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Kochuvilayil A, Varma RP. Understanding caregiver burden and quality of life in Kerala's primary palliative care program: a mixed methods study from caregivers and providers' perspectives. Int J Equity Health 2024; 23:92. [PMID: 38715047 PMCID: PMC11077822 DOI: 10.1186/s12939-024-02155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Family caregivers are vital for long-term care for persons with serious health-related suffering in Kerala. Long-term caregiving and ageing may become burdensome and detrimental to patients and caregivers. We compared the caregiver burden and quality-of-life of ageing caregivers with younger caregivers. We also explored the palliative care nurses' perceptions of the family caregivers' issues. METHODS We did a mixed method study focusing on two groups: (i) three in-depth interviews and a cross-sectional survey among 221 caregivers of palliative care patients in five randomly selected panchayats (most peripheral tier of three-tier local self-government system in India concerned with governance of a village or small town) of Kollam district, Kerala, as part of development and validation of the Achutha Menon Centre Caregiver Burden Inventory; (ii) five in-depth interviews with purposively selected primary palliative care nurses as part of a study on local governments and palliative care. We used a structured interview schedule to collect cross-sectional data on sociodemographic and caregiving-related characteristics, caregiver burden, and health-related quality of life using the EuroQol EQ5D5L and interview guidelines on caregiver issues tailored based on participant type for qualitative interviews. RESULTS Older caregivers comprised 28.1% of the sample and had significantly poorer health and quality-of-life attributes. More senior caregivers experiencing caregiver burden had the lowest mean scores of 0.877 (Standard deviation (SD 0.066, 95% confidence intervals (CI) 0.854-0.899) followed by younger caregivers with high burden (0.926, SD 0.090, 95% CI 0.907-0.945), older caregivers with low burden (0.935, SD 0.058, 95% CI 0.912-0.958) and younger caregivers with low burden (0.980, SD 0.041, 95% CI 0.970-0.990). Caregivers faced physical, psychological, social, and financial issues, leading to a caregiver burden. The relationships between the palliative care nurses and family caregivers were complex, and nurses perceived caregiver burden, but there were no specific interventions to address this. CONCLUSION In our study from Kollam, Kerala, three out of ten caregivers of palliative care patients were 60 years of age or older. They had significantly lower health-related quality of life, particularly if they perceived caregiver burden. Despite being recognized by palliative care nurses, caregiver issues were not systematically addressed. Further research and suitable interventions must be developed to target such problems in the palliative care programme in Kerala.
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Affiliation(s)
- Arsha Kochuvilayil
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India.
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Chidwick H, Baumann A, Ogba P, Banfield L, DiLiberto DD. Exploring adolescent engagement in sexual and reproductive health research in Kenya, Rwanda, Tanzania, and Uganda: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000208. [PMID: 36962492 PMCID: PMC10022240 DOI: 10.1371/journal.pgph.0000208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/23/2022] [Indexed: 06/18/2023]
Abstract
Adolescent sexual and reproductive health (ASRH) in East Africa has prioritized research on the barriers to care, communication, and ASRH knowledge, attitudes, and practices. However, there is little research examining the extent to which meaningful adolescent engagement in research is achieved in practice and how this influences the evidence available to inform ASRH services. This review offers a critical step towards understanding current approaches to adolescent engagement in ASRH research and identifying opportunities to build a strengthened evidence base with adolescent voices at the centre. This scoping review is based on Arksey and O'Malley's (2005) framework, employing a keyword search of four databases via OVID: Medline, Global Health, Embase and PsycINFO. Two reviewers screened title, abstract and full text to select articles examining ASRH in Tanzania, Rwanda, Kenya, and Uganda, published between 2000 and 2020. After articles were selected, data was extracted, synthesized, and thematically organized to highlight emerging themes and potential opportunities for further research. The search yielded 1201 results, 34 of which were included in the final review. Results highlight the methods used to gather adolescent perspectives of ASRH (qualitative), the content of those perspectives (knowledge, sources of information, gaps in information and adolescent friendly services), and the overall narratives that frame discussions of ASRH (risky sexual behaviour, stigma, and gender norms). Findings indicate the extent of adolescent engagement in ASRH research is limited, resulting in a lack of comprehensive evidence, consistent challenges with stigma, little information on holistic concepts and a narrow framing of ASRH. In conclusion, there is opportunity for more meaningful engagement of adolescents in ASRH research. This engagement can be achieved by involving adolescents more comprehensively throughout the research cycle and by expanding the range of ASRH topics explored, as identified by adolescents.
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Affiliation(s)
- Hanna Chidwick
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Baumann
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Ogba
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Deborah D. DiLiberto
- Faculty of Health Sciences, Global Health Office, McMaster University, Hamilton, Ontario, Canada
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Corley AG, Sprockett A, Montagu D, Chakraborty NM. Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116576. [PMID: 35682160 PMCID: PMC9180733 DOI: 10.3390/ijerph19116576] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality practices and provider bias serve as key barriers to care access for the youth. Methods: A narrative review was conducted to describe how poor privacy and confidentiality practices and provider bias impose barriers on young people seeking sexual and reproductive health services and to examine how point of service evaluations have assessed these factors. Results: 4544 peer-reviewed publications were screened, of which 95 met the inclusion criteria. To these articles, another 16 grey literature documents were included, resulting in a total of 111 documents included in the review. Conclusion: Poor privacy and confidentiality practices and provider bias represent significant barriers for young people seeking sexual and reproductive health services across diverse geographic and sociocultural contexts. The authors found that present evaluation methods do not appropriately account for the importance of these factors and that new performance improvement indicators are needed.
