Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis

Prevalence of teenage pregnancy and associated factors in Uganda: a meta-analysis and systematic reviews protocol

INTRODUCTION

Teenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. More than 90% of these live births are estimated to occur in developing countries. The objective of this review is to estimate the prevalence of teenage pregnancy and its associated factors in Uganda.

METHODS AND ANALYSIS

This review protocol will be registered with the PROSPERO database and will be designed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A literature search will be conducted in PubMed, African Journals OnLine, Science Direct and Google Scholar in December 2023. Observational studies that report the prevalence of teenage pregnancy will be included. Studies will be assessed for the risk of bias in duplicate. The data will be pooled using random-effects models to estimate the prevalence of teenage pregnancy, with a 95% CI and I2 statistic capturing heterogeneity.

ETHICS AND DISSEMINATION

This review will not require ethical approval. The findings from the data synthesis will be published in relevant peer-reviewed journals and conferences targeting adolescent and reproductive health.

PROSPERO REGISTRATION NUMBER

CRD42023486460.

Predictors of adolescent childbearing among Ethiopian women with spatial effect adjustment

BACKGROUND

Childbearing under the age of 20 is referred to as teenage childbearing. Compared to high-income countries, it is significantly higher in low-income countries. Adolescent childbearing is influenced by a number of variables, including economic, demographic, and social factors, and these vary geographically. Thus, this study aimed to determine the predictors of adolescent childbearing among Ethiopian women with spatial effect adjustment.

METHODS

A total weighted sample of 4712 women aged 15 to 49 were included. The data were obtained from the 2019 Ethiopia Demographic and Health Survey. A generalized Geoadditive model which accounts for spatial effect and the non-linear effect of continuous variables was adopted to determine the associated factors of adolescent childbearing among Ethiopian women.

RESULTS

The spatial pattern of adolescent childbearing was non-random in Ethiopia with Moran's index statistics 1.731999 (P-value < 0.001). Based on the evidence of spatial variation in a model, the highest risk of adolescent childbearing was observed in Jijiga, Shinilie, Welwel and Walder, Afar (Zone1 and Zone 5), Assosa, Metekel, and Gambela (Zone1). We also noted that women not intending to use a contraceptive method, Muslim religion, living in a rural area, and large household family size were significantly associated with a high risk of adolescent childbearing. Furthermore, our model results also confirmed that higher educational levels, older household age, and good economic status significantly reduced the risk of adolescent childbearing.

CONCLUSIONS

This study revealed that adolescent childbearing distribution was significantly clustered in the Eastern and Southwestern parts of Ethiopia. Intervention programs aimed at the prevention of early marriage and raising awareness of sexual activity are essential to reducing adolescent childbearing.

Mental health problems in pregnant and postpartum women living with HIV in sub-Saharan Africa: Systematic review and meta-analysis protocol

BACKGROUND

Existing evidence on the burden of mental health problems among pregnant and postpartum women living with HIV, a vulnerable population in sub-Saharan Africa (SSA), is limited and fragmented, affecting the development of context-sensitive and integrated interventions. This systematic review aims to provide an up-to-date and comprehensive synthesis of available evidence to estimate the burden and identify the determinants of mental health problems among pregnant and postpartum women living with HIV across countries in sub-Saharan Africa.

METHODS

We will retrieve all relevant studies (published and unpublished) through searches in PubMed, Embase, PsycINFO, CINAHL, LILACS, Google Scholar, Scopus and Web of Science from inception to 30th June 2024, without language restriction. We will use the following search terms 'mental health disorder', 'mental health problem', 'pregnant women', 'postpartum women' and 'HIV' nested with all applicable alternate terms and the names of countries in SSA for running the searches. We will also search HINARI, African Index Medicus, African Journals Online, Academic Search Premier, medRxiv, ProQuest, EBSCO Open Dissertations, and reference lists of relevant studies. We will contact experts in the field for potentially relevant unpublished studies. All retrieved articles from the electronic databases and grey literature will be collated and deduplicated using Endnote and exported to Rayyan QCRI. Two reviewers will independently select studies using a pretested study selection flow chart developed from the pre-specified eligibility criteria. Two reviewers will extract data using a pretested data extraction form and assess the risk of bias in the included studies using the risk of bias tool for prevalence studies by Hoy et al. (2012). Any disagreements will be resolved through discussion between the reviewers. Binary outcomes (prevalence and incidence of mental health problems among pregnant and postpartum women living with HIV) will be evaluated using pooled proportions (for non-comparative studies) and odds ratio (OR) or risk ratio (RR) (for comparative studies), and mean difference for continuous outcomes, all will be reported with their 95% confidence intervals (CIs). Heterogeneity will be assessed graphically for overlapping CIs and statistically using the I2 statistic. If substantial heterogeneity is found, random-effects model meta-analysis will be performed; otherwise, fixed-effect meta-analysis will be employed. We will conduct subgroup analysis (to assess the impact of heterogeneity) and sensitivity analyses to test the robustness of the generated effect estimates to the quality domains. The overall level of evidence will be assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations).

EXPECTED OUTCOMES

The review is expected to produce an up-to-date and comprehensive synthesis of the available evidence, allowing for the generation of country-specific estimates of the burden of mental health problems among mothers living with HIV across SSA populations. Also, the review will attempt to identify the determinants of mental health problems among pregnant and postpartum women living with HIV, to shed light on the factors that contribute to the occurrence of mental health problems in this vulnerable population.

SYSTEMATIC REVIEW REGISTRATION

The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO), with registration ID CRD42023468537.

Between 'block course relationships' and abstinence: cultures of sexuality among students at Addis Ababa University

Inspired by African and other feminist scholarship on gender, sexuality and agency, this article studies narrations of norms and practices in sexual relationships between university students. A main aim of the article is to move beyond the problem focus in earlier scholarship on women, sexuality and reproduction, and to identify potential spaces of freedom and expansion of female agency. The article is based on qualitative research conducted with students at Addis Ababa University. The findings a vivid space for male-female relationships. Study participants report being sexually engaged as "the new normal" and claim that many female students are active both in seeking relationships and in discontinuing them. These ideas and practices indicate increasing female agency and emerge in stark contrast to dominant social norms for sexual conduct, which demand chastity before marriage, particularly for women. Students are conscious of this discrepancy and bring it up in their narratives. Findings also show that some students prefer to stay abstinent and make an effort to avoid sexual relations. We argue that expressions of female agency are evident not only in norm-transgressive sexual conduct, but also in norm-conforming strategies of sexual abstinence.

Knowledge and experiences of adolescent girls and young women in the use of sexual reproductive health and HIV services at health facilities in Maputo City, Mozambique

Background

Knowledge and use of sexual reproductive health and human immunodeficiency virus (SRH and HIV) services are crucial for the prevention of pregnancy and sexually transmitted infections (STIs) among adolescent girls and young women (AGYW). This study aims to assess the knowledge and perceptions of AGYW about the SRH and HIV services offered in health facilities in Maputo, Mozambique.

Material and methods

A cross-sectional descriptive study was conducted based on exit surveys with AGYW held at Zimpeto and 1° de Junho Health Facilities in Maputo City, between May 1, and June 9, 2023. Data were analyzed through descriptive statistics, t-test and ANOVA, using SPSS version 20.

Results

590 AGYW, aged 15-24 years of age, were included in the study. In general, knowledge of SRH and HIV services was fairly high, with knowledge of each specific service offered ranging between 38% and 97%. Knowledge about SRH and HIV services differed depending on the health facility where the AGYW sought SRH and HIV services; the participant's age; their occupation; their religion, and who they lived with. Counseling services were the most commonly reported services attended, with >90% of participants reporting having received counseling for each of the following: STI and HIV and pregnancy prevention, sexuality, and safer sex practices. The quality of SRH and HIV services, and attitudes of the providers were considered good by >90% of AGYW. Roughly 95% of AGYW at Zimpeto Health Facility were either "satisfied" or "very satisfied". Whereas at 1° de Junho Health Facility, only roughly 75% of AGYW were either "satisfied" or "very satisfied", and roughly 20% of AGYW were "little satisfied that their needs had been met that day.

Conclusions

Among AGYW there is high levels of knowledge about counseling services in contrast to diagnostics, treatment and clinical care. Specific attention should be given to ensuring appropriate physical infrastructure, such as dedicated adolescent friendly spaces and comfortable seating, and targeted interventions designed and implemented for those health facilities's identified. Targeted interventions should be designed and implemented for those HF's identified with lower AGYW perceived quality of service delivery.

