Browsing by Author "Wado, Y.D."
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Item HIV trends and disparities by gender and urban–rural residence among adolescents in sub-Saharan Africa(BMC, 2021) Cane, R.M.; Melesse, D.Y.; Kayeyi, N.; Manu, A.; Wado, Y.D.; Barros, A.; Boerma, T.Background: In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international eforts have aimed at reducing sexual transmission of HIV. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban–rural disparities. Methods: HIV prevalence data at ages 15–19 years were obtained for 31 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Country medians and average annual rates of changes were used to summarize the trends for two subregions in sub-Saharan Africa, Eastern and Southern Africa and West and Central Africa, which largely correspond with higher and lower HIV prevalence countries. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban–rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results: HIV prevalence among girls 15–19 years declined in eastern and Southern Africa from 5.7 to 2.6% during 2005–2015 (country median), corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1 to 1.2%. Changes were also observed in West and Central Africa where median HIV prevalence among girls decreased from 0.7 to 0.4% (average annual rate of reduction 5.9%), but not for boys (0.3%). Girl-boy diferences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts in both subregions, and since the urban–rural declines were similar, the gaps persisted during 2005–2015. Conclusions: HIV prevalence among adolescents declined in almost all countries during the last decade, in both urban and rural settings. The urban–rural gap persisted and HIV transmission to girls, but not boys, is still a major chal lenge in Eastern and Southern African countries.Item Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa(BMC, 2021) Melesse, D.Y.; Cane, R.M.; Mangombe, A.; Ijadunola, M.Y.; Manu, A.; Bamgboye, E.; Mohiddin, A.; Kananura, R.M.; Akwara, E.; Plessis, E.; Wado, Y.D.; Mutua, M.K.; Mekonnen, W.; Faye, C.M.; Neal, S.; Boerma, T.Background: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. Methods: We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to exam ine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban–rural residence and educational status (primary or less versus secondary or higher education). Results: In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000–2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10–14 years). Large diferences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban– rural and wealth-related inequalities remained stagnant or widened during 2000–2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. Conclusion: Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.Item “Those are things for married people” exploring parents’/adults’ and adolescents’ perspectives on contraceptives in Narok and Homa Bay Counties, Kenya(Reproductive Health, 2021) Mwaisaka, J.; Wado, Y.D.; Ouedraogo, R.; Oduor, C.; Habib, H.; Njagi, J.; Bangha, M.W.Background: Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. Methods: Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15–19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents. Results: Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents’ sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion. Conclusions: Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.Item “Those are things for married people” exploring parents’/adults’ and adolescents’ perspectives on contraceptives in Narok and Homa Bay Counties, Kenya(Reproductive Health, 2021) Mwaisaka, J.; Wado, Y.D.; Ouedraogo, R.; Oduor, C.; Habib, H.; Njagi, J.; Bangha, M.W.Background: Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay coun- ties, Kenya. Methods: Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15–19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults con- veniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appro- priate for the study to solicit feedback from the targeted respondents. Results: Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent concep- tions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents’ sexuality and risk prevention, (ii) Conceptions about contraception among nul- ligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive consid- erations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion. Conclusions: Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.