Determinants of Sexual Activity and Pregnancy among Unmarried Young Women in Urban Kenya: A Cross-Sectional Study

The prevalence of adolescent pregnancy and its associated consequences in the Eastern Mediterranean region: a systematic review and meta-analysis

BACKGROUND

Adolescent pregnancy is one of the public health problems that both mother and baby suffer from its consequences. This study was conducted to estimate the prevalence and consequences of adolescent pregnancy in the Eastern Mediterranean region.

METHODS

In this systematic review and meta-analysis, four databases (PubMed, ProQuest, Web of Science and Scopus) were systematically searched for relevant articles published from 1990 to 2022. The screening process for articles was conducted in accordance with the PRISMA guidelines. Joanna Briggs checklists were used to assess the quality of included studies. A random effects model was performed for the meta-analysis. Narrative synthesis of adolescent pregnancy prevalence, as well as a meta-analysis of adolescent pregnancy prevalence was performed using STATA 14.

RESULTS

The review included 12 studies and 94,189 study participants. The prevalence of adolescent pregnancy was [9% (95% CI 6.9, 11.2, p < 0.001)]. Pregnancy outcomes included preeclampsia [12.9%(95% CI 7.3,18.5, p < 0.001)], low birth weight [16.1%(95% CI 7.4-24.8, p < 0.001)], anemia [33%(95% CI 14.4, 51.7, p < 0.001)], and cesarean delivery [15.9%(95% CI 11.1-20.7, p < 0.001)].The results showed that 16.9% of deliveries were cesarean sections.

CONCLUSION

The study's findings indicate that adolescent pregnancy is prevalent in the Middle East region and is associated with negative outcomes for teenagers. Therefore, it is necessary to carry out effective interventions to reduce adolescent pregnancy.

Socioeconomic and residence-based inequalities in adolescent fertility in 39 African countries

INTRODUCTION

Despite the advancement in sexual and reproductive healthcare services and several public health measures aimed at controlling fertility rates, countries in sub-Saharan Africa (SSA) still experience higher adolescent fertility rates than other low-and middle-income countries. This study examined the disparities in adolescent fertility in 39 countries in SSA, focusing on socioeconomic and residence-based dimensions.

METHODS

This study involved a secondary analysis of data obtained from 39 recent Demographic and Health Surveys conducted in SSA. The measures of difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) were estimated using the Health Equity Assessment Tool (HEAT) software version 3.1 developed by the World Health Organization. The measures: D, R, PAF, and PAR were used to examine the inequalities in adolescent fertility across the socioeconomic and residence-based dimensions.

RESULTS

Out of the 39 countries included in the study, Guinea (D=27.70), Niger (D=27.50), Nigeria (D=23.90), and Côte d'Ivoire (D=23.60) exhibited the most significant residence-based inequalities in the rate of adolescent fertility, with the higher rate observed among adolescents in rural areas. Rwanda was the sole country that showed a slight inclination towards rural inequality in terms of the rate of adolescent fertility, with a value of D = -0.80. The burden of adolescent fertility was disproportionately higher among young women with low economic status across all the countries, exacerbating wealth-based inequities. The countries with the largest absolute discrepancies were Nigeria (D=44.70), Madagascar (D=41.10), Guinea (D=41.00), and Cameroon (D=40.20). We found significant disparities in educational attainment contributing to unequal inequalities in adolescent fertility, particularly among young women who lack access to formal education. Countries such as Madagascar (D=59.50), Chad (D=55.30), Cameroon (D=54.60), and Zimbabwe (D=50.30) had the most significant absolute disparities.

CONCLUSION

This study revealed that young women residing in rural areas, those in households with low economic status and those with limited educational opportunities experience a disproportionately high burden of adolescent fertility across the 39 countries in SSA. The current findings offer valuable information to governmental entities at all levels regarding the need to ensure the provision of equitable, accessible, and dependable sexual and reproductive health services to the populace, particularly for young women. Therefore, the various stakeholders need to enhance the effectiveness of health policies and legislation pertaining to adolescent women living in rural areas, those from economically disadvantaged households, and those with limited or no access to formal education. Such interventions could potentially reduce adolescent fertility rates and mitigate the adverse maternal and child outcomes associated with high adolescent fertility in SSA.

Geographically weighted regression analysis to assess hotspots of early sexual initiation and associated factors in Ethiopia

Background

Early sexual initiation (ESI) causes unintended pregnancy, sexually transmitted infections (STI), high risk of depression and anxiety, developmental delays, lack of emotional maturity, and difficulty in pursuing education. This study aims to analyze the geographically weighted regression and associated factors of ESI of women in Ethiopia.

