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Kalungi H, Kamacooko O, Lunkuse JF, Namutebi J, Naluwooza R, Price MA, Ruzagira E, Mayanja Y. Prevalence and factors associated with illicit drug and high-risk alcohol use among adolescents living in urban slums of Kampala, Uganda. BMC Public Health 2024; 24:1709. [PMID: 38926824 PMCID: PMC11210115 DOI: 10.1186/s12889-024-19250-x] [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: 10/18/2023] [Accepted: 06/24/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Illicit drug and high-risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence and factors associated with illicit drug and high-risk alcohol consumption. METHODS We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25 March 2019 to 30 March 2020. Data was collected on social demographics, sexual behavior, and reproductive health using interviewer-administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. RESULTS We enrolled 490 participants (60.6% female) with a median age of 18 (IQR 17-18) years, 84.9% had less than secondary education, 48.4% had their sexual debut before 15 years, 47.1% reported paid sex in the past 3 months and 22.8% had a sexually transmitted infection (chlamydia, gonorrhea, and active syphilis) baseline characteristics associated with illicit drug use in the past 3 months were male gender (aOR 12.45; 95% CI 7.21-21.50) being married (aOR 2.26; 95%CI 1.03-4.94) 10 or more paying sexual partners (aOR 2.45; 95%CI 1.05-5.69) and high-risk alcohol use (aOR 3.94; 95%CI 2.10-7.40), baseline characteristics associated with high-risk alcohol use were male gender (aOR 0.29; 95% CI 0.13-0.63) emotional violence from sexual partners (aOR 2.35; 95%CI 1.32-418) illicit drug users com (aOR 3.94; 95% CI 2.10-7.40). CONCLUSION Illicit drug and high-risk alcohol use are prevalent among male adolescents and adolescents involved in high-risk sexual behavior living in the urban slums of Kampala.
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Affiliation(s)
- Hellen Kalungi
- Medical Research Council/Uganda, Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda.
| | - Onesmus Kamacooko
- Child Health and Development Center, College of Health Science, Makerere University, Kampala, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council/Uganda, Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Joy Namutebi
- Medical Research Council/Uganda, Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Rose Naluwooza
- Medical Research Council/Uganda, Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Matt A Price
- International AIDS Initiative (IAVI), 125 Broad St, 10004, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 94143, San Francisco, CA, USA
| | - Eugene Ruzagira
- Medical Research Council/Uganda, Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Yunia Mayanja
- Medical Research Council/Uganda, Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
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Aliyu TK. Situational context of home-based sexual education in urban slums of Ibadan, Nigeria-evidence from a qualitative study. PLoS One 2024; 19:e0304200. [PMID: 38885279 PMCID: PMC11182513 DOI: 10.1371/journal.pone.0304200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 05/07/2024] [Indexed: 06/20/2024] Open
Abstract
This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria. A qualitative exploratory study was conducted in the Southeast and Northeast LGAs of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were tape-recorded, transcribed, and translated into English. Thematic analysis was adopted using ATLAS Ti 9 software. Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that despite understanding the need for SRH discussion, parents and adolescents lack effective communication on SRH issues due to the interference of unfiltered streetwise SRH knowledge and social media exposure. Also, SRH conversation between parents and adolescents promotes gender inequalities as different information is passed to adolescent girls and boys. Interventions that take into account situational occurrences must be geared towards enabling parents to give their adolescents early exposure to relevant, context-specific SRH knowledge.
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Affiliation(s)
- Taofeek Kolawole Aliyu
- Department of Sociology and Anthropology, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Sociology, Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
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Simegn W, Hussen E, Maru Y, Seid AM, Limenh LW, Ayenew W, Melese M, Atsbeha BW. Knowledge, attitude, practices and associated factors of family planning among women living with hiv at the university of Gondar specialized hospital: a cross sectional study. BMC Womens Health 2024; 24:232. [PMID: 38610010 PMCID: PMC11010278 DOI: 10.1186/s12905-024-03036-9] [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: 07/03/2023] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION HIV/AIDS poses a significant health challenge in sub-Saharan African countries, with a disproportionate impact on women of reproductive age. The disparities in knowledge, attitudes, and practices related to family planning among women living with HIV can be intricate and multi-faceted. This study aimed to assess the knowledge, attitude, practice, and associated factors regarding family planning among the women living with HIV at the University of Gondar specialized hospital, Gondar, Ethiopia. METHOD A cross-sectional study was carried out at the University of Gondar Teaching Referral Hospital, focusing on HIV-positive women of reproductive age who visited the ART unit from July 8-28, 2022. Data collection involved the use of pre-tested, structured questionnaires administered through interviews. The gathered data were entered into the electronic Kobo Collect platform and subsequently exported for analysis using SPSS version 26. Descriptive summaries, including frequencies, means, and percentages, were presented through tables and figures. Logistic regression was employed to identify potential predictors, presenting adjusted odds ratios with a 95% confidence interval and a significance level set at a P-value of 0.05. RESULTS A total of 328 study participants were included. About 93% of the study population had good knowledge about modern contraceptives, and about 94% of the study population had good knowledge about safer conception. Only 30.2% of the study population had knowledge of the dual contraceptive method. The attitude and practice of women towards family planning (FP) were 71.0% and 55.8%, respectively. The study revealed that the most commonly employed contraceptive method was injectable contraceptives, constituting 34.2% of usage. Having one and a greater number of children (AOR = 2.25, 95% CI: 1.10, 4.49), having discussions on fertility plans with healthcare providers (AOR = 2.20, 95% CI: 1.02, 4.761), and having good family planning practices (AOR = 2.15, 95% CI: 1.19, 3.87) were significantly associated with the attitude toward family planning. Married women (AOR = 1.88, 95% CI = 1.11, 3.1), able to read and write (AOR = 2.12, 95% CI:1.04,4.32), college and above educational level (AOR = 4.51, 95% CI:1.93,10.87), had discussion on fertility plan with healthcare providers (AOR = 5.09, 95% CI: 1.96, 13.24), knowledge about dual method (AOR = 1.95, CI: 1.08, 3.50), and knowledge about modern contraceptive methods (AOR = 7.24, 95% CI: 1.56, 33.58) were significantly associated with good practice of family planning. CONCLUSION Women living with HIV exhibited notably high levels of knowledge regarding modern contraceptive methods and safer conception. The knowledge of the dual method was low. More than half of the study population had good practice in family planning. More than two-thirds of HIV-positive reproductive-age women had a good attitude about family planning. Having one or a greater number of children, having a discussion on a fertility plan with a healthcare provider, and having a good practice of family planning were significantly associated with a good attitude toward family planning. Married women, education status, discussions on fertility plans with healthcare providers, knowledge about dual methods, and knowledge about modern contraceptive methods were significantly associated with good family planning practices. The stakeholders should design interventions based on the aforementioned factors to improve the attitude and practice of family planning.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Eman Hussen
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yossef Maru
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdulwase Mohammed Seid
- Department of Clinical Pharmacy, School of Pharmacy,College of Medicine and Health Sciences, , University of Gondar, Gondar, Ethiopia
| | - Liknaw Workie Limenh
- Department of pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, , University of Gondar, Gondar, Ethiopia
| | - Wondim Ayenew
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihret Melese
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Berhanemeskel Weldegerima Atsbeha
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sidamo NB, Kerbo AA, Gidebo KD, Wado YD. Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque's Framework. Adolesc Health Med Ther 2024; 15:45-61. [PMID: 38562442 PMCID: PMC10984202 DOI: 10.2147/ahmt.s455517] [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: 01/27/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State. Methods A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software. Results The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents' healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers' behaviors further hindering adolescents' ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents. Conclusion The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.
