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Boku GG, Abeya SG, Ayers N, Abera M. Leadership Commitment and the Quality of Adolescent-Friendly Sexual Reproductive Health Services in Public Health Facilities Among Pastoral Districts of Guji Zone, Ethiopia. J Healthc Leadersh 2024; 16:53-66. [PMID: 38370150 PMCID: PMC10871142 DOI: 10.2147/jhl.s441951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/06/2024] [Indexed: 02/20/2024] Open
Abstract
Background Accessible and high-quality sexual and reproductive health services are essential for adolescents. However, there is a need for more knowledge about the role of leadership and the quality of these services in Ethiopia, where a significant proportion of the population consists of adolescents. Inadequate quality of friendly health services may lead to underutilization and higher rates of unintended pregnancies and sexually transmitted infections. This study aimed to evaluate the leadership role and quality of friendly health services in the pastoral community of East Guji Zone, Ethiopia. Methods We implemented in-depth interviews and focus group discussions with eight key informants and fifty participants. Study design: We used a programmatic qualitative research design. Data were collected using 22 semi-structured questions and analyzed using ATLAS.ti7. Results The findings indicate significantly less commitment to health sector leadership and substandard quality of adolescent-friendly sexual and reproductive health services. Inadequate achievement of the quality of care frameworks, including accessibility, equitability, availability, acceptability, and appropriateness, contributed to the insufficient quality of friendly health services. Conclusions and Recommendations Poor commitment of health facility leaders influenced the quality of adolescent-friendly sexual and reproductive health services in the pastoral community of the East Guji Zone, according to the study. We recommend enhancing organizational and provider readiness, ensuring equitability, and redesigning services through improving leadership commitment, which is crucial to improving the quality of adolescent-friendly health services. The Ministry of Health Ethiopia and relevant stakeholders should consider these recommendations to improve the quality of friendly health services for adolescents in Ethiopia.
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Affiliation(s)
- Gobena Godana Boku
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Department of Nursing, BPP University, London, UK
| | | | - Nicola Ayers
- Department of Nursing, BPP University, London, UK
| | - Muluembet Abera
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Alekhya G, Parida SP, Giri PP, Begum J, Patra S, Sahu DP. Effectiveness of school-based sexual and reproductive health education among adolescent girls in Urban areas of Odisha, India: a cluster randomized trial. Reprod Health 2023; 20:105. [PMID: 37468914 PMCID: PMC10357608 DOI: 10.1186/s12978-023-01643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Various studies revealed that adolescent girls have limited knowledge pertaining to sexual and reproductive health (SRH). The current study assessed the effectiveness of SRH education among adolescent girls in urban areas of Odisha, India. METHODS The study design was a cluster randomized trial, where the clusters composed of eight Odia (regional language) medium government girls' high schools in Bhubaneswar, the capital city of the state of Odisha, India. For the selection of study participants, adolescent girls who were studying in the ninth and tenth standards were recruited from each school. Eight schools were randomized through restrictive randomization at a 1:1 ratio, with four schools each in the intervention and control arm. Baseline and end-line assessments were done using a pre-tested, semi-structured questionnaire. Following baseline assessment, an intervention was given with the help of handbooks developed by the study authors to the schools in the intervention arm. Outcomes included change in knowledge, attitude and practices pertaining to SRH. RESULTS In our study at baseline, there were a total of 790 students, where 469 (59.4%) students were in the intervention arm, and 321 (40.6%) students were in the control arm. At baseline, only 282 (60.1%) in the intervention arm and 171 (53.3%) in the control arm were aware that physical bodily changes due to puberty were normal. After the intervention, there was a statistically significant increase in knowledge in intervention group 367 (94.8%) (p-value < 0.001). Most students used sanitary pads as absorbent, 97.2% in the intervention group and 98.4% in the control group. However, after the intervention, the use of other absorbents reduced to zero in the intervention group with a statistically significant difference (p < 0.05). The number of students having awareness on different methods of contraception increased from 51 (10.9%) to 337 (87.1%) in the intervention arm (p < 0.001), and of those having awareness on STIs/RTIs increased from 177 (38.2%) to 371 (96.1%) in the intervention group (p < 0.001). CONCLUSION From our study, there is a significant proportional change in knowledge, attitude, and practices pertaining to SRH. Our study recommends policymakers and program managers for the implementation of comprehensive SRH in the regular school curriculum. Trial registration CTRI/2021/01/030490, registered on January 15, 2021. Prospectively registered at https://ctri.nic.in/Clinicaltrials/login.php.