Methods

The study utilized data from the Ethiopian Demographic and Health Survey, 2016. It included a weighted sample of 11,775 women. Spatial regression was carried out to determine which factors are related to hotspots of ESI of women. To identify the factors associated with ESI, a multilevel Poisson regression model with robust variance was conducted. An adjusted prevalence ratio (APR) with its 95 % confidence interval was presented.

Results

The prevalence of ESI was 75.3 % (95%CI: 74.6 %, 76.1 %), showing notable spatial variation across different regions of Ethiopia. Areas of significant hotspots of ESI were identified in Western and Southern Tigray, most parts of Amhara, Southern, Central and Western Afar, Eastern Gambella, and North Western SNNPR. The significant variables for the spatial variation of ESI were; being single, rural residence, and having no formal education of the women. Factors including; wealth index, marital status, khat chewing, education level, residence, and region were associated significantly with ESI in the multilevel robust Poisson analysis.

Conclusion

A higher proportion of ESI in women was found. Public health interventions must be made by targeting hotspot areas of ESI through increasing health care access and education (specifically among rural residents), developing a comprehensive sexual education, implementing policies and laws that outlaw early marriage, and mass community-based programs to increase awareness about the importance of delaying sexual activity.

A 'hidden problem': Nature, prevalence and factors associated with sexual dysfunction in persons living with HIV/AIDS in Uganda

BACKGROUND

We conducted a clinic-based cross-sectional survey among 710 people living with HIV/AIDS in stable 'sexual' relationships in central and southwestern Uganda. Although sexual function is rarely discussed due to the private nature of sexual life. Yet, sexual problems may predispose to negative health and social outcomes including marital conflict. Among individuals living with HIV/AIDS, sexual function and dysfunction have hardly been studied especially in sub-Saharan Africa. In this study, we aimed to determine the nature, prevalence and factors associated with sexual dysfunction (SD) among people living with HIV/AIDS (PLWHA) in Uganda.

METHODS

We conducted a clinic based cross sectional survey among 710 PLWHA in stable 'sexual' relationships in central region and southwestern Uganda. We collected data on socio-demographic characteristics (age, highest educational attainment, religion, food security, employment, income level, marital status and socio-economic status); psychiatric problems (major depressive disorder, suicidality and HIV-related neurocognitive impairment); psychosocial factors (maladaptive coping styles, negative life events, social support, resilience, HIV stigma); and clinical factors (CD4 counts, body weight, height, HIV clinical stage, treatment adherence).

RESULTS

Sexual dysfunction (SD) was more prevalent in women (38.7%) than men (17.6%) and majority (89.3% of men and 66.3% of women) did not seek help for the SD. Among men, being of a religion other than Christianity was significantly associated with SD (OR = 5.30, 95%CI 1.60-17.51, p = 0.006). Among women, older age (> 45 years) (OR = 2.96, 95%CI 1.82-4.79, p<0.01), being widowed (OR = 1.80, 95%CI 1.03-3.12, p = 0.051) or being separated from the spouse (OR = 1.69, 95% CI 1.09-2.59, p = 0.051) were significantly associated with SD. Depressive symptoms were significantly associated with SD in both men (OR = 0.27, 95%CI 0.74-0.99) and women (OR = 1.61, 95%CI 1.04-2.48, p = 0.032). In women, high CD4 count (OR = 1.42, 95% CI 1-2.01, p = 0.05) was associated with SD.

CONCLUSION

Sexual dysfunction has considerable prevalence among PLWHA in Uganda. It is associated with socio-demographic, psychiatric and clinical illness factors. To further improve the quality of life of PLWHA, they should be screened for sexual dysfunction as part of routine assessment.

The effectiveness of combined approaches towards improving utilisation of adolescent sexual and reproductive health services in Kenya: a quasi-experimental evaluation

Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15-19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents' discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42-0.79, P = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08-0.82, P = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.

Early Sexual Debut and Its Associated Factors Among Young Women Aged 15-24 in Mali: A Multilevel Analysis