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Affiliation(s)
- Negussie Boti Sidamo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassa Daka Gidebo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Amanu A, Birhanu Z, Godesso A. Sexual and reproductive health literacy among young people in Sub-Saharan Africa: evidence synthesis and implications. Glob Health Action 2023; 16:2279841. [PMID: 38010100 PMCID: PMC10795590 DOI: 10.1080/16549716.2023.2279841] [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: 04/27/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Sexual and reproductive health literacy is a key to attaining and maintaining sexual and reproductive health, especially among young people in low-income countries, such as sub-Saharan Africa. While the importance of sexual and reproductive health literacy is gaining wider recognition, studies on the topic have been mainly concentrated in high-income (developed) countries. OBJECTIVE The aim of this study was to provide a coherent summary and synthesis of the available evidence on sexual and reproductive health literacy among young people in sub-Saharan Africa, with implications for policy, interventions, and research. METHODS The review was conducted using the Joanna Briggs Institute's methodology for reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline to enhance the clarity and transparency of the reporting process. PubMed, CINAHL, AJOL, AIM, and Google Scholar were searched for evidence from 18 March to 20 May 2022. RESULTS The search provided 2,682 articles in total, of which only 24 met the eligibility criteria and were included in this review. The findings revealed persistent sexual and reproductive health information/knowledge gaps, poor sexual and reproductive health-related knowledge and practices, lack of exercising sexual and reproductive health knowledge, and multiple determinants of sexual and reproductive health literacy among young people, ranging from personal to larger structural conditions. CONCLUSION The review found that sexual and reproductive health literacy among young people in sub-Saharan Africa is concerning and has not been fully researched. A deeper understanding of the issue is essential for designing and implementing effective interventions to improve sexual and reproductive health literacy and health outcomes among young people.
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Affiliation(s)
- Adamu Amanu
- Department of Health, Behaviour, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Department of Sociology, College of Social Sciences, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behaviour, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Ameyu Godesso
- Department of Sociology, College of Social Sciences, Jimma University, Jimma, Ethiopia
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Kalungi H, Kamacooko O, Lunkuse JF, Namutebi J, Naluwooza R, Price MA, Ruzagira E, Mayanja Y. Prevalence and Factors Associated with Illicit Drug and High-Risk Alcohol Use among Adolescents Living in Urban Slums of Kampala, Uganda. RESEARCH SQUARE 2023:rs.3.rs-3460610. [PMID: 37961270 PMCID: PMC10635325 DOI: 10.21203/rs.3.rs-3460610/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background; Illicit drug and high risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence, and factors associated with illicit drug and high-risk alcohol consumption. Methods; We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25-March-2019 to 30-March 2020. Data was collected on social-demographics, sexual behavior and reproductive health using interviewer administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. Results; We enrolled 490 participants (60.6% female) with median age 18 (IQR 17-18) years, 91.0% had less than secondary education, 48.4% had their sexual debut before 15years, 47.1% reported paid sex in the past 3 months and 24.7% had a sexually transmitted infection (chlamydia, gonorrhea and/ or active syphilis) at enrolment. The prevalence of illicit drug use was 34.9% while 16.1% were screened as high-risk alcohol users. Illicit drug use was associated with being male (aOR 9.62; 95% CI 5.74-16.11), being married (aOR 2.24; 95%CI 1.07-4.68) and having ≥10 paying sexual partners in the past 3 months (aOR 3.13; 95%CI 1.40-6.98). High risk alcohol use was associated with reporting sex work as the main job (aOR 3.19; 95%CI 1.02-9.94) and having experienced physical (aOR 1.96 95%CI 1.01-3.81) or emotional violence (aOR 2.08; 95%CI 1.14-3.82) from sexual partners. Conclusion: Illicit drug and high-risk alcohol use are prevalent among adolescents involved in high risk sexual behavior and living in urban slums of Kampala. Comprehensive interventions that target substance use among this group of young people are needed and should include measures against intimate partner violence.
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Affiliation(s)
- Hellen Kalungi
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Ug
| | - Onesmus Kamacooko
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Ug
| | - Jane Frances Lunkuse
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Ug
| | - Joy Namutebi
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Ug
| | - Rose Naluwooza
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Ug
| | | | - Eugene Ruzagira
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Ug
| | - Yunia Mayanja
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Ug
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Kalungi H, Kamacooko O, Lunkuse JF, Namutebi J, Naluwooza R, Price MA, Ruzagira E, Mayanja Y. Prevalence and Factors Associated with Illicit Drug and High-Risk Alcohol Use among Adolescents Living in Urban Slums of Kampala, Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.20.23292973. [PMID: 37546898 PMCID: PMC10402224 DOI: 10.1101/2023.07.20.23292973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Illicit drug and high risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence, and factors associated with illicit drug and high-risk alcohol consumption. Methods We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25-March-2019 to 30-March 2020. Data was collected on social-demographics, sexual behavior and reproductive health using interviewer administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. Results We enrolled 490 participants (60.6% female) with median age 18 (IQR 17-18) years, 91.0% had less than secondary education, 48.4% had their sexual debut before 15years, 47.1% reported paid sex in the past 3 months and 24.7% had a sexually transmitted infection (chlamydia, gonorrhea and/ or active syphilis) at enrolment. The prevalence of illicit drug use was 34.9% while 16.1% were screened as high-risk alcohol users. Illicit drug use was associated with being male (aOR 9.62; 95% CI 5.74-16.11), being married (aOR 2.24; 95%CI 1.07-4.68) and having ≥10 paying sexual partners in the past 3 months (aOR 3.13; 95%CI 1.40-6.98). High risk alcohol use was associated with reporting sex work as the main job (aOR 3.19; 95%CI 1.02-9.94) and having experienced physical (aOR 1.96 95%CI 1.01-3.81) or emotional violence (aOR 2.08; 95%CI 1.14-3.82) from sexual partners. Conclusion Illicit drug and high-risk alcohol use are prevalent among adolescents involved in high risk sexual behavior and living in urban slums of Kampala. Comprehensive interventions that target substance use among this group of young people are needed and should include measures against intimate partner violence.