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Affiliation(s)
- G. Alekhya
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, 3rd Floor, Academic Block, Bhubaneswar, Odisha 751019 India
| | - Swayam Pragyan Parida
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, 3rd Floor, Academic Block, Bhubaneswar, Odisha 751019 India
| | - Prajna Paramita Giri
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, 3rd Floor, Academic Block, Bhubaneswar, Odisha 751019 India
| | - Jasmina Begum
- Department of Psychiatry, AIIMS Bhubaneswar, Bhubaneswar, Odisha India
| | - Suravi Patra
- Department of Obstetrics and Gynaecology, AIIMS Bhubaneswar, Bhubaneswar, Odisha India
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Eze II, Mbachu CO, Agu IC, Akamike IC, Eigbiremolen G, Onwujekwe O. Determinants of awareness, value perception, and societal support for sexual and reproductive health services among in-school adolescents in South-eastern Nigeria. BMC Health Serv Res 2023; 23:505. [PMID: 37198600 DOI: 10.1186/s12913-023-09470-z] [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: 01/12/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Adolescents are vulnerable to sexual and reproductive health (SRH) risks yet, have poor utilisation of SRH services due to personal, social, and demographic influences. This study aimed to compare the experiences of adolescents that had received targeted adolescent SRH interventions and those that did not and evaluated the determinants of awareness, value perception, and societal support for SRH service utilisation among secondary school adolescents in eastern Nigeria. METHODS We undertook a cross-sectional study of 515 adolescents in twelve randomly selected public secondary schools, grouped into schools that had received targeted adolescent SRH interventions and those that did not, across six local government areas in Ebonyi State, Nigeria. The intervention comprised training of schools' teachers/counsellors and peer educators and community sensitisation and engagement of community gatekeepers for demand generation. A pre-tested structured questionnaire was administered to the students to assess their experiences with SRH services. Categorical variables were compared using the Chi-square test, and predictors were determined through multivariate logistic regression. The level of statistical significance was determined at p < 0.05 and a 95% confidence limit. RESULTS A higher proportion of adolescents in the intervention group, 126(48%), than in the non-intervention group, 35(16.1%), were aware of SRH services available at the health facility (p-value < 0.001). More adolescents in the intervention than the non-intervention group perceived SRH services as valuable- 257(94.7%) Vs 217(87.5%), p-value = 0.004. Parental/community support for SRH service utilisation was reported by more adolescents in the intervention group than in the non-intervention group- 212 (79.7%) Vs 173 (69.7%), p-value = 0.009. The predictors are (i) awareness-intervention group (β = 0.384, CI = 0.290-0.478), urban residence (β=-0.141, CI=-0.240-0.041), older age (β-0.040, CI = 0.003-0.077) (ii) value perception - intervention group (β = 0.197, 0.141-0.253), senior educational class (β = 0.089, CI = 0.019-0.160), work-for-pay (β=-0.079, CI=-0.156-0.002), awareness (β = 0.192, CI = 0.425-0.721) (iii) parental/community support - work-for-pay (β = 0.095, CI = 0.003-0.185). CONCLUSIONS Adolescents' awareness, value perception, and societal support for sexual and reproductive health services were influenced by the availability of SRH interventions and socio-economic factors. Relevant authorities should ensure the institutionalisation of sex education in schools and communities, targeting various categories of adolescents, to reduce disparity in the utilisation of sexual and reproductive health services and promote adolescents' health.
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Affiliation(s)
- Irene Ifeyinwa Eze
- Department of Community Medicine, College of Health Sciences, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria.
