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Nkurunziza A, Smye VL, Jackson KT, Wathen CN, Cechetto DF, Tryphonopoulos P, Gishoma D, Muhayimana A. "… I carry their stories home …": experiences of nurses and midwives caring for perinatal adolescent mothers in primary health care settings in Rwanda. BMC Nurs 2024; 23:609. [PMID: 39218862 PMCID: PMC11368027 DOI: 10.1186/s12912-024-02247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Adolescent mothers require trauma- and violence-informed care during the perinatal period due to trauma histories and ongoing violence as a result of pregnancy. Nurses and midwives play a critical role in caring for adolescent mothers in primary healthcare settings in Rwanda in the perinatal period. PURPOSE To explore the experiences of nurses and midwives working with adolescent mothers in selected primary healthcare settings in Rwanda to inform the delivery of trauma- and violence- informed care. METHODS This study utilized an interpretive description qualitative approach and was conducted in eight primary healthcare settings in Rwanda. Twelve nurses and midwives working in perinatal services and four heads of health centers participated in in-depth individual interviews. Data were analyzed thematically. RESULTS The analysis revealed four main themes and 11 (sub-themes): (a) relational practice (being creative and flexible, "lending them our ears"); (b) individual challenges of providing care to adolescent mothers (lack of knowledge to provide care related to gender-based violence, and gendered experience); (c) factors contributing to workarounds (inflexible guidelines, lack of protocol and procedures, lack of nurses' and midwives' in service training, and the physical structure of the perinatal environment); and (d) vicarious trauma (living the feelings, "I carry their stories home," and hypervigilance in parenting). CONCLUSION Nurses and midwives find caring for adolescent mothers challenging due to their unique needs. These needs require them to be creative, adaptable, and attentive listeners to better understand their challenges. These practitioners face difficulties such as insufficient specific knowledge related to, for example, gender-based violence, inflexible guidelines, and a lack of protocols and training. Additionally, in the perinatal environment attention to the needs of practitioners in those settings is often lacking, and many nurses and midwives report experiencing vicarious trauma. Consequently, there is a pressing need for guidelines and protocols specifically tailored for the care of adolescent mothers. Ongoing trauma- and violence- informed care training and professional education should be provided to enhance the ability of nurses and midwives to care for adolescent mothers and prevent re-traumatization and mitigate vicarious trauma effectively.
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Affiliation(s)
- Aimable Nkurunziza
- College of Medicine and Health Sciences, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda.
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
- School of Nursing, Nipissing University, North Bay, Canada.
| | - Victoria L Smye
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Kimberley T Jackson
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - C Nadine Wathen
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - David F Cechetto
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Panagiota Tryphonopoulos
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Darius Gishoma
- College of Medicine and Health Sciences, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
- Rwanda Biomedical Center, Mental Health Division, Ministry of Health, Kigali, Rwanda
| | - Alice Muhayimana
- College of Medicine and Health Sciences, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
- School of Therapeutic Sciences, Department of Nursing Education, University of Wiwatersrand, Johannesburg, South Africa
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Tolossa T, Gold L, Dheresa M, Turi E, Yeshitila YG, Abimanyi-Ochom J. Adolescent maternal health services utilization and associated barriers in Sub-Saharan Africa: A comprehensive systematic review and meta-analysis before and during the sustainable development goals. Heliyon 2024; 10:e35629. [PMID: 39170315 PMCID: PMC11336889 DOI: 10.1016/j.heliyon.2024.e35629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction Effective and adequate maternal health service utilization is critical for improving maternal and newborn health, reducing maternal and perinatal mortality, and important to achieve global sustainable development goals (SDGs). The purpose of this systematic review was to assess adolescent maternal health service utilization and its barriers before and during SDG era in Sub-Saharan Africa (SSA). Methods Systematic review of published articles, sourced from multiple electronic databases such as Medline, PubMed, Scopus, Embase, CINAHL, PsycINFO, Web of Science, African Journal Online (AJOL) and Google Scholar were conducted up to January 2024. Assessment of risk of bias in the individual studies were undertaken using the Johanna Briggs Institute (JBI) quality assessment tool. The maternal health service utilization of adolescent women was compared before and after adoption of SDGs. Barriers of maternal health service utilization was synthesized using Andersen's health-seeking model. Meta-analysis was carried out using the STATA version 17 software. Results Thirty-eight studies from 15 SSA countries were included in the review. Before adoption of SDGs, 38.2 % (95 % CI: 28.5 %, 47.9 %) adolescents utilized full antenatal care (ANC) and 44.9 % (95%CI: 26.2, 63.6 %) were attended by skilled birth attendants (SBA). During SDGs, 42.6 % (95 % CI: 32.4 %, 52.8 %) of adolescents utilized full ANC and 53.0 % (95 % CI: 40.6 %, 65.5 %) were attended by SBAs. Furthermore, this review found that adolescent women's utilization of maternal health services is influenced by various barriers, including predisposing, enabling, need, and contextual factors. Conclusions There was a modest rise in the utilization of ANC services and SBA from the pre-SDG era to the SDG era. However, the level of maternal health service utilization by adolescent women remains low, with significant disparities across SSA regions and multiple barriers to access services. These findings indicate the importance of developing context-specific interventions that target adolescent women to achieve SDG3 by the year 2030.