Early sexual debut is associated with increased risk of several sexual and reproductive health problems, including unwanted pregnancies and sexually transmitted infections. Hence, determining factors that promote early sexual initiation is significant to guide policy and inform interventions aimed to promote the health of young people through to adulthood. This study examined the prevalence of early sexual debut and its associated factors among young women in Mali. Using cross-sectional nationally representative data from the 2018 Mali Demographic and Health Survey, a total of 4063 young women aged 15-24 were included in the study. Multilevel binary logistic regression analysis was done to determine the factors associated with early sexual debut. The results were presented using adjusted odds ratios (aOR) and 95% confidence intervals (CIs). The prevalence of early sexual debut in Mali was 17.8% (95% CI; 16-19.7%). Young women who attended higher school had lower odds of early sexual debut (aOR = 0.10, 95% CI; 0.01-0.82) compared to young women who had no formal education. Young women from richest households had lower odds of early sexual debut compared to those from the poorest households (aOR = 0.48, 95% CI; 0.27-0.82). Young women from households with large family size also had lower odds of experiencing early sexual debut compared to those in small family size (aOR = 0.81, 95% CI; 0.66-0.99). Furthermore, the odds of early sexual debut were lower among young women in Koulikoro (aOR = 0.59, 95% CI; 0.39-0.90), Sikasso (aOR = 0.35, 95% CI; 0.21-0.56), Segou (aOR = 0.40, 95% CI; 0.25-0.64), and Mopti (aOR = 0.44, 95% CI; 0.23-0.82) regions compared to young women in Kayes region. Higher odds of early sexual debut were found among currently employed compared to not currently employed young women (aOR = 1.74, 95% CI; 1.42-2.12) and currently married compared to not currently married young women (aOR = 4.64, 95% CI; 3.64-5.92). Young women from the Peulh ethnic groups compared to those from the Bambara ethnic groups were at a higher odds of early sexual debut (aOR = 1.43, 95% CI; 1.03-1.99). The findings suggest the need for interventions aimed at addressing early sexual debut among young women. These can include emphasizing the promotion and importance of female education, addressing the cultural practices that promote negative sexual norms/practices such as child marriages, and ensuring social change through efforts such as creating employment or economic opportunities for families.

Early sexual debut is associated with drug use and decreased educational attainment among males and females in Kisumu County, Kenya

Differing global sociocultural contexts of sexual relationships influence age at first sexual intercourse with potentially long-lasting region-specific effects such as increased risk of contracting HIV and other sexually transmitted infections (STIs). In these cross-sectional analyses of data from the screening and enrollment visits for an HIV incidence study in Kisumu County, Kenya, we evaluated factors associated with having experienced an early sexual debut (ESD) among males and females aged 18-35 years. Clinical evaluation was performed and sexual behaviors were assessed via questionnaire. ESD was defined as self-reported age 15 years or younger at first sexual intercourse. Robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ESD. Of 1057 participants, 542 (51.3%) were female. Participants' median age at study screening was 25 years (interquartile range [IQR]: 22-29), and at sexual debut was 16 years (IQR: 14-17). Five hundred and four participants (47.7%) reported ESD. ESD was less common among females (PR 0.78, CI 0.67-0.90) and participants with more than primary education (PR 0.56, CI 0.47-0.66). ESD was more common in participants with a history of drug use (PR 1.28, CI 1.10-1.49). Drug use removed the protective effect of education (some secondary education or less, no drug use: PR 0.72, CI 0.61-0.85; some secondary education or less, drug use: PR 0.94, CI 0.74-1.18). ESD was common in our study and associated with lower educational attainment and increased likelihood of drug use. Interventions are needed early in life, well before 15 years of age, to encourage engagement in schooling and prevent drug use. Comprehensive sexual education and interventions to prevent drug use may be beneficial before the age of 15 years.

Women's marital status and use of family planning services across male- and female-headed households in low- and middle-income countries

Background

As more households are being led by women, who are often seen as disadvantaged, more attention is being given to the potential association of female household headship with health. We aimed to assess how demand for family planning satisfied by modern methods (mDFPS) is associated with residence in female or male headed households and how this intersects with marital status and sexual activity.

Methods

We used data from national health surveys carried out in 59 low- and middle-income countries between 2010 and 2020. We included all women aged 15 to 49 years in our analysis, regardless of their relationship with the household head. We explored mDFPS according to household headship and its intersectionality with the women's marital status. We identified households as male-headed households (MHH) or female-headed households (FHH), and classified marital status as not married/in a union, married with the partner living in the household, and married with the partner living elsewhere. Other descriptive variables were time since the last sexual intercourse and reason for not using contraceptives.

Results

We found statistically significant differences in mDFPS by household headship among reproductive age women in 32 of the 59 countries, with higher mDFPS among women living in MHH in 27 of these 32 countries. We also found large gaps in Bangladesh (FHH = 38%, MHH = 75%), Afghanistan (FHH = 14%, MHH = 40%) and Egypt (FHH = 56%, MHH = 80%). mDFPS was lower among married women with the partner living elsewhere, a common situation in FHH. The proportions of women with no sexual activity in the last six months and who did not use contraception due to infrequent sex were higher in FHH.

Conclusions

Our findings indicate that a relationship exists between household headship, marital status, sexual activity, and mDFPS. The lower mDFPS we observed among women from FHH seems to be primarily associated with their lower risk of pregnancy; although women from FHH are married, their partners frequently do not live with them, and they are less sexually active than women in MHH.

Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000-2022

BACKGROUND

Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia.

METHODS

This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies.

RESULTS

Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment.

CONCLUSION

From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.