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Affiliation(s)
- Hellen Kalungi
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe 256, Uganda
| | - Onesmus Kamacooko
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe 256, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe 256, Uganda
| | - Joy Namutebi
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe 256, Uganda
| | - Rose Naluwooza
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe 256, Uganda
| | - Matt A. Price
- IAVI, 125 Broad St, New York, NY 10004 USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16 Street, CA 94143 San Francisco, USA
| | - Eugene Ruzagira
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe 256, Uganda
- 1London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Yunia Mayanja
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe 256, Uganda
- 1London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
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Koly KN, Saba J, Billah MA, McGirr A, Sarker T, Haque M, Mustary E, Hanifi SMMA, Begum F. Depressive symptoms and anxiety among women with a history of abortion living in urban slums of Bangladesh. BMC Psychol 2023; 11:197. [PMID: 37403178 DOI: 10.1186/s40359-023-01224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/16/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Globally, major emphasis has been placed on understanding the physiological consequences of losing a pregnancy. However, its mental health impact on socially disadvantaged women remains unexplored. To further inform the field the present study investigated the prevalence and factors associated with the development of depressive symptoms and anxiety among women with a history of spontaneous abortion living in the urban slums of Dhaka, Bangladesh. METHODS Information was obtained from 240 women who experienced a spontaneous abortion from July 2020 to December 2021. It was obtained through the urban health and demographic surveillance system (UHDSS) survey. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to measure mental health symptoms. Bivariate and multivariate linear regression analyses were performed to assess the associated factors with the mental health outcomes. RESULTS Of the 240 women, majority (77.50%) of the women experienced mild to severe depressive symptoms and more than half (58.75%) of the respondants experienced mild to severe anxiety, within one and half years of experiencing spontaneous abortion. A higher level of education and being employed were protective factors for anxiety and depressive symptoms, respectively. However, women with higher sexual and reproductive health rights (SRHR) knowledge had significantly increased anxiety and depressive symptoms. In contrast, receiving post-abortion care (PAC) was associated with decreased anxiety and depressive symptoms. CONCLUSION The findings indicate that ensuring access to affordable PAC services and integrating mental health services into the standard PAC service package is crucial. This study also emphasizes the importance of providing education for women living in urban slums and encouraging them to participate in economic activities.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh.
| | - Jobaida Saba
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Md Arif Billah
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Alba McGirr
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Tithi Sarker
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - Mahbubul Haque
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - Elvina Mustary
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - S M Manzoor Ahmed Hanifi
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Farzana Begum
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
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Murungi T, Benyumiza D, Apio J, Nekesa C, Nalubuuka A, Misuk I, Kumakech E. Factors Associated with Utilization of Sexual and Reproductive Health Services among the Youth in Lira City West, Northern Uganda: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9649792. [PMID: 37250751 PMCID: PMC10212677 DOI: 10.1155/2023/9649792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
Abstract
Background The youth in Uganda, as in much of sub-Saharan Africa, face numerous sexual and reproductive health (SRH) challenges, from human immunodeficiency virus HIV infection, and unsafe abortions to unwanted pregnancies. This study, therefore, assessed the utilization of sexual and reproductive health services and associated factors among the youth in Lira city west, northern Uganda. Methods This was a cross-sectional study conducted in January 2023 among 386 young people (15-24 years) in Lira city west division, Lira city. Multistage cluster sampling technique was used to recruit our study participants. Data were collected using an interviewer-administered questionnaire. Data were analyzed using SPSS version 23, descriptive statistics, cross-tabulation, bivariate, and multivariate logistic regression analyses. All variables were set by p values less than 0.05 and reported adjusted odds ratio with its 95% confidence interval. Results The utilization of SRH services was 42.0% (162/386) among the study participants. Family planning, voluntary HIV counseling and testing (VCT), and general counseling services were the most utilized SRH services in the past 12 months. Young people who were aware of SRH services (AOR: 0.24; 95% CI: 0.08-0.74), were aware of a reproductive health facility (AOR, 4.24; 95% CI: 1.62-11.09), discussed SRH issues with peers/friends (AOR, 3.98; 95% CI: 1.53-10.33), had a sexual partner (AOR, 10.00; 95% CI: 4.05-24.69), had sexual intercourse (AOR, 4.59; 95% CI: 2.18-9.69), and had access to SRH services (AOR, 2.68; 95% CI: 1.12-6.40) were more likely to utilize SRH services compared to their counterparts. Conclusion This study showed a low utilization of sexual and reproductive health services among youth in Lira city west, northern Uganda. Being aware of SRH services, awareness of reproductive health facilities, discussing SRH issues with peers, having sexual intercourse, having a sexual partner, and access to SRH services were independently associated with the utilization of SRH services. Therefore, there is a need to strengthen sustainable multisector approaches aimed at improving awareness and access to sexual and reproductive health services among the youth.
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Affiliation(s)
- Tom Murungi
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O BOX 1035, Lira, Uganda
| | - Deo Benyumiza
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O BOX 1035, Lira, Uganda
| | - Juliet Apio
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O BOX 1035, Lira, Uganda
| | - Catherine Nekesa
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O BOX 1035, Lira, Uganda
| | - Aisha Nalubuuka
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O BOX 1035, Lira, Uganda
| | - Ivan Misuk
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O BOX 1035, Lira, Uganda
| | - Edward Kumakech
- Department of Nursing, Faculty of Nursing and Midwifery, Lira University, P.O BOX.1035, Lira, Uganda
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Akwara E, Pinchoff J, Abularrage T, White C, Ngo TD. The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review. J Urban Health 2023:10.1007/s11524-023-00724-z. [PMID: 37052774 PMCID: PMC10100607 DOI: 10.1007/s11524-023-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.
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Affiliation(s)
| | - Jessie Pinchoff
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Tara Abularrage
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Corinne White
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Thoai D Ngo
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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11
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Arije O, Hlungwani T, Madan J. "They will judge you more like a parent instead of like a health practitioner": Perceptions and preferences of young people regarding sexual and reproductive health services in Southwest Nigeria. DIALOGUES IN HEALTH 2022; 1:100051. [PMID: 38515883 PMCID: PMC10953966 DOI: 10.1016/j.dialog.2022.100051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 03/23/2024]
Abstract
Adolescents and young people (AYP) experience many barriers in the utilization of sexual and reproductive health (SRH) services. These barriers can be cultural, structural, personal or health worker-related. In this study, we explored the perceptions and preferences of AYP in receiving SRH services at public health facilities in a Nigerian setting. We conducted 16 focus group discussion (FGD) sessions with adolescents and young people allowing for maximum variation by sex (male, female), age (15-19 years and 20-24 years), and marital status (married and unmarried). We applied a thematic framework analysis to explore the data collected. Our findings included both positive and negative attitudes of health workers at public health facilities, non-involvement of AYP in activities relating to the planning, implementation, or evaluation of SRH programs for AYP, and non-awareness among AYP of some of the rights that AYP have with respect to SRH services in public health facilities. Many participants preferred younger health workers or those living within their neighborhood. Some older health workers were said to often act as (strict) parents, not health workers. We conclude that the role ascribed to 'neighborhood' nurses in this study is instructive and deserves more attention. Also, there is a need to increase the awareness of the young people about the type of SRH services they can obtain in the public health facilities, as well as, a need for health workers to be trained and retrained in providing SRH services to AYP.