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ifunanya Clara Agu
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, College of Health Sciences, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Godstime Eigbiremolen
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- University of Nigeria, Enugu Campus, Enugu, Nigeria
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Girase B, Parikh R, Vashisht S, Mullick A, Ambhore V, Maknikar S. India's policy and programmatic response to mental health of young people: A narrative review. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Shah T, Prajapati B, Shah V. Situational Analysis of Rashtriya Kishor Swasthya Karyakram at One of the Districts of Gujarat. Indian J Community Med 2022; 47:543-548. [PMID: 36742953 PMCID: PMC9891055 DOI: 10.4103/ijcm.ijcm_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023] Open
Abstract
Background Rastriya Kishor Swasthya Karyakram (RKSK) is a holistic approach implemented for betterment of adolescent health. Barriers in the implementation can be identified by conducting the situational analysis of any program. The present study is a part of the multi-centric study conducted at Sabarkantha district for situational analysis of RKSK. To assess the implementation of various components under RKSK at various levels of health facilities, 2) to identify the barriers faced by services providers in RKSK implementation, and 3) to identify the perception of beneficiaries regarding RKSK. Materials and Methods A Cross-sectional study using a mixed method approach was conducted to review the implementation of the RKSK program at Sabarkantha district. In-depth interview of health personnel involved in implementation of RKSK was conducted using pre-structured and pre-tested interview guide. Ongoing sessions of Adolescent Friendly Health Clinics (AFHCs) were examined, and exit interview of adolescents was conducted. Adolescents residing within limits of the defined facility were also interviewed. Frequency and percentages were used for descriptive analysis, and a thematic qualitative analysis approach was used for qualitative aspects. Results RKSK was implemented successfully at Primary Health Centers. Infrastructure for AFHC was inadequate particularly at higher care facilities. Weekly Iron Folic Acid Supplementation (WIFS) was successfully implemented in the district. Overall sessions conducted at AFHC were found to be satisfactory. Adolescents interviewed in the community were satisfied with the services delivered to them under RKSK. Conclusion For better implementation of RKSK, there is a need to focus on certain issues such as inadequate infrastructure of AFHCs, the lack of trained counselors, unavailability of sanitary pads, and inadequate participation of adolescents from the community in availing RKSK services.
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Affiliation(s)
- Tejas Shah
- Department of Community Medicine, GMERS Medical College, Himmatnagar, Gujarat, India
| | - Bipin Prajapati
- Department of Community Medicine, GMERS Medical College, Himmatnagar, Gujarat, India
| | - Venu Shah
- Department, Community Medicine, GCS Medical College, Ahmedabad, Gujarat, India
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Mackworth-Young CRS, Dringus S, Dauya E, Dziva Chikwari C, Mavodza C, Tembo M, Doyle A, McHugh G, Simms V, Wedner-Ross M, Apollo T, Mugurungi O, Ferrand RA, Bernays S. Putting youth at the centre: co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe. Wellcome Open Res 2022; 7:53. [PMID: 38264344 PMCID: PMC10804048 DOI: 10.12688/wellcomeopenres.17531.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 01/25/2024] Open
Abstract
Background: Youth have disproportionately poor HIV outcomes. We aimed to co-design a community-based intervention with youth to improve HIV outcomes among 16-24 year-olds, to be trialled in Zimbabwe. Methods: We conducted 90 in-depth interviews with youth, family members, community gatekeepers and healthcare providers to understand the barriers to uptake of existing HIV services. The interviews informed an outline intervention, which was refined through two participatory workshops with youth, and subsequent pilot-testing. Results: Participants considered existing services inaccessible and unappealing: health facilities were perceived to be for 'sick people', centred around HIV and served by judgemental providers. Proposed features of an intervention to overcome these barriers included: i) delivery in a youth-only community space; ii) integration of HIV services with broader health services; iii) non-judgemental skilled healthcare providers; iv) entertainment to encourage attendance; and v) tailored timings and outreach. The intervention framework stands on three core pillars, based on optimizing access (community-based youth-friendly settings); uptake and acceptability (service branding, confidentiality, and social activities); and content and quality (integrated HIV care cascade, high quality products, and trained providers). Conclusions: Ongoing meaningful youth engagement is critical to designing HIV interventions if access, uptake, and coverage is to be achieved.
