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Singh R, Abbai N, Apalata TR. Editorial: STI awareness day: diagnosis and control of STIs in LMICs. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1415433. [PMID: 38726052 PMCID: PMC11079305 DOI: 10.3389/frph.2024.1415433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Ravesh Singh
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Service, Durban, South Africa
| | - Nathlee Abbai
- School of Clinical Medicine Laboratory, College of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Teke R. Apalata
- National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha, South Africa
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
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Mahama S, Weichold K, Fehmer N, Mvungu EN, Natsuaki MN. Pubertal status and body image: An inquiry into experiences of adolescents in Ghana and Kenya. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024. [PMID: 38659355 DOI: 10.1111/jora.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
The current study uses a mixed method design to investigate Kenyan and Ghanaian adolescents' experiences of puberty, and the relations between gender, country of origin, pubertal status, and body image appraisals (N = 86; Ghana = 46, Kenya = 40, 52.9% female aged 13 and 14). Qualitative results revealed seven major themes; puberty means a universal period of growth and transition into adulthood but also evokes negative emotions of shame, anxiety, and embarrassment, being in sync with peers during puberty is important and knowing that others in their lives similarly experience puberty is reassuring. Quantitative results revealed significant gender and country differences in pubertal status and body image. Ghanaian adolescents had more advanced pubertal status and more positive body image appraisals compared to Kenyan adolescents. Moderation analysis results revealed that for the Kenyan sample, post-pubertal males had less favorable body image appraisals than their counterparts who were still pre pubertal whilst for females, post-pubertal girls had more favorable body images than their counterparts. No such effects were observed with the Ghanaian sample. The findings highlight the need for context considerations in understanding body image during the pubertal transition to help identify relevant protective factors for possible interventions. The results affirm the importance of positive body image promotions for adolescents within the African context and suggest the need for much more comprehensive sex education with gender-specific components to help allay fears about puberty, thus preventing the development of possible adaptation problems.
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Affiliation(s)
| | | | - Nora Fehmer
- Friedrich Schiller University of Jena, Jena, Germany
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Sikaluzwe M, Phiri M, Lemba M, Shasha L, Muhanga M. Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001-2018). BMC Pregnancy Childbirth 2024; 24:148. [PMID: 38383354 PMCID: PMC10880343 DOI: 10.1186/s12884-024-06311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia. METHODS This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15-49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software. RESULTS Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25-29 years and 30-34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies. CONCLUSIONS The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women's age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies.
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Affiliation(s)
- Milika Sikaluzwe
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
| | - Million Phiri
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Musonda Lemba
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Liness Shasha
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Mikidadi Muhanga
- Department of the Development and Strategic Studies, College of Social Sciences and Humanities, Sokoine University of Agriculture, Morogoro, Tanzania
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Langat EC, Mohiddin A, Kidere F, Omar A, Akuno J, Naanyu V, Temmerman M. Challenges and opportunities for improving access to adolescent and youth sexual and reproductive health services and information in the coastal counties of Kenya: a qualitative study. BMC Public Health 2024; 24:484. [PMID: 38365655 PMCID: PMC10870511 DOI: 10.1186/s12889-024-17999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Globally, adolescents and youth experience high unmet need for sexual and reproductive health (SRH) information and services. In Kenya, evidence shows that more than half of teenage pregnancies are unintended and that half of all new HIV infections occur in people ages 15-24-year-olds, with the majority of those being female. The coastal counties in Kenya record a relatively high adolescent pregnancy rate and higher rates of unmet need for contraception for all women of reproductive age compared to the national average. This study focused on gaining a deeper understanding of the existing challenges to and opportunities for accessing SRH information and services among adolescents and youth (AY) at the Kenyan coast. METHODS Using qualitative methods, this study conducted thirty-six focus group discussions with adolescents, youth, and community health volunteers across all the six coastal counties in Kenya. The sample included adolescents aged 10-14 years in school (male and female), adolescents aged 15-19 years not in education (male and female), youths aged 20-24 years (mix of both male and female), and community health volunteers who were conveniently sampled. Thematic analysis was used to examine the data and report the study results. RESULTS The barriers to accessing AYSRH identified in the study are individual factors (feelings of shame, lack of information, and fear of being judged) parental factors, healthcare worker and health institution factors, teacher/educators factors, and broader contextual factors such as culture, religion, poverty, and illiteracy. Factors that facilitate access to AYSRH information and services included, supportive parenting and culture, AYSRH sessions in schools, peer support, supportive health institutions, gender inclusivity, and digital technology. CONCLUSIONS AYSRH information and services at the Kenyan coast is strongly influenced by a range of individual, social, cultural, and economic factors. Improving access to AYSHR necessitates meaningful AY engagement, provision of youth-friendly services, use of digital technology as alternative pathways for sharing SRH information, strengthening parent-AY relationships, embracing peer-to-peer support, and the adoption of gender-inclusive approaches in AYSRH programming.