Adolescent pregnancy, maternal and child anaemia: Empirical analysis from India, Bangladesh, and Nigeria

Early childbearing poses several potential risks to maternal and child health. This paper empirically analyses the association between teenage pregnancy and child nutritional status, maternal and child anaemia in three countries (Nigeria, India and Bangladesh) that account for the highest proportion of teenage births and/or total number of malnourished teenage mothers and children. Data were sourced from nine waves of Demographic and Health Surveys conducted in Bangladesh, India, and Nigeria from 2005-2018, covering a sample of 27,705 children from Bangladesh, 266,308 children from India and 54,719 children from Nigeria. Our outcome measures of maternal and child nutrition include (i) a composite measure of anthropometric failure for children (CIAF), (ii) maternal anaemia, (iii) childhood anaemia, and (iv) anaemia in maternal-child pairs. Using multivariate regression analysis, we examine the associations between early childbirth, child nutrition, and maternal and child anaemia, controlling for an array of household-level socioeconomic and demographic characteristics. Across all three countries, the prevalence of CIAF (childhood anthropometric failure) is significantly higher among children born to women aged below 17 at first birth. We further find that early pregnancy and childbearing are associated with significantly higher rates of severe/moderate anaemia among both mothers and children in Bangladesh and Nigeria. In the three countries studied, the proportions of teenage mothers with vulnerable socioeconomic status and suboptimal pre-conception care are relatively high, which raises the risk of maternal and child morbidity as well as mortality.

High-risk fertility behaviors and associated factors among married reproductive-age women in sub-Saharan Africa: A multilevel mixed-effect analysis of nationally representative data from 35 countries

BACKGROUND

Although high-risk fertility behaviors are linked with poor maternal and child health outcomes, their prevalence remains higher in resource-limited countries and varies significantly by context. Evidence on the recent estimates of these fertility risks at the sub-Saharan Africa level is limited. Therefore, this study aimed to examine the pooled prevalence of high-risk fertility behaviors and associated factors among married women in this region.

METHODS

Data from DHS of 35 sub-Saharan African countries were used and a weighted sample of 243,657 married reproductive-age women were included in the analysis. A multilevel binary logistic regression models were fitted and the final model was selected based on the log-likelihood and deviance values. A p-value less than 0.05 and an adjusted odds ratio with a corresponding 95% confidence interval were used to identify the factors associated with high-risk fertility behaviors.

RESULTS

The pooled prevalence of high-risk fertility behaviors among women in sub-Saharan Africa was 77.7% [95% CI = 77.6%-77.9], where 43.1% [95% CI: 42.9%-43.3%], and 31.4% [95% CI = 31.2%-31.6%] had a single risk and combination of two or three fertility risks, respectively. The highest level of single-risk fertility pattern was observed in Burundi (53.4%) and Chad had the highest prevalence of both at least one (89.9%) and multiple (53.6%) fertility risks. Early and polygamous marriages, low maternal and husband education, poor wealth index, unmet need for contraception, couple's fertility discordance, rural residence, high community-level early marriage practice, and low community-level women empowerment were associated with risky fertility behaviors.

CONCLUSIONS

More than three-quarters of married women in SSA were engaged in high-risk fertility behaviors, with significant variations across the included countries. Therefore, addressing the modifiable risk factors like improving access to need-based contraceptive methods and empowering couples through education for a better understanding of their reproductive health with particular attention to rural settings are important in reducing these fertility risks. The results also suggest the need to strengthen the policies regulating the prohibition of early and polygamous marriages.

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.

Adolescent girls and young women's (AGYW) access to and use of contraception services in Cape Town: perspectives from AGYW and health care providers

BACKGROUND

Access and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers' perceptions and experiences of providing contraception services to AGYW.

METHODS

Data were collected through semi-structured individual interviews with AGYW aged 15-24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa's Western Cape Province. Thematic analysis was used to analyse the data.

RESULTS

AGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW's access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers' hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW's access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers' work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW.

CONCLUSION

The expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider's hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW's access to and use of contraception services, and subsequently achieve the country's SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers.

Associations between lifetime pregnancy and sexual risk behaviors among 15-24-year-old adolescent girls and young women in South Africa: Secondary analyses of the 2016 Demographic Health Survey

Adolescent girls and young women (AGYW) in South Africa are highly vulnerable to HIV and poor sexual and reproductive health (SRH) outcomes. Interventions must respond to the unique needs of different AGYW groups, such as AGYW who have ever been pregnant. The objective of the study is to examine associations between pregnancy and sexual risk behaviors among AGYW in South Africa. This study used the 2016 nationally representative Demographic and Health Survey (DHS) of South Africa (n = 1935, 15-24 years old). Sexual risk behavior outcomes included: early sexual debut (defined as having sexual intercourse before the age of 15 years), age-disparate relationship (defined as having sexual partners who are five years and older in the past one month), multiple sexual partnerships, no condom use at last sex, and lastly, cumulative sexual risk (defined as reporting at least two of the outcomes: early sexual debut, age-disparate relationship, multiple sexual partners, and no condom use at last sex). Data analyses were conducted using logistic regression in STATA version 16. Statistical significance was determined at a P-value less than 0.05, with 95% confidence interval reported. AGYW who experienced lifetime pregnancy were more likely to report early sexual debut (OR = 1.71, 95%CI = 1.30-2.32), age-disparate relationships (OR = 1.58, 95%CI = 1.20-2.08), no condom use at last sex (OR = 2.77, 95%CI = 2.09-3.69), and cumulative sexual risk (OR = 1.82, 95%CI = 1.38-2.41). Multiple sexual partnerships showed no significant associations with lifetime pregnancy. Married or cohabiting AGYW were more likely to report cumulative sexual risk behaviors. (OR = 2.67, 95%CI = 1.91-3.71). Cumulative sexual risk behaviors were lower among AGYW with secondary education (OR = 0.57, 95%CI = 0.33-0.99) and those from rich households (OR = 0.62, 95%CI = 0.43-0.88). The findings underscore the need for interventions promoting safe sex and relationships, especially among AGYW who have experienced pregnancy. Programming should address the structural, socio-economic drivers of early pregnancy.

Fertility preservation and protection: young women's decision-making about contraceptive use in Zimbabwe

The study explored social and health system influences on young women's decision-making about family planning in a community setting with low uptake. Seventy-two semi-structured interviews were conducted between April 2020 and November 2021, with both young women accessing, and healthcare workers providing, a community-based integrated package of HIV and sexual and reproductive health services (CHIEDZA) in Zimbabwe. Data were thematically analysed. Although long-acting contraception was freely available as part of the CHIEDZA initiative, uptake was low. Young women's contraception choices were influenced by a desired reproductive sequence, which reflected prevailing social norms and was conveyed by peers and female relatives. Nulliparous young women preferred short-term contraception and avoided hormonal contraceptives prepartum to 'preserve' their fertility. Once fertility had been confirmed within marriage through the birth of a child, hormonal contraceptive use became socially permissible. Healthcare workers, cognisant of community discourse, sensitively proposed alternative approaches. Increasing the availability of correct and adequate information and commodities is critical to improving the uptake of contraceptives for young women, but it is insufficient alone. Recognising and responding to local contextual understandings which frame considerations of appropriateness is paramount. Successful implementation of family planning interventions requires engaging with social norms and the influential groups that perpetuate them.

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.

Pooled prevalence and associated factors of teenage pregnancy among women aged 15 to 19 years in sub-Saharan Africa: evidence from 2019 to 2022 demographic and health survey data

BACKGROUND

Teenage pregnancy is becoming one of the most common social and public health problems worldwide, with the highest prevalence in sub-Saharan Africa. Health risks and adverse outcomes of pregnancy and childbirth among adolescent girls are the commonest cause of the global burden of maternal morbidity and mortality. This study is intended to determine the pooled prevalence and determinants of teenage pregnancy in sub-Saharan Africa using the most recent demographic and health survey data (2019-2022).

METHODS

A cross-sectional study was conducted using data from the most recent demographic and health surveys of four countries (Kenya, Tanzania, Gabon, and Cameroon) in sub-Saharan Africa conducted between 2019 and 2022. A total weighted sample of 12,829 teenagers aged 15 to 19 years was included in the study. Data extracted from demographic and health survey data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the dependent variable. Finally, variables with a p-value ≤ 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.

RESULTS

The pooled prevalence of teenage pregnancy among women aged 15 to 19 years was 18.15% (95% CI: 17.49, 18.83). Teenage pregnancy was positively associated with the respondent's age [AOR = 2.97; 95% CI (2.55, 3.46)], educational status [AOR = 2.21; 95% CI (1.62, 3.03)] and [AOR = 1.80; 95% CI (1.54, 2.12)], wealth status [AOR = 2.61; 95% CI (2.12, 3.22)] and [AOR = 1.65; 95% CI (1.33, 2.05)], relation to the household head [AOR = 2.09; 95% CI (1.60, 2.72)], and unmet need for contraception [AOR = 14.3; 95% CI (11.5, 17.8)]. On the other hand, it was negatively associated with marital status [AOR = 0.08; 95% (0.07, 0.10)], working status [AOR = 0.75; 95% CI (0.64, 0.88)], age at first sex [AOR = 0.68; 95% CI (0.58, 0.80)], contraceptive use [AOR = 0.25; 95% CI (0.20, 0.30)], contraceptive knowledge [AOR = 0.27; 95% CI (0.19, 0.40)], and community contraceptive utilization [AOR = 0.85; 95% CI (0.73, 0.99)].

CONCLUSION

In the current study, one out of six young women aged 15 to 19 experienced teenage pregnancy. Therefore, addressing unmet needs for family planning, improving women's educational status, and giving special attention to teenagers with low educational and economic status are recommended.