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Affiliation(s)
- Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Tintswalo Hlungwani
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Jason Madan
- Warwick Medical School, University of Warwick, Warwick, UK
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12
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Bergam S, Sibaya T, Ndlela N, Kuzwayo M, Fomo M, Goldstein MH, Marconi VC, Haberer JE, Archary M, Zanoni BC. "I am not shy anymore": A qualitative study of the role of an interactive mHealth intervention on sexual health knowledge, attitudes, and behaviors of South African adolescents with perinatal HIV. Reprod Health 2022; 19:217. [PMID: 36457044 PMCID: PMC9713189 DOI: 10.1186/s12978-022-01519-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND South Africa has one of the highest burdens of adolescents with perinatally-acquired HIV (APHIV) in the world. APHIV in South Africa have limited access to sexual and reproductive health (SRH) education and services specific to their HIV status. When lacking comprehensive SRH education, APHIV are prone to sexual risk behaviors that can lead to unintended pregnancy, sexually transmitted infections, and HIV transmission. The use of mHealth interventions has been shown to deliver information, foster social support, and improve decision-making skills. In this study, we evaluate how an mHealth intervention influences sexual health knowledge and behaviors in APHIV. METHODS We purposively enrolled adolescents from the intervention arm of a randomized clinical trial assessing a multi-module, moderated WhatsApp-based intervention-Interactive Transition Support for Adolescents Living with HIV (InTSHA)-within a government supported clinic in KwaMashu, an urban township of KwaZulu-Natal, South Africa. We conducted in-depth interviews based on World Health Organization guidelines for asking adolescents about SRH. We thematically analyzed data through an iterative, team-based coding approach combining deductive and inductive elements to contextualize SRH attitudes, knowledge, and behaviors before and after receiving the InTSHA intervention. RESULTS Of the 21 participants, 13 (61.9%) were female and the mean age was 16.6 years. Most participants reported first learning about SRH as young teenagers in school through non-targeted and negative ways, seeking clarification through peers and the internet rather than clinicians or caregivers. Participants reported that InTSHA provided a holistic perspective on relationships, gender, and sexuality specific to growing up with HIV in South Africa. They praised the ability to give and receive information from peers in a moderated setting through the mHealth intervention, building their confidence, decision-making skills, and communication with partners and caregivers throughout their everyday lives. Despite reporting some technological challenges, adolescents agreed that InTSHA was convenient, confidential, and user-friendly. CONCLUSIONS South African APHIV receive incomplete and conflicting sexual education from peers, caregivers, teachers, and technology that can be supplemented by mHealth curricula targeted for the unique needs of APHIV. Future, scaled-up mHealth interventions can lower SRH stigma by expanding access to sexual education and peer support, supplementing adolescents' existing SRH education.
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Affiliation(s)
- Scarlett Bergam
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa ,George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Thobekile Sibaya
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Nompumelelo Ndlela
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Mpume Kuzwayo
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Messaline Fomo
- grid.189967.80000 0001 0941 6502Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA USA
| | | | - Vincent C. Marconi
- grid.189967.80000 0001 0941 6502Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA USA
| | - Jessica E. Haberer
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Moherndran Archary
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Brian C. Zanoni
- grid.189967.80000 0001 0941 6502Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA USA ,grid.428158.20000 0004 0371 6071Children’s Healthcare of Atlanta, Atlanta, GA USA
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13
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Hailu S, Assefa N, Dingeta T, Abdurahman C, Adem M. Unmet need for contraception among married adolescent girls and young women in Haramaya Health and demographic surveillance system, Eastern Ethiopia. Front Glob Womens Health 2022; 3:999860. [PMID: 36420450 PMCID: PMC9678183 DOI: 10.3389/fgwh.2022.999860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 11/02/2023] Open
Abstract
Background The prevalence of unmet need for contraception is the highest in low- and middle-income countries (LMIC). Contraceptive use among young married or unmarried women is lower than that among older women in developing countries. Previous studies generalized the findings to all women of reproductive age and have not investigated psychosocial factors that influence contraceptive use. This study aimed to identify factors associated with unmet need for contraception among young married women in the Haramaya Health and Demographic Surveillance System (HDSS), eastern Ethiopia. Methodology A cross-sectional, community-based study of young married women aged 15-24 years was conducted. A simple random sampling method was used to select 550 young married women. Data were collected using a pretested structured questionnaire. Using adjusted odds ratio (AOR) with a 95% confidence interval (CI), factors associated with unmet need for contraception were identified using multivariable logistic regression analysis. Results The overall prevalence of unmet need for contraception was 154 (30.3%). Adolescents (15-19) (AOR = 2.05, 95% CI: 1.16-3.62), husbands' negative attitude toward contraception (AOR = 2.1, 95% CI: 1.05-4.46), and no previous use of contraception (AOR = 3.9, 95% CI: 2.29-6.71) were significantly and positively associated with unmet need for contraception. On the contrary, young women with secondary education or higher (AOR = 0.55, 95% CI: 0.28-1.084) were negatively and significantly associated with unmet need for contraception. Conclusion The prevalence of unmet need for contraception among young women in Haramaya was high. Unmet need was affected by age, husbands' attitude toward contraceptives, the educational status of women, and previous use of contraception. This study underscored the need to improve girls' educational status to empower them in making contraceptive use decisions with their partners. Programs should also engage male partners who are perceived as key decision-makers when it comes to contraceptive use.
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Affiliation(s)
- Saba Hailu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Chaltu Abdurahman
- Department of Public Health, College of Health and Medical Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mewardi Adem
- Department of Public Health, College of Health and Medical Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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14
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Macharia P, Pérez-Navarro A, Inwani I, Nduati R, Carrion C. Developing an Unstructured Supplementary Service Data-based mobile phone app to provide adolescents with sexual reproductive health information: a human-centered design approach. BMC Med Res Methodol 2022; 22:213. [PMID: 35927636 PMCID: PMC9351084 DOI: 10.1186/s12874-022-01689-4] [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: 04/12/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent pregnancies and sexually-transmitted infections continue to impact 15 - 19-year-olds across the globe. The lack of sexual reproductive health information (SRH) in resource-limited settings due to cultural and societal attitudes towards adolescent SRH could be contributing to the negative outcomes. Innovative approaches, including mobile phone technologies, are needed to address the need for reliable adolescent SRH information. OBJECTIVE The study aimed to co-design a Unstructured Supplementary Service Data (USSD) based mobile app prototype to provide confidential adolescent SRH information on-demand and evaluate the mobile app's usability and user experience. METHODS A human-centered design methodology was applied. This practice framework allowed the perspectives and feedback of adolescent users to be included in the iterative design process. To participate, an adolescent must have been 15 to 19 years old, resided in Kibra and would be able to access a mobile phone. Adolescents were enrolled for the alpha and field testing of the app prototype at different time-points. The Mobile Application Rating Scale (MARS) a multidimensional mobile phone evaluation tool was used to access the functionality, engagement, aesthetics and quality of information in the app. Responses from the MARS were reported as mean scores for each category and a mean of the aggregate scores making the app's quality score. The MARS data was also evaluated as categorical data, A Chi square test of independence was carried out to show significance of any observed differences using cumulative and inverse cumulative distribution functions. RESULTS During the usability test, 62/109 (54.9%) of the adolescents that were followed-up had used the app at least once, 30/62 (48.4%) of these were male participants and 32/62 (51.6%) female. On engagement, the app had a mean score of 4.3/5 (SD 0.44), 4.6/5 (SD 0.38) on functionality, 4.3/5 (SD 0.57) on aesthetics and 4.4/5 (SD 0.60) on the quality of information. The overall app quality mean score was 4.4/5 (SD 0.31). The app was described as 'very interesting' to use by 44/62 (70.9%) of the participants, 20/44 males and 24/44 females. The content was deemed to be either 'perfectly' or 'well targeted' on sexual reproductive health by 60/62 (96.7%) adolescents, and the app was rated 'best app' by 45/62 (72.6%) adolescents, 27/45 females and 18/45 males, with a p-value = 0.011. CONCLUSIONS Adolescents need on-demand, accurate and trusted SRH information. A mobile phone app is a feasible and acceptable way to deliver adolescent SRH information in resource-limited settings. The USSD mobile phone technology shows promise in the delivery of much needed adolescent SRH information on-demand..