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Affiliation(s)
- Tadesse Tolossa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
| | - Lisa Gold
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
| | - Merga Dheresa
- Haramaya University, College of Health and Medical Sciences, Department of Nursing and Midwifery, Harar, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
| | - Yordanos Gizachew Yeshitila
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
- School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Julie Abimanyi-Ochom
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
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Mhango W, Michelson D, Gaysina D. "I felt I needed help, but I did not get any": A multiple stakeholder qualitative study of risk and protective factors, and barriers to addressing common mental health problems among perinatal adolescents in Malawi. Glob Ment Health (Camb) 2023; 10:e73. [PMID: 38024806 PMCID: PMC10663692 DOI: 10.1017/gmh.2023.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Common mental health problems (particularly depression and anxiety) are common among adolescents during the perinatal period. Previous research has identified the distinctive needs of this group and called for contextually appropriate psychosocial interventions. The current study conducted in Malawi aimed to explore risk and protective factors for common mental health problems, and barriers to accessing mental health care, among perinatal adolescents, to develop a contextually relevant intervention for preventing and treating perinatal depression and anxiety. An exploratory qualitative study was conducted in antenatal and postnatal clinics in Zomba district, Malawi in January-March 2022. In-depth individual interviews were completed with perinatal adolescents aged ≤19 (n = 14); their family members (n = 4); and healthcare workers (n = 8). Interview data were subjected to thematic framework analysis. Data were organised around two themes: "psychosocial risk and protective factors" (potential causes of common mental health problems among adolescents); and "health care services" (maternal and mental health services available, and adolescents' experiences of using these services). Interventions need to go beyond targeting symptoms of depression and anxiety to addressing the wider contextual risk factors and barriers to care at the different socioecological levels.
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Affiliation(s)
- Wezi Mhango
- School of Psychology, University of Sussex, Brighton, UK
- Department of Psychology and Medical Humanities, University of Malawi, Zomba, Malawi
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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Tembo CP, Portsmouth L, Burns SK. Mapping the contextual mental health interventions for perinatal adolescent mothers with self-reported common mental symptoms (anxiety and depression) in sub-Saharan African countries: a scoping review. J Child Adolesc Ment Health 2023; 35:147-164. [PMID: 38828874 DOI: 10.2989/17280583.2024.2323922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Introduction: Early preventive interventions may support adolescent mothers' mental health during the perinatal period. However, adolescent maternal mental health interventions have received little empirical research attention. This scoping review maps the evidence on interventions appropriate for adolescent mothers during the perinatal period in Sub-Saharan African countries.Methods: The process was guided by the Joanna Briggs Institute's methodology for scoping reviews. Five databases, MEDLINE, EMBASE, PsycInfo, CINAHL, Google Scholar, and ProQuest, were searched for citations of studies published from 2000. The reporting is according to Preferred Reporting for Systematic Reviews and Meta-analysis (PRISMA).Results: The initial search of databases resulted in 2 757 records. After duplicates were removed, 311 records were screened, and eight records included. Interventions included five key strategies: cognitive behavioural therapy; group problem-solving; psychoeducation; psychosocial group counselling; and integrated mothers and babies course and early childhood development group-based intervention. None of the interventions specifically targeted adolescent mothers, however.Discussion and conclusion: There is limited evidence of interventions specific to adolescent mothers. There is a need for the development, implementation and evaluation of specific interventions relevant to this population group.
