceptions of adolescents' SRH needs converge among stakeholders (including adolescents) and are thought to vary by gender, schooling and marital status. This calls for well-designed gender-responsive interventions that also take into consideration other social stratifiers and adolescent's perceived SRH intervention strategies.
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Affiliation(s)
- Chinyere Cecilia Okeke
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chinyere Ojiugo Mbachu
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ifunanya Clara Agu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ifeyinwa Arize
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chibuike Agu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chinonso Obayi
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Nsukka, Enugu, Nigeria
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19
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Adedze M, Osei-Yeboah R, Morhe ESK, Ngambouk VP. Exploring Sexual and Reproductive Health Needs and Associated Barriers of Homeless Young Adults in Urban Ghana: A Qualitative Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1006-1019. [PMID: 35602180 PMCID: PMC9103610 DOI: 10.1007/s13178-022-00724-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Homelessness has become a major global and public health challenge, especially in low- and middle-income countries. This phenomenon predisposes young adults to severe psychosocial and health challenges. AIM To explore the sexual and reproductive health needs and behaviours of homeless young adults and challenges in accessing these services. METHODS A semi-structured interview guide was used for data collection from in-depth interviews, focus group discussions, and key informant interviews. Data were collected between 01 June and 31 July 2020 from 30 participants using in-depth interviews, two focus group discussions involving 12 participants, and one key informant interview. Thematic analysis was used to analyse transcripts from the interviews. RESULTS The findings show that certain behavioural patterns associated with homelessness impact the lives of homeless young adults in their sexual and reproductive health (SRH) choices, beliefs, and perspectives. This group faces several challenges in accessing sexual and reproductive health services (SRHS) such as modern contraceptives and abortion care. The high cost, and undesirable and unfriendly attitude of service providers in health facilities pose as barriers to accessing SRHS by homeless young adults. CONCLUSION Sustainable and proactive measures must be put in place to address the identified barriers. Timely delivery of accurate information and educative materials, ensuring affordability, and setting up of accessible and friendly facilities could improve SRHS for this group. SOCIAL AND PUBLIC POLICY IMPLICATIONS This study may inform and support policy guideline development to address homelessness and SRH needs of young adults in urban Ghana.
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Affiliation(s)
- Miranda Adedze
- Department of Global Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard Osei-Yeboah
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emmanuel Senanu Komla Morhe
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region Ghana
| | - Vitalis Pemunta Ngambouk
- Section of Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Kyegombe N, Buller AM, Meiksin R, Wamoyi J, Muhumuza R, Heise L. Adolescent girls' perceived readiness for sex in Central Uganda - liminal transitions and implications for sexual and reproductive health interventions. CULTURE, HEALTH & SEXUALITY 2022; 24:391-405. [PMID: 33527889 DOI: 10.1080/13691058.2020.1849802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Young women in Uganda are at risk of negative sexual and reproductive health outcomes, in part because of sex with older men. Theoretically grounded in the concept of liminality, this paper examines perceived markers of adolescent girls' suitability for sexual activity. In 2014, we conducted 19 focus group discussions and 44 in-depth interviews in two communities in Uganda. Interviews were conducted using a semi-structured tool, audio-recorded and transcribed verbatim. Interviews examined markers of transition between childhood, adolescence and adulthood and how these were seen as relating to girls' perceived readiness for sex. Analysis was thematic. Pre-liminal status was most often accorded to childhood. Sex with a child was strongly condemned. Physical changes during puberty and children's increasing responsibility, autonomy and awakening sexuality reflected a liminal stage during which girls and young women were not necessarily seen as children and were increasingly described as suitable for sex. Being over 18, leaving home, and occupying 'adult' spaces reflected post-liminal status and perceived appropriateness for sexual activity including for girls under the age of 18. Interventions that seek to prevent early sexual debut and sexual activity with older men have the potential to reduce sexual and reproductive health risks.
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Affiliation(s)
- Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Baltimore, MD, USA
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21
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Birabwa C, Bakkabulindi P, Wafula ST, Waiswa P, Benova L. Knowledge and use of lactational amenorrhoea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016. BMJ Open 2022; 12:e054609. [PMID: 35193915 PMCID: PMC8867379 DOI: 10.1136/bmjopen-2021-054609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the level of knowledge and use of the lactational amenorrhoea method (LAM) among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health Surveys (DHS). DESIGN Cross-sectional design involving analysis of three DHS (2006, 2011, and 2016) in Uganda. SETTING The data collection took place in Uganda. The DHS are nationally representative surveys on a wide range of indicators including contraception knowledge and use. PARTICIPANTS A total of 1948 (2006), 2026 (2011) and 4276 (2016) adolescents (15-19 years) and 1662 (2006), 1666 (2011) and 3782 (2016) young women (20-24 years) were included. PRIMARY OUTCOME MEASURE Use of LAM among adolescents and young women with a live birth within 6 months before each survey. RESULTS In 2016, less than 1.0% (95% CI: 0.2% to 3.5%) of eligible adolescents correctly used LAM, and 56.3% (95% CI: 48.8% to 63.6%) were passively benefitting from LAM. The median duration of postpartum amenorrhoea (PPA) among adolescents in 2016 was 6.9 months, declining from 8.3 months in 2006. Compared with adolescents (56.7%), eligible young women had higher knowledge of LAM (64.1%) and higher median PPA duration (8.0 months) in 2016. The percentage of eligible adolescents who met the LAM criteria irrespective of whether they reported LAM use (were protected by LAM) decreased from 76.4% (95% CI: 66.5% to 84.0%) in 2006 to 57.2% (95% CI: 49.5% to 64.6%) in 2016. More than 50.0% (95% CI: 49.2% to 63.8%) of eligible adolescents were aware of LAM in 2016, increasing from 6.0% (95% CI: 2.5% to 13.8) in 2006. CONCLUSION Despite increasing awareness of LAM, reported and correct use of LAM was low among adolescents who could benefit from this method in Uganda, and declining over time. Support for adolescents to harness the benefits of correct LAM use should be increased. Additional research is needed to better understand the dynamics of LAM use in adolescents, including the transition to use of other modern contraceptive methods.
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Affiliation(s)
- Catherine Birabwa
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Pamela Bakkabulindi
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Health Support Initiatives, Kampala, Uganda
| | - Solomon T Wafula
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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22
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Mambo SB, Sikakulya FK, Ssebuufu R, Mulumba Y, Wasswa H, Mbina SA, Rusatira JC, Bhondoekhan F, Kamyuka LK, Akib SO, Kirimuhuzya C, Nakawesi J, Kyamanywa P. Challenges in Access and Utilization of Sexual and Reproductive Health Services Among Youth During the COVID-19 Pandemic Lockdown in Uganda: An Online Cross-Sectional Survey. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:705609. [PMID: 36303975 PMCID: PMC9580707 DOI: 10.3389/frph.2021.705609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/24/2021] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Sexual and Reproductive Health access to Information services is still a pressing need for youth in Uganda even during the COVID-19 pandemic, which has disrupted health care access in many countries. The aim of this study was to explore the challenges in access and utilization of sexual and reproductive health services as faced by youth during the COVID-19 pandemic lockdown in Uganda. METHODS This was a cross-sectional study carried out from 28th April 2020 to 11th May 2020 in Uganda. An online questionnaire was disseminated to youth aged between 18 and 30 years over a period of 14 days. The snowball sampling method was used to recruit participants. STATA version 14.2 was used for statistical analysis. RESULTS Of 724 participants, 203 (28%) reported that they did not have access to information and/or education concerning sexual and reproductive health (SRH). More than a quarter of the participants (26.9%, n = 195) reported that testing and treatment services of sexually transmitted infections were not available during the lockdown, and 27.2% could not obtain contraceptive supplies. Access to HIV/AIDS care services and menstrual supplies was also impaired. Lack of transportation was the commonest factor cited as limiting access to SRH services during the lockdown (68.7%), followed by the long distance from home to SRH facilities (55.2%), high cost of services (42.2%) and the curfew (39.1%). Sexually transmitted infections were the commonest SRH problems related to SRH during the lockdown (40.4%) followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Marital, educational, and employment status were significantly correlated with the reported experiences of the participants. CONCLUSION Access to SRH information and services for Ugandan youth was restricted during the COVID-19 lockdown and leaving them vulnerable to various SRH risks and adverse outcomes. Lack of transportation, long distances to health facilities, and high cost of services were important limiting factors. The Government and other stakeholders should incorporate SRH among the priority services to be preserved during future outbreaks.