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Affiliation(s)
- Constance RS. Mackworth-Young
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Stefanie Dringus
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
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Mackworth-Young CRS, Dringus S, Dauya E, Dziva Chikwari C, Mavodza C, Tembo M, Doyle A, McHugh G, Simms V, Wedner-Ross M, Apollo T, Mugurungi O, Ferrand RA, Bernays S. Putting youth at the centre: co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe. Wellcome Open Res 2022; 7:53. [PMID: 38264344 PMCID: PMC10804048 DOI: 10.12688/wellcomeopenres.17531.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 01/29/2024] Open
Abstract
Background: Youth have disproportionately poor HIV outcomes. We aimed to co-design a community-based intervention with youth to improve HIV outcomes among 16-24 year-olds, to be trialled in Zimbabwe. Methods: We conducted 90 in-depth interviews with youth, family members, community gatekeepers and healthcare providers to understand the barriers to uptake of existing HIV services. The interviews informed an outline intervention, which was refined through two participatory workshops with youth, and subsequent pilot-testing. Results: Participants considered existing services inaccessible and unappealing: health facilities were perceived to be for 'sick people', centred around HIV and served by judgemental providers. Proposed features of an intervention to overcome these barriers included: i) delivery in a youth-only community space; ii) integration of HIV services with broader health services; iii) non-judgemental skilled healthcare providers; iv) entertainment to encourage attendance; and v) tailored timings and outreach. The intervention framework stands on three core pillars, based on optimizing access (community-based youth-friendly settings); uptake and acceptability (service branding, confidentiality, and social activities); and content and quality (integrated HIV care cascade, high quality products, and trained providers). Conclusions: Ongoing meaningful youth engagement is critical to designing HIV interventions if access, uptake, and coverage is to be achieved.
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Affiliation(s)
- Constance RS. Mackworth-Young
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Stefanie Dringus
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
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Dayal R, Gundi M. Assessment of the quality of sexual and reproductive health services delivered to adolescents at Ujala clinics: A qualitative study in Rajasthan, India. PLoS One 2022; 17:e0261757. [PMID: 35007310 PMCID: PMC8746710 DOI: 10.1371/journal.pone.0261757] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
The Adolescent Friendly Health Clinic (AFHCs), a key component of the Government of India's National Adolescent Health Programme a.k.a. Rashtriya Kishor Swasthya Karyakram (RKSK), aims to increase the accessibility and utilization of sexual-reproductive health services by adolescents and youth. However, low quality of care provided at AFHCs by counsellors calls for attention. We, thus, explore both the clients' and providers' perspectives using the World Health Organization's (WHO) global standards for quality health-care services for adolescents to assess the quality of the sexual reproductive health service delivery at AFHCs in Rajasthan, India. We conducted a qualitative study, comprising observation of the service delivery using mystery clients (MCs) (n = 12) and in-depth interviews with the counsellors (n = 4) in four AFHCs. Interviews were transcribed in local language and were translated in English. The transcripts were coded thematically. Our study, using five of the eight WHO global standards for quality health-care services for adolescents highlighted several gaps in the quality-of-service delivery at AFHCs. We unearth various intricacies related to the quality of the services provided at the AFHCs by referring to the relevant input, process, and the output criteria of WHO global standards I, III, IV, V and VI. Our study calls for efforts to improve- (i) the counsellors' competencies to increase adolescents' health literacy on sensitive topics, (ii) the facilities at the clinic to ensure privacy, comfort and confidentiality of the adolescents seeking services, (iii) the referrals to improve appropriate package of services, and (iv) an overall environment to ensure an equity and non-discrimination for all the adolescents. Our findings unearth the barriers that both the service providers and the adolescents face at the AFHCs and underscore the need for regular monitoring and evaluation of the AFHCs to strengthen the facility-based intervention of the RKSK programme.