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Affiliation(s)
| | - Abdu Mohiddin
- Center of Excellence in Women and Child Health, Aga Khan University, East Africa, Kenya
| | | | - Anisa Omar
- Department of Gender, Culture, Social Services and Sports, County Government of Kilifi, Kilifi, Kenya
| | - Job Akuno
- Elizabeth Glaser Paediatric AIDS Foundation, Washington, DC, USA
| | - Violet Naanyu
- Center of Excellence in Women and Child Health, Aga Khan University, East Africa, Kenya
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Marleen Temmerman
- Center of Excellence in Women and Child Health, Aga Khan University, East Africa, Kenya
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Shen H, Zhao H, Wang B, Jiang Y. Women's status, empowerment, and utilization of skilled delivery services in Papua New Guinea: an empirical analysis based on structural equation modeling. Front Public Health 2024; 11:1192966. [PMID: 38269389 PMCID: PMC10807043 DOI: 10.3389/fpubh.2023.1192966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background Skilled birth attendants (SBA) facilitate identifying and overcoming labor problems and saving lives. With one of the highest maternal death rates in the Asia-Pacific area, SBA utilization during childbirth among Papua New Guinea (PNG) women remains low. Women's status and empowerment are important factors in maternal and child health services and critical to maternal and child health development. This study is intended to apply structural equation modeling based on data from the Demographic and Health Survey (DHS) to evaluate the causal relationship between women's status, empowerment, and SBA utilization in PNG and the mechanisms of their influence. Methods This study employed data from the 2016-2018 Papua New Guinea Demographic Health Survey (PNG DHS), which recruited 18,175 women aged 15-49 years. A multi-stage sample and a structured questionnaire were used to collect information on maternal health, women's empowerment, and related topics. STATA 17.0 was used to describe the data, while MPLUS 8.2 was employed for structural equation modeling and pathway analysis. Results The two empowerment dimensions of household decision-making (standardized path coefficient, β = 0.049, p < 0.05) and access to health services (β = 0.069, p < 0.01) were positively associated with SBA utilization, while the association between attitudes toward partner violence and SBA utilization was not statistically significant. In addition, mediation analysis revealed that education indirectly influenced SBA utilization through access to health services (β = 0.011, 95% CI: 0.002, 0.022). Conclusion The findings confirmed the direct and indirect effects of women's status and empowerment on SBA utilization in PNG. Therefore, a call for further evidence-based interventions in PNG and possibly Pacific Small Island Developing States (PSIDS) is needed to improve women's educational attainment, household decision-making, and access to health services to enhance maternal and newborn health and well-being.
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Affiliation(s)
- Hao Shen
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hang Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Baoqin Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
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Sawalma M, Shalash A, Wahdan Y, Nemer M, Khalawi H, Hijazi B, Abu-Rmeileh N. Sexual and reproductive health interventions geared toward adolescent males: A scoping review. J Pediatr Nurs 2023; 73:e19-e26. [PMID: 37474422 DOI: 10.1016/j.pedn.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
PROBLEM Male adolescent sexual and reproductive health (SRH) interventions are rare worldwide. The high prevalence of sexually transmitted infections and pregnancies among female and male adolescents worldwide highlights the need for comprehensive interventions that include both genders in the educational process. OBJECTIVE Our main focus is studying and analysing male-focused SRH interventions globally to include males in evidence-based interventions that improve SRH of adolescent males. ELIGIBILITY CRITERIA This Review was conducted using the PRISMA extension for scoping reviews. The following databases were searched: PubMed, Embase, Web of science, Scopus, CINAHL and PsycInfo. INCLUSION CRITERIA 1) No time or date limits; 2)all types of studies; 3)SRH campaign; 4)males; 5)10 to 19 years. SAMPLE Five thousand and sixty-eight articles were identified and 166 peer-reviewed articles met the inclusion criteria. RESULTS Family planning was identified as the primary domain covered for adolescents. While interactive activities was the most common method used to deliver information to adolescents about sexual health. SRH interventions for males were most prevalent in America. While in the Eastern Mediterranean region (EMR), no male interventions were found in our review. CONCLUSION This scoping review emphasizes the need to include adolescent males in sexual and reproductive health interventions, particularly in low- and middle-income countries (LMICs) and the EMR. Policymakers should develop comprehensive programs that address male-specific needs, improve training for intervention providers, and enhance reporting processes to identify gaps and barriers to male inclusion. IMPLICATION Future research should be directed toward the obstacles that prevent SRH interventions targeting males from being carried out.
