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Stoebenau K, Madhavan S, Kim S, Wainaina C. MEASURING UNION FORMALIZATION FOR A NEW GENERATION OF FAMILY DEMOGRAPHY: A CASE STUDY FROM URBAN KENYA. POPULATION AND DEVELOPMENT REVIEW 2024; 50:87-116. [PMID: 38737336 PMCID: PMC11086669 DOI: 10.1111/padr.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
AbstractDespite repeated calls for improved measures of marriage as a process in sub‐Saharan Africa, large‐scale surveys continue to rely on static marital status. As a result, there is an incomplete understanding of the effects of marriage on outcomes of interest. We use qualitative and survey data from a longitudinal study of 1,203 young mothers residing in informal settlements of Nairobi, Kenya, to (1) describe the development of an innovative measure of union formalization (UF) defined as the steps through which a union attains social legitimacy; (2) compare UF with a conventional current marital status measure; (3) examine the distribution of UF steps across union history; and (4) examine the sequence and timing of pregnancy and childbearing within the UF process. We find UF steps indicative of both increasing individualization of marriage and the ongoing importance of kin involvement hold meaning. We demonstrate extensive heterogeneity in the sequence and extent of UF steps completed and interrogate the classification of premarital childbearing using sequence analysis. We argue that measuring UF is feasible and necessary for the next generation of family demography in Africa; UF measures facilitate understanding the linkages among family dynamics, health, and social stratification within the context of ongoing socioeconomic change.
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Soehnchen C, Weirauch V, Schmook R, Henningsen M, Meister S. An acceptance analysis of a sexual health education digital tool in resource-poor regions of Kenya: an UTAUT based survey study. BMC Womens Health 2023; 23:676. [PMID: 38114976 PMCID: PMC10729446 DOI: 10.1186/s12905-023-02839-6] [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: 06/21/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Unplanned pregnancies and sexually transmitted diseases are a concern in Sub-Saharan Africa, particularly in low-income areas. Access to sexual health information is limited, partly due to the absence of comprehensive sex education in the national school curriculum and social taboos. In response to these challenges, this study introduces a web-based prototype, designed to provide essential sexual health information, targeting 18 to 35-year-old Kenyans, focusing on contraception, menstruation, and female genital mutilation. METHOD Aiming to investigate young adults' behavioral intention to use a digital tool for sexuality education, by analyzing factors affecting acceptance and usability in low-income and resource-poor regions in Kenya. To explore the acceptability and use of the developed digital tool, this study used a modified version of the Unified Theory of Acceptance and Use of Technology (UTAUT), complemented by the System Usability Scale (SUS) questionnaire. For statistical analysis, a Structural Equation Model (SEM) including Confirmatory Factor Analysis (CFA) and Linear Regression was used. Regarding the reporting of the E-survey results, the Checklist for Reporting Results of Internet E-surveys (CHERRIES), was considered. RESULTS Survey information from 77 persons (69 female, 7 male, 1 diverse) were collected. A modified UTAUT appears as an appropriate model for measuring the constructs and integrating evidence-based approaches to advanced and safe sexual healthcare information. Results from the SEM showed perceived usefulness, attitude towards healthcare integrated evidence technology, and usability as well as having a significant positive impact on the acceptance, the intention to use as well as wellbeing. Having the resources and knowledge necessary for the usage of a digital tool turns out to have a significant negative impact. A SUS score of 67.3 indicates the usability of the tool for sexual health information, assessed as okay. CONCLUSIONS The study adopts validated methods to assess the acceptability and usability of a digital sexual health education tool in Kenya. Emphasizing its potential effectiveness and highlighting the influence of cultural and contextual factors on technology adoption.
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Affiliation(s)
- Clarissa Soehnchen
- Faculty of Health Informatics / School of Medicine, Witten/Herdecke University, Witten/Herdecke, Deutschland.
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany.
| | - Vera Weirauch
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany
| | - Rebecca Schmook
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany
| | - Maike Henningsen
- Faculty of Health Informatics / School of Medicine, Witten/Herdecke University, Witten/Herdecke, Deutschland
| | - Sven Meister
- Faculty of Health Informatics / School of Medicine, Witten/Herdecke University, Witten/Herdecke, Deutschland
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany
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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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Ringwald B, Tolhurst R, Taegtmeyer M, Digolo L, Gichuna G, Gaitho MM, Phillips–Howard PA, Otiso L, Giorgi E. Intra-Urban Variation of Intimate Partner Violence Against Women and Men in Kenya: Evidence from the 2014 Kenya Demographic and Health Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:5111-5138. [PMID: 36062755 PMCID: PMC9900693 DOI: 10.1177/08862605221120893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although urban areas are diverse and urban inequities are well documented, surveys commonly differentiate intimate partner violence (IPV) rates only by urban versus rural residence. This study compared rates of current IPV victimization among women and men by urban residence (informal and formal settlements). Data from the 2014 Kenya Demographic and Health Survey, consisting of an ever-married sample of 1,613 women (age 15-49 years) and 1,321 men (age 15-54 years), were analyzed. Multilevel logistic regression was applied to female and male data separately to quantify the associations between residence and any current IPV while controlling for regional variation and other factors. Results show gendered patterns of intra-urban variation in IPV occurrence, with the greatest burden of IPV identified among women in informal settlements (across all types of violence). Unadjusted analyses suggest residing in informal settlements is associated with any current IPV against women, but not men, compared with their counterparts in formal urban settlements. This correlation is not statistically significant when adjusting for women's education level in multivariate analysis. In addition, reporting father beat mother, use of current physical violence against partner, partner's alcohol use, and marital status are associated with any current IPV against women and men. IPV gets marginal attention in urban violence and urban health research, and our results highlight the importance of spatially disaggregate IPV data-beyond the rural-urban divide-to inform policy and programming. Future research may utilize intersectional and syndemic approaches to investigate the complexity of IPV and clustering with other forms of violence and other health issues in different urban settings, especially among marginalized residents in informal urban settings.
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Affiliation(s)
| | | | | | - Lina Digolo
- The Prevention Collaborative, Nairobi,
Kenya
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Phiri M, Kasonde ME, Moyo N, Sikaluzwe M, Simona S. A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001-2018). Reprod Health 2023; 20:16. [PMID: 36653839 PMCID: PMC9848028 DOI: 10.1186/s12978-023-01567-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Teenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy as well as its individual and contextual determining factors. METHODS A total pooled weighted sample of 10,010 teenagers (in the age group 15-19) from four waves of the Zambia Demographic and Health Surveys were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Bayesian parameter estimates were produced using lme4 package in R statistical programming environment. RESULTS Results of the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four survey. In multilevel analysis, the odds of being pregnant were higher for teenagers who were employed (aOR = 1.21, 95% CI: 1.02-1.42), married (aOR = 7.71, 95% CI: 6.31-9.52) and those with knowledge of ovulation period (aOR = 1.58, 95% CI: 1.34-1.90). On the other hand, belonging to households in high wealth quintiles, being literate, exposure to mass-media family planning messages and delayed sexual debut were associated with decreased odds of teenage pregnancy. CONCLUSION The study shows that teenage pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy include marital status, and employment, knowledge of ovulation period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.