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Affiliation(s)
- Radhika Dayal
- Department of Poverty Gender and Youth, Population Council, New Delhi, Delhi, India
| | - Mukta Gundi
- Department of Poverty Gender and Youth, Population Council, New Delhi, Delhi, India
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Health Workers’ Perceptions about Maternal and Adolescent Health among Marginalized Populations in India: A Multi-Centric Qualitative Study. WOMEN 2021. [DOI: 10.3390/women1040021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Frontline workers are instrumental in bridging the gap in the utilization of maternal health services. We performed a qualitative cross-sectional study with medical officers, accredited social health activists (ASHA), and auxiliary nurse midwifes (ANM), across 13 districts of India, in order to understand the barriers and enablers, at the system and population levels, for improving access of adolescents and mothers to services. The data were collected by means of in-depth interviews (IDI) with medical officers and focus group discussions (FGD) with ASHA and ANM in 2016. The interview guide was based on the conceptual framework of WHO health interventions to decrease maternal morbidity. Content analysis was performed. In total, 532 frontline workers participated in 52 FGD and 52 medical officers in IDI. Adolescent clinics seemed nonexistent in most places; however, services were provided, such as counselling, iron tablets, or sanitary pads. Frontline workers perceived limited awareness and access to facilities among women for antenatal care. There were challenges in receiving the cash under maternity benefit schemes. Mothers-in-law and husbands were major influencers in women’s access to health services. Adolescent clinics and antenatal or postnatal care visits should be seen as windows of opportunities for approaching adolescents and women with good quality services.
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Chandra A. Neglected Sexual Health in India’s Medical Education and Regulation: Time for a Change. JOURNAL OF PSYCHOSEXUAL HEALTH 2021. [DOI: 10.1177/26318318211050604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ankit Chandra
- Pahadi Jan Swasth Sanstha, Haldwani, Nainital, Uttarakhand, India
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11
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Ganapathi L, Srikrishnan AK, Martinez C, Lucas GM, Mehta SH, Verma V, McFall AM, Mayer KH, Hassan A, Rajan S, O'Cleirigh C, Harris SK, Solomon SS. Young and invisible: a qualitative study of service engagement by people who inject drugs in India. BMJ Open 2021; 11:e047350. [PMID: 34548348 PMCID: PMC8458355 DOI: 10.1136/bmjopen-2020-047350] [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: 11/03/2022] Open
Abstract
OBJECTIVES The HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services. SETTING We conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics. PARTICIPANTS PWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants' narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum. RESULTS Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID. CONCLUSIONS Development of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Clarissa Martinez
- School of Medicine, City University of New York, New York, New York, USA
| | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vinita Verma
- National AIDS Control Organisation, New Delhi, India
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Areej Hassan
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Shobini Rajan
- National AIDS Control Organisation, New Delhi, India
| | - Conall O'Cleirigh
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sion Kim Harris
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Buch RS, Moitra M, Damor R, Chauhan N. Decision-Making Skills: An Assessment among Adolescents in Surat City. Indian J Community Med 2021; 46:195-200. [PMID: 34321725 PMCID: PMC8281850 DOI: 10.4103/ijcm.ijcm_512_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: This study assessed the process of decision-making among adolescents and the factors affecting it and also explored the styles of decision-making among adolescents. Methodology: A cross-sectional study using purposive sampling was carried out involving 1177 college-going students aged between 17 and 19 years. General Decision-Making Style (GDMS) and semi-structured questionnaire was used to collect data. Data were analyzed with the help of SPSS and AMOS. Exploratory and confirmatory factor analyses were run. Results: Good decision-making process was seen among 76.9% of the students. Kaiser–Meyer–Olkin verified that sampling adequacy was 0.8. Scree plot and Monte Carlo parallel analysis were suggestive of four factors which were logically intuitive, avoidant, dependent, and spontaneous styles of making decisions. Cronbach's alpha was 0.7 for GDMS. Staying arrangement, paternal education, fantasy scale score, perspective-taking score, personal distress score, problem-solving, self-esteem, creative thinking, and coping with stress were found statistically significant with decision-making process. While, on confirmatory factor analysis, a five-factor model was found to be fit with minimum discrepancy/degrees of freedom value of 2.68, root mean square error of approximation: 0.038, Comparative Fit Index (CFI): 0.927, Normed Fit Index (NFI): 0.890, parsimony CFI: 0.66, and parsimony NFI: 0.634. A high correlation was observed between rational and intuitive styles. Conclusion: The process of decision-making was found to be good, but styles of making decisions were overlapping