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Affiliation(s)
- Simon Binezero Mambo
- Department of Public Health, School of Allied Health Sciences, Kampala International University Western Campus, Kampala, Uganda
- Youth Alliance for Reproductive Health, Goma, Democratic Republic of the Congo
| | - Franck Katembo Sikakulya
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
| | - Yusuf Mulumba
- Biostatistics, Cancer Institute, Makerere University, Kampala, Uganda
| | | | - Solomon Adomi Mbina
- Department of Public Health, School of Allied Health Sciences, Kampala International University Western Campus, Kampala, Uganda
| | - Jean Christophe Rusatira
- Johns Hopkins Bloomberg School of Public Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Baltimore, MD, United States
| | - Fiona Bhondoekhan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Louis K. Kamyuka
- Department of HIV/TB (CHAI Clinic), Kampala International University Teaching Hospital, Kampala, Uganda
| | - Surat Olabisi Akib
- Department of Pathology, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Kampala, Uganda
| | - Claude Kirimuhuzya
- Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University Western Campus, Kampala, Uganda
| | - Jane Nakawesi
- Department of Paediatrics, Mildmay Uganda Hospital, Wakiso, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
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23
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Nyakato P, Schomaker M, Fatti G, Tanser F, Euvrard J, Sipambo N, Fox MP, Haas AD, Yiannoutsos CT, Davies MA, Cornell M. Virologic non-suppression and early loss to follow up among pregnant and non-pregnant adolescents aged 15-19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study. J Int AIDS Soc 2022; 25:e25870. [PMID: 35032096 PMCID: PMC8760609 DOI: 10.1002/jia2.25870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Older adolescents aged 15–19 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non‐suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa. Methods We included adolescents aged 15–19 years initiating ART between 2004 and 2019, with ≥ one viral load (VL) measurement between 4 and 24.5 months, and ≥ 6 months follow‐up, from six South African cohorts of the International epidemiology Databases to Evaluate AIDS‐Southern Africa (IeDEA‐SA). We defined VNS as VL ≥400 copies/ml and LTFU as not being in care for ≥180 days from ART start and not known as transferred out of the clinic or dead in the first 24 months on ART. We examined factors associated with VNS and LTFU using Fine&Gray competing risk models. Results We included a total of 2733 adolescents, 415 (15.2%) males, median (IQR) age at ART start of 18.6 (17.3, 19.4) years. Among females, 585/2318 (25.2%) were pregnant. Over the 24‐month follow‐up, 424 (15.5%) of all adolescents experienced VNS: range (11.1% pregnant females and 20.5% males). Over half of all adolescents were LTFU before any other event could occur. The hazard of VNS reduced with increasing age and CD4 count above 200 cells/μl at ART initiation among all adolescents having adjusted for all measured patient characteristics [adjusted sub‐distribution hazard ratio (aSHR) 19 vs. 15 years: 0.50 (95% CI: 0.36, 0.68), aSHR: >500 vs. ≤200 cells/μl: 0.22 (95% CI: 0.16, 0.31)]. The effect of CD4 count persisted in pregnant females. Increasing age and CD4 count >200 cells/μl were risk factors for LTFU among all adolescents. Conclusions Older adolescents had a high risk of LTFU shortly after ART start and a low risk of VNS, especially those initiating treatment during pregnancy. Interventions addressing adherence and retention should be incorporated into adolescent‐friendly services to prevent VNS and LTFU and endeavour to trace lost adolescents as soon as they are identified.
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Affiliation(s)
- Patience Nyakato
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria
| | - Geoffrey Fatti
- Kheth'Impilo AIDS-Free Living, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Khayelitsha ART Programme and Medecins Sans Frontieres, Cape Town, South Africa
| | - Nosisa Sipambo
- Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA.,Health Economics & Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Constantin T Yiannoutsos
- Department of Biostatistics, R.M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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24
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Singh NS, Prabhakar P, Ssali A, Namakula S, Namatovu J, Kapiti R, Kasiri J, Mounier-Jack S. "They will say you want to make their home die": A mixed methods study to assess modern family planning use in partnered South Sudanese refugee and host populations in Northern Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000348. [PMID: 36962421 PMCID: PMC10022387 DOI: 10.1371/journal.pgph.0000348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022]
Abstract
The unmet need for family planning among conflict-affected populations is high globally, leaving girls and women vulnerable to unintended pregnancies and poor sexual and reproductive health outcomes. Ours is the first known mixed-methods study to assess the use of modern family planning (FP) methods amongst married or partnered South Sudanese refugee and host populations in Northern Uganda and to explore differences between them. We conducted a cross-sectional survey in July 2019 which included 1,533 partnered women of reproductive age (15-49 years) from host and South Sudanese refugee communities in Kiryandongo and Arua. Qualitative data were collected in October 2019-January 2020 via 34 focus group discussions and 129 key informant interviews with refugee and host populations, health workers, community and religious leaders, health workers, local authorities and humanitarian actors. Our study did not find large differences between South Sudanese refugee and host populations in regard to modern FP use, though refugees reported somewhat poorer FP knowledge, accessibility and utilisation compared to Ugandan women. Reported barriers to FP use relate to access, quality of services, health concerns and family/community opposition, all of which emphasise the importance of men's gendered roles in relationships, cultural and religious beliefs and lack of agency for most women to make their own decisions about reproductive health. Sexual and gender-based violence related to FP use was reported among both refugee and host populations. Additional barriers to FP use include lack of privacy at the public health facilities which reduces confidentiality, mistrust of health workers, and stockouts of FP commodities. Facilitating factors for FP use included: free government health services; the presence of well-trained health workers; and NGOs who give support to populations and conduct community outreaches. The findings of this study underscore the importance of developing and implementing tailored sexual and reproductive health information and services, especially for modern FP methods, in partnership with South Sudanese refugee and host populations in Northern Uganda.
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Affiliation(s)
- Neha S Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pallavi Prabhakar
- Independent Evaluation and Research Cell, BRAC Uganda, Kampala, Uganda
| | - Agnes Ssali
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC/UVRI & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | | | | | | | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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25
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Ssebunya RN, Boopa M, Nguyen D, Ligon L. Disparities in Accessing Sexual and Reproductive Health Services and Rights Among Adolescents and Young People During COVID-19 Pandemic: Culture, Economic, and Gender Perspectives. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:234-242. [PMID: 36311053 PMCID: PMC9589761 DOI: 10.1007/s40475-022-00274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review As the world grapples with the health systems' challenges during the COVID-19 pandemic, addressing the needs of the already vulnerable adolescents and young people is vital. This narrative synthesis is aimed to highlight the current gender, cultural, and socioeconomic dynamics fueling inequalities to accessing sexual, reproductive health and rights (SRHR) services among adolescents and young people in low- and middle-income countries (LMIC). Recent Findings The COVID-19 pandemic has in most countries exacerbated already existing inequalities due to economic, gender, cultural, and legal aspects. Strategies implemented by most governments to mitigate the spread of the virus have also had a negative impact on the access to SRHR services, some of which are long term. Few published studies have assessed the extent to which the pandemic has fueled each of these paradigms regarding access to SRHR, especially among adolescents and young people (AYP). Additionally, there is paucity in data on the same in most countries, as the systems to track such effects were not available at the inception of the pandemic. Summary Despite efforts to mitigate the effects of the pandemic on this population, deficits remain and a multi-stakeholder approach is needed to achieve the intended goals, especially where cultural and gender values are deeply rooted. Further research is needed to quantify how the pandemic has fueled economic, gender, and cultural aspects to influence access to SRHR services among AYP especially in LMIC.