Experiences, prevalence and drivers of disrespect and abuse of adolescents during facility-based childbirth in sub-Saharan Africa: a scoping review protocol

INTRODUCTION

Adolescents are more likely to experience disrespect and abuse (D&A) by skilled health personnel during facility-based childbirth. However, research evidence on the experiences, prevalence and drivers of D&A of adolescents in childbirth is limited. We aim to establish research evidence on the experiences, prevalence and drivers of D&A of adolescents during facility-based childbirth in sub-Saharan Africa and identify gaps in the literature to inform future research.

METHODS AND ANALYSIS

The protocol is designed using Arksey and O'Malley's methodological framework and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will systematically search to retrieve peer-reviewed articles published in English from 2011 to date in PubMed/Medline, EBSCOhost (Africa Wide Information, CINAHL, PsycINFO and SocINDEX), Web of Science (SciELO Citation Index and Web of Science Core Collection) and Scopus. Two independent reviewers will screen the references by titles, abstracts and full texts. Discrepancies in screening results will be resolved through discussions. Key elements of included studies will be charted using a predetermined tool. We will perform numerical analysis and synthesis of narrative accounts of the extent, nature and distribution of review studies.

ETHICS AND DISSEMINATION

No ethical approval is required since the scoping review will use openly available public data and information. Review findings will be disseminated at conferences and published in peer-reviewed journals. No protocol registration is required.

Trends and factors associated with teenage pregnancy in Ethiopia: multivariate decomposition analysis

Teenage is a time of transition from childhood to adulthood. This stage is a time of change and needs particular care and ongoing support. Adolescent pregnancy remains a common health care problem in low- and middle-income countries, and it is associated with higher maternal and neonatal complications. Thus, this study aimed to determine the trends and factors associated with them that either positively or negatively contributed to the change in teenage pregnancy in Ethiopia. Ethiopian Demographic and Health Survey data from 2005 to 2016 were used for this study. A total weighted sample of 10,655 (3265 in 2005, 4009 in 2011, and 3381 in 2016) teenagers was included. Trends and the proportion of teenage pregnancies for each factor over time were explored. Then, a logit-based multivariate decomposition analysis for a non-linear response model was fitted to identify the factors that contributed to the change in teenage pregnancy. Statistical significance was declared at p-value < 0.05 and the analysis was carried out on weighted data. Teenage pregnancy declined significantly from 16.6% (95% CI: 15.4, 17.9) to 12.5% (95% CI: 11.4, 13.6) in the study period, with an annual reduction rate of 2.5%. About 49.8% of the decrease in teenage pregnancy was attributed to the change in the effect of the characteristics. The compositional change in primary educational status (41.8%), secondary or above educational status (24.55%), being from households with a rich wealth index (1.41%) were factors positively contributed to the decline in teenage pregnancy, whereas being from a Muslim religion (-12.5%) was the factor that negatively contributed to the reduction in teenage pregnancy. This study has shown that teenage pregnancy declined significantly; however, it is still unacceptably high. The changes in compositional factors of teenagers were responsible for the observed reduction in the prevalence of teen pregnancy rates in Ethiopia. Educational status, religion, and wealth index were found to be significant factors that contributed to the reduction in teenage pregnancy. Therefore, intervention programs targeting adolescents should address the socio-economic inequalities of these influential factors to reduce teenage pregnancy and related complications.

The profile of adolescent patients presenting to a tertiary maternal mental health clinic

Background

Between March 2021 and April 2022, there were 90 037 documented adolescent pregnancies in South Africa. Statistics SA reports that this number is growing. Pregnancy places adolescents at greater risk of psychiatry-related morbidity and may have far-reaching consequences for their children. To date, there is no published data describing the patient profile of adolescent pregnancies in Gauteng Province, South Africa.

Aim

To describe the patient profile (demographics, schooling history and type of accommodation), pregnancy-related factors, substance use habits and contraceptive use in pregnant adolescents seen at a tertiary care maternal mental health clinic (MMHC).

Setting

The MMHC at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa.

Methods

A retrospective file review of all pregnant adolescents referred to the MMHC between January and June 2022.

Results

The mean age of the patients was 15.2 years; 72% attended school and 97.4% planned to return. Most pregnancies were unplanned (97.9%), wanted (84%) and presented in the second (41.24%) and third (51.55%) trimesters. Most did not report using substances (76.7%). Fifty percent of the participants met the criteria for a major depressive disorder. Repeating a grade was an identifiable risk factor for an increased Edinburgh depression score. An unplanned pregnancy was associated with a higher risk factor assessment.

Conclusion

Pregnant adolescents represent a vulnerable population group. A greater understanding of this patient profile may inform early psychiatric and psychosocial interventions, improved service delivery and help-seeking behaviour.

Contribution

This study gives significant insights into the challenges faced, as well as the health and social needs of pregnant adolescents. This contributes to wholistic care and opportunities for early intervention, including awareness of contraceptive use and the risks of substance use and adolescent pregnancy on mental health, benefiting all South African adolescents.

Teenage pregnancy matters in refugee setup: early pregnancy among adolescent girls in Kule refugee camp, Gambella, Ethiopia

BACKGROUND

An estimated 21 million adolescent girls become pregnant with nearly half of these pregnancies being unintended, and more than half end in unsafe abortion in low and middle-income countries every year. Teenage pregnancy causes serious health, social, and economic consequences around the globe. Despite it is a common problem in the whole community it is more devastating when this occurs in a refugee setup. This study assessed the magnitude of teenage pregnancy in the Kule refugee camp, in Ethiopia.

METHODS

A community-based mixed cross-sectional study was done among 422 adolescent girls. Participants were selected using a systematic sampling technique. A structured, pre-tested, and interviewer-administered questionnaire was used to collect the data. Binary and multivariable logistic regression was used to identify associated factors. Adjusted odds ratio with 95% CI was used to show the strength and direction of the association. For the qualitative part, four focused group discussion sessions were done, and participants were selected purposely. Thematic analysis was used to analyze, and the finding was triangulated with quantitative findings.

RESULT

A total of 146 adolescents (34.6%, 95% CI: (29.9, 38.9)) have experienced pregnancy at least one time. Age (≤ 16) [AOR = 0.48, 95% CI: (0.27, 0.85)], not attending school [AOR = 3.59, 95% CI: (1.2, 10.8)], having a mother with no history of teenage pregnancy [AOR = 0.45, 95% CI: (0.21, 0.98)], being unmarried [AOR = 0.21, 95% CI: (0.12, 0.36)], and having a sister/s with a history of teenage pregnancy [AOR = 2.22, 95% CI: (1.33, 3.7)] were significantly associated factors.

CONCLUSION

More than one-third of adolescents experience teenage pregnancy. The magnitude of teenage pregnancy was high which may lead to serious health consequences for both the mother and their fetus. Addressing cultural barriers and strengthening adolescent reproductive health education to decrease intergenerational transmission of teenage pregnancy through community awareness and strengthening reproductive parent-adolescent Sexual and Reproductive Health communication are important measures to tackle the problem.

Key normative, legal, and policy considerations for supporting pregnant and postpartum adolescents in high HIV-burden settings: a critical analysis

Rates of adolescent pregnancy within sub-Saharan Africa are increasing. Adolescent mothers ages 10-19 years face a distinct set of risks to their own and their children's health, compounded by many economic, social, and epidemiological challenges, such as living with HIV. In navigating this complex developmental period, many adolescent mothers face structural barriers impeding safe transitions to adulthood and motherhood. Drawing on existing literature and emerging data, we outline three normative, legal, and policy issues - violence and gender inequity, access to sexual and reproductive health services, and access to social and structural supports - which affect the health, wellbeing and development of adolescent mothers and their children. We also highlight emergent evidence about programming and policy changes that can better support adolescent mothers and their children. These key proposed responses include removing barriers to SRH and HIV service integration; ensuring implementation of return-to-school policies; and extending social protection systems to cater for adolescent mothers. Despite ongoing global crises and shifts in funding priorities, these normative, legal, and policy considerations remain critical to safeguard the health and wellbeing of adolescent mothers and their children.

Determinants of Adolescent Sexual and Reproductive Health in Sub-Saharan Africa: Protocol for an Umbrella Review

BACKGROUND

Adolescents are a large proportion of the population in sub-Saharan Africa and face multiple risks to their health and well-being. Prior systematic reviews have focused on specific adolescent sexual and reproductive health outcomes such as teen pregnancies, HIV/AIDS, and sexually transmitted diseases. A comprehensive synthesis of the influential factors that shape different aspects of adolescent sexual and reproductive health can inform health policy and program development for this important segment of the population.

OBJECTIVE

This paper presents the protocol for an umbrella review that aims to synthesize the existing knowledge in the literature on the associations among individual, family, and societal factors and sexual and reproductive health outcomes among adolescents in sub-Saharan Africa.