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Affiliation(s)
- Paul Macharia
- Faculty of Computer Sciences, Multimedia and Telecommunication, Universitat Oberta de Catalunya, Barcelona, Spain. .,Consulting in Health Informatics, P.O Box 3966, Nairobi, 00100, Kenya. .,eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Antoni Pérez-Navarro
- Faculty of Computer Sciences, Multimedia and Telecommunication, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Irene Inwani
- Kenyatta National Hospital, Hospital Rd, Nairobi, Kenya
| | - Ruth Nduati
- University of Nairobi, University Way, Nairobi, Kenya
| | - Carme Carrion
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
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Nowshin N, Kapiriri L, Davison CM, Harms S, Kwagala B, Mutabazi MG, Niec A. Sexual and reproductive health and rights of "last mile" adolescents: a scoping review. Sex Reprod Health Matters 2022; 30:2077283. [PMID: 35666196 PMCID: PMC9176670 DOI: 10.1080/26410397.2022.2077283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.
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Affiliation(s)
- Nahela Nowshin
- PhD Student, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada. Correspondence:
| | - Lydia Kapiriri
- Associate Professor, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Colleen M Davison
- Associate Professor, Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sheila Harms
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Betty Kwagala
- Associate Professor, Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Anne Niec
- Professor, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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16
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Odimegwu CO, Ugwu NH. A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa. Reprod Health 2022; 19:119. [PMID: 35549967 PMCID: PMC9096753 DOI: 10.1186/s12978-022-01407-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite national and international commitments and efforts to prevent risky sexual behaviours, a high proportion of young people in South Africa are engaged in risky sexual behaviour. However, most efforts are currently directed toward addressing individual-level factors at the expense of not addressing neighbourhood-level determinants such as social disorganisation, contributing to risky sexual behaviour among young people in South Africa. This study investigated the multilevel factors of risky sexual behaviours among young people by gender in South Africa, using the lens of socio-ecological and social disorganisation frameworks. METHODS Data from a nationally representative sample of 1268 males and 2621 females aged 15-24 years, giving a total of, 3889 never-married youths, were drawn from the 2016 South Africa Demographic and Health Survey. Analysis was conducted using multilevel mixed-effect logistic regressions with random community-level effects. RESULTS Findings show that youth who were from a heterogeneous ethnic group (AOR = 0.49, CI: 0.35-0.67), household size of 5 + members (AOR = 0.78, CI: 0.54-1.15), community education (AOR = 0.97, CI: 0.72-1.32) were associated with low engagement in multiple sexual partnerships. Youths who were employed (AOR = 0.84, CI: 0.59-1.18), and from high-level community poverty (AOR = 0.76, CI: 0.58-1.00) were also associated with reduced odds of unprotected sex. In addition, older youth aged 20-24 years (AOR = 12.6, CI: 9.93-16.00); secondary education attainment (AOR = 1.01, CI 0.58-1.77); family structure (AOR = 1.37, CI: 0.75-1.15); Gauteng province (AOR = 1.45 CI: 0.92-2.28); residential mobility (AOR = 1.25, CI: 1.02-1.53), community media exposure to contraceptives (unprotected sex) (AOR = 1.38, CI: 1.09-1.76) were more likely to engage in risky sexual behaviour. CONCLUSION The study revealed that neighbourhood and individual-level factors were important in explaining the factors associated with risky sexual behaviour among young people in South Africa. In addition, engagement in risky sexual behaviour was high, with minimal variation among young females and males in South Africa. It specifies that the practice of risky sexual behaviour is significantly associated with multilevel factors of social disorganisation that cut across gender. These results imply that there is a need to review policies of sexual risks reduction for each gender, which might help mitigate the adverse effects of social disorganisation for women and men youths in South Africa.
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Affiliation(s)
- Clifford Obby Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nebechukwu Henry Ugwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Institute for Development Studies, University of Nigeria, Enugu Campus, Nigeria.
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Seidu AA, Ameyaw EK, Ahinkorah BO, Baatiema L, Dery S, Ankomah A, Ganle JK. Sexual and reproductive health education and its association with ever use of contraception: a cross-sectional study among women in urban slums, Accra. Reprod Health 2022; 19:7. [PMID: 35033115 PMCID: PMC8760577 DOI: 10.1186/s12978-021-01322-5] [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] [Received: 06/03/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had sexual and reproductive health education would likely utilize contraception. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. Methods A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691, made up of respondents who provided responses to the question on ever used contraception, sex education as well as those with complete information on all the other variables of interest was considered in this study. Binary logistic regression models were fitted to examine association between sexual and reproductive health education and ever use of contraception. Crude odds ratios (cOR) and adjusted odds ratios (aOR) at p-value less than 0.05 were used to assess the strength of the association between the outcome and independent variables. Results More than half (56.73%) of the women have never received sexual and reproductive health education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sexual and reproductive health education had lower odds of ever using contraception (OR = 0.641, 95% CI 0.443, 0.928) and this persisted after controlling for the effect of demographic factors (AOR = 0.652, 95% CI 0.436, 0.975] compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. Conclusion The study revealed a relatively low prevalence of sex education among women in urban slums in Accra. However, sex education was found to increase the odds of ever use of contraception. These findings call for intensified sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms. Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had some form of sex education would likely utilize contraception more than those who have not. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691 girls/women aged 15–49 was considered. More than half (56.73%) of the women had never received some form of sex education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sex education had lower odds of ever using contraception and this persisted after controlling for the effect of demographic factors compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. In sum, the study revealed that while prevalence of sex education was relatively low among urban slum women, sex education generally increased the chances of ever use of contraception. These findings call for more and targeted sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms.
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Affiliation(s)
- Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | - John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, P. O. Box LG 13, Accra, Ghana.
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18
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Akoth C, Oguta JO, Kyololo OM, Nyamu M, Ndirangu MN, Gatimu SM. Factors Associated With the Utilisation and Unmet Need for Modern Contraceptives Among Urban Women in Kenya: A Cross-Sectional Study. Front Glob Womens Health 2022; 2:669760. [PMID: 34977861 PMCID: PMC8716368 DOI: 10.3389/fgwh.2021.669760] [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: 02/19/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya. Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions. Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend. Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.