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Kyegombe N, Buller AM, Meiksin R, Wamoyi J, Muhumuza R, Heise L. Adolescent girls' perceived readiness for sex in Central Uganda - liminal transitions and implications for sexual and reproductive health interventions. CULTURE, HEALTH & SEXUALITY 2022; 24:391-405. [PMID: 33527889 DOI: 10.1080/13691058.2020.1849802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Young women in Uganda are at risk of negative sexual and reproductive health outcomes, in part because of sex with older men. Theoretically grounded in the concept of liminality, this paper examines perceived markers of adolescent girls' suitability for sexual activity. In 2014, we conducted 19 focus group discussions and 44 in-depth interviews in two communities in Uganda. Interviews were conducted using a semi-structured tool, audio-recorded and transcribed verbatim. Interviews examined markers of transition between childhood, adolescence and adulthood and how these were seen as relating to girls' perceived readiness for sex. Analysis was thematic. Pre-liminal status was most often accorded to childhood. Sex with a child was strongly condemned. Physical changes during puberty and children's increasing responsibility, autonomy and awakening sexuality reflected a liminal stage during which girls and young women were not necessarily seen as children and were increasingly described as suitable for sex. Being over 18, leaving home, and occupying 'adult' spaces reflected post-liminal status and perceived appropriateness for sexual activity including for girls under the age of 18. Interventions that seek to prevent early sexual debut and sexual activity with older men have the potential to reduce sexual and reproductive health risks.
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Affiliation(s)
- Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Baltimore, MD, USA
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Mambo SB, Sikakulya FK, Ssebuufu R, Mulumba Y, Wasswa H, Mbina SA, Rusatira JC, Bhondoekhan F, Kamyuka LK, Akib SO, Kirimuhuzya C, Nakawesi J, Kyamanywa P. Challenges in Access and Utilization of Sexual and Reproductive Health Services Among Youth During the COVID-19 Pandemic Lockdown in Uganda: An Online Cross-Sectional Survey. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:705609. [PMID: 36303975 PMCID: PMC9580707 DOI: 10.3389/frph.2021.705609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/24/2021] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Sexual and Reproductive Health access to Information services is still a pressing need for youth in Uganda even during the COVID-19 pandemic, which has disrupted health care access in many countries. The aim of this study was to explore the challenges in access and utilization of sexual and reproductive health services as faced by youth during the COVID-19 pandemic lockdown in Uganda. METHODS This was a cross-sectional study carried out from 28th April 2020 to 11th May 2020 in Uganda. An online questionnaire was disseminated to youth aged between 18 and 30 years over a period of 14 days. The snowball sampling method was used to recruit participants. STATA version 14.2 was used for statistical analysis. RESULTS Of 724 participants, 203 (28%) reported that they did not have access to information and/or education concerning sexual and reproductive health (SRH). More than a quarter of the participants (26.9%, n = 195) reported that testing and treatment services of sexually transmitted infections were not available during the lockdown, and 27.2% could not obtain contraceptive supplies. Access to HIV/AIDS care services and menstrual supplies was also impaired. Lack of transportation was the commonest factor cited as limiting access to SRH services during the lockdown (68.7%), followed by the long distance from home to SRH facilities (55.2%), high cost of services (42.2%) and the curfew (39.1%). Sexually transmitted infections were the commonest SRH problems related to SRH during the lockdown (40.4%) followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Marital, educational, and employment status were significantly correlated with the reported experiences of the participants. CONCLUSION Access to SRH information and services for Ugandan youth was restricted during the COVID-19 lockdown and leaving them vulnerable to various SRH risks and adverse outcomes. Lack of transportation, long distances to health facilities, and high cost of services were important limiting factors. The Government and other stakeholders should incorporate SRH among the priority services to be preserved during future outbreaks.
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Affiliation(s)
- Simon Binezero Mambo
- Department of Public Health, School of Allied Health Sciences, Kampala International University Western Campus, Kampala, Uganda
- Youth Alliance for Reproductive Health, Goma, Democratic Republic of the Congo
| | - Franck Katembo Sikakulya
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
| | - Yusuf Mulumba
- Biostatistics, Cancer Institute, Makerere University, Kampala, Uganda
| | | | - Solomon Adomi Mbina
- Department of Public Health, School of Allied Health Sciences, Kampala International University Western Campus, Kampala, Uganda
| | - Jean Christophe Rusatira
- Johns Hopkins Bloomberg School of Public Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Baltimore, MD, United States
| | - Fiona Bhondoekhan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Louis K. Kamyuka
- Department of HIV/TB (CHAI Clinic), Kampala International University Teaching Hospital, Kampala, Uganda
| | - Surat Olabisi Akib
- Department of Pathology, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Kampala, Uganda
| | - Claude Kirimuhuzya
- Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University Western Campus, Kampala, Uganda
| | - Jane Nakawesi
- Department of Paediatrics, Mildmay Uganda Hospital, Wakiso, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
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Kyegombe N, Meiksin R, Wamoyi J, Heise L, Stoebenau K, Buller AM. Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex. Sex Reprod Health Matters 2020; 28:1700770. [PMID: 31934824 PMCID: PMC7888006 DOI: 10.1080/26410397.2019.1700770] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Adolescent girls and young women (AGYW) in Uganda are at risk of early sexual debut, unwanted pregnancy, violence, and disproportionally high HIV infection rates, driven in part by transactional sex. This paper examines the extent to which AGYW’s participation in transactional sex is perceived to be coerced. We conducted 19 focus group discussions and 44 in-depth interviews using semi-structured tools. Interviews were audio recorded, and transcribed verbatim. Data were analysed using a thematic analysis. While AGYW did not necessarily use the language of coercion, their narratives describe a number of coercive aspects in their relationships. First, coercion by force as a result of “de-toothing” a man (whereby they received money or resources but did not wish to provide sex as “obligated” under the implicit “terms” of the relationships). Second, they described the coercive role that receiving resources played in their decision to have sex in the face of men’s verbal insistence. Finally, they discussed having sex as a result of coercive economic circumstances including poverty, and because of peer pressure to uphold modern lifestyles. Support for income-generation activities, microfinance and social protection programmes may help reduce AGYW’s vulnerability to sexual coercion in transactional sex relationships. Targeting gender norms that contribute to unequal power dynamics and social expectations that obligate AGYW to provide sex in return for resources, critically assessing the meaning of consensual sex, and normative interventions building on parents’ efforts to ascertain the source of their daughters’ resources may also reduce AGYW’s vulnerability to coercion.