METHODS

We will include systematic reviews that identify factors associated with sexual and reproductive health outcomes among adolescents, 10-19 years of age, in sub-Saharan Africa. Reviews can include quantitative and qualitative primary studies with or without meta-analysis. Academic and gray literature searches will identify reviews from PubMed, Scopus, CINAHL, Cochrane Database of Systematic Reviews, ProQuest, Google, and Google Scholar. Two reviewers (MZG and KO) will independently carry out title, abstract, and full text screening, assess methodological quality, and extract data. We will assess the methodological quality of the included studies using the Joanna Briggs Institute standard forms. The review will present findings in narrative form and in tables and will follow PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines.

RESULTS

A preliminary search in April 2023 found 1351 articles to be screened.

CONCLUSIONS

This umbrella review will permit a comprehensive and high-level understanding of the various factors that influence adolescent sexual and reproductive health in sub-Saharan Africa.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023394512; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394512.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51278.

Knowledge and awareness of policies and programmes to reduce adolescent pregnancy in Ghana: a qualitative study among key stakeholders

INTRODUCTION

Adolescent sexual and reproductive health continues to be a major public health issue in low-and middle-income countries. While many countries have policies aimed at reducing adolescent pregnancy, evidence of their impact is unclear. This study sought to explore the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana.

METHODS

We employed a cross-sectional, qualitative study design involving semi-structured interviews with 30 key informants (health and education professionals and grassroot workers) in the Central Region of Ghana. We also conducted a desktop review of policies aimed at reducing adolescent pregnancy in Ghana. We used content analysis to analyse the data.

RESULTS

Eight of the 30 participants demonstrated awareness of policies aimed at reducing adolescent pregnancy but only two could elaborate on this. By contrast, 19 of the 30 participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under each programme. Despite participants' low policy awareness and knowledge, their descriptions of the activities carried out under each programme aligned with the strategies and activities of the policies mentioned, as evident from the desktop review of the policies.

CONCLUSION

Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy.

Magnitude and Factors Associated with Teenage Pregnancy in Somaliland: Evidence from Somaliland Health and Demographic Survey, 2020

Purpose

Teenage pregnancy is estimated to be common in Somaliland. It is linked with adverse perinatal outcomes. However, no study has been conducted in the country on this subject. Therefore, this study intended to assess the magnitude and factors associated with teenage pregnancy in Somaliland.

Patients and Methods

Data from the 2020 Somaliland Health and Demographic Survey (SLHDS); were used in the current analysis. A total sample of 3,786 women in reproductive age groups were involved as participants. The survey used a two-level cluster sampling design, which included initial selection of enumeration areas followed by selection of households. To identify associated factors, binary logistic regression analysis was applied.

Results

The magnitude of teenage pregnancy was 47.2% (95%CI: 45.5-48.9%). Being a nomadic resident (AOR: 1.26; 95%CI: 1.12-1.71), being in the lowest wealth quintiles (AOR: 1.34; 95%CI: 1.01-1.77), being in the Sanaag region (AOR: 1.95;95%CI: 1.54-2.46) and having lower educational attainment (AOR: 2.29; 95%CI: 1.08-4.83) were significantly associated with teenage pregnancy.

Conclusion

Teenage pregnancy is highly prevalent in Somaliland and associated with a lower educational level, lower wealth quintiles and nomadic residence. Hence, governmental and non-governmental organizations should work on educating and financially empowering women by giving particular focus to nomadic people.

Prevalence and factors associated with early childbearing in sub-saharan Africa: evidence from demographic and health surveys of 31 countries

BACKGROUND

Early childbearing remains a public health concern in sub-Saharan Africa (SSA) because it has substantial implications for women's and children's health and population control. However, little is known about recent changes in early childbearing in the region following the implementation of the Family Planning 2020 initiative (FP2020) national-level interventions. Thus, this study examined factors associated with early childbearing among women in SSA.

METHODS

The study used data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2021. The analysis included a pooled sample of 54,671 parous young women aged 20-24 years. A multivariable binary logistic regression model was used to examine the association between early childbearing and individual and household-level factors. All analyses were weighted to account for complex survey design.

RESULTS

The study shows that the mean prevalence of early childbearing was high in SSA at 39% (95% CI: 35, 43). Chad had the highest prevalence of early childbearing, 62% (95% CI: 60, 64) while Rwanda had the lowest prevalence of 13% (95% CI: 11, 15). Completing secondary school (aOR = 0.57; 95% CI: 0.52, 0.62) or attaining tertiary level education (aOR = 0.32; 95% CI: 0.22, 0.45), first sexual debut in the age range 15-24 years (aOR = 0.15; 95% CI: 0.14, 0.16) and desire for a small family size (aOR = 0.63; 95% CI: 0.58, 0.69) were associated with reduced odds of early childbearing among young women in SSA.

CONCLUSION

The study has established that the prevalence of early childbearing is high in SSA. Level of education, age at first sexual debut, household size, and desired family size are associated with early childbearing in SSA. Governments of SSA countries should enhance sexual and reproductive health interventions to change reproductive behaviour, particularly in adolescents and young women.

Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review

BACKGROUND

Adolescent pregnancy is a global public health and social problem that affects both developed and developing countries. Reducing adolescent pregnancy is central to achieving sustainable development goals. In 2021 Nigeria's Adolescent pregnancy was 106 per 1000 and showed an increasing rate. This study, therefore, aims to explore the literature to map the risk factors and interventions against adolescent pregnancy in Nigeria.

METHOD

A scoping review of studies published between January 2007 and December 2022 using PubMed, Web of Science and Africa Journals Online were searched using the keywords' adolescent pregnancy' AND 'Nigeria'. Studies were screened using the eligibility criteria.

RESULTS

A total of 241 articles, of which 229 were identified through the databases and 12 were identified through hand search. After the full-text review, 28 studies met the inclusion criteria and were included in the final review. In Nigeria, the prevalence of adolescent pregnancy is between 7.5 and 49.5%. Associated factors for adolescent pregnancy in Nigeria are multifactorial, including individual, community, societal, school, family, and peer factors. Policies on adolescent sexual and reproductive health exist in Nigeria. Still, the policies need more sponsorship, implementation, and monitoring, while only some interventions on adolescent pregnancy majorly based on contraceptives and education of health providers are available in Nigeria.

CONCLUSION

Associated factors for adolescent Pregnancy in Nigeria are multidimensional, with educational attainment and wealth index being the highest associated factor. Intervention strategies aimed at the educational level have been identified as a critical factor in curbing adolescent pregnancy. Thus, policies on sexual, reproductive, and mental health development specifically targeting adolescents to reduce the cycle of societal dependence by empowering this group economically and educationally are justifiably warranted.

The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial

BACKGROUND

The growing population of adolescents and young people (AYP) aged 15 to 24 in sub-Saharan Africa face a high burden of HIV in many settings. Unintended pregnancies among adolescent girls in the region remain high. Nonetheless, the sexual and reproductive health (SRH) service needs of AYP have remained underserved. We conducted a cluster-randomised trial (CRT) to estimate the impact of community-based, peer-led SRH service provision on knowledge of HIV status and other SRH outcomes, including met need for contraceptives.

METHODS AND FINDINGS

Yathu Yathu was a cluster-randomised trial (CRT) conducted from 2019 to 2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones (approximately 2,350 AYP/zone) that were randomly allocated to the Yathu Yathu intervention or control arm. In each intervention zone, a community-based hub, staffed by peer support workers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15 to 24 were given a Yathu Yathu card, which allowed them to accrue points for accessing SRH services at the hub and health facility (intervention arm) or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive to use SRH services in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome: knowledge of HIV status (self-reporting living with HIV or HIV testing in the last 12 months) and secondary outcomes, including use of pre-exposure prophylaxis (PrEP) in the last 12 months, current use of antiretroviral therapy (ART), and met need for contraceptive services. The sampling was stratified on sex and age group, and we analysed data at cluster-level using a two-stage process recommended for CRTs with <15 clusters/arm. A total of 1,989 AYP consented to participate in the survey (50% male); consent was similar across arms (63% consent/arm). Across zones, knowledge of HIV status ranged from 63.6% to 81.2% in intervention zones and 35.4% to 63.0% in control zones. Adjusting for age, sex, and community, knowledge of HIV status was higher in the intervention arm compared to control (73.3% versus 48.4%, respectively, adjusted prevalence ratio (PR) 1.53 95% CI 1.36, 1.72; p < 0.001). By age and sex, results were similar. There was no evidence for impact on any secondary outcomes, including current use of ART and met need for contraceptives. There were no adverse events reported in either arm. A key limitation of our trial is that approximately 35% of the AYP randomly selected for participation in the endline survey could not be reached.

CONCLUSIONS

Delivering community-based, peer-led SRH services increased knowledge of HIV status among AYP, both males and females, compared with the control arm. Scaling up the highly effective Yathu Yathu strategy has the potential to make a substantial contribution to increasing access to HIV prevention and care services for young people. However, additional implementation research is needed to understand how to improve uptake of broader SRH services, beyond uptake of HIV testing.

TRIAL REGISTRATION

ISRCTN75609016, clinicaltrials.gov number NCT04060420.

Nutritional status and its determinants among adolescents with HIV on anti-retroviral treatment in low- and middle-income countries: a systematic review and meta-analysis

PURPOSE

This review aimed to determine what methods are used to assess nutritional status, the levels of nutritional status, determinants of undernutrition, and nutritional interventions employed for adolescents with HIV on Anti-Retroviral Therapy follow-up in Low- and Middle-Income countries.