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Affiliation(s)
- Mariam Sawalma
- Institute of Community and Public Health, Birzeit University, Palestine.
| | - Aisha Shalash
- Institute of Community and Public Health, Birzeit University, Palestine; School of Medicine, University of Limerick, Limerick, Ireland.
| | - Yasmeen Wahdan
- Institute of Community and Public Health, Birzeit University, Palestine
| | - Maysaa Nemer
- Institute of Community and Public Health, Birzeit University, Palestine.
| | - Hala Khalawi
- The Department of Social Sciences, Bethlehem University, Palestine
| | | | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Palestine.
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Chavula MP, Zulu JM, Goicolea I, Hurtig AK. Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis. Health Res Policy Syst 2023; 21:97. [PMID: 37710251 PMCID: PMC10500755 DOI: 10.1186/s12961-023-01037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/05/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Comprehensive sexuality education (CSE) has recently become salient, but adolescent sexual reproductive health and rights (ASRHR) challenges are still a global health problem. Studying policies which have implications for CSE implementation is a crucial but neglected issue, especially in low and middle-income countries (LMICs) like Zambia. We analyzed policy synergies, challenges and contradictions influencing implementation of CSE framework in Zambia. METHODS We conducted a document review and qualitative interviews with key stakeholders from Non-Governmental Organizations, as well as health and education ministries at the National and all (10) provincial headquarters. Our methods allowed us to capture valuable insights into the synergies, challenges and contradictions that exist in promoting CSE framework in Zambia. RESULTS The study highlighted the synergies between policies that create opportunities for implementation of CSE through the policy window for adoption of sexual reproductive health and rights (SRHR) that opened around the 1990s in Zambia, promotion of inclusive development via education, adoption of an integrated approach in dealing with SRHR problems, and criminalization of gender-based violence (GBV). This analysis also identified the policy challenges and contradictions including restricted delivery of education on contraception in schools; defining childhood: dual legal controversies and implications for children, grey zones on the minimum age to access SRHR services; inadequate disability inclusiveness in SRHR legal frameworks; policy silences/contentious topics: LGBTQI + rights, abortion, and grey zones on the minimum age to access SRHR services. CONCLUSION While many policies support the implementation of CSE in schools, the existence of policy silences and challenges are among the barriers affecting CSE implementation. Thus, policy reformulation is required to address policy silences and challenges to enhance effective promotion and integration of the CSE framework.
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Affiliation(s)
- Malizgani Paul Chavula
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
- Department of Health Policy Management, Promotion and Education, School of Public Health, The University of Zambia, Ridgeway Campus, Box 50110, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health Policy Management, Promotion and Education, School of Public Health, The University of Zambia, Ridgeway Campus, Box 50110, Lusaka, Zambia
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
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Kim EJ, Park B, Kim SK, Park MJ, Lee JY, Jo AR, Kim MJ, Shin HN. A Meta-Analysis of the Effects of Comprehensive Sexuality Education Programs on Children and Adolescents. Healthcare (Basel) 2023; 11:2511. [PMID: 37761708 PMCID: PMC10530760 DOI: 10.3390/healthcare11182511] [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: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Childhood and adolescence are crucial periods for developing one's awareness of sexuality. Comprehensive Sexuality Education (CSE) during these stages is essential for overall growth, fostering healthy self-concepts, and addressing diverse sexual issues among children and adolescents globally. A meta-analysis was conducted to analyze the effectiveness of CSE programs. A literature search was performed on EMBASE, PubMed, CINAHL, Cochrane Library, and PsycInfo for studies published before 14 June 2023, and based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the Comprehensive Meta-Analysis (CMA, V4) software version 4.0 for the analysis and interpreted the effect sizes according to Cohen's definition. Between 2011 and 2020, 21 studies on CSE were published, with the United States having the most publications (17). Of the 34 studies reviewed, 20 were randomized controlled trials. The primary population for CSE was middle/high school students (15), with the most frequent age range being 10-19 years (26). The overall effect size of CSE was significant (effect size = 1.31, p < 0.001), with cognition (effect size = 5.76, p < 0.001) being the most significant. CSE is an effective educational tool for children and adolescents with a significant impact on variables such as cognition and abstinence. It should be incremental from childhood and adolescence to adulthood.