The Role of Effective Knowledge on Contraceptive Methods Use in the Replication of Mother-Daughter Adolescent Pregnancy in Mexico

An important gap in the literature is the analysis of the role of effective knowledge concerning use of contraceptive methods in the intergenerational reproduction of adolescent pregnancy in low- and middle-income countries. Using data from the 2014 Mexico National Survey of Demographic Dynamics, we conducted a retrospective cohort and complete case analysis of women aged ≤ 19 years cohabitating with their mothers and who self-reported having had sexual intercourse at the moment of the survey (n = 5143). We estimated instrumental variable probit models (IV-probit) to assess the association between effective knowledge concerning the use of contraceptive methods and adolescent pregnancy. We stratified our models according to parental history of adolescent pregnancy. Adolescent pregnancy prevalence in our sample was 58.7%. The IV-probit model showed that mothers with a history of adolescent pregnancy were 12.1 percentage points more likely to have daughters who experience adolescent pregnancy. In addition, daughters with effective knowledge concerning the use of contraceptive methods were 1.3 percentage points less likely to experience an adolescent pregnancy. Our findings carry relevant implications for policies seeking to reduce adolescent pregnancy. They highlight the need for policies and programs that tackle the intergenerational transmission of sexual and reproductive behaviors by increasing the information available to adolescents and enhancing their effective knowledge about the use of contraceptive methods. Identifying population groups at higher risk of adolescent pregnancy can contribute to the design of successful reproductive health policies in Mexico and other low- and middle-income countries.

Modern contraceptive use among adolescent girls and young women in Benin: a mixed-methods study

OBJECTIVES

The study aimed to assess the determinants of modern contraceptive method use among young women in Benin.

DESIGN

A mixed-methods design.

SETTING AND PARTICIPANTS

We used the Benin 2017-2018 Demographic and Health Survey datasets for quantitative analysis. Data collection was conducted using multiple-cluster sampling method and through household survey. Qualitative part was conducted in the city of Allada, one of the Fon cultural capitals in Benin. The participants were purposively selected.

OUTCOMES

Contraceptive prevalence rate, unmet need for modern method and percentage of demand satisfied by a modern method for currently married and sexually active unmarried women were measured in the quantitative part. Access barriers and utilisation of modern methods were assessed in the qualitative part.

RESULTS

Overall, 8.5% (95% CI 7.7% to 9.5%) among young women ages 15-24 were using modern contraceptives and 13% (12.1% to 14.0%) among women ages 25 or more. Women 15-24 had a higher unmet need, and a lower demand satisfied by modern contraceptive methods compared with women ages 25 or more. 60.8% (56.9% to 64.7%) of all unmarried young women had unmet need for modern contraceptives. Young women were more likely to use male condoms which they obtain mainly from for-profit outlets, pharmacies and relatives. The factors associated with demand satisfied by a modern method were literacy, being unmarried, knowing a greater number of modern contraceptive methods and experiencing barriers in access to health services. On the other hand, the qualitative study found that barriers to using modern methods include community norms about pre-marital sexual intercourse, perceptions about young women's fertility, spousal consent and the use of non-modern contraceptives.

CONCLUSION

Contraceptive use is low among young women in Benin. The use of modern contraceptives is influenced by sociodemographic factors and social norms. Appropriate interventions might promote comprehensive sexuality education, increase community engagement, provide youth-friendly services and address gender inequalities.

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.

Psychosocial Experiences of Adolescent Girls and Young Women Subsequent to an Abortion in Sub-saharan Africa and Globally: A Systematic Review

Introduction: Unmet need for contraception, unintended pregnancy, and access to safe abortion remain global challenges preventing adolescent girls and young women (AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficulties navigating sexual autonomy, lack of agency or experience negotiating sexual acts, and challenges accessing sexual health information and services. The aim of this systematic review is to assess the psychosocial outcomes of AGYW who have experienced an abortion with particular focus on sub-Saharan Africa, which bears the global burden of unintended pregnancy and risk of death due to unsafe abortion.

Materials and Methods: The systematic review was registered and used search terms to identify peer-reviewed articles relevant to “post-abortion,” “psychosocial,” “adolescent girls,” and “young women” from PubMed, Embase, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature. Examples of psychosocial experiences include quality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020) was used by two reviewers to assess the relevance of each article to psychosocial outcomes of AGYW any time after an abortion or accessing post-abortion services. Analysis was conducted with a focus on data from Africa and comparisons are made to non-African settings.

Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Six selected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, and the remaining articles were from other regions. Themes around stigma, shame, and abandonment associated with the experience of abortion were prevalent in all regions. Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight social isolation as well as learned resilience among young women who abort.