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Affiliation(s)
- Catherine Akoth
- Institute of Tropical and Infectious Diseases, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - James Odhiambo Oguta
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.,Health Section, UNICEF, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Martin Nyamu
- Institute of Tropical and Infectious Diseases, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Samwel Maina Gatimu
- School of Economics, University of Nairobi, Nairobi, Kenya.,Diabetic Foot Foundation of Kenya, Nairobi, Kenya
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19
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Hellwig F, Coll CVN, Blumenberg C, Ewerling F, Kabiru CW, Barros AJD. Assessing Wealth-Related Inequalities in Demand for Family Planning Satisfied in 43 African Countries. Front Glob Womens Health 2021; 2:674227. [PMID: 34816227 PMCID: PMC8594043 DOI: 10.3389/fgwh.2021.674227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Around 80% of the African population lives in urban areas, and a rapid urbanization is observed in almost all countries. Urban poverty has been linked to several sexual and reproductive health risks, including high levels of unintended pregnancies. We aim to investigate wealth inequalities in demand for family planning satisfied with modern methods (mDFPS) among women living in urban areas from African countries. Methods: We used data from 43 national health surveys carried out since 2010 to assess wealth inequalities in mDFPS. mDFPS and the share of modern contraceptive use were stratified by groups of household wealth. We also assessed the ecological relationship between the proportion of urban population living in informal settlements and both mDFPS and inequalities in coverage. Results: mDFPS among urban women ranged from 27% (95% CI: 23–31%) in Chad to 87% (95% CI: 84–89%) in Eswatini. We found significant inequalities in mDFPS with lower coverage among the poorest women in most countries. In North Africa, inequalities in mDFPS were identified only in Sudan, where coverage ranged between 7% (95% CI: 3–15%) among the poorest and 52% (95% CI: 49–56%) among the wealthiest. The largest gap in the Eastern and Southern African was found in Angola; 6% (95% CI: 3–11%) among the poorest and 46% (95% CI: 41–51%) among the wealthiest. In West and Central Africa, large gaps were found for almost all countries, especially in Central African Republic, where mDFPS was 11% (95% CI: 7–18%) among the poorest and 47% (95% CI: 41–53%) among the wealthiest. Inequalities by type of method were also observed for urban poor, with an overall pattern of lower use of long-acting and permanent methods. Our ecological analyses showed that the higher the proportion of the population living in informal settlements, the lower the mDFPS and the higher the inequalities. Conclusion: Our results rise the need for more focus on the urban-poorer women by public policies and programs. Future interventions developed by national governments and international organizations should consider the interconnection between urbanization, poverty, and reproductive health.
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Affiliation(s)
- Franciele Hellwig
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Fernanda Ewerling
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Caroline W Kabiru
- Population Dynamics and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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20
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Birabwa C, Chemonges D, Tetui M, Baroudi M, Namatovu F, Akuze J, Makumbi F, Ssekamatte T, Atuyambe L, Hernandez A, Sewe MO. Knowledge and Information Exposure About Family Planning Among Women of Reproductive Age in Informal Settlements of Kira Municipality, Wakiso District, Uganda. Front Glob Womens Health 2021; 2:650538. [PMID: 34816206 PMCID: PMC8594013 DOI: 10.3389/fgwh.2021.650538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: A high unmet need for family planning (FP) prevails in sub-Saharan Africa. Knowledge, awareness creation, and ensuring accessibility are frequently used to increase FP uptake. However, evidence on knowledge or information dissemination about FP among marginalized populations in urban settings in Africa is limited. This study explored the knowledge of FP methods, media exposure, and contact with FP providers among women from an informal settlement in Uganda. Methods: Using a cross-sectional study design, we interviewed 626 women aged 15–49 years living in informal settlements of Kira municipality, selected through multistage sampling. Using a standard questionnaire, data was collected on socioeconomic characteristics, knowledge of FP methods, and access to media FP messages among others. Binomial log-linear regression was used to assess disparities in exposure to media FP messages or provider information. Data were analyzed using STATA version 14, at a 5% level of statistical significance. Results: Nearly all women in the survey were aware of FP methods (99.7%). On average, each woman was aware of 10 FP methods. The most commonly known methods were male condoms (98.2%), injectables (97.4%), and the oral contraceptive pill (95.2%). Use of any contraceptive was found among 42.7% of respondents. Exposure to media was found in 70.6% of the respondents, mostly through television (58.5%) and radio (58.3%). Discussing FP with a provider was significantly associated with media exposure (aPR 1.4, 95% CI: 1.24–1.56). Less than 50% of women who were not using FP had contact with an FP provider. Women in union (aPR 1.6, 95% CI: 1.01–2.68) and those with access to media messages (aPR 2.5, 95% CI: 1.37–4.54) were more likely to have contact with a provider to discuss FP. Conclusion: There is high general awareness about FP methods and media exposure, but method use was low. Further exploration of women's understanding of FP methods and the fit between existing education programs and FP knowledge needs in this urban setting should be conducted. The potential for mobile health solutions in this urban population should be explored. Future studies should focus on the knowledge and understanding of FP among unmarried and nulliparous women and those with no access to media information.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Dennis Chemonges
- Department of Programs, Population Services International Uganda, Kampala, Uganda.,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.,School of Pharmacy, Waterloo University, Waterloo, ON, Canada.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Fredinah Namatovu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Joseph Akuze
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, 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
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Alison Hernandez
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maquins Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
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21
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Karp C, Moreau C, Sheehy G, Anjur-Dietrich S, Mbushi F, Muluve E, Mwanga D, Nzioki M, Pinchoff J, Austrian K. Youth Relationships in the Era of COVID-19: A Mixed-Methods Study Among Adolescent Girls and Young Women in Kenya. J Adolesc Health 2021; 69:754-761. [PMID: 34465510 PMCID: PMC8460286 DOI: 10.1016/j.jadohealth.2021.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/21/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Measures to mitigate COVID-19's impact may inhibit development of healthy youth relationships, affecting partnership quality and sexual and reproductive health (SRH) outcomes. METHODS We conducted a mixed-methods study to understand how COVID-19 affected girls' and young women's relationships in Kenya. Bivariate and multivariate logistic regression examined factors associated with relationship quality dynamics and SRH outcomes among 756 partnered adolescents aged 15-24 years. Qualitative data from in-depth interviews were analyzed using inductive thematic analysis to explore youth perceptions of how intimate relationships changed during COVID-19. RESULTS Nearly three-quarters of youth described changes in relationship quality since COVID-19 began, with 24% reporting worsening. Reduced time with partners was the strongest predictor of changed relationship quality. Youth experiencing complete or partial COVID-19-related household income loss had heightened risk of deteriorating partnerships (relative risk ratio = 2.43 and 2.02; p < .05); those whose relationships worsened were more likely to experience recent intimate partner violence, relative to no relationship change (20.8% vs. 3.5%; p < .001). Qualitative analysis revealed how COVID-19 mitigation measures hindered intimate relationships, school closures accelerated marriage timelines, and economic hardships strained relationships, while increasing early pregnancy risk and girls' financial dependency on their partners. CONCLUSIONS COVID-19 disrupted adolescent girls' and young women's romantic relationships, depriving some of partner emotional support and exposing others to sexual violence, early pregnancy, and economically motivated transactional relationships. Increased social support systems, including access to psychosocial services, are needed in low-income communities in Kilifi, Kisumu, and Nairobi, in particular the informal settlement areas, to mitigate COVID-19's consequences on girls' SRH.
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Affiliation(s)
- Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland.
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland; Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, Inserm, Villejuif, France
| | - Grace Sheehy
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Selena Anjur-Dietrich
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
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22
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Gillespie B, Allen H, Pritchard M, Soma-Pillay P, Balen J, Anumba D. Agency under constraint: Adolescent accounts of pregnancy and motherhood in informal settlements in South Africa. Glob Public Health 2021; 17:2125-2138. [PMID: 34569422 DOI: 10.1080/17441692.2021.1981974] [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: 10/20/2022]
Abstract
AbstractProgress in adolescent sexual and reproductive health (SRH) remains unequal: adolescent pregnancies are more likely to occur in marginalised communities, or in very poor households. This study aimed to comprehend from adolescents' own perspectives, the circumstances of falling pregnant and coping with motherhood in informal settlements in South Africa, to better understand the SRH challenges adolescents in these settings may face. A qualitative study was carried out over a two-month period in 2019 to analyse the perceptions held by adolescents in informal settlements served by four community-level clinics in the adjacent township. We found that adolescents face overlapping barriers in seeking to avoid unintended pregnancy in informal settlements. Once they become mothers, their trajectory is limited by the resources and support available from their own parents, particularly their mothers, and to a lesser extent, their partners. We draw on the concept of agency to examine their accounts and to highlight the importance of addressing broader contextual constraints.