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Affiliation(s)
| | - Bitna Park
- Department of Nursing, Gangneung-Wonju National University, 150 Heungeop-myeon Namwon-ro, Wonju-si 26403, Gangwon-do, Republic of Korea; (E.J.K.); (S.K.K.); (M.J.P.); (J.Y.L.); (A.R.J.); (M.J.K.); (H.N.S.)
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Zulu JM, Mwamba T, Rosen A, Matenga TFL, Mulanda J, Kaimba M, Chilembo M, Silondwa M, Kamboyi RL, Simwanza SC, Sichone G, Chavula MP. Community engagement for the Voluntary Medical Male Circumcision (VMMC) program: an analysis of key stakeholder roles to promote a sustainable program in Zambia. Gates Open Res 2023; 6:50. [PMID: 37069966 PMCID: PMC10105033 DOI: 10.12688/gatesopenres.13587.2] [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] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Background: Within the Voluntary Medical Male Circumcision (VMMC) programme, community engagement has been central in facilitating the acceptance of VMMC, especially in non-circumcising communities. We used the case of the development of community engagement plans for sustainability of VMMC in Zambia to illustrate diversity of stakeholders, their power, roles, and strategies in community engagement. Methods: Data were collected using document review, in-depth interviews (n=35) and focus group discussions (n=35) with community stakeholders, health workers, health centre committees, counsellors, teachers, community volunteers and parents/caregivers. Data were analysed using thematic analysis. The analysis was guided by the power and interest model. Results: Differences were noted between the rural and urban sites in terms of power/influence and interest rating of community stakeholders who could be involved in the sustainability phase of the VMMC response in Zambia. For example, in the urban setting, neighbourhood health committees (NHCs), health workers, leaders of clubs, community health workers (CHWs), radio, television and social media platforms were ranked highest. From this list, social media and television platforms were not highly ranked in rural areas. Some stakeholders had more sources of power than others. Forms or sources of power included technical expertise, local authority, financial resources, collective action (action through schools, churches, media platforms, other community spaces), and relational power. Key roles and strategies included strengthening and broadening local coordination systems, enhancing community involvement, promoting community-led monitoring and evaluation, through the use of locally recognised communication spaces and channels, facilitating ownership of VMMC, and improving local accountability processes in VMMC activities. Conclusions: By consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision.
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Affiliation(s)
- Joseph M. Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Trevor Mwamba
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Alyssa Rosen
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Tulani Francis L. Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Joseph Mulanda
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Mutale Kaimba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Masitano Chilembo
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Madaliso Silondwa
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Royd L. Kamboyi
- Ministry of Health, Ministry of Health, Lusaka, Lusaka, 10101, Zambia
| | | | - George Sichone
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Malizgani Paul Chavula
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
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Shibuya F, Estrada CA, Sari DP, Takeuchi R, Sasaki H, Warnaini C, Kawamitsu S, Kadriyan H, Kobayashi J. Teachers' conflicts in implementing comprehensive sexuality education: a qualitative systematic review and meta-synthesis. Trop Med Health 2023; 51:18. [PMID: 36973712 PMCID: PMC10042670 DOI: 10.1186/s41182-023-00508-w] [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: 12/07/2022] [Accepted: 02/19/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Comprehensive sexuality education (CSE) enables children and young people to learn about the cognitive, emotional, physical, and social characteristics of sexuality. Teachers experience conflicts in teaching CSE due to different cultural and religious backgrounds. This qualitative systematic review aimed to describe the conflicts experienced by teachers in the implementation of CSE in schools. Furthermore, this study aimed to identify the causes of conflict among teachers in implementing CSE. METHODS This article focused on teachers' conflicts in implementing CSE from 2010 to 2022. Online bibliographic databases, such as PubMed, Web of Science, and ERIC, were used to search for relevant articles. The following search term was used: Teacher, Comprehensive Sexuality Education, and Conflict. RESULTS A total of 11 studies were included in the review. All 11 studies were conducted in countries with a predominantly Christian population. The majority of the studies were conducted in Africa. The study respondents included teachers, school principals, and school coordinators. The studies identified that CSE implementation is related to multiple conflicts, depending on the context of the country. Five themes on the causes of conflict emerged from the thematic meta-synthesis: (1) Hesitancy in talking about sex education among teachers due to the cultural and religious context; (2) non-integration of traditional sex education into comprehensive sexuality education, (3) fostering effective facilitation of CSE among teachers, (4) determining the appropriate age to start sex education, and (5) roles of stakeholders outside the school. CONCLUSIONS This qualitative systematic review and thematic meta-synthesis highlighted several conflicts among teachers in CSE implementation. Despite the teachers having a perception that sex education should be provided, traditional sex education has not yet transformed to CSE. The study findings also emphasize the need to identify the teacher's role in CSE implementation. The thematic meta-synthesis also strongly reflected the context of Christianity in Europe and Africa; thus, further research on the religious context in other regions is needed.