Discussion: Navigating abortion as an AGYW involves managing internalized and perceived stigma, fear of violence, secrecy, and growing resilient in order to overcome the significant barriers that society and culture place on access to an essential service in sexual and reproductive health. Post-abortion psychosocial outcomes highlight the need for support services and investigation of contexts that perpetuate and necessitate unsafe abortion. Empowerment of AGYW may present an important opportunity to build self-agency and positive coping mechanisms to withstand social pressures during stigmatizing circumstances associated with abortion.

Prevalence and associated factors of adolescent pregnancy (15-19 years) in East Africa: a multilevel analysis

Background

Adolescent pregnancy is a major public health problem both in developed and developing countries with huge consequences to maternal health and pregnancy outcomes. However, there is limited evidence on the prevalence and associated factors of adolescent pregnancy in East Africa. Therefore, this study aimed to investigate the prevalence and associated factors of adolescent pregnancy in Eastern Africa.

Method

The most recent Demographic and Health Survey (DHS) datasets of the 12 East African countries were used. A total weighted sample of 17, 234 adolescent girls who ever had sex was included. A multilevel binary logistic regression analysis was fitted to identify the significantly associated factors of adolescent pregnancy. Finally, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the factors that are significantly associated with adolescent pregnancy.

Results

The overall prevalence of adolescent pregnancy in East Africa was 54.6% (95%CI: 53.85, 55.34%). In the multivariable multilevel analysis; being age 18–19 years [AOR = 3.06; 95%CI: 2.83, 3.31], using contraceptive [AOR = 1.41; 95%CI: 1.28, 1.55], being employed girls [AOR = 1.11; 95%CI: 1.03, 1.19], being spouse/head within the family [AOR = 1.62; 95% CI: 1.45, 1.82], and being from higher community level contraceptive utilization [AOR = 1.10; 95%CI:1.02, 1.19] were associated with higher odds of adolescent pregnancy. While adolescent girls attained secondary education and higher [AOR = 0.78; 95%CI: 0.68, 0.91], initiation of sex at age of 15 to 14 years [AOR = 0.69; 95%CI: 0.63, 0.75] and 18 to 19 years [AOR = 0.31; 95%CI: 0.27, 0.35], being unmarried [AOR = 0.25; 95%CI: 0.23, 0.28], having media exposure [AOR = 0.85; 95%CI: 0.78, 0.92], and being girls from rich household [AOR = 0.64; 95%CI: 0.58, 0.71] were associated with lower odds of adolescent pregnancy.

Conclusion

This study found that adolescent pregnancy remains a common health care problem in East Africa. Age, contraceptive utilization, marital status, working status, household wealth status, community-level contraceptive utilization, age at initiation of sex, media exposure, educational level and relation to the household head were associated with adolescent pregnancy. Therefore, designing public health interventions targeting higher risk adolescent girls such as those from the poorest household through enhancing maternal education and empowerment is vital to reduce adolescent pregnancy and its complications.

"Those are things for married people" exploring parents'/adults' and adolescents' perspectives on contraceptives in Narok and Homa Bay Counties, Kenya

Background

Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya.

Methods

Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15–19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents.

Results

Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents’ sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion.

Conclusions

Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.

Human papillomavirus vaccine and risky sexual behavior: Regression discontinuity design evidence from Brazil

This study aims to analyze the hypothesis of moral hazard caused by vaccination against human papillomavirus (HPV), regarding girls' beginning of sex life and, once they have begun their sex life, to understand whether it reduces the probability of girls using a condom in their first sexual intercourse. The data are from the 2015 National Survey of School Health (PeNSE). The model used is the regression discontinuity, with the discontinuity in the age of the girls who were able to participate in the public vaccination campaign. The results of the so-called Fuzzy-RDD show that the campaign was effective in increasing the likelihood of vaccination by 26.7-27.6 percentage points. There is no observable effect on young women initiating their sex lives or refraining from using condoms. The results are tested by several robustness methods. This is the first work to use quasi-experimental models in a developing country with low vaccination coverage in Latin America and show that it is necessary to increase awareness campaigns with parents, so they will know that there is no effect of vaccination on the beginning of sex life and condom use.

Prevalence and Determinants of Early Initiation of Sexual Intercourse Among Youth Girls in Ethiopia

PURPOSE

The aim of the study was to identify the prevalence and associated factors of early sexual initiation among youth girls in Ethiopia.

DESIGN AND METHODS

From 15,683 women participants of the 2016 EDHS, a sub-sample of 6401 youth girls aged 15-24 years were selected; from which 5737 youth girls who had a complete response to all variables of interest were retained for analysis. Bivariable and multivariable regression analysis were carried out.