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Affiliation(s)
- Rutu Sanjaybhai Buch
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Mohua Moitra
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Rahul Damor
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Naresh Chauhan
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
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Kululanga LI, Kadango A, Lungu G, Jere D, Ngwale M, Kumbani LC. Knowledge deficit on health promotion activities during pregnancy: the case for adolescent pregnant women at Chiladzulu District, Malawi. BMC Pregnancy Childbirth 2020; 20:699. [PMID: 33198665 PMCID: PMC7667800 DOI: 10.1186/s12884-020-03386-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/30/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adolescent pregnancy is a public health concern in Malawi as it is associated with high risks of adverse pregnancy outcomes. Almost 29% of adolescent women aged 15-19 years are already mothers and adolescent fertility rate is also high estimated at 136 per 1000 women. Therefore, the aim of the study was to explore knowledge of pregnant adolescents on importance of antenatal care and health promotion during pregnancy. METHODS A qualitative descriptive design was used to solicit information on significance of antenatal care and how adolescents promote their health during pregnancy. Data was collected from 77 pregnant adolescents, purposively sampled from Namitambo and Namadzi Heath Centres in Chiladzulu District, Malawi. A semi-structured interview guide was used for data collection. Data were analysed manually following principles of qualitative content analysis. RESULTS Themes that emerged from the qualitative data included: knowledge deficit on the purpose and benefits of antenatal care; knowledge deficit on services offered at antenatal care clinic; knowledge deficit on danger signs during antenatal period and antenatal emergency care; knowledge deficit on effects of alcohol and smoking; knowledge deficit on nutrition during pregnancy; and knowledge deficit on importance of rest during pregnancy. CONCLUSION This study has shown knowledge deficit among adolescent mothers that may contribute to poor pregnancy outcomes. Several factors could be attributed to such knowledge deficit. Therefore, healthcare systems and healthcare professionals have a responsibility to enhance health literacy of pregnant adolescents with an ultimate goal of improving maternal and neonatal health outcomes.
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Affiliation(s)
- Lucy Ida Kululanga
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi.
| | - Alice Kadango
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Gaily Lungu
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Diana Jere
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Matthews Ngwale
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Lily Caroline Kumbani
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
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Improving use of maternal care services among married adolescent girls: an intervention study in rural India. J Biosoc Sci 2020; 53:336-355. [PMID: 32326992 DOI: 10.1017/s0021932020000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examined the effect of the Safe Adolescent Transition and Health Initiative (SATHI) programme on the use of maternal care services among rural, pregnant adolescents in India. This was an intensive community-based, multi-site intervention project conducted in Maharashtra state between 2008 and 2011. Its aims were to improve the reproductive health of married adolescent girls and avert the adverse consequences of early motherhood. It had a quasi-experimental, case-control, pre-post design to enable rigorous evaluation. This study used cross-sectional data from 644 married girls aged under 19 years at baseline and 802 at endline to assess the maternal care outcomes of antenatal care, delivery and postnatal services and nutrition during pregnancy. Difference-in-differences analysis showed that all outcomes improved significantly in the study sites between baseline and endline, and the improvement in study sites was significantly larger than in the control sites. Multivariate analysis showed a statistically significant dose-response effect of intervention participation for antenatal care, pregnancy nutrition and postnatal care. Study participation was not statistically significantly associated with higher rates of safe or institutional delivery. The analysis suggests that training and supporting community health workers to work with married adolescent girls using interpersonal communication and interacting frequently with them and their families and communities can significantly improve the use of maternal care services among this population. With almost a million community health workers and 200,000 auxiliary nurse midwives at the community level providing primary level care in India, this intervention offers a proven strategy to replicate and scale-up to reach large numbers of married adolescent girls who do not currently use maternal care services.