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Affiliation(s)
- Nambusi Kyegombe
- Assistant Professor, Social and Structural Determinants of Health, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Research Fellow, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- Social and Behavioural Researcher, Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Lori Heise
- Professor of Social Epidemiology, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Baltimore, MD, USA
| | - Kirsten Stoebenau
- Assistant Research Professor, Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Ana Maria Buller
- Assistant Professor in Social Science, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Perry S, Fair CD, Burrowes S, Holcombe SJ, Kalyesubula R. Outsiders, insiders, and intermediaries: village health teams' negotiation of roles to provide high quality sexual, reproductive and HIV care in Nakaseke, Uganda. BMC Health Serv Res 2019; 19:563. [PMID: 31409336 PMCID: PMC6692941 DOI: 10.1186/s12913-019-4395-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Community health workers, known as Village Health Teams (VHTs) in Uganda, play a central role in increasing access to community-based health services. The objective of this research is to explore tensions that may emerge as VHTs navigate multiple roles as community members and care providers particularly when providing sensitive reproductive health and HIV care. Methods Twenty-five VHTs from a rural clinic in Uganda completed semi-structured interviews focused on experiences providing services. Interview questions focused on challenges VHTs face providing services and strategies for improving quality care. After translation from Luganda and transcription, interviews were analyzed using content analysis to identify emergent themes. Results Most VHTs were female (n = 16). The average age was 46, and average length of VHT work, 11 years. Analyses revealed that all VHTs capitalized upon the duality of their position, shifting roles depending upon context. Three themes emerged around VHTs’ perceptions of their roles: community insiders, professional outsiders, and intermediaries. A caregiver “insider” role facilitated rapport and discussion of sensitive issues. As community members, VHTs leveraged existing community structures to educate clients in familiar settings such as “drinking places”. However, this role posed challenges as some VHTs felt compelled to share their own resources including food and transport money. Occupying a professional outsider role offered VHTs respect. Their specialized knowledge gave them authority to counsel others on effective forms of family planning. However, some VHTs faced opposition, suspicions about their motives, and violence in this role. In balancing these two roles, the VHTs adopted a third as intermediaries, connecting the community to services in the formalized health care system. Participants suggested that additional training, ongoing supervision, and the opportunity to collaborate with other VHTs would help them better navigate their different roles and, ultimately, improve the quality of service. Conclusions As countries scale up family planning and HIV services using VHTs, supportive supervision and ethical dilemma training are recommended so VHTs are prepared for the challenges of assuming multiple roles within communities. Electronic supplementary material The online version of this article (10.1186/s12913-019-4395-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha Perry
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
| | - Cynthia D Fair
- Professor and Chair of Public Health Studies, Elon University, Elon, NC, USA
| | - Sahai Burrowes
- Associate Professor, Public Health Program, Touro University California, Vallejo, CA, USA
| | | | - Robert Kalyesubula
- Makerere University College of Health Sciences, Kampala, Uganda. .,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda.
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Rukundo GZ, Abaasa C, Natukunda PB, Allain D. Parents' and caretakers' perceptions and concerns about accessibility of antenatal services by pregnant teenagers in Mbarara Municipality, Uganda. Midwifery 2019; 72:74-79. [PMID: 30825792 DOI: 10.1016/j.midw.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 01/05/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Uganda has one of the highest teenage pregnancy rates in Sub-Saharan Africa and the world. About a quarter of teenagers become pregnant annually. This is much higher than the global rate of 11%. When a teenager becomes pregnant, caring responsibilities are usually shared between the teenage mother and the baby's grandmother. Previous research has largely focused on the experiences of teenagers, leaving out the parents and caregivers. This paper describes parents and caretakers' perceptions and concerns about accessibility of antenatal services by pregnant teenagers in three divisions of Mbarara Municipality in southwestern Uganda. METHODS This was a qualitative cross-sectional descriptive study. Thirty in-depth interviews with parents and caregivers were conducted. The study was conducted in the Nyamitanga, Kakoba and Kamukuzi divisions in Mbarara Municipality, southwestern Uganda. Data analysis was done manually by identifying emergent themes which were then coded and organized into concepts which were later developed into explanations. RESULTS According to parents and other caregivers, teenage pregnancy is considered a significant challenge both for themselves and for the teenagers. Often, pregnant teenagers lack information on the available antenatal care services. They struggle with stigma and also lack social and financial support from parents. In addition, the teenagers lack support from reproductive health workers. The parents and caregivers also struggle with the stigma of their children's pregnancy and are often unaware of any available teenager friendly ANC services. CONCLUSIONS Parents and caregivers find it difficult to cope with their children's pregnancy. They are not aware of any existing teenager-friendly antenatal services, yet antenatal services specifically targeting teenagers are necessary. In planning programs for antenatal services, parents and caregivers also need to be equipped with knowledge and skills required for them to guide and support the pregnant teenagers.