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Affiliation(s)
- Rogers N. Ssebunya
- Baylor College of Medicine Children Foundation, Mulago Hospital Complex, P.O. Box 72052, Kampala, Uganda
| | - Mafusi Boopa
- Baylor College of Medicine Children Foundation, Maseru, Lesotho
| | | | - Lee Ligon
- Baylor College of Medicine, Houston, Texas USA
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26
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Tetui M, Ssekamatte T, Akilimali P, Sirike J, Fonseca-Rodríguez O, Atuyambe L, Makumbi FE. Geospatial Distribution of Family Planning Services in Kira Municipality, Wakiso District, Uganda. Front Glob Womens Health 2021; 1:599774. [PMID: 34816171 PMCID: PMC8593998 DOI: 10.3389/fgwh.2020.599774] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Access to family planning (FP) services remains a challenge, particularly in informal urban settlements. The unmet need for FP in these settings is high, with a correspondingly high prevalence of unintended pregnancies that may lead to unsafe abortions. However, there is a paucity of quality data on the distribution of FP services in such settings in Uganda. This paper described the geospatial distribution of FP services in Kira Municipality, Wakiso District, Uganda. Methods: This was a cross-sectional study in which we determined the availability and distribution of FP services in Kira Municipality. Community mapping and analysis were conducted using ArcGIS (version 10.1) and ArcGIS Online. Stata version 13.1 was used for data analysis. Chi-square test was used to compare the contraceptive provision and availability among facilities from informal and formal settlements. Results: Of the 176 healthcare facilities surveyed, only 42% (n = 74) offered contraceptives in informal settlements. The majority of the facilities were privately owned small clinics (95%). At least 80% of the facilities provided three or more modern contraceptive methods, with no difference (p = 0.107) between facilities in informal and formal settlements. Only 30.7% (p = 0.001) of the facilities provided at least one long-acting contraceptive. Similarly, 20 and 12% (p = 0.001) of the facilities had implants and intrauterine devices (IUDs) on the day of the survey. Almost 25% of the facilities did not offer contraceptive services (counseling and commodities) to unmarried adolescents. Conclusions: Most facilities were small privately-owned clinics, offering at least three modern contraceptive methods. The unavailability of long-acting reversible methods in the informal settings may affect the quality of FP services due to limited choice. The inequity in service provision that disfavors the unmarried adolescent may increase unwanted/unintended pregnancies. We recommend that local governments and partners work toward filling the existing commodities gap and addressing the discrimination against unmarried adolescents in such settings.
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Affiliation(s)
- Moses Tetui
- School of Pharmacy, Waterloo University, Waterloo, ON, Canada.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Pierre Akilimali
- Department of Nutrition Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Judith Sirike
- Division of Social Development, Intergovernmental Authority on Development, Kampala, Uganda
| | - Osvaldo Fonseca-Rodríguez
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
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27
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Agu IC, Mbachu CO, Ezenwaka U, Okeke C, Eze I, Arize I, Ezumah N, Onwujekwe O. Variations in utilization of health facilities for information and services on sexual and reproductive health among adolescents in South-East, Nigeria. Niger J Clin Pract 2021; 24:1582-1589. [PMID: 34782494 DOI: 10.4103/njcp.njcp_48_21] [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: 11/04/2022]
Abstract
Background Adolescents' sexual and reproductive health has an important influence on a country's long-term national growth. There is a high level of burden due to poor adolescent sexual and reproductive health (ASRH) in Nigeria, especially the Ebonyi State. Evidence shows that in the Sub-Saharan African region, most adolescents experience poor access to information and other services relating to their sexual and reproductive health. Many cultures in Africa see matters around sex and sexuality as social taboos. Aims This study aimed to access variations in the utilization of health facilities for sexual and reproductive health information and services among adolescents in the Ebonyi State, Nigeria. This will inform the design of interventions to improve ASRH. Patients and Methods A total of 1,057 in-school and out-of-school adolescents aged 13-18 years were selected using cluster sampling of households from the six selected local government areas (LGAs) in this cross-sectional survey. Structured questionnaires were used to collect data. Descriptive statistics were performed alongside stratification analysis. Tabulation, bivariate and multivariate logistic regression analyses were undertaken. A household wealth index was calculated using the total household consumption calculated divided by the number of people in the household (per capita household consumption). The per capita household consumption was used to categorize the households into socioeconomic quintiles. The variable was used to differentiate key variables into socioeconomic quintile equity analysis. Results A majority of the respondents had never visited any type of health facility to receive either sexual and reproductive health (SRH) information (90.2%) or services (97.1%). The utilization rate of health facilities for SRH information was 9.8% while for other SRH services was 2.8%. The patent medicine vendor (PMV) was the most visited type of facility for SRH information and other services. Schooling was a strong predictor of health facilities' utilization for SRH information (P < 0.01) and other services (P < 0.01). Conclusion Utilization of health facilities for information and services among adolescents in the Ebonyi State is very low and favorable toward informal service providers such as PMVs. The establishment and strengthening of the existing youth-friendly centers, school clinics, and occasional outreach programs designed specifically to target adolescents would perhaps improve adolescents' access to adequate information and health facility utilization for sexual, reproductive, and health services.
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Affiliation(s)
- I C Agu
- Health Policy Research Group; Institute of Public Health, University of Nigeria Nsukka, Nsukka, Nigeria
| | - C O Mbachu
- Health Policy Research Group; Institute of Public Health; Department of Community Medicine, University of Nigeria Nsukka, Nsukka, Nigeria
| | - U Ezenwaka
- Health Policy Research Group; Health Administration and Management, Nsukka, Nigeria
| | - C Okeke
- Health Policy Research Group; Institute of Public Health; Department of Community Medicine, University of Nigeria Nsukka, Nsukka, Nigeria
| | - I Eze
- Health Policy Research Group, Nsukka, Nigeria
| | - I Arize
- Health Policy Research Group; Health Administration and Management, Nsukka, Nigeria
| | - N Ezumah
- Health Policy Research Group, Nsukka, Nigeria
| | - O Onwujekwe
- Health Policy Research Group; Health Administration and Management, Nsukka, Nigeria
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28
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Dombola GM, Manda WC, Chipeta E. Factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, Malawi: a qualitative study. Reprod Health 2021; 18:209. [PMID: 34663362 PMCID: PMC8524908 DOI: 10.1186/s12978-021-01259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/06/2021] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15-19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15-19 years old) leaving out the young adolescents (10-14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10-14 years. METHODS This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10-14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis. RESULTS Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents' perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies. CONCLUSION The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.
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Affiliation(s)
- Gift Mtawali Dombola
- Department of Health Systems and Policy, College of Medicine, Private Bag 360, Blantyre, Malawi
| | | | - Effie Chipeta
- The Centre for Reproductive Health, College of Medicine, Private Bag 360, Blantyre, Malawi
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29
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Ninsiima LR, Chiumia IK, Ndejjo R. Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review. Reprod Health 2021; 18:135. [PMID: 34176511 PMCID: PMC8237506 DOI: 10.1186/s12978-021-01183-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 06/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01183-y. Access and utilisation of Youth-friendly sexual and reproductive health is still a big challenge for the youth especially in sub-Saharan Africa. In this study, we explored the underlying reasons for the low access and utilisation of youth-friendly sexual and reproductive health services and potential solutions to the problem. Articles used in this study were retrieved from different data sources and those that contained barriers and facilitators of access and utilisation of youth-friendly sexual and reproductive health services implementation were summarised. The key barriers were negative attitude of health workers and their being unskilled emanating from the administrative section theme. The individual factor was the lack of knowledge among youth. The promoters of utilisation were community outreaches, health education and improvement of the quality of services in the clinics for adolescents/ young people’s needs. Moving forward, stakeholders should aim at increasing the training of health workers and improving the quality of services being offered to the youth. To address the individual barriers, youth should be reached with information through community outreaches and education in schools.
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Affiliation(s)
- Lesley Rose Ninsiima
- Department of Health Systems and Policy, College of Medicine, The University of Malawi, Blantyre, Malawi. .,Africa Center of Excellence in Public Health and Herbal Medicine, Department of Health Systems and Policy, Global Health Implementation, University of Malawi, Blantyre, Malawi.