METHODS

Established methods were used to systematically identify and retrieve studies published in five databases between January 2000 to May 2021, and citation searching. Quality was appraised and findings were synthesized using narrative analysis and meta-analysis.

RESULT

Body Mass Index is the major indicator of nutritional status. The pooled prevalence of stunting, wasting, and overweight were 28.0%, 17.0%, and 5.0%, respectively. Adolescent males are 1.85 and 2.55 times more likely than adolescent females to suffer from both stunting and wasting at AOR = 1.85 (95%:1.47, 2.31) and AOR = 2.55 (95%: 1.88, 3.48), respectively. Similarly, adolescents with a history of opportunistic infections were 2.97 times more likely to be stunted than uninfected adolescents, AOR = 2.97 (95%:1.73, 5.12). One single intervention study found significant improvements in anthropometric status after nutritional supplementation.

CONCLUSION AND RECOMMENDATION

The few studies that have been conducted on nutritional status in adolescents living with HIV in low- and middle-income countries indicate that stunting and wasting are common in this population. Avoiding opportunistic infections is an important protective factor but the review highlighted the generally inadequate and fragmented nature of nutritional screening and support programs. Development of comprehensive and integrated systems for nutritional assessment and intervention services during ART follow-up should be prioritized to improve adolescent clinical outcomes and survival.

Prevalence, Trends, and Factors Associated with Teen Motherhood in Nigeria: An Analysis of the 2008-2018 Nigeria Demographic and Health Surveys

Background: Teen pregnancy and childbearing are common in Nigeria, and understanding the complexities, such as sociodemographics and economic factors including sexual and reproductive health knowledge and awareness among adolescents over time can trigger innovative approaches and interventions. This study intends to capture the patterns and associated factors of teen motherhood among sexually active adolescents (15-19 years) between 2008 and 2018. Methods: The study data was extracted from 2008, 2013, and 2018 Nigeria Demographic and Health Surveys. Descriptive analysis was presented using frequencies and percentages; multivariable analysis was conducted using log-binomial logistic regression at a p-value <0.05. All analyses were performed using Stata 15.0, weighted and adjusted for the complex survey design and population size. Results: The prevalence of teen motherhood increased between the three successive survey waves (50.9% vs. 52.4% vs. 55.2%) from 2008, 2013, and 2018. Although, the pooled adjusted analysis revealed no significant change over the 10-year period. Knowledge of modern contraceptive methods, primary education, non-Catholic Christians, residing in the South-South region, and those currently or formerly married were associated with increased risk of teen motherhood. There was an inverse relationship between teen motherhood and wealth status; lower wealth status was associated with high adolescent pregnancy and childbearing. Conclusion: This study revealed an increase in the proportion of teen pregnancy and childbearing in Nigeria. Notably, there exist variations across age groups, geographic location, educational level, religious belief, marital and economic status. Interventions that ensure comprehensive sexuality education, girl child education, and economic empowerment especially for school dropouts are advocated to reduce teen motherhood.

Psychosocial determinants of pre-exposure prophylaxis use among pregnant adolescent girls and young women in Cape Town, South Africa: A qualitative study

BACKGROUND

In South Africa, at least 7.5 million people (age ≥15 years) are living with Human Immunodeficiency Virus (HIV). In 2020, 220,000 new infections occurred, approximately one-third of which were among cisgender adolescent girls and women (age ≥15 years). The perspectives of pregnant adolescent girls and young women (AGYW) as key, targeted end-users of pre-exposure prophylaxis (PrEP) in this setting are not well known.

METHODS

We purposively recruited participants enrolled in an ongoing cohort study at an urban antenatal clinic in Cape Town, South Africa for in-depth interviews between July-September 2020. We restricted our analysis to pregnant AGYW (age: 16-25 years) who initiated daily oral PrEP (Tenofovir/Emtricitabine) antenatally and self-reported either high PrEP persistence (≥25 days in the past 30 days and no missed PrEP collection), or low PrEP persistence and/or discontinuation (missing >5 days in the last 30 days or missed PrEP collection). The findings were organized thematically, per the adapted Health Behavior Model (2000), using Nvivo-v.1.5.

RESULTS

We interviewed 18 AGYW (mean age = 22 years), at a mean of 14 weeks postpartum. Higher self-esteem and high-quality study provider-client relationships, including empathic psychosocial support, facilitated PrEP continuation. Reported barriers included unstable social structure characteristics (i.e., financial hardship) and individual factors (i.e., unintended pregnancy, parental rejection, and inadequate peer- and [non-cohabiting] partner support). Participants self-perceived a need for PrEP, feeling susceptible to non-consensual, forced sex, or considering partners' (presumed) sexual risk-taking. Limited community awareness regarding PrEP availability and/or perceived complexity in navigating health system access to PrEP, impede continuation.

CONCLUSIONS

PrEP-focused healthcare access pathways for pregnant and postpartum AGYW need to be simplified. Further research is needed on health system determinants (i.e., structural barriers, provider-client interactions, and related outcomes) of oral PrEP utilization. In 2022, South Africa announced regulatory approval of long-acting PrEP options (i.e., the dapivirine ring for non-pregnant women and injectable cabotegravir, respectively); these may mitigate implementation barriers reported in this study. However, the safety and efficacy of long-acting PrEP (e.g., injectables, implants) among pregnant or breastfeeding women, specifically, remains to be confirmed in this setting.

Prevalence and factors associated with teenage pregnancy in Sierra Leone: evidence from a nationally representative Demographic and Health Survey of 2019

BACKGROUND

Globally, teenage pregnancy remains a public health concern because of the associated maternal and perinatal morbidity and mortality. To address the extensive social, political and economic effects of teenage pregnancy, there is need for current epidemiological evidence on its prevalence and associated factors, especially from low resource settings where the burden is highest.

METHODS

We used data from the 2019 Sierra Leone Demographic and Health Survey (SLDH), which included 3,427 female adolescents. Multistage stratified sampling was used to select study participants. Teenage pregnancy was defined as those who had ever either had a child, or terminated a pregnancy, or were currently pregnant. Multivariable logistic regression was conducted to determine the factors associated with teenage pregnancy using SPSS version 25(Armonk, NY: IBM Corp).

RESULTS

The prevalence of teenage pregnancy was 22.1% [758/3,427]. Of these, 17.8%, (608/3427), had ever had childbirth, 4.2%, (144/3427), were pregnant, and 1.2%, (40/3427) had ever terminated a pregnancy. After adjusting for confounders, the odds of teenage pregnancy among married girls were about 15 times more than the odds among those who were not married (aOR; 15.31, 95% CI: 11.17-20.98) while the odds of teenage pregnancy among girls from the poorest households were 2.5 times more than the odds among girls from the richest households.

CONCLUSION

The prevalence of teenage pregnancy in Sierra Leone is high. To reduce teenage pregnancy, the government of Sierra Leone and its partners should target married, older teenagers and those from poor households. Policies giving teenage mothers a second chance by encouraging them to return to school after childbirth should be encouraged as an alternative to early marriages.

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.

Correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa

BACKGROUND

Adolescent girls and young women are vulnerable populations who are at risk of several adverse sexual and reproductive health outcomes, including unintended pregnancies, sexually transmitted infections, unsafe abortions, and death from pregnancy-related complications. In this study, we examined the correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa (SSA).

METHODS

We extracted data from the most recent Demographic and Health Surveys (DHS) of 31 countries in SSA. Countries whose surveys were conducted from 2010 to 2020 were included in the study. A total of 108,572 adolescent girls and young women (15-24 years) were included in the study. We used a multilevel mixed-effect binary logistic regression analysis to examine the correlates of repeat pregnancies among adolescent girls and young women in SSA.

RESULTS

We found that adolescent girls and young women aged 20-24 [aOR = 2.36; 95%CI = 2.22, 2.51], those married [aOR = 7.52; 95%CI = 6.81, 8.30], living with a partner [aOR = 7.51; 95%CI = 6.87, 8.21], and those who had sexual intercourse before age 20 [aOR = 1.41; 95%CI = 1.33, 1.51] had higher odds of experiencing repeat pregnancies compared to those aged 15-19, those never in a union, those whose first sexual intercourse occurred at age 20 and above, respectively. Respondents exposed to listening to radio [aOR = 1.12; 95%CI = 1.06, 1.18] and those who justified intimate partner violence [aOR=1.13; 95%CI = 1.07, 1.19] had higher odds of experiencing repeat pregnancies compared to those who never listened to radio and those who did not justify intimate partner violence, respectively. Young women who had attained secondary or higher educational level [aOR = 0.83; 95%CI = 0.78, 0.90], those exposed to reading newspaper or magazine [aOR = 0.90; 95%CI = 0.82, 0.98], those residing in rural areas [aOR = 0.92; 95%CI = 0.86, 0.98], and those belonging to the richer [aOR = 0.87; 95%CI = 0.80, 0.95] and richest [aOR = 0.68; 95%CI = 0.61, 0.76] wealth quintile were less likely to experience repeat pregnancies.