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Affiliation(s)
- Million Phiri
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia ,grid.11951.3d0000 0004 1937 1135Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mwewa E. Kasonde
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Nkuye Moyo
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Milika Sikaluzwe
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Simona Simona
- grid.12984.360000 0000 8914 5257Department of Social Work and Sociology, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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Ayalew HG, Liyew AM, Tessema ZT, Worku MG, Tesema GA, Alamneh TS, Teshale AB, Yeshaw Y, Alem AZ. Prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa, a multilevel analysis. BMC Womens Health 2022; 22:464. [PMID: 36404306 PMCID: PMC9677641 DOI: 10.1186/s12905-022-02048-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unintended pregnancy predisposes women to unsafe abortion, malnutrition, mental illness, and even death. Though adolescent girls and young women are at higher risk of unintended pregnancy, there is a paucity of evidence in its burden and associated factors in sub-Saharan Africa. Therefore, this study aimed to assess the prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa. METHOD This study was a secondary data analysis of 36 sub-Saharan African countries with a total weighted sample of 17,797 adolescent girls and young women. A multilevel logistic regression model was fitted and, the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was reported to assess the association between the independent variables and unintended pregnancy in Sub-Saharan Africa. RESULT The pooled prevalence of unintended pregnancy in sub-Saharan Africa was 30.01 with 95% CI (29.38-30.74). In multivariable multilevel logistic regression analysis, adolescent girls, and young women with higher education (AOR = 0.71 95%CI 0.52-0.97), those who know modern contraceptive methods (AOR = 0.86 95%CI 0.75-0.98), and traditional contraceptive methods (AOR = 0.90, 95%CI 0.59-0.95), married (AOR = 0.80, 95%CI 0.73-0.88), those from female-headed households (AOR = 0.86,95%CI 0.78-0.94), had lower odds of unintended pregnancy. Whereas adolescent girls and young women from Central Africa (AOR = 2.09,95%CI 1.23-3.55), southern Africa (AOR = 5.23, 95%CI 2.71-10.09), and Eastern Africa (AOR = 1.07,95%CI 1.07-2.66) had higher odds of unintended pregnancy. CONCLUSION Prevalence of unintended pregnancy in Sub-Saharan Africa is high. Therefore, educating adolescent girls and young women, and improving their knowledge about family planning services is vital. It is also better for the government of countries in sub-Saharan Africa and other global and local stakeholders to work hard to ensure universal access to sexual and reproductive healthcare services, including family planning, education, and the integration of reproductive health into national strategies and programs to reduce unintended pregnancy.
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Affiliation(s)
- Hiwotie Getaneh Ayalew
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
- Department of Human Physiology, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Darfour-Oduro SA, Grigsby-Toussaint DS. Impact of social environment on sexual behaviors of adolescent girls in 12 sub-Saharan African countries: a cross-sectional study. Reprod Health 2022; 19:139. [PMID: 35710414 PMCID: PMC9205096 DOI: 10.1186/s12978-022-01448-0] [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: 03/03/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Early sexual debut among adolescent girls may result in teenage pregnancy and sexually transmitted diseases. In sub-Saharan Africa (SSA), pregnancy among adolescent girls may adversely impact the continuation of their education, general health status, and birth outcomes. However, few cross-national studies have examined the role that the social environment plays in adolescent girls' sexual behaviors in SSA. In this study, we explored adolescent girls' social environment and the impact on their sexual behaviors.. METHODS The country selection was based on availability of Global School-Based Student Health Survey (GSHS) national data (2003-2015). The total analytic sample was 22,067 adolescent girls from 12 countries in SSA. Descriptive statistics were generated to determine the characteristics of adolescent girls and independent samples t-test analysis were performed to determine whether there were differences between the social environment and age of sexual debut and sexual partners. Logistic regression models were used to determine the association between adolescent girls' social environment and sexual debut. RESULTS The study results showed variations across the 12 countries. Almost one in five (19.9%) adolescent girls reported to have ever engaged in sexual intercourse. Their mean age of sexual debut was 13.21 (13.04-13.37) years and mean number of sexual partners was 2.19 (2.08-2.29). We found that adolescent girls who reported not being connected with their parents were more likely to debut sex (aOR = 1.32, 95% CI, 1.14-1.53, p < 0.000). Parental monitoring was significantly associated with sexual debut but after controlling for the confounding variables (age, class grade and drug use), the association was no longer significantly positively associated. Adolescent girls who felt supported by their peers had a significantly higher number of sexual partners than those who did not feel supported by their peers. CONCLUSION The social environment of adolescent girls plays a very important role in sexual debut, age of sexual debut, and the number of sexual partners. Sexual health policies targeting adolescent girls are likely to achieve positive impacts if they focus on improving parental connectedness and peer support.
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Affiliation(s)
- Sandra A. Darfour-Oduro
- grid.8652.90000 0004 1937 1485Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Diana S. Grigsby-Toussaint
- grid.40263.330000 0004 1936 9094Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
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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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Truong HHM, Guzé MA, Ouma D, Bushman D, Mocello AR, Kadede K, Bukusi EA, Odhiambo F, Cohen CR. Community-Based HIV Testing for Urban Youth in Western Kenya. AIDS Behav 2022; 26:814-821. [PMID: 34518938 PMCID: PMC10643049 DOI: 10.1007/s10461-021-03441-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
Youth aged 15-24 years comprise 48% of new HIV infections and 15% of persons living with HIV in Kisumu County, Kenya. We assessed factors associated with HIV infection among youth participating in the Community Health Initiative (CHI) implemented in an urban informal settlement in 2018. Predictors of HIV infection were assessed by multivariable logistic regression. CHI engaged 4,441 youth through community health campaigns and home-based HIV testing. HIV prevalence was 3.5% overall and 7.1% among young women aged 20-24. There were 24 youth newly identified as HIV-positive out of 157 total HIV-positive youth. HIV-positive status was positively associated with being female (aOR = 2.46; 95% CI 1.57, 3.84) and aged 20-24 (aOR = 2.40; 95% CI 1.52, 3.79), and inversely associated with secondary school education or higher (aOR = 0.27; 95% CI 0.16, 0.44). Our findings highlight the need for HIV prevention programs specially tailored for youth to further reduce new HIV infections in this priority population.