RESULTS

The prevalence of early initiation of sexual intercourse among study participants was 2201(38.4%). The mean age of sexual intercourse initiation was 16.5 years. The odds of early sexual initiation was higher among respondents belonging to age group of 20-24 (AOR = 6.81, 95% CI (8.7, 12.13)), being from rural areas (AOR = 1.68, 95%CI (1.04, 2.70)), living in Gambella (AOR = 2.38, 95%CI (1.19, 4.78)), being from poorest wealth quintile (AOR = 1.41, 95%CI (0.83, 2.41)), being not employed (AOR = 1.59, 95%CI (1.23, 2.05)), have comprehensive HIV knowledge (AOR = 1.2, 95% CI (1.74, 2.35), didn't read newspaper or magazine (AOR = 1.39, 95% CI (1.77,2.53)), never used internet (AOR = 3.19, 95% CI (0.87,11.66)), smoked cigarette (AOR = 1.47, 95%CI (0.41, 5.19), used modern contraceptive (AOR = 1.20, 95%CI (0.81, 1.77)), used Voluntary, Counseling and Testing (VCT) service (AOR = 1.48, 95%CI, (1.11, 1.97)) and chewed chat (AOR = 2.21, 95%CI (3.41, 4.41)) when compared with their counterparts.

CONCLUSIONS

The current study revealed that early sexual initiation is an important public health problem among youth girls in Ethiopia. Factors which were significantly associated with early initiation of sexual intercourse include: being older age, being from rural residence, living in Gambella region, being unemployment, being from poor wealth quintile, lack of comprehensive HIV knowledge, decreased frequency of reading newspaper or magazine, lack of use of internet, cigarette smoking, VCT utilization, and chat chewing.

PRACTICE IMPLICATIONS

A legal age for buying alcohol, cigarette, and chat should be set. Strategies focusing on poverty reduction, entrepreneurship, and awareness creation on the consequence of early initiation of sexual intercourse should be emphasized.

Prevalence of teenage pregnancy and the associated contextual correlates in Rwanda

The rate of teenage pregnancy remains unacceptably high in most developing countries. In Rwanda, studies show a rapid increase over the past two decades despite the political achievements of women's empowerment, and efforts to curtail child sexual abuse. Unfortunately, the current knowledge of the household determinants of teenage pregnancies in Rwanda is limited, as recent studies have focused on providing numbers with little analysis of proximate causal factors or focused on the individual determinants. The study uses secondary data from the recent Rwanda Demographic and Health Survey (RDHS: 2014-2015) to analyse household factors associated with teenage pregnancies in Rwanda. In addition to descriptive analysis, we ran logistic regression models to determine the level of association between teenage pregnancy and household socioeconomic characteristics. Results indicate that marital status and age of household head, household size, number of bedrooms given the size of the household, and the educational level of the household-head are significantly associated with teenage pregnancy (p < 0.01). Teen girls from small households are more likely to get pregnant than those from large families, while financial, social and educational empowerment of parents, and harmonious household contexts contribute to lessening the cases of teenage pregnancy. It indicates that social and economic support to teen girls which include parental supervision, guidance, and financial care are essential aspects to consider in order to reduce teenage pregnancy rates. The study suggests that in addition to efforts directed to teens themselves, strategies for reducing teen pregnancies should focus on a range of household-level contexts that form two broad categories: empowering parents and maintaining parents' harmonious decisions on teen girls.

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

Background

Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034.

Methods

Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398).

Findings

Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001).

Conclusions

A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening.

Knowledge and misconceptions surrounding family planning among Young Maasai women in Kenya

Adolescent fertility rates are high in Kenya and increase the likelihood of maternal and infant morbidity and mortality. Our objective was to explore the knowledge, perceptions, and barriers surrounding the use of family planning services among young Maasai women in Laikipia County, Central Kenya. Individual interviews with 50 participants were conducted in Laikipia County, Kenya during June and July of 2019. Qualitative data was visualised using JMP software and coded using the framework method for content analysis. Several overarching themes were identified. First, we identified a high rate of unintended pregnancy and a low rate of family planning use. Second, we found that many young Maasai women believe that only women that are married and have finished childbearing should utilise family planning services. Finally, we document highly prevalent myths among young women in the Maasai community that the use of family planning will lead to negative health consequences, such as infertility and cancer. We conclude that the Maasai community of Laikipia County, Kenya needs comprehensive family planning education that will improve knowledge and dispel myths in order to empower young Maasai women to make informed decisions surrounding family planning.

Geographical variations of early age sexual initiation among reproductive-age women in Ethiopia: evidence from EDHS 2016

Background

The early age of sexual initiation contribute a lot for various risks such as mistimed pregnancy followed by insecure termination, developing fistula and contracting sexually transmitted infections which are currently the major public health concerns for low-income countries. Therefore, the purpose of this study was to detect spatial clusters and identify factors associated with an early age sexual initiation of women in the reproductive age group.

Methods

We used a population-based nationwide representative Ethiopian Demographic and Health Survey (EDHS) 2016 data.. A total of 12,033 respondents of reproductive age (15–49 years) women who had at least one event of sexual intercourse was retrieved and included for the analysis. Spatial cluster detection and autocorrelation analysis were also done to explore the patterns of early age sexual initiation.