CONCLUSION

The correlates of repeat pregnancies include age, age at first sexual intercourse, marital status, exposure to media, justification of intimate partner violence, wealth index, educational attainment, and place of residence. The findings underscore the need for governments and policymakers in SSA to implement policies that target the most at-risk groups: those with no formal education, the poor, and adolescent girls. Our findings also highlight the need to strengthen advocacy against the justification of intimate partner violence and intensify girl-child education.

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001-2018)

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.

Prevalence of teenage pregnancy and its associated factors in high fertility sub-Saharan Africa countries: a multilevel analysis

BACKGROUND

Teenage pregnancies are persistently high among adolescent women in high fertility countries in sub-Saharan Africa. It has been attributed to the high unmet need for family planning in this population. The aim of this study was to determine the prevalence and factors associated with teenage pregnancy in high fertility countries in sub-Saharan Africa.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 33,391 adolescent girls who had ever had sexual contact were included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors for teenage pregnancy. Finally, the Adjusted Odds Ratio (AOR) with a 95% confidence interval was used to declare as statistically significant.

RESULTS

The overall teenage pregnancy in sub-Saharan Africa high frtility countries was 24.88% (95% CI, 24.42, 25.35). Educational status; no formal education (AOR = 1.39, 95% CI, 1.23, 1.56) and primary education (AOR = 1.45, 95% CI, 1.30, 1.62), not working (AOR = 1.32, 95% CI, 1.21, 1.45), being married (AOR = 67.88, 95% CI, 61.33, 75.12), poor (AOR = 1.47, 95% CI, 1.32, 1.65) and middle wealth quantile (AOR = 1.21, 95% CI, 1.07, 1.35), knowledge about contracptives (AOR = 2.45, 95% CI, 2.19, 2.74), unmet need for family planning (AOR = 2.42, 95% CI, 2.14, 2.74), Angola (AOR = 9.59, 95% CI, 7.82, 11.77), Chad (AOR = 3.05, 95% CI, 2.49, 3.74), DR.Congo (AOR = 3.77, 95% CI, 3.06, 4.65), and Mali (AOR = 1.84, 95% CI, 1.47, 2.28) were factors significantly associated with teenage pregnancy.

CONCLUSIONS

This study found that teenage pregnancy remains a common public health problem in the study areas. Level of education, marital status, occupation, wealth index, unmet need for family planning, knowledge about contraceptives, and country were significantly associated with teenage pregnancy. Hence, for sustainable development goal 3 to be realized by 2030, there must be investment in policy implementation and evaluation, as well as engagement with stakeholders in adolescents' sexual and reproductive health.

Prevalence and Factors Associated with Risky Sexual Behaviors Among Sexually Active Female Adolescents in Zambia

Despite decades long commitment to women's reproductive health rights, sexually transmitted diseases and unintended pregnancies continue to be major public health concerns in sub-Saharan Africa. In order to provide an evidence base for future policy and services, this study aims to explore the prevalence and factors associated with risky sexual behaviors (RSB) among sexually active Zambian female adolescents using a nationally representative sample. Data on females, aged 15-19 (n = 3000), were obtained from the 2018 Zambia Demographic and Health Survey, an interviewer-administered, nationally representative survey that used multistage sampling. The study conducted multiple logistic regression to explore the correlates of RSB. Of the 3000 respondents, 49.7% (1490) reported ever having sexual intercourse of which 71.1% reported engaging in RSB. Among sexually active female adolescents, the following RSB percentage were reported: intercourse before age 16 (50.6%), nonuse of condoms at last intercourse (37.8%), engaging in transactional sex (6.2%), alcohol use at last intercourse (4.6%), and multiple sexual partners (1.9%). Educational attainment and household wealth showed strong inverse trends with RSB risk and there were notably large geographic differences in RSB within Zambia (22.1% in Lusaka region vs. 62.4% in Western province). The multiple logistic regression results revealed that those who were younger, unmarried, with less than secondary education, without access to Internet, and residents of Western Zambia were significantly more likely to have engaged in RSB (AOR: 1.74-7.69, p < 0.05). Given the negative health outcomes associated with RSB, Zambian adolescent health care programs may strategically target limited resources to the identified risk groups.

Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014-2016

Background

Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear.

Objectives

To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania.

Methods

Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014–2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15–19 years, compared to mothers aged 20–29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival.

Results

About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20–29 years-old-mothers, HR 1.80 (95% CI 1.22–2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62–10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers.

Conclusion

Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents’ obstetric care conducted by only skilled personnel should be introduced and implemented.

Socio-economic factors associated with adolescent pregnancy and motherhood: Analysis of the 2017 Ghana maternal health survey

BACKGROUND

Adolescent pregnancy and motherhood have been linked to several factors stemming from social, cultural and to a large extent economic issues. This study examined the socio-economic factors associated with adolescent pregnancy and motherhood in Ghana.

DESIGN

This was a secondary analysis of the 2017 Ghana Maternal Health Survey, which was a nationally representative cross-sectional survey. Data from 4785 adolescents aged between 15-19 years were included in the analysis. Adolescent pregnancy was defined as adolescents who have ever been pregnant, whiles adolescent motherhood was defined as adolescents who have ever given birth. Weighted logistic regression was used to assess the association between the socio-economic variables and adolescent pregnancy and motherhood.

RESULTS

Of the 25062 women aged between 15 and 49 years included in the 2017 maternal health survey, 4785 (19.1%) were adolescents between 15-19 years. Adolescent pregnancy was reported in 14.6% (CI:13.2% -16.1%) of the respondents, whereas 11.8% (CI: 10.5% -13.1%) of the respondents had ever given birth. In the multivariate regression analysis, zone (p<0.001), wealth index (p<0.001), age (p<0.001), marital status (p<0.001) and level of education (p<0.001) were all significantly associated with adolescent pregnancy and motherhood. The odds of pregnancy and motherhood were significantly higher in the Middle and Coastal zones (p<0.001), and among older adolescents (p<0.001). However, the odds of pregnancy and motherhood was significantly lower among adolescents from households with the highest wealth index (p<0.001), among those who were never married (p<0.001) and among adolescents who had secondary/higher education (p<0.001).

CONCLUSION

Several socio-economic variables including education, household wealth, marital status and zone of residence were significantly associated with adolescent pregnancy and adolescent motherhood. Sexual and reproductive health education should be intensified among these populations. Adolescent friendly corners should be made available and accessible to all adolescents in Ghana irrespective of where they live or their age.

"I am not shy anymore": A qualitative study of the role of an interactive mHealth intervention on sexual health knowledge, attitudes, and behaviors of South African adolescents with perinatal HIV

BACKGROUND

South Africa has one of the highest burdens of adolescents with perinatally-acquired HIV (APHIV) in the world. APHIV in South Africa have limited access to sexual and reproductive health (SRH) education and services specific to their HIV status. When lacking comprehensive SRH education, APHIV are prone to sexual risk behaviors that can lead to unintended pregnancy, sexually transmitted infections, and HIV transmission. The use of mHealth interventions has been shown to deliver information, foster social support, and improve decision-making skills. In this study, we evaluate how an mHealth intervention influences sexual health knowledge and behaviors in APHIV.

METHODS

We purposively enrolled adolescents from the intervention arm of a randomized clinical trial assessing a multi-module, moderated WhatsApp-based intervention-Interactive Transition Support for Adolescents Living with HIV (InTSHA)-within a government supported clinic in KwaMashu, an urban township of KwaZulu-Natal, South Africa. We conducted in-depth interviews based on World Health Organization guidelines for asking adolescents about SRH. We thematically analyzed data through an iterative, team-based coding approach combining deductive and inductive elements to contextualize SRH attitudes, knowledge, and behaviors before and after receiving the InTSHA intervention.

RESULTS

Of the 21 participants, 13 (61.9%) were female and the mean age was 16.6 years. Most participants reported first learning about SRH as young teenagers in school through non-targeted and negative ways, seeking clarification through peers and the internet rather than clinicians or caregivers. Participants reported that InTSHA provided a holistic perspective on relationships, gender, and sexuality specific to growing up with HIV in South Africa. They praised the ability to give and receive information from peers in a moderated setting through the mHealth intervention, building their confidence, decision-making skills, and communication with partners and caregivers throughout their everyday lives. Despite reporting some technological challenges, adolescents agreed that InTSHA was convenient, confidential, and user-friendly.

CONCLUSIONS

South African APHIV receive incomplete and conflicting sexual education from peers, caregivers, teachers, and technology that can be supplemented by mHealth curricula targeted for the unique needs of APHIV. Future, scaled-up mHealth interventions can lower SRH stigma by expanding access to sexual education and peer support, supplementing adolescents' existing SRH education.

Teenage pregnancy and its predictors in Africa: A systematic review and meta-analysis

Objective

Although teenage pregnancy has declined in the last decade, it remains a major public health issue in Africa. Maternal mortality is common among teenagers due to their increased risk of obstetric and medical complications. In Africa, there is a lack of robust and comprehensive data on the prevalence and predictors of teenage pregnancy. As a result, this systematic review and meta-analysis were carried out to summarize evidence that will assist concerned entities in identifying existing gaps and proposing strategies to reduce teenage pregnancy in Africa.