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Affiliation(s)
- Hong-Ha M Truong
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA.
| | - Mary A Guzé
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
| | - David Ouma
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Dena Bushman
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
| | - A Rain Mocello
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
| | | | - Elizabeth A Bukusi
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Craig R Cohen
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
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Tetui M, Ssekamatte T, Akilimali P, Sirike J, Fonseca-Rodríguez O, Atuyambe L, Makumbi FE. Geospatial Distribution of Family Planning Services in Kira Municipality, Wakiso District, Uganda. Front Glob Womens Health 2021; 1:599774. [PMID: 34816171 PMCID: PMC8593998 DOI: 10.3389/fgwh.2020.599774] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Access to family planning (FP) services remains a challenge, particularly in informal urban settlements. The unmet need for FP in these settings is high, with a correspondingly high prevalence of unintended pregnancies that may lead to unsafe abortions. However, there is a paucity of quality data on the distribution of FP services in such settings in Uganda. This paper described the geospatial distribution of FP services in Kira Municipality, Wakiso District, Uganda. Methods: This was a cross-sectional study in which we determined the availability and distribution of FP services in Kira Municipality. Community mapping and analysis were conducted using ArcGIS (version 10.1) and ArcGIS Online. Stata version 13.1 was used for data analysis. Chi-square test was used to compare the contraceptive provision and availability among facilities from informal and formal settlements. Results: Of the 176 healthcare facilities surveyed, only 42% (n = 74) offered contraceptives in informal settlements. The majority of the facilities were privately owned small clinics (95%). At least 80% of the facilities provided three or more modern contraceptive methods, with no difference (p = 0.107) between facilities in informal and formal settlements. Only 30.7% (p = 0.001) of the facilities provided at least one long-acting contraceptive. Similarly, 20 and 12% (p = 0.001) of the facilities had implants and intrauterine devices (IUDs) on the day of the survey. Almost 25% of the facilities did not offer contraceptive services (counseling and commodities) to unmarried adolescents. Conclusions: Most facilities were small privately-owned clinics, offering at least three modern contraceptive methods. The unavailability of long-acting reversible methods in the informal settings may affect the quality of FP services due to limited choice. The inequity in service provision that disfavors the unmarried adolescent may increase unwanted/unintended pregnancies. We recommend that local governments and partners work toward filling the existing commodities gap and addressing the discrimination against unmarried adolescents in such settings.
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Affiliation(s)
- Moses Tetui
- School of Pharmacy, Waterloo University, Waterloo, ON, Canada.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Pierre Akilimali
- Department of Nutrition Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Judith Sirike
- Division of Social Development, Intergovernmental Authority on Development, Kampala, Uganda
| | - Osvaldo Fonseca-Rodríguez
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
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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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Wainaina CW, Sidze EM, Maina BW, Badillo-Amberg I, Anyango HO, Kathoka F, Khasowa D, Okoror CEM. Psychosocial challenges and individual strategies for coping with mental stress among pregnant and postpartum adolescents in Nairobi informal settlements: a qualitative investigation. BMC Pregnancy Childbirth 2021; 21:661. [PMID: 34583684 PMCID: PMC8480022 DOI: 10.1186/s12884-021-04128-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was part of a project funded under the Grand Challenges Explorations initiative to engage adolescent girls living in the main slums of Nairobi. This involved an innovative co-creation initiative through jointly designing and testing the feasibility of a toolkit of information, skill, and confidence-building, and coping mechanisms that can effectively shield them and their peers against the risks of mental stress during pregnancy and early motherhood. METHODS Qualitative interviews and discussions from visual methodologies including Photovoice, digital storytelling, and public service announcements were conducted with 30 pregnant and adolescent mothers aged 14-19 years in four informal settlements either pregnant or having a child less than 2 years. The aims included; to generate an inventory of mental stressors during pregnancy and early motherhood; understand how mental stress affects the ability to seek care for themselves and their child, and understand individual coping strategies. RESULTS The psychosocial challenges identified in order of importance included: chased from home by the parents; economic hardship; neglect and abandonment by the person responsible for the pregnancy; stigmatization by family, friends, and the community; feelings of shattered dreams; and daily stress related to living in poor and unhygienic conditions. During the pregnancy and early motherhood, the participants experienced feelings of embarrassment, shame, hopelessness, and to the extreme, suicidal thoughts clouded their minds. Main coping strategies included social isolation for some, socializing with other pregnant and adolescent mothers, and negative behaviors like the uptake of illicit drugs and alcohol and risky sexual relationships. CONCLUSION The unpreparedness for early motherhood infused with inadequate psychosocial support led to increased mental stress and risk of depression. The interconnection between the triggers to mental stress showed the need to focus on a multifaceted approach to address the wellbeing of pregnant and adolescent mothers.
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Affiliation(s)
| | | | - Beatrice W Maina
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | | | | | - Dorcas Khasowa
- Mental health consultant, University of Nairobi, Nairobi, Kenya
| | - Collins E M Okoror
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Nigeria
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13
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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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14
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Bain LE, Ahinkorah BO, Seidu AA, Budu E, Okyere J, Kongnyuy E. Beyond counting intended pregnancies among young women to understanding their associated factors in sub-Saharan Africa. Int Health 2021; 14:501-509. [PMID: 34520526 PMCID: PMC9450639 DOI: 10.1093/inthealth/ihab056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/01/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background In this article we report the prevalence and determinants of intended or wanted pregnancies among young women 15–24 y of age in selected sub-Saharan African countries. Methods This cross-sectional study used pooled data from current Demographic and Health Surveys conducted between 1 January 2010 and 31 December 2019 in 29 countries in sub-Saharan Africa (SSA). The sample size comprised 14 257 young women (15–24 y of age). Multivariable binary logistic regression models were used to present the results as adjusted odds ratios. Results The prevalence of intended pregnancies was 67.7%, with the highest and lowest prevalence in Gambia (89.9%) and Namibia (37.7%), respectively. Intended pregnancy was lower among young women who had knowledge of modern contraceptives, those with a secondary/higher education and those with four or more births. Lower odds of intended pregnancy were observed among young women in the richer wealth quintile and those who lived in southern Africa. Conclusions To reduce intended pregnancies in sub-Saharan African countries such as Gambia, Burkina Faso and Nigeria, there is a need for government and non-governmental organisations to recalibrate current and past interventions such as investment in increasing formal education for women and poverty alleviation programmes, as well as augmenting job creation, including skill-building. These interventions have to be sensitive to the cultural realities of each setting, especially with regards to early marriages and womanhood.
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Affiliation(s)
- Luchuo Engelbert Bain
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln. Brayford Pool, Lincoln, Lincolnshire. LN6 7TS, UK.,Global South Health Research and Services, GSHS, Amsterdam, The Netherlands
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia.,Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
| | - Eugene Budu
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Tetui M, Baroudi M, Ssekamatte T, Birabwa C, Kibira SP, Atuyambe L, Delamou A, Makumbi FE. Total Demand, Use and Unmet Need for Modern Contraceptives Among Women Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda. Implications for Urban Health. Front Glob Womens Health 2021; 2:655413. [PMID: 34816210 PMCID: PMC8593938 DOI: 10.3389/fgwh.2021.655413] [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: 01/18/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality. Methods: A cross-sectional study conducted among 626 women in the reproductive age (15-49 years) in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0. Results: The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women's education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48-0.97) and high decision-making power (PR 0.64, 95% CI: 0.50-0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01-1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24-2.34). Conclusions: Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.
