Implementation of Adolescent and Youth Friendly Health Services in a Rural Region of Tigray, Ethiopia

Background

The Eastern Zone of the Tigray (Ethiopia) is inhabited by 900,000 people, 34% of whom are adolescents and young people between 10-24 years of age, who are easily influenced by the social and family context and are exposed to significant health risks associated with the earliness of their approach to sexual life. Nonetheless, even if a complete health service is available, the quality is often undermined by the lack of the so-called Youth-Friendly Corners (high confidentiality spaces reserved for young people), promoted internationally by WHO. The aim of the study is to evaluate the effectiveness of the program established in this zone by the Medical Collaboration Committee regarding the creation of friendly health services for adolescent and youth people (AYFHS), especially built for sex education, family planning, abortion, and sexual transmitted infection (STI) prevention.

Methods

The program “#Youths at the centre!” was implemented in 20 rural health centers in the North-East Tigray on April 2018. Data from these AYFHS were collected monthly in aggregated indicators, separated for gender and age class. Use of AYFHS during 2018 and 2019 was assessed using percentage and 95% confidence interval and the period of implementation of the project and centers' characteristics were analyzed to investigate differences in AYFHS utilization.

Results

A monthly mean of 6.04% (6.01% - 6.08%) of adolescents and young people utilized an AYHFS for any of its service; 0.03% accessed for counseling, diagnosis, and treatment of STI, 1.31% for family planning, 1.09% for delivery, and 0.05% for legal abortion. Lower level of utilization was observed in more remote health centers, despite a general increase across the study period.

Conclusions

This project shows the importance of providing friendly facilities dedicated to adolescents and youth in low-income countries, in order to increment the utilization of health services from this population, especially in rural contexts.

Key messages

In rural areas of Africa the risks associated with poor health information of young people and the earliness of the beginning of sexual life remain a Public Health problem. In low income countries the presence of high confidentially spaces for young people in the Health Services could increase their utilization, especially for sex education and family planning.

Tending the 'monthly flower:' a qualitative study of menstrual beliefs in Tigray, Ethiopia

Background

Menstruation is a universal aspect of human female reproductive life. Management of menstrual flow presents hygiene challenges to girls and women in low-income countries, especially when they first start their periods. As part of a project to improve menstrual hygiene management in the Tigray Region of Ethiopia, we explored the local understanding of menstruation through focus-group discussions and individual interviews.

Methods

A detailed ethnographic survey of menstrual beliefs was carried out through 40 focus group discussions, 64 in-depth key informant interviews, and 16 individual case histories in the Tigray Region of northern Ethiopia. A total of 240 individuals participated in six types of focus groups (pre-menarchal girls, menstruating adolescents, married women of reproductive age, post-menopausal women, adolescent males, and married men). In-depth interviews were also carried out with 80 individuals, including Orthodox Christian priests, imams from the Muslim community, principals of primary and secondary schools, teachers and nurses, as well as menstruating schoolgirls and women. Audio data were transcribed and translated, then broken down into discrete codes using Atlas Ti software (version 7.5.4, Atlas.ti Scientific Software Development Mnbh, Berlin) and further grouped into related families and sub-families based on their content. The results were then synthesized to produce a cohesive narrative concerning menstruation in Tigray.

Results

Recurrent themes identified by participants included descriptions of the biology of menstruation (which were sometimes fanciful); the general unpreparedness of girls for menarche; cultural restrictions imposed by menstruation on females (particularly the stigma of ritual uncleanliness in both Christian and Muslim religious traditions); the prevalence and challenges of unmet menstrual hygiene needs at schools (including lack of access to sanitary pads and the absence of acceptable toilet/washing facilities); and the stigma and shame associated with menstrual hygiene accidents in public.

Conclusions

Changes in the educational system in northern Ethiopia are required to improve student understanding of the biology of menstruation, to foster gender equity, to overcome the barriers to school attendance presented by poor menstrual hygiene management, and to create a society that is more understanding and more accepting of menstruation.