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Affiliation(s)
- Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology (MUST), Mbarara Uganda.
| | - Catherine Abaasa
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara Uganda.
| | - Peace Byamukama Natukunda
- Department of Applied Psychology, Kampala International University, Kampala Uganda; Department of Social Work, Uganda Christian University, Mukono Uganda.
| | - Dominic Allain
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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'Ring' your future, without changing diaper - Can preventing teenage pregnancy address child marriage in Zambia? PLoS One 2018; 13:e0205523. [PMID: 30346966 PMCID: PMC6197635 DOI: 10.1371/journal.pone.0205523] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022] Open
Abstract
Teenage pregnancy and child marriage are prevalent in Zambia and are complexly interrelated issues with common causes and effects. The aim of this study was to explore factors in the social and cultural environment shaping young people's sexual behaviour, with specific attention to teenage pregnancy and child marriage in Eastern Zambia. The study was conducted in selected wards in Petauke, Chadiza and Katete districts, using an exploratory mixed-method design including a household survey, focus group discussions and in-depth interviews. The participants included 1,434 young females and males aged 15 to 24, female and male parents and caregivers; grandmothers; traditional leaders; teachers; health and social workers; representatives from youth associations, community-based and non-governmental organizations; and district level policy makers. Qualitative data were analysed using thematic content analysis and NVivo was used to manage the data, while survey data were analysed using Stata. The study revealed a high prevalence rate of teenage pregnancy (48%) and child marriage (13%) among young women. The mean age at first pregnancy or fatherhood was lower among female (17) than male respondents (20). A clear interlinkage between teenage pregnancy and child marriage was found, the two issues were mutually reinforcing. While teenage pregnancy appeared both as a cause and consequence of child marriage, marriage was mostly a common response to pregnancy. Early sexual debut, limited knowledge and use of contraception, poverty and limited future perspectives as well as sexual and gender norms were identified as the main causative factors of teenage pregnancy and therefore, child marriage. Based on the findings, a conceptual model to explain the interrelationships between young people's sexual behaviour, teenage pregnancy and child marriage is discussed. To address teenage pregnancy and child marriage in Eastern Zambia, there is a need to look into the realities and needs of young people regarding sex and relationships.
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Newton-Levinson A, Leichliter JS, Chandra-Mouli V. Help and Care Seeking for Sexually Transmitted Infections Among Youth in Low- and Middle-Income Countries. Sex Transm Dis 2017; 44:319-328. [PMID: 28499280 PMCID: PMC5434953 DOI: 10.1097/olq.0000000000000607] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ability to seek help or medical care for sexually transmitted infections (STIs) is vital for sexually active youth; yet, their needs are often unmet. METHODS We conducted a qualitative systematic review of studies to assess youth and provider views about the behaviors of young people in help seeking and care seeking for STI services in low- and middle-income countries. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (age, 10-24 years) and/or health service providers. Eighteen studies were identified for inclusion from 18 countries. Thematic analyses identified key themes across the studies. RESULTS The majority of studies included discussion of youth not seeking treatment, resorting to self-treatment, or waiting to access care, suggesting that many youth still do not seek timely care for STIs. Youth desired more information on sexual health and cited barriers related to fear or taboos in obtaining help or information, especially from providers or parents. Many did not recognize symptoms or waited until symptoms worsened. However, many youth were able to identify a number of sources for STI related care including public and private clinics, pharmacies, alternative healers, and nongovernmental organizations. Youth's help seeking and care seeking preferences were frequently influenced by desires for confidentiality, friendliness, and cost. CONCLUSIONS Youth in low- and middle-income countries experience significant barriers in help seeking for STIs and often do not seek or postpone medical care. Improving uptake may require efforts to address clinic systems, provider attitudes, confidentiality, and cultural norms related to youth sexuality.
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Affiliation(s)
- Anna Newton-Levinson
- From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University; †Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jami S. Leichliter
- From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University; †Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University; †Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Schwandt HM, Speizer IS, Corroon M. Contraceptive service provider imposed restrictions to contraceptive access in Urban Nigeria. BMC Health Serv Res 2017. [PMCID: PMC5393003 DOI: 10.1186/s12913-017-2223-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Schwandt HM, Speizer IS, Corroon M. Contraceptive service provider imposed restrictions to contraceptive access in urban Nigeria. BMC Health Serv Res 2017; 17:268. [PMID: 28403858 PMCID: PMC5389090 DOI: 10.1186/s12913-017-2233-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/06/2017] [Indexed: 11/28/2022] Open
Abstract
Background Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Methods Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Results Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator’s reports of service provision bias. Conclusions Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population - interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2233-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hilary M Schwandt
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA. .,Fairhaven College, Western Washington University, Bellingham, WA, USA.