| | - Isabel Kazanga Chiumia
- Department of Health Systems and Policy, College of Medicine, The University of Malawi, Blantyre, Malawi
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Bukuluki P, Kisaakye P, Mwenyango H, Palattiyil G. Adolescent sexual behaviour in a refugee setting in Uganda. Reprod Health 2021; 18:131. [PMID: 34167555 PMCID: PMC8222959 DOI: 10.1186/s12978-021-01181-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children under 18 years old constituted more than half (52%) of the refugee population in 2017. Adolescent Sexual and reproductive health is an essential component of primary health care. Yet, not every refugee adolescent is able to access sexual and reproductive health services. Methods Using quantitative data from 356 refugee adolescents and qualitative data (17 in-depth interviews and nine key informant interviews), we examine refugee adolescent sexual behaviour in Bidibidi settlement—the largest refugee settlement in Uganda using a binary logistic regression model. Results The results show that 25% of refugee adolescents in Bidibidi refugee settlement had ever had sex. After controlling for all factors, results show that refugee adolescents aged 16–18 years (OR = 3.47; 95% CI = 1.09–10.94), males (OR = 17.59; 95% CI = 4.48–69.07), not in school (OR = 14.57; 95% CI = 2.20–96.35) were more likely to engage in sexual behaviour than their counterparts. Refugee adolescents who do not agree that a girl cannot get pregnant if she has sex while standing up (knowledge about getting pregnant) were significantly less associated with sexual behaviour (OR = 0.30; 95% CI = 0.10–0.85). Conclusions Results from this study show that keeping refugee adolescents in school and providing sexual and reproductive health information are likely to delay refugee adolescents’ engagement in sexual behaviour. Therefore, there is need to promote keeping refugee adolescents in school in order to improve sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda. Sexual and reproductive health is an essential component of primary health care. Limited access to sexual and reproductive health (SRH) services for adolescent refugees particularly in low income countries can affect their reproductive health. Similarly, limited knowledge of the determinants of sexual behaviour of adolescent refugees in low income countries puts them at risk of SRH challenges. This study uses quantitative data from 356 adolescent refugees and qualitative (17 in-depth interviews with adolescent refugees and nine key informant interviews with service providers) to examine the factors that influence the sexual behaviour of adolescent refugees in Bidibidi refugee settlement. The findings show that older age, male sex, not being in school and having knowledge of getting pregnant were associated with sexual behaviour among adolescent refugees in Bidibidi refugee settlement in Uganda. There is need to promote keeping refugee adolescents in school and providing them with relevant SRH information to contribute to improving sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda.
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Affiliation(s)
- Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda.
| | - Hadijah Mwenyango
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - George Palattiyil
- Social Work, School of Social and Political Science, The University of Edinburgh, Scotland, UK
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Rossier C, Marchin A, Kim C, Ganatra B. Disclosure to social network members among abortion-seeking women in low- and middle-income countries with restrictive access: a systematic review. Reprod Health 2021; 18:114. [PMID: 34098958 PMCID: PMC8186048 DOI: 10.1186/s12978-021-01165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background Health care for stigmatized reproductive practices in low- and middle-income countries (LMICs) often remains illegal; when legal, it is often inadequate, difficult to find and / or stigmatizing, which results in women deferring care or turning to informal information sources and providers. Women seeking an induced abortion in LMICs often face obstacles of this kind, leading to unsafe abortions. A growing number of studies have shown that abortion seekers confide in social network members when searching for formal or informal care. However, results have been inconsistent; in some LMICs with restricted access to abortion services (restrictive LMICs), disclosure appears to be limited. Main body This systematic review aims to identify the degree of disclosure to social networks members in restrictive LMICs, and to explore the differences between women obtaining an informal medical abortion and other abortion seekers. This knowledge is potentially useful for designing interventions to improve information on safe abortion or for developing network-based data collection strategies. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles, published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in LMICs with restricted access to abortion services. We categorized settings into four types by possibility of anonymous access to abortion services and local abortion stigma: (1) anonymous access possible, hyper stigma (2) anonymous access possible, high stigma (3) non-anonymous access, high stigma (4) non-anonymous access, hyper stigma. We screened 4101 references, yielding 79 articles with data from 33 countries for data extraction. We found a few countries (or groups within countries) exemplifying the first and second types of setting, while most studies corresponded to the third type. The share of abortion seekers disclosing to network members increased across setting types, with no women disclosing to network members beyond their intimate circle in Type 1 sites, a minority in Type 2 and a majority in Type 3. The informal use of medical abortion did not consistently modify disclosure to others. Conclusion Abortion-seeking women exhibit widely different levels of disclosure to their larger social network members across settings/social groups in restrictive LMICs depending on the availability of anonymous access to abortion information and services, and the level of stigma. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01165-0. Women seeking an induced abortion in LMICs often face inexistent or inadequate, difficult to find and/ or stigmatizing legal services, leading to the use of informal methods and providers, and unsafe abortions. A growing number of studies have shown that abortion seekers contact social network members beyond their intimate circle when seeking care. However, results have been inconsistent. We searched Pubmed, POPLINE, AIMS, LILACS, IMSEAR, and WPRIM databases for peer-reviewed articles published in any language from 2000 to 2018, concerning abortion information seeking, communication, networking and access to services in restrictive LMICs. We screened 4101 references, yielding 79 articles with data from 33 countries for extraction. We grouped countries (or social groups within countries) into four types of settings: (1) anonymous access possible, hyper stigma; (2) anonymous access possible, high stigma; (3) non-anonymous access, high stigma; (4) non-anonymous access, hyper stigma. Most studies fitted Type 3. Disclosing to network members increased across setting types: no women confided in network members in Type 1 settings, a minority in Type 2 and a majority in Type 3. No setting fitted Type 4. The informal use of medical abortion did not modify disclosure to others. Abortion seekers in restrictive LMICs frequently contact their social network in some settings/groups but less frequently in others, depending on the availability of anonymous access to abortion care and the level of stigma. This knowledge is useful for designing interventions to improve information on safe abortion and for developing network-based data collection strategies.
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Affiliation(s)
- Clémentine Rossier
- Université de Genève, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | | | - Caron Kim
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Nalwanga R, Nuwamanya E, Nuwasiima A, Babigumira JU, Asiimwe FT, Babigumira JB. Utilization of a mobile phone application to increase access to sexual and reproductive health information, goods, and services among university students in Uganda. Reprod Health 2021; 18:95. [PMID: 34001178 PMCID: PMC8127235 DOI: 10.1186/s12978-020-01037-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Innovations to increase access to sexual and reproductive health (SRH) information, goods, and services are needed, particularly in low-income settings. This study assessed the utilization of a mobile phone application (MPA) to increase access to SRH information, goods, and services among university students in Uganda. METHODS We conducted a cross-sectional analysis of data from: (1) an endline survey performed as a consequence of a randomized controlled trial (RCT) of the effectiveness of the MPA, and (2) data from use of the MPA for accessing information, goods, and services over the 6-month time period of the RCT, obtained from in-MPA data collection service providers. We performed descriptive analysis of participant characteristics and their association with the utilization of the MPA using logistic regression; analyses of MPA use for accessing different types of information, goods, and services by gender; and analyses of functionality attributes of the MPA and related services. RESULTS In the study population of young (median 22 years) predominantly female (61%) students, the utilization of the MPA by those who downloaded it was high (81% overall, 82% female, and 82% male). The most popular information portal was the frequently asked questions (71% utilization); the most popular goods were condoms for males (77% utilization) and sanitary pads for females (94% utilization); and the most popular service was HIV testing and counseling (60% utilization). The MPA demonstrated predominantly positive (responsiveness, non-distracting in-app advertisements, and ease of use) attributes. CONCLUSION A mobile phone app to increase access to SRH information, goods, and services among university students in Uganda demonstrated high utilization. The results of this study support ongoing and future technical improvement efforts and research on effectiveness, economic efficiency, and scalability, along the continuum of activities to scale this intervention in order to improve SRH in low-income settings. TRIAL REGISTRATION MUREC1/7 No. 07/05-18. Registered; June 29, 2018.
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Affiliation(s)
| | - Elly Nuwamanya
- GHE Consulting, P.O Box 27011, Kampala, Uganda
- Department of Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg, P. O Box 414, 40530, Gothenburg, Sweden
| | | | | | | | - Joseph B Babigumira
- Saw Swee Hock School of Public Health, National University of Singapore , Block MD1, 12 Science Drive 2, Tahir Foundation Building, #09-03M, Singapore, 117549, Singapore
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Tuhebwe D, Babirye S, Ssendagire S, Ssengooba F. The extent to which the design of available reproductive health interventions fit the reproductive health needs of adolescents living in urban poor settings of Kisenyi, Kampala, Uganda. BMC Public Health 2021; 21:933. [PMID: 34001043 PMCID: PMC8130317 DOI: 10.1186/s12889-021-10933-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/28/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The rate at which informal urban settlements (slums) are developing in Low and Middle Income. Countries (LMICs) like Uganda is high. With this, comes the growing intersection between urbanization and the reproductive health of key populations. Currently, a number of interventions are being implemented to improve the Reproductive Health (RH) of adolescents in Kisenyi, the largest informal urban settlement in Kampala, the capital of Uganda. Despite these efforts, adolescent RH indicators have persistently remained poor in Kisenyi. This could be indicative of a gap between the provided and needed adolescent RH interventions. We assessed the fit between the available interventions and the RH needs of adolescents living in Kisenyi. METHODS We conducted a qualitative study in July 2019-February 2020 in Kisenyi. The methodology was guided by the Word Health Organization global standards for quality-health care services for adolescents, the "For whom? Where? By whom? and What?" Framework of sexual RH service delivery and the realist evaluation approach. Eight focus group discussions were conducted with adolescents 15-19 years to explore their RH needs. The design and implementation of the available adolescent RH interventions were assessed by conducting Key Informant interviews with 10 RH service providers in Kisenyi. Validation meetings were held with adolescents and they scored the extent to which the various design features of the existing interventions fit the adolescents' RH needs. RESULTS The available RH interventions focused on meeting the sexual RH needs like providing family planning services but less on social needs like livelihood and sanitation which the adolescents identified as equally important. While the providers designed intervention to target 10-24 year olds, the adolescents preferred to have interventions that specifically targeted the study population 15-19 years. Most interventions were facility-based while, the adolescents desired community based outreaches. CONCLUSION The packaging and mode of delivery of interventions were perceived less holistic to meet the adolescents' needs. Most interventions were designed to address the sexual and family planning needs while ignoring the wider social and livelihood needs. More holistic and outreach-based programming that addresses RH within the broader context of livelihood and sanitation requirements are more likely to be effective.