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Affiliation(s)
- Bronwen Gillespie
- Department of Oncology and Metabolism, Academic Unit of Reproductive and Developmental Medicine-Obstetrics and Gynaecology, The University of Sheffield, Sheffield, UK
| | - Haddijatou Allen
- School of Health and Related Research, Regent Court (ScHARR), The University of Sheffield, Sheffield, UK
| | - Matthew Pritchard
- School of Health and Related Research, Regent Court (ScHARR), The University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Julie Balen
- School of Health and Related Research, Regent Court (ScHARR), The University of Sheffield, Sheffield, UK
| | - Dilly Anumba
- Department of Oncology and Metabolism, Academic Unit of Reproductive and Developmental Medicine-Obstetrics and Gynaecology, The University of Sheffield, Sheffield, UK
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23
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Tossou Y. Prenatal consultation and survival of children under five in Togo. Int J Health Plann Manage 2021; 36:2336-2350. [PMID: 34455612 DOI: 10.1002/hpm.3302] [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: 11/20/2020] [Revised: 06/17/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Child survival is low in Togo, often linked to socio-economic and other exogenous factors such as lack of antenatal consultation and Bacille Calmette-Guérin (BCG) vaccination. These different variables impacting the chances of survival of children underneath five have not been completely examined. The objective of this study is to analyse the socio-economic variables that influence the survival risk of children beneath five in Togo. METHODS These different variables influencing the chances of survival of the data used is from the 2017 MICS6 Overview. It speaks to an arrangement of broadly agent tests of families, children matured 0-5 years, women matured 15-49 years and men matured 15-59 years. Information on pre-birth meetings and the inoculation status of children at (BCG) were collected from this overview. The Cox corresponding risks backslide illustrate is used to evaluate the connection between pre-birth visits and child survival. RESULTS The risk of survival in children beneath 5 years is high as the age of the mother increases. This risk is 0.48 for the age between 19 and 24 years (AHR = 2.485, 95% CI 1.49-4.13). A child born to a woman with no education is at high risk of child survival (AHR = 2.96, 95% CI 092-9.36). Furthermore, the results show that women with twins have a high risk of 0.44 of the death of these children (AHR = 1.44, 95% CI 1.25-1.67). In addition, (BCG) vaccination has been related with an expanded recurrence in children, where it was found that 70.37% of vaccinated children were born to women who had experienced pre-birth meetings. CONCLUSION Basic risk variables for child survival can offer assistance in defining policy suggestions for children's wellbeing. The results recommend they have to empower policies to improve women's proficiency, the presence of a wellbeing insurance framework is suggested to decrease the burden of care, implement a procedure for access to antenatal meetings.
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Affiliation(s)
- Yaovi Tossou
- Economic Sciences, University of Lomé, Lome, Togo
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24
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Chandra-Mouli V, Neal S, Moller AB. Adolescent sexual and reproductive health for all in sub-Saharan Africa: a spotlight on inequalities. Reprod Health 2021; 18:118. [PMID: 34134737 PMCID: PMC8208826 DOI: 10.1186/s12978-021-01145-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Venkatraman Chandra-Mouli
- Department of Sexual and Reproductive Health and Research/Human Reproduction Programme, World Health Organization, Geneva, Switzerland.
| | - Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research/Human Reproduction Programme, World Health Organization, Geneva, Switzerland
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25
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McGranahan M, Bruno-McClung E, Nakyeyune J, Nsibirwa DA, Baguma C, Ogwang C, Serunjogi F, Nakalembe J, Kayaga M, Sekalala S, Oyebode O. Realising sexual and reproductive health and rights of adolescent girls and young women living in slums in Uganda: a qualitative study. Reprod Health 2021; 18:125. [PMID: 34118954 PMCID: PMC8199558 DOI: 10.1186/s12978-021-01174-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/06/2021] [Indexed: 11/11/2022] Open
Abstract
Background Sexual and reproductive health and rights are critical entitlements best supported through human rights-based approaches empowering rights-holders to claim their rights and duty bearers to fulfil their obligations. Implementing these requires information on the current needs and challenges faced by those seeking to claim their sexual and reproductive health and rights. We aimed to identify the underlying factors influencing the realisation of sexual and reproductive health and rights for adolescent girls and young women living Ugandan slums by: (1) exploring the role of relevant service providers and stakeholders; and (2) uncovering knowledge and gaps in protecting adolescent girls’ and young women’s sexual and reproductive health and rights. Methods Qualitative data were collected through focus groups and interviews focused on current knowledge, behaviours and attitudes towards sexual and reproductive health and rights among adolescent girls and young women, service providers and stakeholders. Data were analysed thematically using NVivo software. Ten in-depth interviews were conducted with key informants; two focus groups were held with adolescent girls and young women living in two slums in Uganda (21 participants in total); and three focus groups were held with community leaders, service providers, teachers and parents (30 participants in total). Results Adolescent girls and young women lacked information regarding their sexual health, services available, and redress mechanisms for rights violations. Formal sources of information were frequently inaccessible. Family members were sometimes the source of rights violations, and informal methods of redressing rights were often sought. Stigma and fear were common features both in healthcare and in the pursuit of formal justice, with duty-bearers habitually breaking confidentiality. Education and training were the predominant suggestions offered for change.
Conclusions Adolescent girls and young women continue to face obstacles in achieving their full sexual and reproductive health and rights. Targeted interventions for the realisation of adolescent girls’ and young women’s sexual and reproductive health and rights can address underlying causes and positively shift attitudes to promote health. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01174-z. Every woman is entitled to good sexual and reproductive health. This involves being free from sexually transmitted infections, gender-based violence and maternal mortality, and able to access essential health services. In low and middle-income countries, adolescents comprise a fifth of the population, yet their sexual and reproductive health needs are often overlooked. Adolescent girls and young women are more likely to experience gender-based violence, sexually transmitted infections and poor access to sexual and reproductive health services. Those living in slums have even worse outcomes, but little evidence exists regarding the opportunities and barriers to improving sexual and reproductive health among adolescent girls and young women in a slum setting. In this study, we conducted focus groups and interviews with 21 adolescent girls and young women living in two Ugandan slums, 10 individuals with an essential role, for example, at state level, as well as 30 other stakeholders including healthcare workers, teachers, parents, district leaders and community support officers working with adolescent girls and young women. Results indicate that adolescent girls and young women lack information regarding their sexual health, what services are available and who and where to go if they experience violations such as sexual assault. In instances of sexual assault, fear and stigma prevented adolescent girls and young women from going to the police, and instead disputes were handled informally between families. Participants in our focus groups and interviews felt that education and training were needed, and that health services need to improve. Interventions are necessary to improve adolescent girls’ and young women’s sexual and reproductive health in this setting.