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Awang H, Ab Rahman A, Sukeri S, Hashim N, Nik Abdul Rashid NR. Adolescent-friendly health services in primary healthcare facilities in Malaysia and its correlation with adolescent satisfaction level. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2019. [DOI: 10.1080/02673843.2019.1685556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Hafizuddin Awang
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Malaysia
| | - Azriani Ab Rahman
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Malaysia
| | - Surianti Sukeri
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Malaysia
| | - Noran Hashim
- Maternal and Child Health Unit , Kelantan State Health Department, Kota Bharu, Kelantan, Malaysia
| | - Nik Rubiah Nik Abdul Rashid
- Adolescent Health Sector, Family Health Development Division, Ministry of Health, Parcel E, Federal Government Administration Centre , Putrajaya, Malaysia
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Pandey PL, Seale H, Razee H. Exploring the factors impacting on access and acceptance of sexual and reproductive health services provided by adolescent-friendly health services in Nepal. PLoS One 2019; 14:e0220855. [PMID: 31393927 PMCID: PMC6687105 DOI: 10.1371/journal.pone.0220855] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/24/2019] [Indexed: 11/19/2022] Open
Abstract
Adolescent-friendly health programs have been in place in Nepal since 2008, yet uptake of the services for sexual and reproductive health remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their acceptance and utilization from the perspectives of adolescents, health care staff, and key community informants. This study applied a qualitative research design involving six focus groups with 52 adolescents and in-depth interviews with 16 adolescents, 13 key informants, and 9 health care providers from six adolescent-friendly health facilities in Nepal. Thematic analysis was conducted for data analysis. The key themes identified as barriers include access issues due to travel, institutional health care barriers, perceived lack of privacy and confidentiality, and the unprofessional attitudes of staff towards the sexual health needs of adolescents. These themes are underpinned by gendered ideology and a moral framework around the sexual behavior of adolescents. Interview responses suggested that health care providers take a policing role in prescribing adolescents’ conformity to this moral framework in their delivery of reproductive health care and services. While physical access to health services may be problematic for some adolescents, this is not the priority issue. Attention needs to be given to increasing the capacity of health care providers to deliver services without imposing their own and socially sanctioned moral frameworks around adolescent sexual behavior. Such capacity building should include training that is experiential and emphasizes the importance of confidentiality and non-judgmental attitudes.
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Affiliation(s)
- Pushpa Lata Pandey
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Husna Razee
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Mahalakshmy T, Premarajan KC, Soundappan K, Rajarethinam K, Krishnamoorthy Y, Rajalatchumi A, Mathavaswami V, Chandar D, Chinnakali P, Dongre AR. A Mixed Methods Evaluation of Adolescent Friendly Health Clinic Under National Adolescent Health Program, Puducherry, India. Indian J Pediatr 2019; 86:132-139. [PMID: 30173336 DOI: 10.1007/s12098-018-2755-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the awareness and utilization of Adolescent Friendly Health Clinic (AFHC) services among school going adolescents (14-19 y) and to explore the forces 'for' and 'against' the utilization of AFHC services in Puducherry, India. METHODS This mixed-methods study was conducted in two primary health centres. Record review assessed the utilization of AFHC service. Survey assessed the awareness on AFHC services and self-reported illnesses and their treatment seeking behavior. Group interviews were conducted with adolescent girls, boys and healthcare providers. A summative content analysis was done to organize the 'for' and 'against' forces for service utilization. RESULTS Of the 311 adolescents, less than 50% were aware of the services available at AFHC. Utilization of Weekly Iron and Folic Acid Supplementation was good. Only 2-10% of adolescents consulted the outpatient services of the Primary Health Centre for the treatment of their health problems. The authors found low utilization of AFHC services (15% among girls, zero among boys). One of the reasons for low utilization was poor awareness. Though free sanitary napkins motivated the girls to avail the services, boys considered the AFHC as a girl's clinic. Healthcare providers suggested that building rapport and trust with adolescents and their parents, involving school teachers and ensuring privacy in the clinic would increase the utilization. CONCLUSIONS There is a huge gap between the awareness and utilization of AFHC services. The reasons for non-utilization were poor awareness and misconceptions about the clinic. Training of health staffs on communication skills, and supportive supervision could improve the utilization.