| | - Ilene S Speizer
- Carolina Population Center at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Meghan Corroon
- Carolina Population Center at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Newton-Levinson A, Leichliter JS, Chandra-Mouli V. Sexually Transmitted Infection Services for Adolescents and Youth in Low- and Middle-Income Countries: Perceived and Experienced Barriers to Accessing Care. J Adolesc Health 2016; 59:7-16. [PMID: 27338664 PMCID: PMC5289742 DOI: 10.1016/j.jadohealth.2016.03.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Access to sexual and reproductive health (SRH) services is vital for sexually active adolescents; yet, their SRH care needs are often unmet. METHODS We conducted a qualitative systematic review of mixed methods studies to assess adolescent and provider views of barriers to seeking appropriate medical care for sexually transmitted infection (STI) services for adolescents. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (aged 10-24 years) and/or health service providers. Nineteen studies were identified for inclusion from 15 countries. Thematic analyses identified key themes across the studies. RESULTS Findings suggest that youth lacked knowledge about STIs and services. In addition, youth experienced barriers related to service availability and a lack of integration of services. The most reported barriers were related to acceptability of services. Youth reported avoiding services or having confidentiality concerns based on provider demographics and some behaviors. Finally, experiences of shame and stigma were common barriers to seeking care. CONCLUSIONS Adolescents in low- and middle-income countries experience significant barriers in obtaining STI and SRH services. Improving uptake may require efforts to address clinic systems and provider attitudes, including confidentiality issues. Moreover, addressing barriers to STI services may require addressing cultural norms related to adolescent sexuality.
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Affiliation(s)
- Anna Newton-Levinson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jami S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rukundo GZ, Abaasa C, Natukunda PB, Ashabahebwa BH, Allain D. Antenatal services for pregnant teenagers in Mbarara Municipality, Southwestern Uganda: health workers and community leaders' views. BMC Pregnancy Childbirth 2015; 15:351. [PMID: 26693812 PMCID: PMC4688948 DOI: 10.1186/s12884-015-0772-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 12/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, about 11% of all annual births involve adolescents aged 15-19 years. Uganda has one of the highest teenage pregnancy rates in Sub-Saharan Africa. This study assessed stakeholders' views concerning factors affecting availability, accessibility and utilization of teenager friendly antenatal services in Mbarara Municipality, southwestern Uganda. METHOD This was a cross-sectional descriptive study utilizing Key Informant Interviews (KIIs). It was conducted in three divisions of Mbarara Municipality. The KIIs were held six Village Health Team (VHT) members, three gynecologists, six midwives, three Community leaders (LC 3 Secretaries for women affairs), one police officer from the Family and Child protection unit at Mbarara Police and three Traditional Birth Attendants (TBAs). Data analysis was done manually by identifying emergent themes which were later coded and organized into concepts which were later developed into explanations. RESULTS Reproductive health stakeholders generally considered teenage pregnancy to be among the high risk pregnancies that need to be handled with care. In addition, the reproductive health workers described their experience with teenagers as challenging due to their limited skills when it comes to addressing adolescent-specific needs. Adolescent-friendly services were defined as those that could provide privacy, enough time and patience when dealing with teenagers. With this description, there were no teenager-friendly antenatal services in Mbarara municipality at the time of the study. There is need for proactive steps to establish these services if the needs of this subgroup are to be met. CONCLUSION There are no teenager friendly antenatal services in Mbarara municipality and few teenagers access and utilise the available general antenatal services. There is need for specialized training for health workers who deal with pregnant teens in Mbarara Municipality in order for them to provide teenager friendly services.
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Affiliation(s)
- Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda.
| | - Catherine Abaasa
- Kampala International University, Western Campus, Bushenyi, Uganda.
| | | | | | - Dominic Allain
- Department of Paediatrics, University of Alberta, Calgary, AB, Canada.
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Archana S, Nongkrynh B, Anand K, Pandav CS. Feasibility and validity of using WHO adolescent job aid algorithms by health workers for reproductive morbidities among adolescent girls in rural North India. BMC Health Serv Res 2015; 15:400. [PMID: 26390862 PMCID: PMC4578239 DOI: 10.1186/s12913-015-1067-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 09/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background High prevalence of reproductive morbidities is seen among adolescents in India. Health workers play an important role in providing health services in the community, including the adolescent reproductive health services. A study was done to assess the feasibility of training female health workers (FHWs) in the classification and management of selected adolescent girls’ reproductive health problems according to modified WHO algorithms. Methods The study was conducted between Jan-Sept 2011 in Northern India. Thirteen FHWs were trained regarding adolescent girls’ reproductive health as per WHO Adolescent Job-Aid booklet. A pre and post-test assessment of the knowledge of the FHWs was carried out. All FHWs were given five modified WHO algorithms to classify and manage common reproductive morbidities among adolescent girls. All the FHWs applied the algorithms on at least ten adolescent girls at their respective sub-centres. Simultaneously, a medical doctor independently applied the same algorithms in all girls. Classification of the condition was followed by relevant management and advice provided in the algorithm. Focus group discussion with the FHWs was carried out to receive their feedback. Results After training the median score of the FHWs increased from 19.2 to 25.2 (p – 0.0071). Out of 144 girls examined by the FHWs 108 were classified as true positives and 30 as true negatives and agreement as measured by kappa was 0.7 (0.5–0.9). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 % (88.2–97.4), 78.9 % (63.6–88.9), 92.5 % (86.0–96.2), and 83.3 % (68.1–92.1) respectively. Discussion A consistent and significant difference between pre and post training knowledge scores of the FHWs were observed and hence it was possible to use the modified Job Aid algorithms with ease. Limitation of this study was the munber of FHWs trained was small. Issues such as time management during routine work, timing of training, overhead cost of training etc were not taken into account. Conclusions Training was successful in increasing the knowledge of the FHWs about adolescent girls’ reproductive health issues. The FHWs were able to satisfactorily classify the common adolescent girls’ problems using the modified WHO algorithms. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1067-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Siddaiah Archana
- Centre for Community Medicine, All India Institute of Medical Sciences, #14, Ground floor, Near old OT block, Ansari Nagar, New Delhi, 110029, India.