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Affiliation(s)
- Chimwemwe Pindani Tembo
- Saint John of God College of Health Sciences, Mzuzu Malawi
- Population Health, Curtin University, Perth, Australia
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Crooks R, Bedwell C, Lavender T. Adolescent experiences of pregnancy in low-and middle-income countries: a meta-synthesis of qualitative studies. BMC Pregnancy Childbirth 2022; 22:702. [PMID: 36096763 PMCID: PMC9469636 DOI: 10.1186/s12884-022-05022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Fertility rates among adolescents have fallen globally, yet the greatest incidence remains in low-and middle-income countries (LMICs). Gaining insight into adolescents needs and experiences of pregnancy will help identify if context specific services meet their needs and how to optimise pregnancy experiences. A meta-synthesis of qualitative studies considering adolescent experiences of pregnancy in LMICs has not yet been published. Aim To synthesise available qualitative evidence to provide greater understanding of the needs and experiences of adolescents who become pregnant in low-and middle-income countries. Methods An extensive search utilised six databases and citations searching. Studies were included if they were of a qualitative or mixed methods design. Participants lived in LMICs and were adolescents who were pregnant, had experienced pregnancy during adolescence or were an adolescent male partner. Relevant studies were assessed for quality to determine suitability for inclusion. A meta-ethnography approach was used to generate themes and a final line of argument. Results After screening and quality assessment 21 studies were included. The meta-ethnography generated four themes, A wealth of emotions, I am not ready, Impactful relationships and Respectful and disrespectful care. Unplanned, unwanted and unacceptable pregnancies were a source of shame, with subsequent challenging personal relationships and frequently a lack of needed support. Even when pregnancy was wanted, adolescents faced the internal conflict of their desires not always aligning with socio-cultural, religious and family expectations. Access, utilisation and experiences of care were significantly impacted by adolescents’ relationships with others, the level of respectful care experienced, and engagement with adolescent friendly services. Conclusions Adolescents who experience pregnancy in LMICs deserve support to meet their personal and pregnancy needs; efforts are needed to tailor the support provided. A lack of a health care provider knowledge and skills is an obstacle to optimal support, with more and better training integral to increasing the availability of adolescent friendly and respectful care. Adolescents should be involved in the planning of health care services and supported to make decisions about their care. The diversity across countries mean policy makers and other stakeholders need to consider how these implications can be realised in each context. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05022-1.
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Affiliation(s)
- Rachel Crooks
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Carol Bedwell
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tina Lavender
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Family context and individual characteristics in antenatal care utilization among adolescent childbearing mothers in urban slums in Nigeria. PLoS One 2021; 16:e0260588. [PMID: 34843583 PMCID: PMC8629214 DOI: 10.1371/journal.pone.0260588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Adolescent pregnancy contributes significantly to the high maternal mortality in Nigeria. Research evidence from developing countries consistently underscores Antenatal Care (ANC) among childbearing adolescents as important to reducing high maternal mortality. However, more than half of pregnant adolescents in Nigeria do not attend ANC. A major gap in literature is on the influence of family context in pregnant adolescent patronage of ANC services. Methods The study utilized a cross-sectional survey with data collected among adolescent mothers in urban slums in three Nigerian states namely, Kaduna, Lagos, and Oyo. The survey used a multi-stage sampling design. The survey covered a sample of 1,015, 1,009 and 1,088 childbearing adolescents from each of Kaduna, Lagos, and Oyo states respectively. Data were analyzed at the three levels: univariate, bivariate and multivariate. Results Overall, about 70 percent of female adolescents in our sample compared with 75 percent in the Demographic and Health Survey (DHS) had any antenatal care (ANC) visit. About 62 percent in our sample compared with 70 percent in the DHS had at least 4 ANC visits, and, about 55 percent in our sample compared with 41 percent of the DHS that had 4 ANC visits in a health facility with skilled attendant (4ANC+). Those who have both parents alive and the mother with post-primary education have higher odds of attending 4ANC+ visits. The odds of attending 4ANC+ for those who have lost both parents is almost 60% less than those whose parents are alive, and, about 40% less than those whose mothers are alive. The influence of mother’s education on 4ANC+ attendance is more significant with large disparity when both parents are dead. Conclusion The study concludes that identifying the role of parents and community in expanding access to ANC services among adolescent mothers is important in improving maternal health in developing countries.