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Affiliation(s)
- Fumiko Shibuya
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Crystal Amiel Estrada
- Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, 625 Pedro Gil Street, Ermita Manila, Philippines
| | - Dian Puspita Sari
- Faculty of Medicine, University of Mataram, Jalan Pendidikan 37, Mataram, West Nusa Tenggara, 83125, Indonesia
| | - Rie Takeuchi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Hirono Sasaki
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Cut Warnaini
- Faculty of Medicine, University of Mataram, Jalan Pendidikan 37, Mataram, West Nusa Tenggara, 83125, Indonesia
| | - Saki Kawamitsu
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Hamsu Kadriyan
- Faculty of Medicine, University of Mataram, Jalan Pendidikan 37, Mataram, West Nusa Tenggara, 83125, Indonesia
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
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chilambe¹ K, Mulubwa C, Zulu JM, Chavula MP. Experiences of teachers and community-based health workers in addressing adolescents' sexual reproductive health and rights problems in rural health systems: a case of the RISE project in Zambia. BMC Public Health 2023; 23:335. [PMID: 36793027 PMCID: PMC9930354 DOI: 10.1186/s12889-023-15199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)' experiences in addressing ASRHR problems in in rural health systems in Zambia. METHODOLOGY The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services. RESULTS The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution. CONCLUSION This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.
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Affiliation(s)
- Kunda chilambe¹
- Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, P.O Box 50110, Zambia
| | - Chama Mulubwa
- Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, P.O Box 50110, Zambia
- Department of Epidemiology and Global Health, Umea University, Umea, 90187 Sweden
| | - Joseph Mumba Zulu
- Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, P.O Box 50110, Zambia
| | - Malizgani Paul Chavula
- Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, P.O Box 50110, Zambia
- Department of Epidemiology and Global Health, Umea University, Umea, 90187 Sweden
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Mbarushimana V, Goldstein S, Conco DN. "Not just the consequences, but also the pleasurable sex": a review of the content of comprehensive sexuality education for early adolescents in Rwanda. BMC Public Health 2023; 23:49. [PMID: 36609366 PMCID: PMC9824976 DOI: 10.1186/s12889-022-14966-0] [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: 07/05/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Responding to adolescents' educational needs in sexual and reproductive health and rights (SRHR) is central to their sexual health and achieved through school-based comprehensive sexuality education (CSE). In 2016, Rwanda introduced CSE through the competence-based curriculum in schools to enhance learners' knowledge about sexuality, gender, and reproductive health issues, including HIV/AIDS. However, globally, the content of CSE is sometimes dissimilar, and little evidence surrounds its scope in many settings, including Rwanda. In addition, the extent to which CSE aligns with international guidelines has yet to be well known. This study assesses major areas of CSE for early adolescents in Rwanda, analyses how CSE correlates with international guidelines and makes recommendations accordingly. METHODS We reviewed the Rwandan competence-based curriculum to map CSE competences for early adolescents and conducted semi-structured interviews with key informants (N = 16). Eleven of the 23 curriculum documents met the selection criteria and were included in the final review. We manually extracted data using a standard form in Microsoft Excel and analysed data using frequency tables and charts. Interviews were thematically analysed in NVivo 11 for Windows. FINDINGS We found 58 CSE competences for early adolescents across various subjects, increasing with school grades. All recommended CSE areas were addressed but to a variable extent. Most competences fall under four recommended areas: sexual and reproductive health; human body and development; values, rights, and sexuality; and understanding gender. The least represented area is violence and staying safe. Of the 27 expected topics, there are two to six CSE competences for 13 topics, one CSE competence for each of the six others, and none for the eight remaining ones. Qualitative findings support these findings and suggest additional content on locally controversial but recommended areas of sexual pleasure, orientation, desire and modern contraceptive methods. CONCLUSION This study explores the CSE content for early adolescents in Rwanda and how they align with sexuality education standards. Ensuring equal coverage of CSE areas and addressing missing topics may improve CSE content for this age group and foster their SRHR.