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Affiliation(s)
- Doreen Tuhebwe
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
| | - Susan Babirye
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Steven Ssendagire
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
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Amongin D, Kågesten A, Tunçalp Ö, Nakimuli A, Nakafeero M, Atuyambe L, Hanson C, Benova L. Later life outcomes of women by adolescent birth history: analysis of the 2016 Uganda Demographic and Health Survey. BMJ Open 2021; 11:e041545. [PMID: 33568369 PMCID: PMC7878126 DOI: 10.1136/bmjopen-2020-041545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To describe the long-term socioeconomic and reproductive health outcomes of women in Uganda by adolescent birth history. DESIGN Cross-sectional study. SETTING Uganda. PARTICIPANTS Women aged 40-49 years at the 2016 Uganda Demographic and Health Survey. OUTCOME MEASURES We compared socioeconomic and reproductive outcomes among those with first birth <18 years versus not. Among those with a first birth <18 years, we compared those with and without repeat adolescent births (another birth <20 years). We used two-sample test for proportions, linear regression and Poisson regression. FINDINGS Among the 2814 women aged 40-49 years analysed, 36.2% reported a first birth <18 years and 85.9% of these had a repeat adolescent birth. Compared with women with no birth <18 years, those with first birth <18 years were less likely to have completed primary education (16.3% vs 32.2%, p<0.001), more likely to be illiterate (55.0% vs 44.0%, p<0.001), to report challenges seeking healthcare (67.6% vs 61.8%, p=0.002) and had higher mean number of births by age 40 years (6.6 vs 5.3, p<0.001). Among women married at time of survey, those with birth <18 years had older husbands (p<0.001) who also had lower educational attainment (p<0.001). Educational attainment, household wealth score, total number of births and under-5 mortality among women with one adolescent birth were similar, and sometimes better, than among those with no birth <18 years. CONCLUSIONS Results suggest lifelong adverse socioeconomic and reproductive outcomes among women with adolescent birth, primarily in the category with repeat adolescent birth. While our results might be birth-cohort specific, they underscore the need to support adolescent mothers to have the same possibilities to develop their potentials, by supporting school continuation and prevention of further unwanted pregnancies.
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Affiliation(s)
- Dinah Amongin
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anna Kågesten
- Department of Global Public Health, Karolinska Institute, Solna, Sweden
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - A Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary Nakafeero
- Department of Epidemiology and Biostatistics, 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
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Solna, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Oppong FB, Logo DD, Agbedra SY, Adomah AA, Amenyaglo S, Arhin-Wiredu K, Afari-Asiedu S, Ae-Ngibise KA. Determinants of contraceptive use among sexually active unmarried adolescent girls and young women aged 15-24 years in Ghana: a nationally representative cross-sectional study. BMJ Open 2021; 11:e043890. [PMID: 33550261 PMCID: PMC7925931 DOI: 10.1136/bmjopen-2020-043890] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE There is a decline in contraceptive use among sexually active unmarried young women in Ghana. This study assessed the prevalence of contraceptive knowledge and use, and the determinant of contraceptive use among sexually active unmarried young women in Ghana. DESIGN This was a nationally representative cross-sectional survey, using data from the 2017 Ghana Maternal Health Survey. Weighted logistic regression was used to assess the association between background and obstetric characteristics of young women and contraceptive use. SETTING Ghana. PARTICIPANTS A total of 809 sexually active unmarried adolescent girls (15-19 years) and young women (20-24 years). PRIMARY AND SECONDARY OUTCOME MEASURES Knowledge and use of both modern and traditional contraceptive methods. RESULTS Knowledge of at least one modern and traditional contractive method was 99.8% and 95.0%, respectively. The prevalence of contraceptive use was 43%-with 34% modern and 9% traditional methods. From the unadjusted analyses, age (p=0.002), past pregnancy (p<0.001), abortion in the past 5 years (p=0.007) and history of childbirth (p=0.025) were independently associated with contraceptive use, whereas education (p=0.072), place of residence (p=0.702), household wealth (p=0.836) and age at first sex (p=0.924) were not independently associated with contraceptive use. In the adjusted analysis, contraceptive use was significantly higher among respondents with secondary education compared with those with primary education (OR 2.43, 95% CI 1.31 to 4.49, p=0.017), and was higher among respondents with a history of pregnancy (OR 2.13, 95% CI 1.48 to 3.06, p<0.001). CONCLUSION There is a significant gap between knowledge and use of contraceptives among the study population. While intensifying knowledge of adolescents and young women on contraceptives, adolescent-friendly corners should be established at vantage points to increase utilisation and to prevent societal stigma on young women who access contraceptives services.
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Affiliation(s)
| | | | - Senyo Yao Agbedra
- Sunyani Municipal Health Directorate, Ghana Health Service, Sunyani, Ghana
| | | | - Seidu Amenyaglo
- Department of Global and International Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Apolot RR, Tetui M, Nyachwo EB, Waldman L, Morgan R, Aanyu C, Mutebi A, Kiwanuka SN, Ekirapa E. Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District- Uganda. Int J Equity Health 2020; 19:191. [PMID: 33131497 PMCID: PMC7604956 DOI: 10.1186/s12939-020-01267-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12-19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges. METHODS This qualitative study utilized in-depth interviews conducted in August 2018 among 15 purposively selected adolescent women who had given birth 2 years prior to the study and had attended CSC meetings. The study was conducted in six sub counties of Kibuku district where the CSC intervention was implemented. Research assistants transcribed the audio-recorded interviews verbatim, and data was analyzed manually using the framework analysis approach. FINDINGS This study found five major maternal health challenges faced by adolescents during pregnancy namely; psychosocial challenges, physical abuse, denial of basic human rights, unfriendly adolescent services, lack of legal and cultural protection, and lack of birth preparedness. The CSC addressed general maternal and new born health issues of the community as a whole rather than specific adolescent health related maternal health challenges. CONCLUSION The maternal health challenges faced by adolescents in Kibuku have a cultural, legal, social and health service dimension. There is therefore need to look at a multi-faceted approach to holistically address them. CSCs that are targeted at the entire community are unlikely to address specific needs of vulnerable groups such as adolescents. To address the maternal health challenges of adolescents, there is need to have separate meetings with adolescents, targeted mobilization for adolescents to attend meetings and deliberate inclusion of their maternal health challenges into the CSC.
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Affiliation(s)
- Rebecca R. Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Evelyne B. Nyachwo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Linda Waldman
- Institute of Development Studies, Library Road, Brighton, BN1 9RE UK
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Christine Aanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Suzanne N. Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
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Boydell V, Nulu N, Hardee K, Gay J. Implementing social accountability for contraceptive services: lessons from Uganda. BMC Womens Health 2020; 20:228. [PMID: 33046065 PMCID: PMC7549211 DOI: 10.1186/s12905-020-01072-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women's barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care. METHODS This exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated. RESULTS The case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue. CONCLUSION The study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic.
