Exploring adolescent engagement in sexual and reproductive health research in Kenya, Rwanda, Tanzania, and Uganda: A scoping review

Evaluating the coverage of sexually transmitted infection prevention and control services in eight districts in Central Uganda: lot quality assurance sampling survey

INTRODUCTION

Sexually transmitted infections (STIs) are a major global public health problem, associated with infertility, adverse pregnancy outcomes, and significant social and economic burdens. These challenges are particularly severe in underprivileged communities. A 2024 World Health Organisation report highlighted a global surge in STIs, requiring intensified efforts to improve their control and management. In order to appropriately respond and reverse the status quo, it is important to understand the extent to which the current interventions have reached the beneficiaries. This study aimed to assess the coverage of sexually transmitted infection (STI) services using the Lot Quality Assurance Sampling (LQAS) approach in eight districts of Central Uganda.

METHODOLOGY

A household survey was conducted in eight districts, targeting four population groups: mothers of children aged 0-11 months, women aged 15-49 years, men aged 15 + years, and youth aged 15-25 years. LQAS was used, with each district stratified into five supervision areas (SAs). In each SA, 19 respondents were randomly sampled from each target group. The survey assessed key indicators related to STIs, including knowledge of STI symptoms, knowledge of actions to take when infected with an STI, and engagement in risky sexual behavior. The study also examined condom use during risky sex, circumcision acceptance and non-acceptance among men, including reasons for its acceptance or non-acceptance. Overall and district-specific coverage was calculated with 95% confidence intervals. Indicator coverage in the SAs was classified using LQAS decision rules (DRs) for each indicator, using the overall coverage as benchmark for setting the DR.

RESULTS

The findings revealed that mothers of children aged 0-11 months demonstrated superior knowledge of STIs and appropriate actions to take if one has an STI. Men (15 + years) and youth (15-24 years) reported engaging more in risky sexual behavior compared to women 15-49 years and mothers of children aged 0-11 months. Relatedly, men 15 + years reported higher condom use during risky intercourse. Youth were more likely to be circumcised than older men. Coverage for most indicators varied across SAs and districts. However, one in forty of the SAs fell short of average coverage in all the indicators. Personal hygiene was the leading motivator for circumcision acceptance while fear of pain was the leading driver for refusal to accept being circumcised.

CONCLUSIONS

The findings highlight vital disparities in STI knowledge and risky sexual behavior among different demographic groups. These findings inform public health strategies to address STI disparities and improve reproductive health outcomes. District and SA-specific bottleneck analysis is recommended in order to provide actionable solutions to improve low-indicator coverage in low-coverage districts and SAs.

A qualitative study of parents and healthcare providers' partnership in improving adolescent sexual and reproductive health services in Rwanda

Background

Adolescents in Africa encounter various sexual and reproductive health (SRH) challenges, such as insufficient information, societal stigma, inadequate services, and cultural obstacles. Enhancing collaboration between parents and healthcare providers can foster trust, improve communication, and provide better support, ultimately leading to improved access, quality, and utilization of SRH services (SRHS) for adolescents.

Objective

This paper offers perspectives from parents and healthcare providers on the roles of their partnerships in improving adolescent SRHS.

Design

The research employed a qualitative phenomenological study design.

Methods

The study included eight focus group discussions with parents whose adolescents attended selected youth centers and four face-to-face in-depth interviews with healthcare providers who worked there.

Results

The research revealed two prominent themes regarding the partnership between parents and healthcare professionals in adolescent SRH. The initial theme represents the perspectives of healthcare providers, emphasizing the importance of service awareness, cultural norms, geographic obstacles, and the necessity of parental consent as critical subthemes. The following theme reflects the viewpoints of parents, concentrating on the dialogue surrounding sexual health, the role of healthcare providers in promoting family conversations, and the request for support in providing sexual health information to their adolescents.

Conclusion

Collaboration between healthcare providers and parents is essential for improving adolescents' access to SRHS, which can greatly mitigate health-related risks. Nonetheless, this partnership encounters obstacles stemming from insufficient awareness of available services, sociocultural influences, and a lack of parental understanding regarding SRH topics. It is imperative to tackle these challenges through focused educational initiatives and enhanced communication strategies to create a supportive atmosphere that enables both adolescents and their parents to effectively address SRH concerns.

Addressing social norms for adolescent timing and spacing of pregnancy in low and middle-income countries: Developing a global research agenda

Background

Social norms shape adolescent sexual and reproductive health behaviours contributing to contraceptive and pregnancy outcomes. No global research agendas exist to guide research on adolescent social norms shifting in low- and middle-income countries (LMICs). We developed a social norms research agenda to improve adolescent healthy timing and spacing of pregnancy in LMICs.

Methods

We adapted and applied the Child Health and Nutrition Research Initiative (CHNRI) method. A group of researchers guided the process, and consulted with diverse experts to develop a list of 21 research questions for global stakeholders to score via an online survey. Survey participants scored each research question according to four criteria (fills key gap, feasible, impactful, equitable). Research priority scores (RPS) and average expert agreement (AEA) statistics were calculated for each question and analysed overall and by stakeholder region and profession.