Results

The median age at first sexual intercourse among respondents was 16 (±3.3) years and more than half (66.2%) had their first sexual intercourse before the age of 18 years. The spatial variations of the age of sexual initiation was nonrandom and clustered with a Moran’s I = 0.413 (P-value < 0.001). In addition, five significant spatial clusters were also identified. Moreover, the probability of starting sex at an earlier age was associated with the respondent’s residence, marital status, educational attainment and wealth index.

Conclusion

This study found a higher proportion of an early age sexual initiation of women. Respondent’s residence, marital status, educational attainment and wealth index were significantly associated with early sexual initiation. The SaTScan analysis identified five statistical significant spatial clusters which indicate that there were geographical variations. Therefore, integrated interventions focusing on the identified high spot clustered areas are recommended to reduce early age sexual initiation.

Factors associated with family, school and behavioral characteristics on sexual initiation: A gender analysis for Brazilian adolescents

Adolescence is a period of transition between childhood and adulthood. The article aims to study the individual, family and school characteristics of adolescents beginning their sexual lives. The database we used was the 2015 PeNSE (National Adolescent School-based Health Survey) and the methodology was the survival analysis. The results show that boys initiate sexual activity before girls and risky behaviors associated with the use of licit and illicit drugs increase the chance of having early sex. In addition, this work highlights the importance of parental practices in reducing the chances of beginning sexual activity, as well as the presence of school workshops on the risks of pregnancy. It should be noted that intervention strategies need to be differentiated according to gender in order to increase effectiveness.

The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women

In sub-Saharan Africa, adolescent girls and young women (AGYW) are 5 to 14 times more likely to be infected with HIV than their male peers. Every day, more than 750 AGYW are infected with HIV. Many factors make girls and young women particularly vulnerable to HIV, including gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. The President's Emergency Plan for AIDS Relief (PEPFAR) is dedicating significant resources through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) partnership to impact the lives of women and girls based on PEPFAR's mission to help countries achieve epidemic control of HIV/AIDS. The data show that new HIV infections must be reduced in AGYW, or the global community risks losing the extensive progress made towards reaching epidemic control. With support from PEPFAR and private sector partners-the Bill & Melinda Gates Foundation, Gilead Sciences, Girl Effect, Johnson & Johnson and ViiV Healthcare, DREAMS works together with partner governments to deliver a core package of interventions that combines evidence-based approaches that go beyond the health sector, addressing the structural drivers that directly and indirectly increase girls' HIV risk. Not only is DREAMS an effort to reduce new HIV infections, but it aims to reduce other critical vulnerabilities such as gender-based violence. When girls and young women thrive, the effects are felt throughout their families, communities and countries.

Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis

BACKGROUND

Adolescence is the period between 10 and 19 years with peculiar physical, social, psychological and reproductive health characteristics. Rates of adolescent pregnancy are increasing in developing countries, with higher occurrences of adverse maternal and perinatal outcomes. The few studies conducted on adolescent pregnancy in Africa present inconsistent and inconclusive findings on the distribution of the problems. Also, there was no meta-analysis study conducted in this area in Africa. Therefore, this systematic review and meta-analysis were conducted to estimate the prevalence and sociodemographic determinant factors of adolescent pregnancy using the available published and unpublished studies carried out in African countries. Also, subgroup analysis was conducted by different demographic, geopolitical and administrative regions.

METHODS

This study used a systematic review and meta-analysis of published and unpublished studies in Africa. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed. All studies in MEDLINE, PubMed, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases were searched using relevant search terms. Data were extracted using the Joanna Briggs Institute tool for prevalence studies. STATA 14 software was used to perform the meta-analysis. The heterogeneity and publication bias was assessed using the I2 statistics and Egger's test, respectively. Forest plots were used to present the pooled prevalence and odds ratio (OR) with 95% confidence interval (CI) of meta-analysis using the random effect model.

RESULT

This review included 52 studies, 254,350 study participants. A total of 24 countries from East, West, Central, North and Southern African sub-regions were included. The overall pooled prevalence of adolescent pregnancy in Africa was 18.8% (95%CI: 16.7, 20.9) and 19.3% (95%CI, 16.9, 21.6) in the Sub-Saharan African region. The prevalence was highest in East Africa (21.5%) and lowest in Northern Africa (9.2%). Factors associated with adolescent pregnancy include rural residence (OR: 2.04), ever married (OR: 20.67), not attending school (OR: 2.49), no maternal education (OR: 1.88), no father's education (OR: 1.65), and lack of parent to adolescent communication on sexual and reproductive health (SRH) issues (OR: 2.88).