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Kululanga LI, Kadango A, Lungu G, Jere D, Ngwale M, Kumbani LC. Knowledge deficit on health promotion activities during pregnancy: the case for adolescent pregnant women at Chiladzulu District, Malawi. BMC Pregnancy Childbirth 2020; 20:699. [PMID: 33198665 PMCID: PMC7667800 DOI: 10.1186/s12884-020-03386-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/30/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adolescent pregnancy is a public health concern in Malawi as it is associated with high risks of adverse pregnancy outcomes. Almost 29% of adolescent women aged 15-19 years are already mothers and adolescent fertility rate is also high estimated at 136 per 1000 women. Therefore, the aim of the study was to explore knowledge of pregnant adolescents on importance of antenatal care and health promotion during pregnancy. METHODS A qualitative descriptive design was used to solicit information on significance of antenatal care and how adolescents promote their health during pregnancy. Data was collected from 77 pregnant adolescents, purposively sampled from Namitambo and Namadzi Heath Centres in Chiladzulu District, Malawi. A semi-structured interview guide was used for data collection. Data were analysed manually following principles of qualitative content analysis. RESULTS Themes that emerged from the qualitative data included: knowledge deficit on the purpose and benefits of antenatal care; knowledge deficit on services offered at antenatal care clinic; knowledge deficit on danger signs during antenatal period and antenatal emergency care; knowledge deficit on effects of alcohol and smoking; knowledge deficit on nutrition during pregnancy; and knowledge deficit on importance of rest during pregnancy. CONCLUSION This study has shown knowledge deficit among adolescent mothers that may contribute to poor pregnancy outcomes. Several factors could be attributed to such knowledge deficit. Therefore, healthcare systems and healthcare professionals have a responsibility to enhance health literacy of pregnant adolescents with an ultimate goal of improving maternal and neonatal health outcomes.
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Affiliation(s)
- Lucy Ida Kululanga
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi.
| | - Alice Kadango
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Gaily Lungu
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Diana Jere
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Matthews Ngwale
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
| | - Lily Caroline Kumbani
- University of Malawi, Kamuzu College of Nursing, P.O. Box 415, Blantyre Campus, Blantyre, Malawi
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Bastos RA, Alves VLP, Sena RMDC, Jesus JVFD, Rodrigues L, Surita FGDC, Turato ER. The structure of qualitative studies: a bibliometric pattern of biomedical literature. CIENCIA & SAUDE COLETIVA 2020; 26:3199-3208. [PMID: 34378709 DOI: 10.1590/1413-81232021268.12922020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/09/2020] [Indexed: 11/22/2022] Open
Abstract
The lack of knowledge in the biomedical literature regarding the validity of qualitative studies might be related to the lower number of qualitative studies that have been published. The criticisms range from a lack of theoretical depth to the superficial discussions of empirical findings. The aim of this study was to explore the bibliometric entities and the trends in the structure of qualitative research in the biomedical literature. A bibliometric analysis and mapping of the biomedical literature were used. The number of studies selected was 1,725. The heath themes with the most publications included Health Management (12%) and Women's Health (9.8%), while the authors of the studies had academic affiliation in 76 different countries. The sample sizes were between 11 and 20 participants (27.13%) and the Grounded Theory framework (9.04%) stood out. The improved structuring of a qualitative research extends the effective communication between health providers and researchers, and support in the management of clinical situations.