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Affiliation(s)
- Moses Tetui
- School of Pharmacy, Waterloo University, Waterloo, ON, Canada
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Simon Peter Kibira
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Alexandre Delamou
- Africa Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Science and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- National Training and Research Center in Rural Health of Maferinyah, Forecariah, Guinea
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
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Ajayi AI, Odunga SA, Oduor C, Ouedraogo R, Ushie BA, Wado YD. "I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls. Reprod Health 2021; 18:19. [PMID: 33482843 PMCID: PMC7821647 DOI: 10.1186/s12978-021-01078-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background While the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15–19 in two Kenya counties with the highest rate of teenage pregnancy. Methods We used the “In Their Hands” (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls’ reasons for having unintended pregnancy. Results Overall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22–2.20), had primary or no formal education (AOR 1.50 95% CI 1.11–2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25–2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies. Conclusion A massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya.
| | - Sally Atieno Odunga
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Clement Oduor
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Ramatou Ouedraogo
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Yohannes Dibaba Wado
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
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17
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Ranatunga IDJC, Jayaratne K. Proportion of unplanned pregnancies, their determinants and health outcomes of women delivering at a teaching hospital in Sri Lanka. BMC Pregnancy Childbirth 2020; 20:667. [PMID: 33153469 PMCID: PMC7643445 DOI: 10.1186/s12884-020-03259-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unplanned pregnancy is a significant public health issue in both low- and high-income countries. The burden of unplanned pregnancy is reflected in women opting for pregnancy terminations and it can be detrimental to the women and her family as well as the health system and society. Solid data on the proportion of unplanned pregnancies are using more specific tools such as the London Measure of Unplanned Pregnancy (LMUP) needed to address the issue in Sri Lankan contexts. The objective was to describe the proportion of unplanned pregnancies, their determinants and the health outcomes of women delivering at Colombo North Teaching Hospital-Ragama (CNTH). METHODS A cross-sectional study was carried out among 494 consecutive pregnant women selected by non-probability consecutive sampling who were admitted for the confinement at CNTH. A pre-tested structured interviewer-administered questionnaire was used to collect data on antenatal women and intentionality measured by self-administered six-item LMUP. Maternal and newborn health outcomes were ascertained in each post-partum women before discharge. Data were analyzed with the Mann-Whitney U tests, Kruskal-Wallis tests and spearman rank correlation. We also evaluated the psychometric properties of the Sinhalese version of LMUP. RESULTS The response rate was 97.8 and 17.2% of pregnancies ending at birth were unplanned, 12.7% were ambivalent and 70.1% were planned. Associated factor profile of women with unplanned pregnancies includes; not married women (p = 0.001), educated up to the passing of GCE ordinary level by women (p < 0.001) and spouse (p < 0.001), primiparity (p = 0.002) and inadequate knowledge on emergency contraceptives (p = 0.037). Less planned pregnancies were also significantly associated with anemia (p = 0.004), low mood for last 2 weeks (p < 0.001), having a partner with problematic alcohol consumption (p < 0.001), presence of Gender-Based Violence (GBV) (p < 0.001), poor relationship satisfaction with partner (p < 0.001) and family (p < 0.001). Inadequate pre-pregnancy preparation and antenatal care were associated with an unplanned pregnancy. No differences were found in neonatal outcomes. Sinhalese version of the LMUP scale was found to be accepted, valid and reliable with the Cronbach's alpha of 0.936. CONCLUSIONS A sizeable proportion of pregnancies were unplanned. Teenage pregnancies, non-marital relationships and inadequate knowledge on emergency contraceptives, maternal anemia, low mood, and GBV were modifiable associated factors which could be prevented by evidence-based locally applicable approaches.
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Affiliation(s)
| | - Kapila Jayaratne
- Family Health Bureau, Ministry of Health, 231 De Saram Place, Colombo 10, Sri Lanka
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18
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Onyango EO, Elliott SJ. Bleeding Bodies, Untrustworthy Bodies: A Social Constructionist Approach to Health and Wellbeing of Young People in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7555. [PMID: 33080818 PMCID: PMC7589892 DOI: 10.3390/ijerph17207555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022]
Abstract
The Sustainable Development Goals provide a global development agenda that is meant to be inclusive of all people. However, the development needs for vulnerable populations such as youth are not reflected within the policy agenda of some developing countries. One of the reasons for this is that research that explores health and wellbeing concerns for young people are sparse in the region and where they exist, the focus has been on marginalized subgroups. To address this gap, this cross-sectional study explored the health and wellbeing of youth in Kenya. We conducted 10 focus group discussions and 14 in-depth interviews with youth ages 15 to 24 years. A thematic analysis of the data revealed that structural factors are important influencers of youth perceptions and their social constructions of health and wellbeing. Kenyan youth are concerned about the health status and healthcare services in their communities, as well as issues of community trust of youths and perceived risks of political misuse and emotional suffering. Our findings suggest that youth transitioning into adulthood in resource-constrained areas experience feelings of powerlessness and inability to take charge over their own life. This impacts how they perceive and socially construct health and wellbeing.
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Affiliation(s)
- Elizabeth Opiyo Onyango
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON N2N 1N2, Canada;
- School of Nursing and Midwifery, Masinde Muliro University of Science and Technology, Kakamega 50100, Kenya
| | - Susan J. Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON N2N 1N2, Canada;
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19
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Wado YD, Bangha M, Kabiru CW, Feyissa GT. Nature of, and responses to key sexual and reproductive health challenges for adolescents in urban slums in sub-Saharan Africa: a scoping review. Reprod Health 2020; 17:149. [PMID: 32998741 PMCID: PMC7526107 DOI: 10.1186/s12978-020-00998-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing adolescents' sexual and reproductive health and rights (SRHR) requires an understanding of the socio-cultural and spatial settings within which they live. One setting of particular importance is the informal settlements or 'slums' that are gradually dominating the urban space. We undertook a scoping review and synthesis of existing evidence on adolescent SRHR in slums in sub-Saharan Africa (SSA) focusing on the characteristics and nature of existing evidence. METHODS The scoping review was conducted based on Arksey and O'Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and using PRISMA reporting guidelines for scoping reviews. A comprehensive search was undertaken in PubMed, POPLINE, African Journals Online (AJOL), Bioline International and Google Scholar. The search was confined to studies published in peer reviewed journals and reports published online between January 2000 and May 2019. Studies were included in the review if they addressed SRHR issues among adolescents living in urban slums in SSA. RESULTS The review included a total of 54 studies. The majority (79.5%) of studies were quantitative. The bulk of studies (85.2%) were observational studies with only eight intervention studies. While half (27) of the studies focused exclusively on adolescents (10-19 years), 12 studies combined adolescents with other young people (10-24 years). The studies were skewed towards sexual behavior (44%) and HIV/AIDS (43%) with very few studies focusing on other SRHR issues such as contraception, abortion, gender-based violence and sexually transmitted infections (STIs) other than HIV. Most of the studies highlighted the significantly higher risks for poor SRHR outcomes among adolescents in slums as compared to their peers in other settlements. CONCLUSION Young people growing up in slums face tremendous challenges in relation to their SRHR needs resulting in poor outcomes such as early and unintended pregnancy, STIs, and sexual violence. The results of this review point to several potential target areas for programming, policy, and research aimed at improved adolescent SRHR in slums in SSA.