| | - B Nongkrynh
- Centre for Community Medicine, All India Institute of Medical Sciences, #14, Ground floor, Near old OT block, Ansari Nagar, New Delhi, 110029, India.
| | - K Anand
- Centre for Community Medicine, All India Institute of Medical Sciences, #14, Ground floor, Near old OT block, Ansari Nagar, New Delhi, 110029, India.
| | - C S Pandav
- Centre for Community Medicine, All India Institute of Medical Sciences, #14, Ground floor, Near old OT block, Ansari Nagar, New Delhi, 110029, India.
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Stern E, Pascoe L, Shand T, Richmond S. Lessons learned from engaging men in sexual and reproductive health as clients, partners and advocates of change in the Hoima district of Uganda. CULTURE, HEALTH & SEXUALITY 2015; 17 Suppl 2:S190-205. [PMID: 25953243 PMCID: PMC4706030 DOI: 10.1080/13691058.2015.1027878] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/07/2015] [Indexed: 05/24/2023]
Abstract
This study examined the impact of a three-year intervention project conducted in the Hoima district of Uganda, which sought to engage men in sexual and reproductive health as clients, equal partners and advocates of change. Structured surveys with 164 self-reported heterosexual men aged 18-54 years were used to assess knowledge and attitudes towards sexual and reproductive health. Data from these were analysed using Stata and SPSS. Additionally, five focus groups were conducted with the female partners and male beneficiaries of the project and with project peer educators. Four interviews were conducted with project staff and male beneficiaries. Data from these and the focus groups were analysed using a thematic approach. Following the intervention, a significantly greater number of men accessed, and supported their partners in accessing sexual health services services, had gained sexual and reproductive health awareness, reported sharing domestic duties and contraceptive decision-making, and displayed a decreased tolerance for domestic violence. It was more difficult to assess men's involvement and behaviours as advocates of change, which sheds light on the complexities of a gender transformative project and the importance of evaluating such projects from both men's and their partners' perspectives and at different levels of the male involvement model in sexual and reproductive health.
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Affiliation(s)
- Erin Stern
- Women's Health Research Unit, University of Cape Town, Cape Town, South Africa
| | | | - Tim Shand
- Sonke Gender Justice, Cape Town, South Africa
| | - Samantha Richmond
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
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Atuyambe LM, Kibira SPS, Bukenya J, Muhumuza C, Apolot RR, Mulogo E. Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation in Wakiso district, Uganda. Reprod Health 2015; 12:35. [PMID: 25896066 PMCID: PMC4416389 DOI: 10.1186/s12978-015-0026-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Adolescents are frequently reluctant to seek sexual and reproductive health services (SRH). In Uganda, adolescent health and development is constrained by translation of the relevant policies to practice. Recent studies done in central Uganda have shown that there is need for a critical assessment of adolescent friendly services (AFS) to gain insights on current practice and inform future interventions. This study aimed to assess the sexual reproductive health needs of the adolescents and explored their attitudes towards current services available. METHODS A qualitative study was conducted in Wakiso district, central Uganda in September 2013.Twenty focus group discussions (FGDs) stratified by gender (10 out-of-school, and 10 in-school), were purposefully sampled. We used trained research assistants (moderator and note taker) who used a pretested FGD guide translated into the local language to collect data. All discussions were audio taped, and were transcribed verbatim before analysis. Thematic areas on; adolescent health problems, adolescent SRH needs, health seeking behaviour and attitudes towards services, and preferred services were explored. Data was analysed using atlas ti version 7 software. RESULTS Our results clearly show that adolescents have real SRH issues that need to be addressed. In and out-of-school adolescents had sexuality problems such as unwanted pregnancies, sexually transmitted infections (STIs), defilement, rape, substance abuse. Unique to the females was the issue of sexual advances by older men and adolescents. We further highlight RH needs which would be solved by establishing adolescent friendly clinics with standard recommended characteristics (sexuality information, friendly health providers, a range of good clinical services such as post abortion care etc.). With regard to health seeking behaviour, most adolescents do not take any action at first until disease severity increase. CONCLUSIONS Adolescents in Uganda have multiple sexual and reproductive health needs that require special focus through adolescent friendly services. This calls for resource support in terms of health provider training, information education and communication materials as well as involvement of key stakeholders that include parents, teachers and legislators.
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Affiliation(s)
- Lynn M Atuyambe
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda.
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda.
| | - Justine Bukenya
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
| | - Rebecca R Apolot
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda.
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Kampala, Uganda.