Methods

The review is registered by the international prospective register of systematic reviews (CRD42021275013). This search included all published and unpublished observational studies written in English between August 23, 2016, and August 23, 2021. The articles were searched using databases (PubMed, CINHAL [EBSCO], EMBASE, POPLINE, Google Scholar, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, and SCOPUS). Data synthesis and statistical analysis were conducted using STATA version 14 software. Forest plots were used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) of meta-analysis using the random effect model.

Results

A total of 43,758 teenagers (aged 13-19) were included in 23 studies. In Africa, the overall pooled prevalence of teenage pregnancy was 30% (95% CI: 17-43). Western Africa had the highest prevalence of teenage pregnancy 33% (95% CI: 10-55). Age (18-19) (OR = 2.99 [95% CI = 1.124-7.927]), wealth index (OR = 1.84 [95% CI = 1.384-2.433]), and marital status (OR = 6.02 [95% CI = 2.348-15.43]) were predictors of teenage pregnancy in Africa.

Conclusion

In Africa, nearly one-third of teenagers become pregnant. Teenage pregnancy was predicted by age (18-19), wealth index, and marital status. Strengthening interventions aimed at increasing teenagers' economic independence, reducing child marriage, and increasing contraceptive use among married teenagers can help to prevent teenage pregnancy.

Trends and determinants of adolescent pregnancy: Results from Kenya demographic health surveys 2003-2014

Background

Adolescent pregnancy increases the risk of disability and death due to unsafe abortion, prolonged labour and delivery, and complications after birth. Availability of accurate data is important to guide decision-making related to adolescent sexual reproductive health (ASRH). This study analyses the trends in prevalence and factors associated with adolescent pregnancy in Kenya using data from three national Demographic Health Surveys (2003, 2008/2009, 2014).

Methods

Our analysis focused on a subsample of data collected from women aged 20 to 24 years. A trend analysis was performed to establish a change in the rate of adolescent pregnancy in 2003, 2008/2009, and 2014 survey data points. Binary Logistic regression and pooled regression analysis were used to explore factors associated with adolescent pregnancy.

Results

The percentage of women aged 20 to 24 years who reported their first pregnancy between ages 15 and 19 years was 42% in 2003 and 42.2% in 2009 but declined to 38.9% in 2014. Using regression analyses, we established that education status, marital status, religion and wealth quintile were associated with adolescent pregnancy. Trend analysis shows that there was an overall decreasing trend in adolescent pregnancy between 2003 and 2014.

Conclusion

Although Kenya has made strides in reducing the prevalence of adolescent pregnancy in the last decade, much more needs to be done to further reduce the burden, which remains high.

Definition

Adolescents: Although WHO defines the adolescence period as being 10–19 years, this paper focuses on the late adolescent period, 15–19 years, here in referred to as adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01986-6.

The prevalence of teenage pregnancy and early motherhood and its associated factors among late adolescent (15-19) years girls in the Gambia: based on 2019/20 Gambian demographic and health survey data

INTRODUCTION

Pregnancy and early motherhood among teenage girls is the current issue of public health burden in developing countries. Although the Gambia has one of the highest adolescent fertility rates in Africa, there is no data record about it in The Gambia. Therefore, this study aimed to assess the prevalence of pregnancy and early motherhood and its determinants among late adolescent girls in the Gambia.

METHODS

It is a secondary data analysis using the 2019-20 Gambian demographic and health survey data. A total of 2,633 weighted 15-19 years old girls were included in the study. Using Stata 14 version, a pseudo logistic regression analysis method was employed to declare factors significantly associated with pregnancy and early motherhood among 15-19 years old late-adolescent girls in the Gambia. Variables with a p-value of < 0.2 were entered into multivariable regression analysis, and after controlling other confounding factors adjusted odds ratio of 95% CI was applied to identify associated variables.

RESULTS

Pregnancy and early motherhood were found in 13.42% of late adolescent Gambian girls. Logistic regression analysis depicted that a unit increase in adolescent age was positively significantly associated with pregnancy and early motherhood (adjusted odds ratio [aOR] = 2.15; 95% confidence interval [CI] = 1.93,2.39), after period ended knowledge of ovulatory cycle (aOR = 1.99; 95% CI = 1.23,3.22), being from a family size of greater than ten (aOR = 1.25; 95 CI = 1.01,1.55) times more likely to become pregnant and early motherhood than their counterparts respectively. In contrast, rich in wealth (aOR = 0.35; 95% CI = 0.23,0.54), having primary education (aOR = 0.58; 95% CI = 0.43,0.79), secondary and above education (aOR = 0.12; 95% CI = 0.09,0.17).

CONCLUSION

Pregnancy and early motherhood remain significant public health challenges in the Gambia. Strengthening female education, empowerment, reproductive health life skill training and awareness, encouraging disadvantaged females, and designing timely policies and interventions are urgently needed.

Ethically acceptable consent approaches to adolescent research in South Africa

Background

Adolescents are a unique population with significant unmet health needs. They are often excluded from research that may benefit them as they are perceived as vulnerable and needing protection from research participation. For Research Ethics Committees, conflicting positions in statutes, regulations and ethical guidelines about who provides informed consent for adolescent involvement in health research can be a significant barrier to approving adolescent research. For researchers, the requirement for parental/guardian proxy consent or prolonged approval processes may potentially result in the exclusion of those adolescents most vulnerable and at risk, particularly if issues such as gender-based violence, gender identity, sexuality and sexual practices are in question.

Objectives

To describe the challenges to adolescent research and suggest strategies to address these.

Method

We consider the legal and ethical framework in South Africa regarding the consenting age for adolescents in research, outline the challenges and, using examples of best practices, suggest strategies to address the current conundrum.

Results

We suggest three principles to guide Research Ethics Committees on their approach to reviewing health research involving adolescents. Strategies to develop ethically acceptable approaches to adolescent research and consent processes are described, which include community involvement. We elaborate on examples of nuanced approaches to adolescent research.

Conclusion

The inclusion of adolescents in research is critical in informing appropriate and effective health services for this vulnerable population, whilst providing an opportunity to link them into care and services where relevant.

Access to mass media and teenage pregnancy among adolescents in Zambia: a national cross-sectional survey

OBJECTIVE

Teenage pregnancies and childbirths are associated with negative health outcomes. Access to health information enables adolescents to make appropriate decisions. However, the relationship between access to health information through mass media and teenage pregnancy has not received much attention in existing literature. We therefore examined the association between access to mass media and teenage pregnancy in Zambia.

DESIGN

Cross-sectional.

SETTING

Zambia.

PARTICIPANTS

Weighted sample of 3000 adolescents aged 15-19 years.

OUTCOME MEASURE

Teenage pregnancy that included adolescents who were currently pregnant or had had an abortion or had given birth in the last 5 years preceding the survey.

RESULTS

Out of 3000 adolescents, 897 (29.9%, 95% CI: 28.1% to 31.3%) were pregnant or had ever been pregnant. Majority of the adolescents resided in rural areas (55.9%) and had secondary education (53.6%). Adolescents who had exposure to internet, newspapers or magazines, radio and television were 10.5%, 22.6%, 43.1% and 43.1%, respectively. Adolescents who had daily access to newspapers or magazines (adjusted OR (AOR): 0.33, 95% CI: 0.13 to 0.82) or using internet (AOR: 0.54, 95% CI: 0.30 to 0.95) were less likely to be pregnant or to have had a pregnancy compared with those with no access to newspapers and internet, respectively.

CONCLUSION

Our study suggests that internet use and reading of newspapers or magazines may trigger behavioural change as an effective approach to reducing teenage pregnancy. Behavioural change communicators can implement mass media campaigns using newspapers, magazines and the internet to publicise adolescent health messages that can encourage adolescents to adopt healthy behaviours and prevent teenage pregnancies.

A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa

BACKGROUND

Despite national and international commitments and efforts to prevent risky sexual behaviours, a high proportion of young people in South Africa are engaged in risky sexual behaviour. However, most efforts are currently directed toward addressing individual-level factors at the expense of not addressing neighbourhood-level determinants such as social disorganisation, contributing to risky sexual behaviour among young people in South Africa. This study investigated the multilevel factors of risky sexual behaviours among young people by gender in South Africa, using the lens of socio-ecological and social disorganisation frameworks.

METHODS

Data from a nationally representative sample of 1268 males and 2621 females aged 15-24 years, giving a total of, 3889 never-married youths, were drawn from the 2016 South Africa Demographic and Health Survey. Analysis was conducted using multilevel mixed-effect logistic regressions with random community-level effects.