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Affiliation(s)
- Rodrigo Almeida Bastos
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP). R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Vera Lucia Pereira Alves
- Departamento de Psicologia Médica e Psiquiatria, Faculdade de Ciências Médicas, UNICAMP. Campinas SP Brasil
| | | | - Juliana Vasconcellos Freitas de Jesus
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP). R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Larissa Rodrigues
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP). R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Fernanda Garanhani de Castro Surita
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP). R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Egberto Ribeiro Turato
- Departamento de Psicologia Médica e Psiquiatria, Faculdade de Ciências Médicas, UNICAMP. Campinas SP Brasil
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Chirwa GC, Mazalale J, Likupe G, Nkhoma D, Chiwaula L, Chintsanya J. An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi. PLoS One 2019; 14:e0225374. [PMID: 31747437 PMCID: PMC6867649 DOI: 10.1371/journal.pone.0225374] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi. METHODS The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing. RESULTS The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%). CONCLUSION The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.
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Affiliation(s)
| | - Jacob Mazalale
- Department of Economics, University of Malawi, Chancellor College, Zomba, Malawi
| | - Gloria Likupe
- Health Nursing and Midwifery, University of Hull, Hull, United Kingdom
| | - Dominic Nkhoma
- Health Policy Unit, University of Malawi, College of Medicine, Lilongwe, Malawi
| | - Levison Chiwaula
- Department of Economics, University of Malawi, Chancellor College, Zomba, Malawi
| | - Jesman Chintsanya
- Department of Population Studies, University of Malawi, Chancellor College, Zomba, Malawi
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Hackett K, Lenters L, Vandermorris A, LaFleur C, Newton S, Ndeki S, Zlotkin S. How can engagement of adolescents in antenatal care be enhanced? Learning from the perspectives of young mothers in Ghana and Tanzania. BMC Pregnancy Childbirth 2019; 19:184. [PMID: 31122199 PMCID: PMC6533671 DOI: 10.1186/s12884-019-2326-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 04/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background Adolescents are especially vulnerable due to increased biological, social and economic risks associated with early pregnancy and childbirth, yet most pregnancy and childbirth-related complications are preventable through a combination of proven, cost-effective clinical interventions including timely antenatal care (ANC). The voices and specific needs of adolescents are currently underrepresented in the literature on antenatal and maternity care. Objectives were to a) increase our understanding of adolescents’ experiences with, and perceptions of, ANC and b) explore how these perspectives might be applied towards future initiatives to enhance adolescent care-seeking behaviour. Methods This cross-sectional qualitative study employed 14 focus group discussions with 112 adolescents aged 15–20 years in Singida Region in Tanzania and Volta and Eastern Regions in Ghana who had accessed ANC during their most recent pregnancy. We were particularly interested in what these young women valued and understood about their ANC experience, as this would provide insights into what factors motivated them to seek care. Transcripts were analyzed using conventional content analysis. Based on emergent themes and drawing on the Health Belief Model (HBM) as an analytical tool, a conceptual framework was developed to illustrate the myriad factors influencing adolescents’ decision to attend ANC. Results Interpreting results through an adapted HBM demonstrates that adolescent health-seeking behaviour can vary widely among individuals and within communities, is shaped by the opinions of family members and peers, and is intrinsically influenced by broader health systems-level factors. Conclusions The results led to our development of an adapted theory-based framework to illustrate the complexity of adolescent care-seeking during pregnancy in resource-poor settings. We demonstrate that while an adolescent mother is capable of exercising her own agency, she is also developmentally vulnerable to external influences and must be supported in her ability to make autonomous decisions. While the model presented here focuses specifically on ANC utilization, it may have applications for understanding how adolescents engage with health services more broadly. Electronic supplementary material The online version of this article (10.1186/s12884-019-2326-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristy Hackett
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Lindsey Lenters
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada
| | - Ashley Vandermorris
- Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
| | - Curtis LaFleur
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon St. W, Whitby, ON, L1N 5S9, Canada
| | - Sam Newton
- Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana
| | - Sidney Ndeki
- PRAXIS Tanzania, 5th Floor Mariam Tower, Ilala, Shaurimoyo Street, Dar es salaam, Tanzania
| | - Stanley Zlotkin
- Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
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