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Michaels-Igbokwe C, Lagarde M, Cairns J, Terris-Prestholt F. Using decision mapping to inform the development of a stated choice survey to elicit youth preferences for sexual and reproductive health and HIV services in rural Malawi. Soc Sci Med 2014; 105:93-102. [DOI: 10.1016/j.socscimed.2014.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 01/02/2014] [Accepted: 01/08/2014] [Indexed: 11/26/2022]
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Chilinda I, Hourahane G, Pindani M, Chitsulo C, Maluwa A. Attitude of Health Care Providers towards Adolescent Sexual and Reproductive Health Services in Developing Countries: A Systematic Review. Health (London) 2014. [DOI: 10.4236/health.2014.614203] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pilgrim NA, Ahmed S, Gray RH, Sekasanvu J, Lutalo T, Nalugoda FK, Serwadda D, Wawer MJ. Sexual coercion among adolescent women in Rakai, Uganda: does family structure matter? JOURNAL OF INTERPERSONAL VIOLENCE 2013; 28:1289-1313. [PMID: 23295373 PMCID: PMC4415158 DOI: 10.1177/0886260512468246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Studies on adolescent girls' vulnerability to sexual coercion in Sub-Saharan Africa have focused mainly on individual and partner risk factors, rarely investigating the role the family might play in their vulnerability. This study examined whether household family structure and parental vital status were associated with adolescent girls' risk of sexual coercion in Rakai, Uganda. Modified Poisson regression was used to estimate relative risk of sexual coercion in the prior 12 months among 1,985 unmarried and married adolescent girls aged 15 to 19 who were participants in the Rakai Community Cohort Study between 2001 and 2008. Among sexually active girls, 11% reported coercion in a given past year. Unexpectedly, living with a single mother was protective against experiencing coercion. As much as 4.1% of never-married girls living with single mothers reported coercion, compared to 7.8% of girls living with biological fathers (adj. relative risk [RR] = 2.24, 95% confidence interval [CI]: 0.98-5.08) and 20% of girls living in stepfather households (adj. RR = 4.73, 95% CI: 1.78-12.53). Ever-married girls whose mothers alone were deceased were more likely to report coercion than those with both parents alive (adj. RR = 1.56, 95% CI: 1.08-2.30). Protecting adolescent girls from sexual coercion requires prevention approaches that incorporate the family, with particular emphasis on including the men (e.g. fathers) who might play an influential role in young girls' sexual development. Understanding the family dynamics underlying the risk and protective effects of a given household structure might highlight new ways in which to prevent sexual coercion.
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Affiliation(s)
- Nanlesta A Pilgrim
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Tavrow P, Withers M, McMullen K. Age matters: differential impact of service quality on contraceptive uptake among post-abortion clients in Kenya. CULTURE, HEALTH & SEXUALITY 2012; 14:849-862. [PMID: 22812449 DOI: 10.1080/13691058.2012.700324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper analyses the impact of high quality, user-friendly, comprehensive sliding-scale post-abortion services on clients' uptake of contraception in a Kenyan town. Data were drawn from detailed physician records in a private clinic that served 1080 post-abortion clients in 2006. All clients received confidential family planning counselling and were offered a complete range of contraceptives at no additional cost. One quarter of clients were below age 19. Prior to the abortion, no client aged 10-18 years reported having used contraception, as compared to 60% of clients aged 27-46 years. After the abortion and family planning counselling session, only 6% of clients aged 10-18 chose a method, as compared to 96% of clients aged 27-46, even though contraception was free, the provider strongly promoted family planning to everyone and all clients had just experienced an unwanted pregnancy. Significant predictors of contraceptive uptake post-abortion were: having a child, a previous termination, prior contraceptive use and being older than 21. These findings suggest that availability, affordability and youth-friendliness are not sufficient to overcome psycho-social barriers to contraceptive use for sexually-active young people in Kenya. To reduce unwanted pregnancies, more attention may be needed to developing youth-friendly communities that support responsible sexuality among adolescents.
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Affiliation(s)
- Paula Tavrow
- Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, USA.
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Nalwadda G, Tumwesigye NM, Faxelid E, Byamugisha J, Mirembe F. Quality of care in contraceptive services provided to young people in two Ugandan districts: a simulated client study. PLoS One 2011; 6:e27908. [PMID: 22132168 PMCID: PMC3221686 DOI: 10.1371/journal.pone.0027908] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/27/2011] [Indexed: 11/26/2022] Open
Abstract
Background Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15–24 in two rural districts in Uganda. Methods Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed. Results Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy. Conclusions The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed.
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Affiliation(s)
- Gorrette Nalwadda
- Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda.
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Renju J, Andrew B, Nyalali K, Kishamawe C, Kato C, Changalucha J, Obasi A. A process evaluation of the scale up of a youth-friendly health services initiative in northern Tanzania. J Int AIDS Soc 2010; 13:32. [PMID: 20731835 PMCID: PMC2944311 DOI: 10.1186/1758-2652-13-32] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 08/23/2010] [Indexed: 11/18/2022] Open
Abstract
Background While there are a number of examples of successful small-scale, youth-friendly services interventions aimed at improving reproductive health service provision for young people, these projects are often short term and have low coverage. In order to have a significant, long-term impact, these initiatives must be implemented over a sustained period and on a large scale. We conducted a process evaluation of the 10-fold scale up of an evaluated youth-friendly services intervention in Mwanza Region, Tanzania, in order to identify key facilitating and inhibitory factors from both user and provider perspectives. Methods The intervention was scaled up in two training rounds lasting six and 10 months. This process was evaluated through the triangulation of multiple methods: (i) a simulated patient study; (ii) focus group discussions and semi-structured interviews with health workers and trainers; (iii) training observations; and (iv) pre- and post-training questionnaires. These methods were used to compare pre- and post-intervention groups and assess differences between the two training rounds. Results Between 2004 and 2007, local government officials trained 429 health workers. The training was well implemented and over time, trainers' confidence and ability to lead sessions improved. The district-led training significantly improved knowledge relating to HIV/AIDS and puberty (RR ranged from 1.06 to 2.0), attitudes towards condoms, confidentiality and young people's right to treatment (RR range: 1.23-1.36). Intervention health units scored higher in the family planning and condom request simulated patient scenarios, but lower in the sexually transmitted infection scenario than the control health units. The scale up faced challenges in the selection and retention of trained health workers and was limited by various contextual factors and structural constraints. Conclusions Youth-friendly services interventions can remain well delivered, even after expansion through existing systems. The scaling-up process did affect some aspects of intervention quality, and our research supports others in emphasizing the need to train more staff (both clinical and non-clinical) per facility in order to ensure youth-friendly services delivery. Further research is needed to identify effective strategies to address structural constraints and broader social norms that hampered the scale up.