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Affiliation(s)
- Yohannes Dibaba Wado
- African Population and Health Research Center, APHRC Campus, Manga Close, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Martin Bangha
- African Population and Health Research Center, APHRC Campus, Manga Close, P.O. Box 10787-00100, Nairobi, Kenya
| | - Caroline W Kabiru
- African Population and Health Research Center, APHRC Campus, Manga Close, P.O. Box 10787-00100, Nairobi, Kenya
| | - Garumma T Feyissa
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
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20
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Rossier C, Schoumaker B, Delaunay V, Beguy D, Jain A, Bangha M, Aregay A, Beck B, Derra K, Millogo M, Dube AN, Siaka K, Wamukoya M, Zabre P. Adolescent Fertility Is Lower than Expected in Rural Areas: Results from 10 African HDSS. Stud Fam Plann 2020; 51:177-192. [PMID: 32529644 DOI: 10.1111/sifp.12116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The adolescent birth rate (ABR) is an important indicator of maternal health, adolescent sexual health, and gender equity; it remains high in sub-Saharan Africa. While Demographic and Health Surveys (DHS) are the main source of ABR estimates, Health and Demographic Surveillance Systems (HDSS) also produce ABRs. Studies are lacking, however, to assess the ease of access and accuracy of HDSS ABR measures. In this paper, we use birth and exposure data from 10 HDSS in six African countries to compute local ABRs and compare these rates to DHS regional rates where the HDSS sites are located, standardizing by education and place of residence. In rural HDSS sites, the ABR measure is on average 44 percent lower than the DHS measure, after controlling for education and place of residence. Strong temporary migration of childless young women out of rural areas and different capacities in capturing temporarily absent women in the DHS and HDSS could explain this discrepancy. Further comparisons based on more strictly similar populations and measures seem warranted.
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Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya. Reprod Health 2020; 17:79. [PMID: 32487239 PMCID: PMC7268390 DOI: 10.1186/s12978-020-00938-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Parents are an important source of sexual and reproductive health (SRH) information for very young adolescents and are likely to have a significant influence on adolescents’ sexual attitudes, values, and risk-related beliefs. This study explored the nature and content of parent-child communication about SRH issues. Methods Thirty-two parents and 30 adolescent boys and girls aged between 11 and 13 years participated in narrative interviews in a resource-poor urban setting in Nairobi, Kenya. Interviews were audio-recorded, transcribed, translated into English, and uploaded on Atlas.ti software for coding and analysis. Results Findings from the study show gender differences in parent-child communication. More girls than boys reported that they had talked with their parents about romantic relationships. Four approaches—no communication, fear-based communication, supportive communication, and involving an external person were used by parents in SRH communication. Parents hostile attitudes towards romantic relationships during adolescence discouraged adolescents from disclosing their relationship status. While communication did occur, it was mainly reactive, one-sided, and authoritarian, often initiated by parents. Conclusions Parents need to be empowered with adequate and factual SRH information and effective communication strategies to enhance communication with very young adolescents. There is a need for further research to identify the most effective parent-child communication approaches to improve SRH outcomes among adolescents.
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Rehnström Loi U, Klingberg-Allvin M, Gemzell-Danielsson K, Faxelid E, Oguttu M, Makenzius M. Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 23:100486. [PMID: 31951913 DOI: 10.1016/j.srhc.2020.100486] [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] [Received: 08/21/2019] [Revised: 11/05/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate contraceptive uptake among PAC-seeking women reporting either planned pregnancies (PP) or unplanned pregnancies (UP) and to identify factors associated with UP. STUDY DESIGN This was a sub-study nested in randomised controlled trial (RCT) on women who sought PAC in a low-resource setting in western Kenya. The analysis was based on 807 women who were followed up at 7-10 days and by 472 women at 3 months. MAIN OUTCOME MEASURES Descriptive statistics and a binary logistic regression model with odds ratios (OR) and 95% confidence intervals (CI) were used. RESULTS Of the 807 women, 375 (46.3%) reported UP, and 432 (53.3%) PP. Most women, regardless of reported pregnancy intention, agreed to start using contraceptive methods: UP 273 (72.8%) and PP 338 (78.2%), respectively, P = 0.072. Independent factors associated with UP were young age (14-20 years; OR 1.177; 95% CI, 1.045-2.818; P = 0.033), unmarried status (OR 9.149; 95% CI, 5.719-14.638; P < 0.001), nulliparity (OR 1.968; 95% CI, 1.287-3.008; P = 0.002), concealed pregnancy (OR 7.708; 95% CI, 3.299-18.012; P < 0.001) and absence of a partner at the clinic visit (OR 3.174; 95% CI, 2.214-4.552; P < 0.001). At 3-month follow-up, there was no difference in contraceptive use between the UP group (161; 77.4%) and the PP group (193; 73.7%), P = 0.350. CONCLUSION Contraceptive counselling should be systematically offered to all PAC-seeking women, regardless of their stated pregnancy intention. Adolescents, unmarried women, nulliparous, women with concealed pregnancy and attending the PAC clinic without a partner should be given extra attention by PAC providers offering contraceptive counselling.
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Affiliation(s)
- Ulrika Rehnström Loi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Monica Oguttu
- Kisumu Medical Education Trust (KMET), Kisumu, Kenya
| | - Marlene Makenzius
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Kassahun EA, Zeleke LB, Dessie AA, Gersa BG, Oumer HI, Derseh HA, Arage MW, Azeze GG. Factors associated with unintended pregnancy among women attending antenatal care in Maichew Town, Northern Ethiopia, 2017. BMC Res Notes 2019; 12:381. [PMID: 31277714 PMCID: PMC6612166 DOI: 10.1186/s13104-019-4419-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/29/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Unintended pregnancy is one of the most public health issues in the world, and it is the major sexual and reproductive health problem which carries a higher risk of morbidity and mortality for women, often due to unsafe abortion. Even though family planning services are effective and available than ever before, unintended pregnancy and unsafe abortion are the major public health problems in the study area. Therefore, this study aimed at assessing the magnitude and associated factors of unintended pregnancy among pregnant women attending antenatal care follow up in Maichew town, northern Ethiopia. An institution based cross-sectional study was conducted on 329 pregnant women selected with a systematic sampling technique from April 5 to May 4, 2017. RESULT The magnitude of unintended pregnancy among pregnant women attending antenatal care in Maichew was found to be 29.7% (95% CI 24.30, 35.50). On the other hand, single in marital status (AOR = 38.6, 95% CI 10.07, 148.01), living alone (AOR = 9.9, 95% CI 1.80, 53.40) and having three or four children (AOR = 3.5, 95% CI 1.10, 11.04) were factors associated with an unintended pregnancy. Creating awareness about unintended pregnancy associated factors and implication of unintended pregnancy is highly recommended.