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Affiliation(s)
- Valens Mbarushimana
- grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ,grid.10818.300000 0004 0620 2260School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Susan Goldstein
- grid.11951.3d0000 0004 1937 1135SAMRC/Centre for Health Economics and Decision Science, School of Public Health, Faculty of Health Sciences, PRICELESS SA, University of the Witwatersrand, Johannesburg, South Africa
| | - Daphney Nozizwe Conco
- grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Pepito VCF, Amit AML, Tang CS, Co LMB, Aliazas NAK, De Los Reyes SJ, Baquiran RS, Tanchanco LBS. Exposure to family planning messages and teenage pregnancy: results from the 2017 Philippine National Demographic and Health Survey. Reprod Health 2022; 19:229. [PMID: 36544191 PMCID: PMC9769471 DOI: 10.1186/s12978-022-01510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Teenage pregnancy is known to have physical, emotional, and psychosocial effects. Because of these risks, family planning and contraception messages have been disseminated in various forms of media, but their association with teenage pregnancy has not been studied previously in the Philippines. This study aims to examine the association between exposure to various family planning and contraception messages disseminated in various media channels and pregnancy among Filipino women aged 15-19. The study also intended to examine interactions between the different media channels where these family planning and contraception messages are being disseminated on their effect on teenage pregnancy. METHODS We used data from the individual recode of the 2017 Philippine National Demographic and Health Survey. We used logistic regression for survey data to study the association between exposure to family planning and contraception messages and teenage pregnancy. RESULTS Out of 5120 respondents, 44% of respondents have accessed information on contraception from the internet, 25% have heard information about contraception through the radio, 55% of respondents have heard about contraception via television, 15% have read about contraception in the newspapers and magazines, and only 6% have received information on contraception via short messaging service (SMS). There were 420 (8.56%) who have ever been pregnant. After adjusting for confounding variables, those who were exposed to family planning/contraceptive messages via the internet (aOR: 0.90; 95% CI: 0.59, 1.35) and newspapers/magazines (aOR: 0.78; 95% CI: 0.44, 1.41) have lower odds of teenage pregnancy, but no strong evidence of their effectiveness. On the other hand, exposure to family planning messages through the radio (aOR: 1.06; 95% CI: 0.71, 1.59), television (aOR: 1.09; 95% CI: 0.72, 1.65), and short messaging service (aOR: 1.29; 95% CI: 0.51, 3.22) marginally increase the risk of teenage pregnancy. We did not find any pairwise interactions between the different exposure variables. CONCLUSIONS Our results highlight the need to improve the content and key messages of contraceptive and family planning messages in the Philippines, especially those that are broadcasted online and in print media. There is also a need to increase the reach of these different family planning and contraception messages, especially by utilizing social media and other print and online media platforms commonly used by the youth.
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Affiliation(s)
- Veincent Christian F. Pepito
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
| | - Arianna Maever L. Amit
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines ,grid.11159.3d0000 0000 9650 2179National Clinical Trials and Translation Center, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Clinton S. Tang
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
| | - Luis Miguel B. Co
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
| | - Neil Andrew K. Aliazas
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
| | - Sarah J. De Los Reyes
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines ,Dr. Fe del Mundo Medical Center, Quezon, Philippines
| | - Raymundo S. Baquiran
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
| | - Lourdes Bernadette S. Tanchanco
- grid.443223.00000 0004 1937 1370School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines ,The Medical City, Pasig, Philippines ,MedMom Institute for Human Development, Mandaluyong, Philippines
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