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Affiliation(s)
- Jenny Renju
- Liverpool School of Tropical Medicine, Liverpool, UK.
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Khalaf I, Abu Moghli F, Froelicher ES. Youth-friendly reproductive health services in Jordan from the perspective of the youth: a descriptive qualitative study. Scand J Caring Sci 2010; 24:321-31. [PMID: 20233355 DOI: 10.1111/j.1471-6712.2009.00723.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims at describing the needs for reproductive health services among Jordanian youth, identifying problems youth encounter when using reproductive health services, and identifying youths' perceptions of the characteristics of youth-friendly reproductive health services. METHODS A qualitative study using focus groups was conducted on a convenience sample of 60 young men (n = 33) and women (n = 27) (age 12-18 years) selected from the three regions of Jordan. The focus groups were audio taped, and content analysis was used to analyse the data. RESULTS The results revealed that the participants' knowledge about aspects of reproductive health was limited or inadequate. The participants indicated their need for reproductive health information and quality services. The major barriers to using reproductive health services were unpleasant facilities, unprofessional conduct and ill-informed professionals. Youth expressed many ideas about how services could be improved to be more 'youth friendly'. CONCLUSIONS The findings of this study can be useful to health services planners and healthcare providers to improve services and start youth-friendly reproductive health services in Jordan and to develop educational programmes that may improve healthcare professionals' knowledge and attitudes and advance their interpersonal skills for working with youth.
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Affiliation(s)
- Inaam Khalaf
- Faculty of Nursing, University of Jordan, Amman, Jordan.
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Forrest JI, Kaida A, Dietrich J, Miller CL, Hogg RS, Gray G. Perceptions of HIV and fertility among adolescents in Soweto, South Africa: stigma and social barriers continue to hinder progress. AIDS Behav 2009; 13 Suppl 1:55-61. [PMID: 19343491 DOI: 10.1007/s10461-009-9552-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/16/2009] [Indexed: 11/28/2022]
Abstract
The scale up of highly active antiretroviral therapy (HAART) for the treatment of HIV has raised new concerns relating to fertility desires and outcomes. Among these concerns is social stigma surrounding HIV and childbearing. High rates of infection and patterns of high fertility make adolescents a crucial demographic to qualify perceptions of HIV and fertility. We conducted two focus groups (n = 11 males, n = 8 females) with participants ascertained from an HIV adolescent community advisory board in Soweto, South Africa. Adolescents raised concern over re-infection by HIV positive couples attempting to conceive. They also used this concern to justify their attitudes that HIV positive couples should adopt when faced with the desire to have children. Lastly, participants spoke of a need to revise adolescent sexual and reproductive health services to make them more youth-friendly where users could avoid stigma generated by community healthcare workers. This study adds to the growing literature that calls for an evaluation of adolescent HIV educational programs and a healthcare worker intervention that specifically targets stigma surrounding HIV and childbearing.
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Affiliation(s)
- Jamie I Forrest
- Faculty of Health Sciences, Simon Fraser University, 8888 University Avenue, Burnaby, BC, Canada.
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Farid-ul-Hasnain S, Johansson E, Krantz G. What do young adults know about the HIV/AIDS epidemic? Findings from a population based study in Karachi, Pakistan. BMC Infect Dis 2009; 9:38. [PMID: 19323807 PMCID: PMC2678138 DOI: 10.1186/1471-2334-9-38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 03/26/2009] [Indexed: 11/22/2022] Open
Abstract
Background HIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of this epidemic. This study investigated Pakistani young adults' (male and female) knowledge and awareness of the HIV/AIDS disease. Methods A population-based, cross-sectional study of 1,650 male and female adults aged 17–21 years living in Karachi was conducted using a structured questionnaire. A multi-stage cluster sampling design was used to collect data representative of the general population in an urban area. Bivariate and multivariate analyses were performed separately for males and females. Results Of 1,650 subjects, 24 per cent (n = 390) reported that they had not heard of HIV/AIDS. Among the males, those with a poor knowledge were younger (AOR = 2.20; 95 per cent CI, 1.38, 3.49), with less than six years of schooling (AOR = 2.46; 1.29 4.68) and no computer at home (AOR = 1.88; 1.06 3.34). Among the females, the risk factors for poor knowledge were young age (AOR = 1.74; 1.22, 2.50), low socio-economic status (AOR = 1.54; 1.06, 2.22), lack of enrolment at school/college (AOR = 1.61; 1.09, 2.39) and being unmarried (AOR = 1.85; 1.05, 3.26). Conclusion Alarming gaps in knowledge relating to HIV/AIDS were detected. The study emphasises the need to educate young adults and equip them with the appropriate information and skills to enable them to protect themselves from HIV/AIDS. However, taboos surrounding public discussions of sexuality remain a key constraint to preventive activities.
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