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Affiliation(s)
- Majel McGranahan
- University of Warwick Medical School, Medical School Building, Coventry, UK.
| | | | - Joselyn Nakyeyune
- Center for Health, Human Rights and Development (CEHURD), Kampala, Uganda
| | | | - Christopher Baguma
- Center for Health, Human Rights and Development (CEHURD), Kampala, Uganda
| | - Christopher Ogwang
- Center for Health, Human Rights and Development (CEHURD), Kampala, Uganda
| | - Francis Serunjogi
- Center for Health, Human Rights and Development (CEHURD), Kampala, Uganda
| | - Judith Nakalembe
- Center for Health, Human Rights and Development (CEHURD), Kampala, Uganda
| | - Marianna Kayaga
- Center for Health, Human Rights and Development (CEHURD), Kampala, Uganda
| | | | - Oyinlola Oyebode
- University of Warwick Medical School, Medical School Building, Coventry, UK
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26
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Libous JL, Montañez NA, Dow DE, Kapetanovic S, Buckley J, Kakhu TJ, Kamthunzi P, Maliwichi LA, Vhembo T, Chawana TD, Nematadzira T, Donenberg GR. IMPAACT 2016: Operationalizing HIV Intervention Adaptations to Inform the Science and Outcomes of Implementation. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:662912. [PMID: 36303985 PMCID: PMC9580741 DOI: 10.3389/frph.2021.662912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction: Uptake of evidence-based interventions for adolescents and young adults living with HIV (AYA-LWH) in sub-Saharan Africa (SSA) is complex, and cultural differences necessitate local adaptations to enhance effective implementation. Few models exist to guide intervention tailoring, yet operationalizing strategies is critical to inform science and implementation outcomes, namely acceptability, appropriateness, feasibility, fidelity, and sustainability. This paper describes operationalizing the ADAPT-ITT framework applied to a manualized trauma-informed cognitive behavioral therapy (TI-CBT) intervention addressing mental and sexual health for AYA-LWH in SSA in preparation for a randomized controlled trial (RCT). Methods: Phase 1 of the RCT focused on operationalizing ADAPT-ITT steps 3-7 to tailor the intervention for use in eight sites across Botswana, Malawi, South Africa, and Zimbabwe. Well-defined processes were developed to supplement the general guidelines for each step to provide clear, consistent direction on how to prepare and conduct each step, including documenting, assessing, and determining adaptations, while maintaining intervention fidelity. The processes provided efficient standardized step-by-step progression designed for future replication. All sites participated in Phase 1 using the created tools and strategies to translate and present the TI-CBT to community stakeholders for feedback informing local adaptations. Results: The research team developed and operationalized materials guiding adaptation. A translation review process verified local adaptability, maintained core concepts, and revealed differing interpretations of words, idioms, and culturally acceptable activities. Strategically designed tools comprised of feedback and translation verification forms resulted in meticulous management of adaptations. Robust collaborations between investigators, research managers, site personnel, and topical experts maximized multidisciplinary expertise, resulting in ~10-15 personnel per site facilitating, collecting, assessing, and integrating local feedback. Processes and tools operationalized in steps 3-7 effectively addressed implementation outcomes during community engagements (n = 108), focus groups (n = 5-8 AYA-LWH and caregivers per group), and strategic training of youth leaders. Discussion: This paper offers a novel generalizable approach using well-defined processes to guide intervention adaptation building on the ADAPT-ITT framework. The processes strengthen the science of implementation and provide much-needed specificity in adaptation steps to optimize and sustain real-world impact and help researchers and community stakeholders maximize existing infrastructure, culture, and resources to inform implementation strategies.
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Affiliation(s)
- Jennifer L. Libous
- International Maternal Pediatric Adolescent AIDS Clinical Trials Network, Science Facilitation, FHI 360, Washington, DC, United States
| | - Nicole A. Montañez
- International Maternal Pediatric Adolescent AIDS Clinical Trials Network, Science Facilitation, FHI 360, Washington, DC, United States
| | - Dorothy E. Dow
- Division of Pediatrics Infectious Diseases, Duke University Medical Center, Durham, NC, United States
| | - Suad Kapetanovic
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, United States
| | - Janice Buckley
- Soweto International Maternal Pediatric Adolescent AIDS Clinical Trials Network Clinical Research Site, Johannesburg, South Africa
| | - Tebogo Jacqueline Kakhu
- Gaborone Prevention/Treatment Trials Clinical Research Site, Botswana-Harvard School of Public Health-AIDS Initiative Partnership Clinical Trials Unit, Gaborone, Botswana
| | - Portia Kamthunzi
- Malawi Clinical Research Site, University of North Carolina Project, Lilongwe, Malawi
| | - Limbika A. Maliwichi
- College of Medicine-Johns Hopkins University Blantyre Clinical Research Site, Department of Psychology, University of Malawi-Chancellor College, Zomba, Malawi
| | - Tichaona Vhembo
- Harare Family Care Clinical Research Site, University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Tariro Dianah Chawana
- St. Mary's Clinical Research Site, University of Zimbabwe Clinical Trials Research Centre, Chitungwiza, Zimbabwe
| | - Teacler Nematadzira
- Seke North Clinical Research Site, University of Zimbabwe Clinical Trials Research Centre, Chitungwiza, Zimbabwe
| | - Geri R. Donenberg
- Healthy Youths Program, Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL, United States
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Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kacholia V, Kyambadde P, Kiera UM, Mbuagbaw L. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study. Trop Med Int Health 2021; 26:572-581. [PMID: 33560587 PMCID: PMC8248412 DOI: 10.1111/tmi.13560] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To explore experiences, preferences and engagement with HIV testing and prevention among urban refugee and displaced adolescents and youth in Kampala, Uganda, with a focus on the role of contextual factors in shaping access and uptake. Methods This qualitative community‐based study with urban refugee and displaced youth aged 16–24 living in Kampala’s informal settlements involved five focus groups (FG), including two with young women, two with young men, and one with sex workers from March to May 2019. We also conducted five in‐depth key informant interviews. We conducted thematic analysis informed by Campbell and Cornish’s conceptualisation of material and symbolic contexts. Results Refugee/displaced youth participants (n = 44; mean age: 20.25, SD: 2.19; men: n = 17; women: n = 27) were from the Democratic Republic of Congo (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1). Participant narratives reflected material and symbolic contexts that shaped HIV testing awareness, preferences and uptake. Material contextual factors that presented barriers to HIV testing and prevention engagement included transportation costs to clinics, overcrowded living conditions that limited access to private spaces, low literacy and language barriers. Symbolic contexts that constrained HIV testing engagement included medical mistrust of HIV testing and inequitable gender norms. Religion emerged as an opportunity to connect with refugee communities and to address conservative religious positions on HIV and sexual health. Conclusion Efforts to increase access and uptake along the HIV testing and prevention cascade can meaningfully engage urban refugee and displaced youth to develop culturally and contextually relevant services to optimise HIV and sexual health outcomes.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | | | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Simon Mwima
- National AIDS Control Program, Ministry of Health, Kampala, Uganda.,Bukedi Prevention Institute, Kampala, Uganda
| | - Vibhuti Kacholia
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda.,Most At Risk Population Initiative (MARPI), Mulago Hospital, Kampala, Uganda
| | - Uwase Mimy Kiera
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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