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Affiliation(s)
- Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Chemin Rigot 2, 1202, Geneva, Switzerland.
| | - Nanono Nulu
- Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Jill Gay
- MIA, What Works Association, Washington, DC, USA
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Abd El-Mawgod MM, Elghazally SA, Mohammed HM, Elkayat MR, Osman DMM. Views and attitudes of university students in Upper Egypt towards youth health centers. JOURNAL OF THE EGYPTIAN PUBLIC HEALTH ASSOCIATION 2020; 95:24. [PMID: 32990875 PMCID: PMC7524945 DOI: 10.1186/s42506-020-00046-x] [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: 12/24/2019] [Accepted: 06/25/2020] [Indexed: 11/30/2022]
Abstract
Background A healthy youth is considered the major human resource for any country development. They are suffering from unmet health needs. Considering these needs and their attitude towards the use of youth health center (YHC) services would help to improve both the quality and quantity of these services. Objectives To identify the students’ perceived health needs and their attitude towards use of the YHCs in Assiut University campus, Upper Egypt a cross-sectional study was conducted among 305 randomly selected university students. Data were collected using an interviewer-administered questionnaire. Results The majority of the students (80%) said that youth have special health needs. The most reported needs were psychological support, health education on different topics including reproductive health and sexually transmitted diseases, and nutritional services respectively. There was a high perception among surveyed students (71.5%) that the existing health services are inadequate for meeting their needs. Counseling, laboratory services, and premarital examination were the most frequently reported services mentioned by youth to be offered in YHCs. The majority (78.1%) preferred the health provider to be of the same sex. Despite the prevailing conservative culture in Upper Egypt, the students had positive attitude towards availability of sexual and reproductive information and establishment of a YHC in the university campus. A low awareness rate (15.1%) about the already existing YHC in university campus was revealed. Conclusion University students perceived that there are unmet needs for youth-specialized services, mainly for providing sexual and reproductive information, and establishment of an on-campus YHC. The study provides important information for policymakers about the perspectives of youth which should be taken into consideration when new YHC are planned and implemented.
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Affiliation(s)
- Mohamed M Abd El-Mawgod
- Department of Public Health and Community Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
| | | | - Heba M Mohammed
- Public Health and Community Medicine Department, Assiut University, Assiut, Egypt
| | | | - Doaa M M Osman
- Public Health and Community Medicine Department, Assiut University, Assiut, Egypt
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Using Andersen's Behavioral Model of Health Care Utilization to Assess Contraceptive Use among Sexually Active Perinatally HIV-Infected Adolescents in Uganda. Int J Reprod Med 2020; 2020:8016483. [PMID: 33062664 PMCID: PMC7542496 DOI: 10.1155/2020/8016483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda. Methods Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen's Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis. Results Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use. Conclusion Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.
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Jonas K, Duby Z, Maruping K, Dietrich J, Slingers N, Harries J, Kuo C, Mathews C. Perceptions of contraception services among recipients of a combination HIV-prevention interventions for adolescent girls and young women in South Africa: a qualitative study. Reprod Health 2020; 17:122. [PMID: 32795366 PMCID: PMC7427945 DOI: 10.1186/s12978-020-00970-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
Background Adolescent girls and young women (AGYW) in low- and middle- income countries (LMICs) have high rates of unintended pregnancies and are at higher risk for HIV infection compared to older women of reproductive age. Using a socio-ecological model approach, this research investigated perceptions of contraception services among AGYW who had been recipients of a combination HIV-prevention intervention, to better understand factors affecting their access to and use of contraception services. Method Qualitative methods used in this study included focus group discussions (FGDs) and in-depth interviews (IDIs) with 185 AGYW aged 15–24 years living in five of the ten intervention districts. All interviews and FGDs were audio-recorded and data were analyzed thematically using Nvivo 12 software with manual identification of themes and labelling of raw data. Results The findings reveal that many AGYW, especially those in the younger age group 15–19 years, experience difficulties in accessing contraception services, mainly at the interpersonal and health service levels. Lack of support for the use of contraceptives from parents/caregivers as well as from sexual partners were key barriers at the interpersonal level; while providers’ negative attitude was the main barrier at the health service level. The majority of school-going AGYW felt that bringing contraception services and other sexual and reproductive health (SRH) services on to the school premises would legitimize their use in the eyes of parents and help to overcome barriers related to parental support and acceptance, as well as overcome some of the health service and structural level barriers. However, views among school-going AGYW about school-based provision of contraception services were mixed, clouded with concerns relating to confidentiality. Conclusion Interventions to improve parental/caregiver and sexual partner support for the use of contraception services by AGYW, as well as efforts to expand the provision of contraception services on the school premises are urgently needed. Future interventions should incorporate multi-level approaches to address structural and contextual barriers to access and use of contraception services to gain maximum effect.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB, South African Medical Research Council, Cape Town, South Africa
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Ndayishimiye P, Uwase R, Kubwimana I, Niyonzima JDLC, Dzekem Dine R, Nyandwi JB, Ntokamunda Kadima J. Availability, accessibility, and quality of adolescent Sexual and Reproductive Health (SRH) services in urban health facilities of Rwanda: a survey among social and healthcare providers. BMC Health Serv Res 2020; 20:697. [PMID: 32727609 PMCID: PMC7392715 DOI: 10.1186/s12913-020-05556-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/19/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adolescents are still getting pregnant and contracting Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs) in Rwanda as elsewhere. Quality and comprehensive SRH services and information for adolescents is valuable for adolescents' wellbeing. This study aimed at understanding SRH services providers' viewpoints on accessibility, availability, and quality of SRH services provided to adolescents in selected cities of Rwanda. METHOD The study was a descriptive cross-sectional survey conducted between May 2018 and May 2019 in six selected cities of Rwanda using a mixed-methods approach. A checklist was used to collect data from 159 conveniently selected SRH services providers. The survey tool was validated. SPSS version 20 was used to describe quantitative data and ATLAS TI version 5.2 was used to code and analyze the qualitative data thematically. RESULTS Qualitatively, health care providers reported that the availability of adolescent SRHS are satisfactory with access to accurate SRH information, contraceptive methods, prevention and management of STIs and HIV services, and counselling. However, the accessibility of some services remains limited. According to respondents, some products such as female condoms are less in demand and often expire before they can be distributed. One nurse clarified that they render services at a low price if an adolescent has insurance medical coverture. Religious leaders and family members may hinder adolescents from health-seeking behavior by promoting abstinence and discouraging use of protective means. Quantitatively, we found that 94.3% of health facilities provide information to adolescents on SRH services that were available and 51.6% affirmed delivering services at a low cost. Only 57.2% of respondents mentioned that adolescents are involved in designing the feedback mechanisms at their facilities. CONCLUSION SRH services in Rwanda are available for the general population and are not specifically designed for adolescents. These SRH services seem to be fairly accessible to adolescents with insufficient quality as adolescents themselves do not get to be fully involved in service provision among other aspects of quality SRH as stated by the World Health Organization (WHO). Therefore, there is a need to improve the present quality of these services to meet adolescents' needs in an urban setting.
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Affiliation(s)
- Pacifique Ndayishimiye
- Youth Service Organization (YSO), Musanze and Huye Districts, P. O box 511, Huye, Rwanda
| | - Rosine Uwase
- Youth Service Organization (YSO), Musanze and Huye Districts, P. O box 511, Huye, Rwanda
| | - Isabelle Kubwimana
- Youth Service Organization (YSO), Musanze and Huye Districts, P. O box 511, Huye, Rwanda
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Ezenwaka U, Mbachu C, Ezumah N, Eze I, Agu C, Agu I, Onwujekwe O. Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: an application of the socio-ecological model. BMC Public Health 2020; 20:1162. [PMID: 32711497 PMCID: PMC7382857 DOI: 10.1186/s12889-020-09276-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 07/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background High rate of teenage pregnancy in Nigeria is potentially an indication of poor access to and utilization of contraceptives among this age group. This paper presents findings from in-depth exploration of perceived barriers to utilization of contraceptive services by adolescents. Methods A qualitative study was conducted in six communities in Ebonyi state, southeast Nigeria. Eighty-one in-depth interviews and six focus group discussions were conducted. Respondents comprised policy makers, community leaders, health service providers and parents of adolescents. Pre-tested interview guides were used to collect information on perceived barriers to utilization of contraceptive services by adolescents. All interviews were audio recorded and transcribed in English. Data was analysed using thematic framework approach, and the socio-ecological model was adapted for data synthesis. Results Individual level factors that limit access to contraceptives for adolescents include lack of awareness and poor knowledge, fear of side effects, low self-esteem, and inability to afford cost of services. Interpersonal (family-related) barriers to access include poor parent-child communication of sexual and reproductive health matters and negative attitude of parents towards to sexuality education for adolescents. Health systems barriers to accessing contraceptives for adolescents include lack of privacy and confidentiality, stock-out of contraceptive commodities, judgmental attitude of health workers, insufficient staff that are skilled in adolescent sexual and reproductive health. Gendered cultural norms, societal shaming and religious intolerance also preclude adolescents from accessing and using contraceptive services. Wider societal factors such as negative peer and media influence, absence of sexuality education in schools, lack of social networks in communities; and macro level factors such as poor economic conditions were also perceived to limit access to contraceptives for adolescents. Conclusion Utilization of contraception is constrained by an interplay of factors acting at various levels. Addressing these barriers could contribute to improved access to contraceptive services for adolescents, as well as reduction in unwanted teenage pregnancy.