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Affiliation(s)
| | - Liknaw Bewket Zeleke
- College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Amanuel Addisu Dessie
- Department of Public Health, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
| | | | | | - Hunegnaw Alemaw Derseh
- Department of Nutrition, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulugeta Wodaje Arage
- Department of Midwifery, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Getnet Gedefaw Azeze
- Department of Midwifery, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
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Solanke BL, Kupoluyi JA, Akinyemi JO, Banjo OO. Do Community Characteristics Influence Unintended Pregnancies in Kenya? Malawi Med J 2019; 31:56-64. [PMID: 31143398 PMCID: PMC6526337 DOI: 10.4314/mmj.v31i1.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Most existing studies on unintended pregnancies tend to examine the influence of individual socio-demographic and health characteristics without sufficient attention to community characteristics. This study examines community characteristics influencing unintended pregnancies in Kenya. Methods Data were extracted from the 2014 Kenya Demographic and Health Survey (KDHS). The outcome variable was unintended pregnancy. The explanatory variables were selected individual and community level variables. The Multilevel mixed-effects logistic regression was applied. Results Findings show 41.9% prevalence of unintended pregnancies. Community characteristics such as community education, community timing for initiation of childbearing, community fertility norms, and community media exposure significantly influence the likelihood of unintended pregnancies. The Intra-Cluster Correlation (ICC) provided evidence that community characteristics had effects on unintended pregnancies. Conclusion There is evidence that community characteristics influence the prevalence of unintended pregnancies in Kenya. Community sensitisation and mobilisation should be central to all efforts aiming to reduce prevalence of unintended pregnancies.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Nigeria.,Demography and Population Studies Programme, University of the Witwatersrand, South Africa
| | - Joseph Ayodeji Kupoluyi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Nigeria.,Tropical Institute of Community Heath, Great Lakes University of Kisumu, Kenya
| | - Joshua Odunayo Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria.,Demography and Population Studies Programme, University of the Witwatersrand, South Africa
| | - Olufunmilayo Olufunmilola Banjo
- Department of Demography and Social Statistics, Obafemi Awolowo University, Nigeria.,Demography and Population Studies Programme, University of the Witwatersrand, South Africa
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Chung HW, Kim EM, Lee JE. Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review. J Adolesc 2018; 69:180-188. [PMID: 30390598 PMCID: PMC6284104 DOI: 10.1016/j.adolescence.2018.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/30/2018] [Accepted: 10/19/2018] [Indexed: 11/17/2022]
Abstract
Introduction Adolescent pregnancy causes serious problems not only for girls, but also for their family, and society. This study aimed to understand factors related to adolescent pregnancy in low- and middle-income countries using a multilevel approach adopted by Bronfenbrenner's ecological model. Methods A total of 11,933 studies published in between 2000 and 2015 were identified in 4 databases. Based on inclusion criteria and risk of bias assessment, a total of 67 articles were retrieved for analysis. Results Thematic analysis revealed that early marriage, sexual risk behaviors, substance use, family experience of adolescent birth, peer pressure, and lack of sex education and health service increased the hazards of adolescent pregnancy. Communication with parents, school activities, community meetings, laws, and government policies protected adolescents from pregnancy. Conclusions Results of this study suggests that the background of adolescents and complex interactions among various factors should be considered for pregnancy. In future research, mixed-method that supplements the methodological weaknesses of previous studies is also recommended.
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Affiliation(s)
- Hye Won Chung
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Eun Mee Kim
- Department of International Studies, Graduate School of International Studies, Ewha Womans University, Seoul, South Korea
| | - Ji-Eun Lee
- Department of International Studies, Graduate School of International Studies, Ewha Womans University, Seoul, South Korea.
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Doyle AM, Floyd S, Baisley K, Orindi B, Kwaro D, Mthiyane TN, Muuo S, Shahmanesh M, Ziraba A, Birdthistle I. Who are the male sexual partners of adolescent girls and young women? Comparative analysis of population data in three settings prior to DREAMS roll-out. PLoS One 2018; 13:e0198783. [PMID: 30265667 PMCID: PMC6161870 DOI: 10.1371/journal.pone.0198783] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) Partnership aims to reduce HIV incidence among adolescent girls and young women (AGYW,15-24y) with a core package of evidence-based interventions. Some interventions, including voluntary HIV counselling and testing and circumcision, will be targeted at the male sexual partners of AGYW. A priority of DREAMS is to characterise the male partners for effective targeting. METHODS Using population-based data (2010-2015) in three DREAMS impact evaluation settings in Kenya and South Africa, we describe the demographic characteristics and sexual behaviour of male partners reported by AGYW, and the characteristics of males who report sexual activity with AGYW. RESULTS In all settings, over 90% of recent male partners reported by AGYW were aged <35 years. Median ages of spousal and non-spousal partners were 29 and 23 years respectively in uMkhanyakude (rural South Africa) and 21 and 20 years respectively in Nairobi (urban Kenya). Most males reporting an AGYW partner had never been married (89%) and many were in school (39%). Most male partners reported only 1 AGYW partner in the past year; in Gem (rural Kenya) and Nairobi 25%-29% reported 2+(AGYW or older female) partners. Concurrent partners were reported by 16% of male partners in Gem and 3-4% in uMkhanyakude. Two thirds of male partners in Gem reported testing for HIV in the past 6 months and under half in uMkhanyakude reported testing for HIV in the past year. Almost all (96%) partners in Nairobi were circumcised, compared to 45% in Gem and 43% in uMkhanyakude. CONCLUSIONS With almost all AGYW's sexual partners aged 15-34 years, this is an appropriate target group for DREAMS interventions. Encouraging young men to reduce their number of partners and concurrency, and uptake prevention and treatment services such as HIV testing, circumcision and ART is crucial in the effort to reduce HIV among both AGYW and young men.
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Affiliation(s)
- Aoife M. Doyle
- MRC Tropical Epidemiology Group, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sian Floyd
- MRC Tropical Epidemiology Group, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kathy Baisley
- MRC Tropical Epidemiology Group, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- African Health Research Institute, KwaZulu- Natal, South Africa
| | - Benedict Orindi
- African Population and Health Research Center, Nairobi, Kenya
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Daniel Kwaro
- Kenya Medical Research Institute, Gem, Siaya county, Kenya
| | | | - Sheru Muuo
- African Population and Health Research Center, Nairobi, Kenya
| | - Maryam Shahmanesh
- African Health Research Institute, KwaZulu- Natal, South Africa
- University College London, London, United Kingdom
| | - Abdhalah Ziraba
- African Population and Health Research Center, Nairobi, Kenya
| | - Isolde Birdthistle
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Soura AB, Lankoande YB, Sanogo S, Compaore Y, Senderowicz L, Spencer G. Understanding premarital pregnancies among adolescents and young women in Ouagadougou, Burkina Faso. COGENT SOCIAL SCIENCES 2018; 4:1-18. [PMID: 30310826 PMCID: PMC6166577 DOI: 10.1080/23311886.2018.1514688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/18/2018] [Indexed: 06/08/2023]
Abstract
In developing countries, young women between 15 and 24 years of age account for more than 40% of unsafe abortions due to the high number of unwanted and/or out-of-wedlock pregnancies. However, much about the profile of adolescents and young women who usually experience premarital pregnancies remains unknown. This study sought to understand the risk of pregnancy before marriage among adolescents and young women in Ouagadougou, Burkina Faso. By using longitudinal data from a demographic surveillance system, we tested the explanatory power of two theoretical assumptions on premarital childbearing in sub-Saharan Africa, which assumptions are the cultural inheritance model and the social capital model. The results confirmed the explanatory power of the cultural inheritance model on the one hand and partially confirmed the power of the social capital model on the other hand. These results highlight the need for a multipronged approach to sexual and reproductive health for young people. Efforts against premarital pregnancies among adolescents and young women would be more effective if they were based on participatory approaches, incorporating actions at both community and institutional levels, as suggested by the recent Global Accelerated Action for the Health of Adolescents logical framework.