RESULTS

Findings show that youth who were from a heterogeneous ethnic group (AOR = 0.49, CI: 0.35-0.67), household size of 5 + members (AOR = 0.78, CI: 0.54-1.15), community education (AOR = 0.97, CI: 0.72-1.32) were associated with low engagement in multiple sexual partnerships. Youths who were employed (AOR = 0.84, CI: 0.59-1.18), and from high-level community poverty (AOR = 0.76, CI: 0.58-1.00) were also associated with reduced odds of unprotected sex. In addition, older youth aged 20-24 years (AOR = 12.6, CI: 9.93-16.00); secondary education attainment (AOR = 1.01, CI 0.58-1.77); family structure (AOR = 1.37, CI: 0.75-1.15); Gauteng province (AOR = 1.45 CI: 0.92-2.28); residential mobility (AOR = 1.25, CI: 1.02-1.53), community media exposure to contraceptives (unprotected sex) (AOR = 1.38, CI: 1.09-1.76) were more likely to engage in risky sexual behaviour.

CONCLUSION

The study revealed that neighbourhood and individual-level factors were important in explaining the factors associated with risky sexual behaviour among young people in South Africa. In addition, engagement in risky sexual behaviour was high, with minimal variation among young females and males in South Africa. It specifies that the practice of risky sexual behaviour is significantly associated with multilevel factors of social disorganisation that cut across gender. These results imply that there is a need to review policies of sexual risks reduction for each gender, which might help mitigate the adverse effects of social disorganisation for women and men youths in South Africa.

School-going adolescent girls' preferences and views of family planning services in Phalombe district, Malawi: A descriptive, cross-sectional study

BACKGROUND

Low uptake of family planning services by adolescent girls remains a public health concern. An estimated 120 out of every 1,000 girls aged 15 to 19 years are having unplanned pregnancies in the sub-Saharan region. Between January and June 2020, the Phalombe District of Malawi reported 3,030 adolescent pregnancies. At this stage, most Malawian schools were closed due to the COVID-19 pandemic. The high rate of adolescent pregnancies prompted the Ministry of Health to provide emergency contraceptives to reduce the number of unplanned pregnancies among adolescents. The provision of emergency contraceptives would be effective if girls were willing and able to access these family planning services. We thus explored the views of school-going adolescent girls regarding their preferences for modern family planning methods including emergency contraceptives in Phalombe, Malawi.

METHODS

This was a cross-sectional, descriptive study, where quantitative data were collected using a structured questionnaire. Participants included randomly sampled school-going adolescent girls from eight purposively selected secondary schools and eight randomly selected primary schools. All the schools were sampled from three purposively selected Traditional Authorities namely Nkhulambe, Jenala and Nkhumba which had reported high numbers of adolescent pregnancies. We analyzed the GeoPoints for schools and health facilities using ArcGIS, while adolescent girls' views were analyzed using STATA.

RESULTS

Participants included 388 adolescent girls, ranging in age from 10 to 19 years (median age = 15.5 years, SD = 1.9 years). Participants were hesitant to use contraceptives because they were afraid of being stigmatized and embarrassed, had to travel long distances to reach the service center, knew little about modern family planning and were afraid of medical complications.

CONCLUSION

The uptake of family planning services by adolescent girls can be improved by bringing healthcare services closer to schools and homes. Family planning services should employ health workers who are non-judgmental and who are able to remove the stigma associated with family planning. Health workers should at any given opportunity, address the misconceptions and beliefs that adolescents have towards contraceptives. Community sensitization and health talks should be done to improve adolescent girls' understanding of family planning services.

Spatial distribution and factors associated with adolescent pregnancy in Nigeria: a multi-level analysis

Background

Adolescent pregnancy is a global public health and social phenomenon. However, the prevalence of adolescent pregnancy varies between and within countries. This study, therefore, sought to investigate the spatial distribution and factors associated with adolescent pregnancy in Nigeria.

Methods

Using data from the women’s recode file, a sample of 9448 adolescents aged 15-19 were considered as the sample size for this study. We employed a multilevel and spatial analyses to ascertain the factors associated with adolescent pregnancy and its spatial clustering.

Results

The spatial distribution of adolescent pregnancy in Nigeria ranges from 0 to 66.67%. A high proportion of adolescent pregnancy was located in the Northern parts of Nigeria. The likelihood of adolescent pregnancy in Nigeria was high among those who had sexual debut between 15 to 19 years [aOR = 1.49; 95%(CI = 1.16-1.92)], those who were currently married [aOR = 67.00; 95%(CI = 41.27-108.76)], and adolescents whose ethnicity were Igbo [aOR = 3.73; 95%(CI = 1.04-13.30)], while adolescents who were currently working [aOR = 0.69; 95%(CI = 0.55-0.88)] were less likely to have adolescent pregnancy.

Conclusion

A high proportion of adolescent pregnancy was located in the Northern parts of Nigeria. In addition, age at sexual debut, educational level, marital status, ethnicity, and working status were associated with adolescent pregnancy. Therefore, it is vital to take cognizant of these factors in designing adolescent pregnancy prevention programs or strengthening existing efforts in Nigeria.

Bringing social context into global biomedical HIV cure-related research: An urgent call to action

Advances in science have ushered in a wave of new potential curative and control strategies for HIV that could eliminate the current requirement for life-long antiretroviral therapy (ART) for people living with HIV (PLWH). In this article, we argue that it is critical to consider social contexts in the development of HIV cure trial protocols. The biological and behavioral risk factors for HIV acquisition by study participants are inseparable from the social context in which these participants live. The article discusses an example of a cohort established to further HIV cure research that included social context, called the FRESH Acute HIV study, which combines a sociostructural intervention while conducting HIV prevention, treatment and cure-related research in Durban, South Africa. We make an urgent call to action to include sociobehavioral components as instrumental in future HIV cure trials in global context.

Proximate and distal factors associated with the stall in the decline of adolescent pregnancy in Uganda

Background

Adolescent pregnancy in Uganda declined from 31% in 2000–01 to 25% in 2006 but thereafter stalled at 25% from 2006 to 2016. This paper investigates the factors associated with the recent stall in the rate of decline of adolescent pregnancy in Uganda.

Methods

We used logistic regression models for 4 years (2000–01, 2006, 2011 and 2016) of data from the Uganda Demographic Health Survey to explore proximate and distal factors of adolescent pregnancy in Uganda. We carried out Blinder-Oaxaca decomposition models to explore the contributions of different factors in explaining the observed decline in adolescent pregnancy between 2001 and 2006, and the subsequent stall between 2006 and 2016.

Results

We found that marriage among women aged 15–19 years, and early sexual debut, were strongly associated with adolescent pregnancy. These declined substantially between 2000 and 01 and 2006, leading to a decline in adolescent pregnancy. Their decline was in turn associated with rising levels of female education and household wealth. After 2006, education levels and household wealth gains stalled, with associated stalls in the decline of marriage among women aged 15–19 years and sexual debut, and a stall in the decline of adolescent pregnancy.

Conclusions

The stall in the decline of adolescent pregnancies in Uganda was linked to a stall in the reduction of adolescent marriage, which in turn was associated with limited progress in female educational attainment between 2006 and 2016. We emphasize the need for a renewed focus on girl’s education and poverty reduction to reduce adolescent pregnancy in Uganda and subsequently improve health outcomes for adolescent girls.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11403-6.

Under-5 mortality in sub-Saharan Africa: is maternal age at first childbirth below 20 years a risk factor?

OBJECTIVES

This study aimed at examining the association between young maternal age at first childbirth and under-5 mortality in sub-Saharan Africa (SSA).

DESIGN AND SETTING

This cross-sectional study pooled nationally-representative data from the most recent Demographic and Health Surveys conducted in 30 countries in SSA from 2010 to 2019.

PARTICIPANTS

116 379 mothers of children under 5.

RESULTS

The prevalence of adolescent childbirth and death in children under 5 in SSA were 57.36% (95% CI 53.73% to 60.99%) and 4.10% (95% CI 3.65% to 4.54%), respectively. Children born to mothers whose first childbirth occurred at <20 years were 11% more likely to die before the age of 5 compared with those whose mothers' first childbirth occurred at age ≥20 years (adjusted odds ratio (aOR) 1.11; 95% CI 1.05 to 1.18). In terms of the covariates, the likelihood of under-5 mortality was higher among children born to single (aOR 1.54; 95% CI 1.41 to 1.67) and cohabiting mothers (aOR 1.10; 95% CI 1.01 to 1.21) compared with married mothers. Children born to mothers who were obese were more likely to die before the age of 5 compared with those born to mothers with normal body weight (aOR 1.17; 95% CI 1.09 to 1.26). The odds of under-5 mortality were higher among children whose weight at birth was <2500 g compared with those whose weight was ≥2500 g at birth (aOR 1.83; 95% CI 1.64 to 2.03).

CONCLUSIONS

The findings call for the need to enhance policies aimed at reducing under-5 mortality in SSA by reducing adolescent pregnancy and childbirth through family planning, comprehensive sexuality education, and the elimination of child marriage. Again, Since under-5 mortality among adolescent mothers is linked with their poor socio-economic status, there is the need for government and non-governmental organisations in SSA to introduce poverty alleviation programmes and improve access to both formal and informal education as a way of enhancing the socioeconomic status of adolescent mothers. Public health education, through continuous advocacy programmes should be done to encourage adolescent mothers to access antenatal care and health facility deliveries as a way of enhancing the survival status of their children. These interventions should be implemented, taking into consideration other characteristics of mothers such marital status and BMI and child's characteristics such as child's weight, which were found to be associated with high under-5 mortality.