Results

We received 185 survey responses. Participants were, on average, 44 years old, 64% were women, 70% were from LMICs and 47% were implementers. The RPS ranged from 52 to 81% (74% median) and the AEA ranged from 49 to 70% (58% median). Nearly 70% of stakeholders gave the same score to each of the top five research questions. The top five research priorities focused on effective norm-shifting interventions (NSIs) strategies, processes and indicators to NSIs, and NSI adaptation and scale-up.

Conclusions

Using a collaborative and rigorous process with diverse representation from LMICs and implementers, we reached consensus on five priority research questions to guide future adolescent social norms research to improve healthy timing and spacing of pregnancy in LMICs.

Social-ecological factors associated with trajectories of adolescent sexual and reproductive health stigma: longitudinal cohort findings with urban refugee youth in Kampala

Background Stigma towards sexually active young people presents profound barriers to uptake of sexual and reproductive health (SRH) services, including HIV testing and contraception. Yet, few studies have examined adolescent SRH stigma trajectories over time. To address this knowledge gap, we examined associations between social-ecological factors and trajectories of adolescent SRH stigma among urban refugee youth in Kampala, Uganda. Methods This longitudinal cohort study with refugee youth in Kampala collected data on adolescent SRH stigma at four time-points between 2022 and 2024. We used latent class growth analyses to examine distinct trajectories of adolescent SRH stigma, and examined baseline social-ecological and socio-demographic factors associated with class membership using multivariable logistic regression. Results Among the participants (n =164 with n =668 observations; mean age 19.9 years, standard deviation2.5 years; 52.8% cisgender women), we categorised two distinct adolescent SRH stigma trajectories: consistently high (n =496; 74.2%) and sustained low (n =172; 25.8%). In multivariable analyses, living in Uganda ≥1year at baseline assessment (1-5years: adjusted odds ratio [aOR]5.28, confidence interval [CI]2.29-12.19, P P 10years: aOR3.89, CI1.56-9.68, P P P P P Conclusions Social-ecological and socio-demographic factors were associated with consistently high levels of adolescent SRH stigma over 2years. Multi-level strategies can meaningfully engage youth in developing stigma reduction strategies for SRH service delivery.

Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana

Introduction

Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana.

Methods

A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables.

Results

The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes.

Conclusions

The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.

Sexual and reproductive health knowledge, attitudes, and behaviors: A survey of 12-17 year old Sudanese refugees in Chad

Adolescents living in humanitarian settings are often at a higher risk of negative sexual and reproductive health outcomes, and yet, limited information is available on adolescents' experiences and needs in these settings while available services do not always correspond to their needs. This study explored knowledge, attitudes, and behaviors relating to sexual and reproductive health among 12-17 year old refugees from Darfur currently living in two refugee camps in eastern Chad. The research team conducted a cross-sectional survey of 689 adolescent girls and boys, informed by participatory research activities, to explore key sexual and reproductive health topics. This study found that sexual and reproductive health knowledge among adolescents is low, with only 69.1% able to identify at least one modern contraceptive method. Early marriage was uncommon (5% of girls, 0.8% of boys), but 17.6% of adolescents had already had a romantic relationship. Few adolescents (11.4%) had ever had sex, but among these adolescents,18.4% reported using a condom the last time they had sex. No boys reported current modern contraceptive use, but 28.3% of girls, both married and unmarried, reported current use. These findings demonstrate the importance of making sexual and reproductive health services in humanitarian settings more adolescent-responsive and minimizing barriers to access, including addressing community stigma surrounding adolescents' use of sexual and reproductive health services and increasing trust in the confidentiality of sexual and reproductive health services in the camps.

Adaptation of the sexual and reproductive empowerment scale for adolescents and young adults in Kenya

Measuring empowerment is critical to understanding the level of control adolescents and young adults (AYA) have over their sexual and reproductive health (SRH) behaviors, and could provide a key window into addressing their unique SRH needs. We adapted the Sexual and Reproductive Empowerment (SRE) scale for AYA for use in an East African context. This multi-method qualitative study sampled 15-23 year-old female adolescents and young adults in Kisumu, Kenya. We conducted in-depth interviews (n = 30) and analyzed transcripts with an inductive, constant comparison approach. Empowerment domains were integrated with Kabeer's (1999) framework in a conceptual model, which we referenced to revise the original and develop new scale items. Items underwent expert review, and were condensed and translated through team-based consensus-building. We evaluated content validity in cognitive interviews (n = 25), during which item phrasing and word choice were revised to generate an adapted SRE scale. Participants (n = 55) had a median age of 18 (range 16-23), and 75% were under 19 years. We categorize three types of adaptations to the SRE scale: new item generation, item revision, and translation/linguistic considerations. We developed nine new items reflecting AYA's experiences and new domains of empowerment that emerged from the data; new domains relate to self-efficacy in accessing sexual and reproductive health care, and how material needs are met. All items were revised and translated to echo concepts and language relevant to participants, navigating the multilingualism common in many African countries. Centering the voices of female Kenyan AYA, this study provides insight into measuring the latent construct of adolescent sexual and reproductive empowerment in an East African setting, and supports the adapted SRE scale's content validity for Kenya. We detail our multi-method, theory-driven approach, contributing to limited methods guidance for measure adaptation across contexts and among diverse adolescent populations.