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Affiliation(s)
- Abdramane Bassiahi Soura
- Institut Superieur des Sciences de la Population (ISSP), University Ouaga 1 Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | - Souleymane Sanogo
- Institut Superieur des Sciences de la Population (ISSP), University Ouaga 1 Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | - Leigh Senderowicz
- Department of Global Health and Population, Harvard University, Boston, USA
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Estrada F, Suárez-López L, Hubert C, Allen-Leigh B, Campero L, Cruz-Jimenez L. Factors associated with pregnancy desire among adolescent women in five Latin American countries: a multilevel analysis. BJOG 2018; 125:1330-1336. [DOI: 10.1111/1471-0528.15313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- F Estrada
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - L Suárez-López
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - C Hubert
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - B Allen-Leigh
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Campero
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Cruz-Jimenez
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
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29
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Scott RH, Filippi V, Moore AM, Acharya R, Bankole A, Calvert C, Church K, Cresswell JA, Footman K, Gleason J, Machiyama K, Marston C, Mbizvo M, Musheke M, Owolabi O, Palmer J, Smith C, Storeng K, Yeung F. Setting the research agenda for induced abortion in Africa and Asia. Int J Gynaecol Obstet 2018; 142:241-247. [PMID: 29745418 DOI: 10.1002/ijgo.12525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/05/2018] [Accepted: 05/04/2018] [Indexed: 11/07/2022]
Abstract
Provision of safe abortion is widely recognized as vital to addressing the health and wellbeing of populations. Research on abortion is essential to meet the UN Sustainable Development Goals. Researchers in population health from university, policy, and practitioner contexts working on two multidisciplinary projects on family planning and safe abortion in Africa and Asia were brought together for a workshop to discuss the future research agenda on induced abortion. Research on care-seeking behavior, supply of abortion care services, and the global and national policy context will help improve access to and experiences of safe abortion services. A number of areas have potential in designing intervention strategies, including clinical innovations, quality improvement mechanisms, community involvement, and task sharing. Research on specific groups, including adolescents and young people, men, populations affected by conflict, marginalized groups, and providers could increase understanding of provision, access to and experiences of induced abortion. Methodological and conceptual advances, for example in the measurement of induced abortion incidence, complications, and client satisfaction, conceptualizations of induced abortion access and care, and methods for follow-up of patients who have induced abortions, will improve the accuracy of measurements of induced abortion, and add to understanding of women's experiences of induced abortions and abortion care.
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Affiliation(s)
- Rachel H Scott
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Clara Calvert
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Cicely Marston
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Katerini Storeng
- London School of Hygiene & Tropical Medicine, London, UK.,University of Oslo, Oslo, Norway
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Osok J, Kigamwa P, Stoep AV, Huang KY, Kumar M. Depression and its psychosocial risk factors in pregnant Kenyan adolescents: a cross-sectional study in a community health Centre of Nairobi. BMC Psychiatry 2018; 18:136. [PMID: 29776353 PMCID: PMC5960084 DOI: 10.1186/s12888-018-1706-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/24/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Adolescent pregnancies within urban resource-deprived settlements predispose young girls to adverse mental health and psychosocial adversities, notably depression. Depression in sub-Saharan Africa is a leading contributor to years lived with disability (YLD). The study's objective was to determine the prevalence of depression and related psychosocial risks among pregnant adolescents reporting at a maternal and child health clinic in Nairobi, Kenya. METHODS A convenient sample of 176 pregnant adolescents attending antenatal clinic in Kangemi primary healthcare health facility participated in the study. We used PHQ-9 to assess prevalence of depression. Hierarchical multivariate linear regression was performed to determine the independent predictors of depression from the psychosocial factors that were significantly associated with depression at the univariate analyses. RESULTS Of the 176 pregnant adolescents between ages 15-18 years sampled in the study, 32.9% (n = 58) tested positive for a depression diagnosis using PHQ-9 using a cut-off score of 15+. However on multivariate linear regression, after various iterations, when individual predictors using standardized beta scores were examined, having experienced a stressful life event (B = 3.27, P = 0.001, β =0.25) explained the most variance in the care giver burden, followed by absence of social support for pregnant adolescents (B = - 2.76, P = 0.008, β = - 0.19), being diagnosed with HIV/AIDS (B = 3.81, P = 0.004, β =0.17) and being young (B = 2.46, P = 0.038, β =0.14). CONCLUSION Depression is common among pregnant adolescents in urban resource-deprived areas of Kenya and is correlated with well-documented risk factors such as being of a younger age and being HIV positive. Interventions aimed at reducing or preventing depression in this population should target these groups and provide support to those experiencing greatest stress.
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Affiliation(s)
- Judith Osok
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 20386, 00100 Nairobi, Kenya
| | - Pius Kigamwa
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 19676 (00202), Nairobi, Kenya
| | - Ann Vander Stoep
- Psychiatry & Behavioral Sciences and Epidemiology, Child Health Institute, University of Washington, 6200 NE 74th Street, Suite 210, Seattle, WA 88115-1538 USA
| | - Keng-Yen Huang
- Department of Public Health and Child and Adolescent Psychiatry, New York University, New York, NY 10016 USA
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, Nairobi, 00100 (47074) Kenya
- Research Department of Clinical Health and Educational Psychology, University College London, London, WC1E 7BT UK
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Hall JA, Barrett G, Phiri T, Copas A, Malata A, Stephenson J. Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis. PLoS One 2016; 11:e0165621. [PMID: 27798710 PMCID: PMC5087885 DOI: 10.1371/journal.pone.0165621] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2012 there were around 85 million unintended pregnancies globally. Unintended pregnancies unnecessarily expose women to the risks associated with pregnancy, unsafe abortion and childbirth, thereby contributing to maternal mortality and morbidity. Studies have identified a range of potential determinants of unplanned pregnancy but have used varying methodologies, measures of pregnancy intention and analysis techniques. Consequently there are many contradictions in their findings. Identifying women at risk of unplanned pregnancy is important as this information can be used to help with designing and targeting interventions and developing preventative policies. METHODS 4,244 pregnant women from Mchinji District, Malawi were interviewed at home between March and December 2013. They were asked about their pregnancy intention using the validated Chichewa version of the London Measure of Unplanned Pregnancy, as well as their socio-demographics and obstetric and psychiatric history. A conceptual hierarchical model of the determinants of pregnancy intention was developed and used to inform the analysis. Multiple random effects linear regression was used to explore the ways in which factors determine pregnancy intention leading to the identification of women at risk of unplanned pregnancies. RESULTS 44.4% of pregnancies were planned. On univariate analyses pregnancy intention was associated with mother and father's age and education, marital status, number of live children, birth interval, socio-economic status, intimate partner violence and previous depression all at p<0.001. Multiple linear regression analysis found that increasing socio-economic status is associated with increasing pregnancy intention but its effect is mediated through other factors in the model. Socio-demographic factors of importance were marital status, which was the factor in the model that had the largest effect on pregnancy intention, partner's age and mother's education level. The effect of mother's education level was mediated by maternal reproductive characteristics. Previous depression, abuse in the last year or sexual abuse, younger age, increasing number of children and short birth intervals were all associated with lower pregnancy intention having controlled for all other factors in the model. This suggests that women in Mchinji District who are either young, unmarried women having their first pregnancy, or older, married women who have completed their desired family size or recently given birth, or women who have experienced depression, abuse in the last year or sexual abuse are at higher risk of unintended pregnancies. CONCLUSION A simple measure of pregnancy intention with well-established psychometric properties was used to show the distribution of pregnancy planning among women from a poor rural population and to identify those women at higher risk of unintended pregnancy. An analysis informed by a conceptual hierarchical model shed light on the pathways that lead from socio-demographic determinants to pregnancy intention. This information can be used to target family planning services to those most at risk of unplanned pregnancies, particularly women with a history of depression or who are experiencing intimate partner violence.