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Affiliation(s)
- Uchenna Ezenwaka
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria. .,Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu-Campus, Enugu, Nigeria.
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
| | - Irene Eze
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria.,Department of Community Medicine, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Chibuike Agu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
| | - Ifunanya Agu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria.,Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu-Campus, Enugu, Nigeria
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Nmadu AG, Mohammed S, Usman NO. Barriers to adolescents' access and utilisation of reproductive health services in a community in north-western Nigeria: A qualitative exploratory study in primary care. Afr J Prim Health Care Fam Med 2020; 12:e1-e5. [PMID: 32787401 PMCID: PMC7433241 DOI: 10.4102/phcfm.v12i1.2307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is a dearth of qualitative studies exploring in-depth barriers that adolescents face in accessing and utilising reproductive health services (RHS) in Nigerian primary healthcare centres. Aim This study explored the barriers hindering adolescents’ access to and utilisation of RHS in primary healthcare centres. Setting This study was conducted in three primary healthcare centres in Kaduna North Local government area, Nigeria. Methods This study used an exploratory descriptive qualitative design. Fourteen adolescents and three RHS providers were selected and interviewed. The data collection methods included individual in-depth interviews with adolescents and key informant interviews with service providers. Interviews were conducted between January 2017 and April 2017. Thematic content analysis was used to analyse the data. Results This study identified three thematic barriers to adolescent’s utilisation of RHS. These included individual, social and health system barriers. Individual factors included the following: inadequate knowledge about RHS and poor attitudes of adolescents towards RHS; social factors such as parental influence, community and religious norms, financial constraints and stigma; and health system factors such as poor attitudes of service providers and inconvenient health facility opening hours hindered adolescents from utilising RHS. Most prominent was the strong influence of the social factors that affected adolescents to the extent that they felt constrained to freely utilise RHS out of a sense of commitment to religious values. Conclusion The findings highlight the need for the development of programmes that would foster collective responsibility for supportive environments within communities and health facilities for positive adolescent RHS experiences.
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Affiliation(s)
- Awawu G Nmadu
- Faculty of Community Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa; and, Department of Community Medicine, Faculty of Clinical Sciences, Kaduna State University, Kaduna.
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Diallo A, Diallo Y, Magassouba AS, Bah IK, Sy T. [Sexual intercourse among students in Matoto, Conakry, Guinea]. Pan Afr Med J 2020; 35:113. [PMID: 32637011 PMCID: PMC7320788 DOI: 10.11604/pamj.2020.35.113.20733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/23/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction The purpose of this study is to analyze the factors associated with sexual practices among adolescent students in Matoto, Conakry. Methods We conducted a cross-sectional, descriptive and analytical study of students aged 10-19 years attending colleges and high schools in Matoto, Conakry over a period of 3 months (1 March -31 May 2018). Results Out of 500 students surveyed, 226 (162 girls and 64 boys; 45.2%) reported having sexual intercourse. Condom was used by 16.4% of students and contraceptives by 35.4%. The rate of sexually transmitted infections was 23.5%. Among girls who had sexual intercourse, 32.1% had had at least one unintended pregnancy ending in clandestine abortion in 30.8% of cases. The factor associated with sexual practices among adolescents was night life (p = 0.000). Conclusion Sexual intercourse is frequent among adolescent students in Matoto. Condom and contraceptives are little used. In our study, night life was the principal factor associated with sexual practice.
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Affiliation(s)
- Abdourahamane Diallo
- Service de Gynécologie-Obstétrique, Hôpital National Ignace Deen, CHU de Conakry, Conakry, Guinée.,Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Yaya Diallo
- Service de Gynécologie-Obstétrique, Hôpital National Ignace Deen, CHU de Conakry, Conakry, Guinée.,Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | | | - Ibrahima Koussy Bah
- Service de Gynécologie-Obstétrique, Hôpital National Ignace Deen, CHU de Conakry, Conakry, Guinée.,Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Telly Sy
- Service de Gynécologie-Obstétrique, Hôpital National Ignace Deen, CHU de Conakry, Conakry, Guinée.,Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
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Kyegombe N, Meiksin R, Wamoyi J, Heise L, Stoebenau K, Buller AM. Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex. Sex Reprod Health Matters 2020; 28:1700770. [PMID: 31934824 PMCID: PMC7888006 DOI: 10.1080/26410397.2019.1700770] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Adolescent girls and young women (AGYW) in Uganda are at risk of early sexual debut, unwanted pregnancy, violence, and disproportionally high HIV infection rates, driven in part by transactional sex. This paper examines the extent to which AGYW’s participation in transactional sex is perceived to be coerced. We conducted 19 focus group discussions and 44 in-depth interviews using semi-structured tools. Interviews were audio recorded, and transcribed verbatim. Data were analysed using a thematic analysis. While AGYW did not necessarily use the language of coercion, their narratives describe a number of coercive aspects in their relationships. First, coercion by force as a result of “de-toothing” a man (whereby they received money or resources but did not wish to provide sex as “obligated” under the implicit “terms” of the relationships). Second, they described the coercive role that receiving resources played in their decision to have sex in the face of men’s verbal insistence. Finally, they discussed having sex as a result of coercive economic circumstances including poverty, and because of peer pressure to uphold modern lifestyles. Support for income-generation activities, microfinance and social protection programmes may help reduce AGYW’s vulnerability to sexual coercion in transactional sex relationships. Targeting gender norms that contribute to unequal power dynamics and social expectations that obligate AGYW to provide sex in return for resources, critically assessing the meaning of consensual sex, and normative interventions building on parents’ efforts to ascertain the source of their daughters’ resources may also reduce AGYW’s vulnerability to coercion.
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Affiliation(s)
- Nambusi Kyegombe
- Assistant Professor, Social and Structural Determinants of Health, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Research Fellow, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- Social and Behavioural Researcher, Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Lori Heise
- Professor of Social Epidemiology, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Baltimore, MD, USA
| | - Kirsten Stoebenau
- Assistant Research Professor, Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Ana Maria Buller
- Assistant Professor in Social Science, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Munea AM, Alene GD, Debelew GT. Quality of youth friendly sexual and reproductive health Services in West Gojjam Zone, north West Ethiopia: with special reference to the application of the Donabedian model. BMC Health Serv Res 2020; 20:245. [PMID: 32209071 PMCID: PMC7092526 DOI: 10.1186/s12913-020-05113-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background Although there has been momentum in implementing sexual and reproductive health services in Ethiopia, young people remain underserved despite their demonstrated needs. Quality care improves utilization of health service and increases the likelihood of obtaining ongoing care. However, little is known about the quality of youth-friendly sexual and reproductive health service in Ethiopia. Therefore, this study sought to investigate the quality of youth-friendly sexual and reproductive health service in West Gojjam Zone, North West Ethiopia. Methods Health facility-based cross-sectional study was conducted in West Gojjam zone in 2018 to assess the quality of the service using the Donabedian model. The assessment was done through the triangulation of multiple methods: simulated client study; structured interviews with service providers; observations; and key informant interview with providers and expertise. Fifty-four visits were made to 18 randomly selected health facilities by three simulated clients trained to present three different scenarios (i.e., adolescent with sexually transmitted infection, pregnancy test request and a lady with dry cough). Data were entered and analyzed using SPSS version 21. Facility visit score of ≥ 75% in all quality component categorized as “good quality” otherwise classified as performing below the standard. Thematic analysis was done to analyze qualitative data. Results In this study, none of the health facilities achieved ≥ 75% in the three components of quality measurement. From 18 health facilities, 6(33.3%) provided low quality in all domains. Process component, which measures client-provider interaction and privacy/confidentiality, was the most compromised one. However, a promising result was reported in the input quality that measured the availability of trained providers, drugs, and supplies. The presence of community-based health insurance and age driven comprehensive youth-friendly service delivery approach were identified as challenges to deliver quality services. Conclusions The quality of the service ranges from low to medium, with adolescent related elements performing poorly. Minor renovations of health facilities, training on client handling, and contextual modifying the age driven youth-friendly service approach may improve the quality of the services.