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Affiliation(s)
- Thulasingam Mahalakshmy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India.
| | - Kariyarath Cheriyath Premarajan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India
| | - Kathirvel Soundappan
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanagarethinam Rajarethinam
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India
| | - Yuvaraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India
| | - Adhisakthi Rajalatchumi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India
| | - Vijayageetha Mathavaswami
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India
| | - Deepika Chandar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605009, India
| | - Amol R Dongre
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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Patel P, Puwar T, Shah N, Saxena D, Trivedi P, Patel K, Yasobant S, Fancy M, Matela H, Savaliya S, Kalpana P, Rana R. Improving Adolescent Health: Learnings from an Interventional Study in Gujarat, India. Indian J Community Med 2018; 43:S12-S17. [PMID: 30686868 PMCID: PMC6324041 DOI: 10.4103/ijcm.ijcm_286_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/05/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are multiple risk factors during adolescence, which become precursors of various diseases and injuries inflicting high morbidity, mortality, and disability. There are several gaps in adolescent health research in India; one among them is that programs targeting adolescent health are constrained by the absence of rigorous interventional research informing interventions for improving adolescent health. This study aims to document the effectiveness of intervention on adolescent health and knowledge change on the risk factors among adolescents in one of the selected districts in Gujarat, India. METHODS This was an interventional study with quasi-experimental design executed in one of the blocks of Gujarat. Baseline was conducted in 2013-2014 followed by intervention and the end line during 2016-2017. A structured validated questionnaire after pilot testing was executed to collect information on sociodemographic profile, nutrition status, menstrual hygiene practices, reproductive and sexual health, substance abuse, program awareness and utilization, and empowerment through life skills of adolescents in baseline and end line survey. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp). RESULTS This study documented increased awareness regarding anemia, knowledge about STD and HIV/AIDS, reduced addiction to tobacco, improved practices during menstrual hygiene and engagement with adolescent services/schemes in the intervention site. CONCLUSION This study concludes that evidence-based interventions lead to increase in knowledge and practices; however, some improvements have also been documented in the nonintervention site. Therefore, changes due to interventions could not be attributed completely for improving adolescent health. Further long term interventional studies are required to develop a robust evidence on improving health of adolescents in India.
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Affiliation(s)
- Pallavi Patel
- Centre for Health Education, Training and Nutrition Awareness, Ahmedabad, Gujarat, India
| | - Tapasvi Puwar
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Neeta Shah
- Centre for Health Education, Training and Nutrition Awareness, Ahmedabad, Gujarat, India
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Poonam Trivedi
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Krupali Patel
- Center for Development Research (ZEF), Bonn, Germany
| | | | - Manish Fancy
- Department of Health, Government of Gujarat, Sabarkantha, Gujarat, India
| | - Hema Matela
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Shital Savaliya
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Pachillu Kalpana
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Ritu Rana
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
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Hoopes AJ, Agarwal P, Bull S, Chandra-Mouli V. Erratum to: Measuring adolescent friendly health services in India: A scoping review of evaluations. Reprod Health 2017; 14:43. [PMID: 28302136 PMCID: PMC5353798 DOI: 10.1186/s12978-016-0267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Andrea J Hoopes
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Box B025, Aurora, CO, USA.
| | - Paras Agarwal
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Sheana Bull
- Department of Community and Behavioral Health, Colorado School of Public Health, 13001 E. 17th Place, B119, Bldg 500, Room E3345A, Aurora, CO, 80045, USA.,Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Venkatraman Chandra-Mouli
- Division of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, 27, Switzerland
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