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Affiliation(s)
- Jennifer Anne Hall
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
- * E-mail:
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
| | | | - Andrew Copas
- Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, United Kingdom
| | - Address Malata
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Judith Stephenson
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
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How does poverty affect children's nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition. Public Health Nutr 2016; 20:608-619. [PMID: 27645101 PMCID: PMC5468798 DOI: 10.1017/s1368980016002445] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child’s death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya. Design Analysis of ten focus group discussions and ten individual interviews with key informants. The main topic discussed was the root causes of child undernutrition in the slums. The focus group discussions and key informant interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo by extracting concepts and using a constant comparison of data across the different categories of respondents to draw out themes to enable a thematic analysis. Setting Two slum communities in Nairobi, Kenya. Subjects Women of childbearing age, community health workers, elders, leaders and other knowledgeable people in the two slum communities (n 90). Results Participants demonstrated an understanding of undernutrition in children. Conclusions Findings inform target criteria at community and household level that can be used to identify children at risk of undernutrition. To tackle the immediate and underlying causes of undernutrition, interventions recommended should aim to: (i) improve maternal health and nutrition; (ii) promote optimal infant and young children feeding practices; (iii) support mothers in their working role; (iv) increase access to family planning; (v) improve water, sanitation and hygiene (WASH); (vi) address alcohol problems at all levels; and (vii) address street food issues with infant feeding counselling.
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Sarnquist C, Sinclair J, Omondi Mboya B, Langat N, Paiva L, Halpern-Felsher B, Golden NH, Maldonado YA, Baiocchi MT. Evidence That Classroom-Based Behavioral Interventions Reduce Pregnancy-Related School Dropout Among Nairobi Adolescents. HEALTH EDUCATION & BEHAVIOR 2016; 44:297-303. [PMID: 27486178 DOI: 10.1177/1090198116657777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effect of behavioral, empowerment-focused interventions on the incidence of pregnancy-related school dropout among girls in Nairobi's informal settlements. METHOD Retrospective data on pregnancy-related school dropout from two cohorts were analyzed using a matched-pairs quasi-experimental design. The primary outcome was the change in the number of school dropouts due to pregnancy from 1 year before to 1 year after the interventions. RESULTS Annual incidence of school dropout due to pregnancy decreased by 46% in the intervention schools (from 3.9% at baseline to 2.1% at follow-up), whereas the comparison schools remained essentially unchanged ( p < .029). Sensitivity analysis shows that the findings are robust to small levels of unobserved bias. CONCLUSIONS Results suggest that these behavioral interventions significantly reduced the number of school dropouts due to pregnancy. As there are limited promising studies on behavioral interventions that decrease adolescent pregnancy in low-income settings, this intervention may be an important addition to this toolkit.
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Affiliation(s)
| | | | | | | | - Lee Paiva
- 4 No Means No Worldwide, San Francisco, CA, USA
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Smith-Greenaway E, Sennott C. Death and Desirability: Retrospective Reporting of Unintended Pregnancy After a Child's Death. Demography 2016; 53:805-34. [PMID: 27150965 PMCID: PMC4884011 DOI: 10.1007/s13524-016-0475-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Social scientists have long debated how to best measure pregnancy intentions. The standard measure relies on mothers' retrospective reports of their intentions at the time of conception. Because women have already given birth at the time of this report, the resulting children's health-including their vital status-may influence their mothers' responses. We hypothesize that women are less likely to report that deceased children were from unintended pregnancies, which may explain why some cross-sectional studies have shown that children from unintended pregnancies have higher survival, despite the fact that longitudinal studies have shown the opposite is true. Using Demographic and Health Survey data from 31 sub-Saharan African countries, we confirm that mothers are less likely to report that deceased children resulted from unintended pregnancies compared with surviving children. However, the opposite is true for unhealthy children: mothers more commonly report that unhealthy children were from unintended pregnancies compared with healthier children. The results suggest that mothers (1) revise their recall of intentions after the traumatic experience of child death and/or (2) alter their reports in the face-to-face interview. The study challenges the reliability of retrospective reports of pregnancy intentions in high-mortality settings and thus also our current knowledge of the levels and consequences of unintended pregnancies in these contexts.
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Affiliation(s)
- Emily Smith-Greenaway
- Department of Sociology, University of Southern California, 851 Downey Way, HSH, Office 309, Los Angeles, CA, 90089, USA.
| | - Christie Sennott
- Department of Sociology, Purdue University, West Lafayette, IN, USA
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Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, Musoke RN, Norris SA, Madise NJ, Griffiths P. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. MATERNAL AND CHILD NUTRITION 2014; 11:314-32. [PMID: 25521041 PMCID: PMC6860346 DOI: 10.1111/mcn.12161] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings. This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In‐depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with women of childbearing age, community health workers, village elders and community leaders and other knowledgeable people in the community. A total of 19 IDIs, 10 FGDs and 11 KIIs were conducted, and were recorded and transcribed verbatim. Data were coded in NVIVO and analysed thematically. We found that there was general awareness regarding optimal breastfeeding practices, but the knowledge was not translated into practice, leading to suboptimal breastfeeding practices. A number of social and structural barriers to optimal breastfeeding were identified: (1) poverty, livelihood and living arrangements; (2) early and single motherhood; (3) poor social and professional support; (4) poor knowledge, myths and misconceptions; (5) HIV; and (6) unintended pregnancies. The most salient of the factors emerged as livelihoods, whereby women have to resume work shortly after delivery and work for long hours, leaving them unable to breastfeed optimally. Women in urban poor settings face an extremely complex situation with regard to breastfeeding due to multiple challenges and risk behaviours often dictated to them by their circumstances. Macro‐level policies and interventions that consider the ecological setting are needed.
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Affiliation(s)
| | - Frederick Wekesah
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Milka Wanjohi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Alex C Ezeh
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Rachel N Musoke
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nyovani J Madise
- Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, UK
| | - Paula Griffiths
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health and Human Development, Loughborough University, Loughborough, UK
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