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Affiliation(s)
| | - Getu Degu Alene
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Nalukwago J, Alaii J, van den Borne B, Bukuluki PM, Kimbowa M, Bockh E, Coutinho SM, Crutzen R. A process evaluation of the Communication for Healthy Communities adolescent health program in Uganda. HEALTH EDUCATION RESEARCH 2020; 35:15-31. [PMID: 31763679 PMCID: PMC6991622 DOI: 10.1093/her/cyz032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/17/2019] [Indexed: 06/10/2023]
Abstract
This study is a process evaluation of an adolescent-focused intervention of the USAID Communication for Healthy Communities program, in Uganda. We used mixed methods including observation, consultations and review of program documents to collect data on program coverage, reach and factors influencing implementation. Findings show that program activities were successfully implemented through collaborative partnerships with service partners and the community. Interpersonal communication complemented by mass-media messaging was effective in reaching and empowering adolescents with health information to make informed choices for behavior change. The program used theoretical frameworks to guide targeted interventions through audience segmentation and community empowerment. Targeted mass-media messaging and placement was found to be pertinent for program reach. Working through existing community structures is important for an effective reach of health promotion programs. Lessons identified for scaling-up adolescent health programs include the need to harmonize training and deployment of community champions by development partners, recruit audience-specific influential champions and link income-generating activities to health education interventions. There is thus need to collaboratively develop and institutionalize effective monitoring and evaluation strategies during program inception and design phases for appropriate accountability, ownership and a continuation of gains.
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Affiliation(s)
- Judith Nalukwago
- Department of Health Promotion, Faculty of Health, Medicine and Life Science, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
- FHI 360 (Family Health International), USAID/Communication for Healthy Communities Project, Plot 15 Kitante Close, PO Box 5768, Kampala, Uganda
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, PO Box 7062, Kampala, Uganda
| | - Jane Alaii
- Context Factor Solutions, PO Box 27598-00100, Nairobi, Kenya
| | - Bart van den Borne
- Department of Health Promotion, Faculty of Health, Medicine and Life Science, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Paul Mukisa Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, PO Box 7062, Kampala, Uganda
| | - Musa Kimbowa
- FHI 360 (Family Health International), USAID/Communication for Healthy Communities Project, Plot 15 Kitante Close, PO Box 5768, Kampala, Uganda
| | - Emily Bockh
- FHI 360 (Family Health International), Durham, NC, USA
| | - Sheila Marunga Coutinho
- FHI 360 (Family Health International), USAID/Communication for Healthy Communities Project, Plot 15 Kitante Close, PO Box 5768, Kampala, Uganda
| | - Rik Crutzen
- Department of Health Promotion, Faculty of Health, Medicine and Life Science, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
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Chirwa GC, Mazalale J, Likupe G, Nkhoma D, Chiwaula L, Chintsanya J. An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi. PLoS One 2019; 14:e0225374. [PMID: 31747437 PMCID: PMC6867649 DOI: 10.1371/journal.pone.0225374] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi. METHODS The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing. RESULTS The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%). CONCLUSION The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.
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Affiliation(s)
| | - Jacob Mazalale
- Department of Economics, University of Malawi, Chancellor College, Zomba, Malawi
| | - Gloria Likupe
- Health Nursing and Midwifery, University of Hull, Hull, United Kingdom
| | - Dominic Nkhoma
- Health Policy Unit, University of Malawi, College of Medicine, Lilongwe, Malawi
| | - Levison Chiwaula
- Department of Economics, University of Malawi, Chancellor College, Zomba, Malawi
| | - Jesman Chintsanya
- Department of Population Studies, University of Malawi, Chancellor College, Zomba, Malawi
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Kadam DD, Saurabha US, Tiwari SC. Health needs of adolescent girls living in an urban slum of a metropolitan city- A mixed method approach. J Family Med Prim Care 2019; 8:2661-2666. [PMID: 31548951 PMCID: PMC6753809 DOI: 10.4103/jfmpc.jfmpc_481_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/20/2019] [Accepted: 07/12/2019] [Indexed: 11/09/2022] Open
Abstract
Context: Adolescents constitute nearly 21% of the population in India. They are more likely to be constrained than adults from access to and timely use of appropriate care. Adolescence in girls is a turbulent period. The changes that take place during this period need to be made stress free. These are mostly physiological, for which simple family remedies can be found out. Objectives: 1. Assessing the health needs of adolescent girls living in an urban slum. 2. Identifying the barriers in accomplishing the health needs. Methodology: This was a community-based cross-sectional study with mixed method approach. A focus group discussion was held with 13 adolescent girls. FGD results were used to prepare a questionnaire to interview 80 adolescent girls. Results: The FGD revealed adolescent girls needed more information on menstrual hygiene, reproductive health, and its associated illness. Totally, 45% of the adolescent girls belonged to the age group 17–19 years. About 90% had inadequate knowledge on reproductive health. They preferred group sessions over one-to-one session on these topics and their mother as the source of information. Conclusion: The reproductive and sexual healthcare education that is currently being imparted to the girls need to be devised in such a way that it empowers them. A family member—the mother needs to be trained so that she can make this age transition smooth and stress free. The correct scientific knowledge will help in ensuring sustainable development.
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Affiliation(s)
- Dilip D Kadam
- Department of Community Medicine, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - U S Saurabha
- Department of Community Medicine, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Sayali C Tiwari
- Department of Community Medicine, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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Yakubu I, Garmaroudi G, Sadeghi R, Tol A, Yekaninejad MS, Yidana A. Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial. Reprod Health 2019; 16:124. [PMID: 31416450 PMCID: PMC6694566 DOI: 10.1186/s12978-019-0784-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/29/2019] [Indexed: 12/28/2022] Open
Abstract
Background Adolescent pregnancy is a worldwide problem because of its health, social, economic and political repercussions on the globe. Even though the rates of adolescent pregnancy have declined over the decade, there is still unacceptably high rates especially in lower and middle-income countries including Ghana. Although the problem has been widely investigated, there is little information on the effectiveness of different methods to improve adolescent sexual abstinence based on theoretical models. This study is aimed to assess an educational intervention program on sexual abstinence based on the Health Belief Model (HBM) among adolescent girls in Northern Ghana. Methods A cluster randomized control trial was conducted in Ghana from April to August 2018. Participants within the ages of 13–19 years were enrolled voluntarily from six randomly selected Senior High Schools (3 for intervention and 3 for control). A total of 363 adolescent were enrolled. A self-structured questionnaire was administered to both groups of participants at baseline and endpoint of the study. Control participants received their normal classes whiles the intervention group additionally received comprehensive sexuality education for 1 month. Qualified midwives conducted the health education program. At least two sessions were conducted for each participating class weekly. The lessons focused on perceived susceptibility, perceived severity of adolescent pregnancy, perceived benefits, perceived barriers to adolescent pregnancy prevention, personal and family values, perceived self-efficacy and knowledge of contraceptives. Educational strategies such as discussions, demonstrations, role-play and problem solving techniques were used to deliver the lessons. Sexual abstinence was the outcome variable of the study and it was measured after 3 months of the intervention. Binary logistic regression was used to assess the impact of the intervention on sexual abstinence practice. Results At baseline, there was no difference between control and intervention groups. The mean score of Knowledge and attitude for control were (58.17 and 139.42) and intervention (60.49 and 141.36) respectively. Abstinence practice was 69.4% for control and 71.6% in the intervention group. However, after the intervention, the mean score of knowledge and attitude for control were (87.58 and 194.12) respectively. Sexual abstinence in the control was 84.4% and intervention was 97.3% respectively. The educational interventions resulted in a significant difference in sexual abstinence between intervention and control groups (OR = 13.89, 95% Confidence Interval (2.46–78.18, P < 0.003). Conclusion Educational intervention, which was guided by HBM, significantly improved sexual abstinence and the knowledge of adolescents on pregnancy prevention among the intervention group. Provision of comprehensive sex education guided by behavioural theories to adolescents at Senior High Schools in Ghana is recommended. Trial registration This trial was retrospectively registered in Protocol Registration and Results System (PRS) with trial number NCT03384251.
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Affiliation(s)
- Ibrahim Yakubu
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran. .,Department of Nursing, Nursing and Midwifery Training College, Gushegu, Ghana.
| | - Gholamreza Garmaroudi
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Tol
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Adadow Yidana
- Department of Community Health and Family Medicine, School of Medicine, University for Development Studies, Tamale, Ghana
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