CONCLUSIONS

Overall, nearly one-fifth of adolescents become pregnant in Africa. Several sociodemographic factors like residence, marital status, educational status of adolescents, their mother's and father's, and parent to adolescent SRH communication were associated with adolescent pregnancy. Interventions that target these factors are important in reducing adolescent pregnancy.

Understanding premarital pregnancies among adolescents and young women in Ouagadougou, Burkina Faso

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.

Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review

Background

Adolescent pregnancy has been persistently high in sub-Saharan Africa. The objective of this review is to identify factors influencing adolescent pregnancies in sub-Saharan Africa in order to design appropriate intervention program.

Methods

A search in MEDLINE, Scopus, Web of science, and Google Scholar databases with the following keywords: determinants, factors, reasons, sociocultural factors, adolescent pregnancy, unintended pregnancies, and sub- Saharan Africa. Qualitative and cross-sectional studies intended to assess factors influencing adolescent pregnancies as the primary outcome variable in sub- Saharan Africa were included. Our search was limited to, articles published from the year 2000 to 2017 in English. Twenty-four (24) original articles met the inclusion criteria.

Results

The study identified Sociocultural, environmental and Economic factors (Peer influence, unwanted sexual advances from adult males, coercive sexual relations, unequal gender power relations, poverty, religion, early marriage, lack of parental counseling and guidance, parental neglect, absence of affordable or free education, lack of comprehensive sexuality education, non-use of contraceptives, male’s responsibility to buy condoms, early sexual debut and inappropriate forms of recreation). Individual factors (excessive use of alcohol, substance abuse, educational status, low self-esteem, and inability to resist sexual temptation, curiosity, and cell phone usage). Health service-related factors (cost of contraceptives, Inadequate and unskilled health workers, long waiting time and lack of privacy at clinics, lack of comprehensive sexuality education, misconceptions about contraceptives, and non-friendly adolescent reproductive services,) as influencing adolescent pregnancies in Sub-Saharan Africa

Conclusion

High levels of adolescent pregnancies in Sub-Saharan Africa is attributable to multiple factors. Our study, however, categorized these factors into three major themes; sociocultural and economic, individual, and health service related factors as influencing adolescent pregnancies. Community sensitization, comprehensive sexuality education and ensuring girls enroll and stay in schools could reduce adolescent pregnancy rates. Also, provision of adolescent-friendly health services in schools and healthcare centers and initiating adolescent empowerment programs could have a positive impact.

Multilevel determinants of teenage childbearing in sub-Saharan Africa in the context of HIV/AIDS

This paper examined national variations and multilevel determinants of teenage childbearing in sub-Saharan Africa (SSA) in the context of HIV/AIDS using data from recent Demographic and Health Surveys conducted in 29 countries of SSA. Results showed significant community and national variations in teenage childbearing, partly explained by socio-economic and HIV/AIDS context. At community level, lower HIV/AIDS stigma, higher wealth and female education were associated with lower teenage childbearing. However, national socio-economic status had an intricate relationship with teenage childbearing. Higher national GDP per-capita was generally associated with higher teenage childbearing, and this relationship was stronger in lower HIV prevalence countries.

Newborn Care Practices among Adolescent Mothers in Hoima District, Western Uganda

INTRODUCTION

Adolescent childbearing remains a major challenge to improving neonatal mortality especially in Sub Saharan countries which are still struggling with high neonatal mortality rates. We explored essential newborn care practices and associated factors among adolescent mothers in Western Uganda.

METHODS

Data were collected among 410 adolescent mothers with children aged one to six months in Hoima district. Three composite variables (appropriate neonatal breastfeeding, cord care and thermal protection) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression analysis was conducted to identify factors independently associated with practice of essential newborn care.

RESULTS

Appropriate newborn feeding, optimal thermal protection and dry cord care were practiced by 60.5%, 67.2% and 31% of adolescent mothers respectively. Independent predictors' of cord care were: knowledge of cord care (AOR 5.34, 95% CI (1.51-18.84) and having delivered twins (AOR 0.04, 95% CI (0.01-0.22). The only predictor of thermal care was knowledge (AOR 25.15, 95% CI (7.01-90.20). Staying in a hospital for more than one day postpartum (AOR 2.45, 95%CI (1.23-4.86), knowledge of the correct time of breastfeeding initiation (AOR 14.71, 95% CI (5.20-41.58), predicted appropriate neonatal feeding, whereas; adolescent mothers who had had a caesarean delivery (AOR 0.19, 95% CI (I 0.04-0.96) and a male caretaker in the postnatal period (AOR 0.18, 95% CI (0.07-0.49) were less likely to practice the recommended newborn feeding.

CONCLUSION

Sub optimal essential newborn care practice was noted especially suboptimal cord care. Adolescent mothers should be a focus of strategies to improve maternal and neonatal health.