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Item Acceptability and stakeholders perspectives on feasibility of using trained psychologists and health workers to deliver school-based sexual and reproductive health services to adolescents in urban Accra, Ghana(Reproductive Health, 2018-07) Tabong, P.T.N.; Maya, E.T.; Adda-Balinia, T.; Kusi-Appouh, D.; Birungi, H.; Tabsoba, P.; Adongo, P.B.Background Adolescent sexual and reproductive health is recognized as a key developmental issue of international concern. However, adolescents’ access to sexual and reproductive health (SRH) information and services is largely inadequate in sub-Saharan Africa. With increasing enrollment in schools, this could be an avenue to reach adolescents with SRH information and services. This study was therefore conducted to assess the acceptability and stakeholders’ perspectives on the feasibility of using health workers and trained psychologists to provide school-based SRH services in Ghana. Methods Fourteen (14) focus group discussions (N = 136) were conducted; 8 among adolescents aged 12–17 years (4 boys, 4 girls groups), 4 among parents (2 males, 2 females groups) and two among mixed teacher groups. We also conducted 18 in-depth interviews with teachers, managers of schools, health workers, clinical psychologists, as well as adolescent SRH program managers in the Ghana Health Service, Ghana Education Service, UNICEF, UNESCO and National Population Council, Ghana. We audio-recorded all interviews and took field notes. Interviews were transcribed and transcripts imported into NVivo 11 for analysis using grounded theory approach to qualitative data analysis. Results Many respondents reported that it was challenging for parents and/or teachers to provide adolescents with SRH information. For this reason, they agreed that it was a good idea to have health workers and psychologists provide SRH information and services to adolescents in school. Although, there was general agreement about providing SRH services in school, many of the respondents disagreed with distribution of condoms in schools as they believed that availing condoms would encourage adolescents to experiment with sex. While majority of respondents thought it was acceptable to use psychologists and health workers to provide school-based sexual and reproductive health to adolescents, some teachers and education managers thought the implementation of such a program would oppose practical challenges. Key among the challenges were how to pay for the services that health workers and trained psychologists will render, and the availability of psychologists to cater for all schools. Conclusion Stakeholders believe it is feasible and acceptable to use trained psychologists and health workers to deliver school-based SRH information and services in the Ghanaian school context. However, provisions must be made to cater for financial and other logistical considerations in the implementation of school-based SRH programs.Item Adolescent mental health services in West Africa: a comparative analysis of Burkina Faso, Ghana, and Niger(Child and Adolescent Psychiatry and Mental Health, 2024) Amenah, M.A.; Ibrahim, N.; Fenny, A.P.Background Adolescent mental health (AMH) is a critical issue worldwide, particularly in West Africa, where it is intensified by socio-economic, cultural, and security challenges. Insecurity and the presence of mining sites expose adolescents to hazardous environments, substance abuse, and adulterated alcohol, further aggravating their mental health. Despite these severe issues, research on AMH in this region remains limited. This study aims to analyze the provision of AMH services in Burkina Faso, Ghana, and Niger, highlighting the unique challenges these countries face within the broader West African healthcare context. Methods The study adopted a multi-stage, stratified sampling design to collect data from primary healthcare centers (PHCs) in the three countries. Using STATA.17, Descriptive analysis was conducted on the data related to availability of AMH services, types of mental health disorders treated, resources available, and OPD attendance rates. The analysis also incorporated factors such as the rural-urban divide and the presence of national guidelines for AMH services. Results The findings reveal a significant shortfall in the provision of AMH services across the region, with less than 30% of PHCs across all the countries offering these services. The study also highlights a pronounced rural-urban disparity in AMH service availability, a general absence of national guidelines for AMH care, and low OPD attendance rates. Conclusion The study highlights the urgent need for comprehensive policy reform and targeted interventions to enhance AMH services in West Africa. Key policy reforms should include the development and implementation of national guidelines for AMH care and integration of AMH services into primary healthcare. Additionally, efforts should focus on capacity building through the training of mental health professionals, increasing public awareness to reduce stigma, and ensuring equitable resource allocation across rural and urban areas. Improving AMH care is essential not only for the well-being of adolescents but also for driving broader socio-economic development in the region.Item Adolescent Problem Gambling in Rural Ghana: Prevalence and Gender Diferentiation(Springer, 2021) Odame, S.K.; Quarshie, E.N.; Oti‑Boadi, M.; Andoh‑Arthur, J.; Asante, K.O.Problem gambling among young people is now a public health challenge in sub-Saharan Africa. However, the behaviour remains understudied, particularly, among rural-dwell ing young people in countries within the subregion. We aimed to estimate the 12 months prevalence of problem gambling and to describe the overall and gender diferences and commonalities in personal factors and social adversities associated with problem gambling among adolescents in rural Ghana. We conducted a cross-sectional survey involving a ran dom sample of 1101 in-school adolescents aged 10–19 years in a rural district in East ern Ghana; we used the DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) question naire to assess problem gambling during the previous 12 months. Personal lifestyle and psychosocial variables were assessed using adopted items from the 2012 WHO–Global School-based Student Health Survey. Overall, three in 10 adolescents (3 in 10 females; 4 in 10 males) in rural Ghana reported problem gambling in the previous 12 months. Female adolescents who experienced problem gambling were more likely to report family-related social adversities, while adolescent male problem gambling was associated with school related factors and interpersonal factors outside the family context. Regardless of gender, sexual abuse victimisation was associated with three times increase in the odds of experi encing problem gambling. Relative to the prevalence of gambling among adolescents in urban contexts in other countries within sub-Saharan Africa, the estimates of problem gam bling among in-school rural adolescents in Ghana are higher. Although further studies are needed to understand the nuances of the behaviour, the evidence of this study underscores the need for general and targeted health promotion, intervention and prevention eforts to mitigate the family, school, and interpersonal social adversities associated with adolescent problem gambling in rural Ghana.Item Adolescent self-harm in Ghana: a qualitative interview-based study of firsthand accounts(BMC Psychiatry, 2020-06-01) Quarshie, E.N-B.; Waterman, M.G.; House, A.O.Background: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives of Ghanaian adolescents reporting self-harm - for deeper reflections on the interpretive repertoires available in their cultural context for making sense of self-harm in adolescents. Methods: Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential thematic analysis to the data. Results: Adolescents’ description of the background to their self-harm identified powerlessness in the family context and unwanted adultification in the family as key factors leading up to self-harm among both in-school and streetconnected adolescents. Adolescents’ explanatory accounts identified the contradictory role of adultification as a protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents was identified as a means of “enactment of tabooed emotions and contestations”, as a “selfish act and social injury”, as “religious transgression”, while it was also seen as improving social relations. Conclusions: The first-person accounts of adolescents in this study implicate familial relational problems and interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as an understandable response, and as a strong communicative signal in response to powerlessness and family relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and are likely to be generalisable to many other countries in sub-Saharan Africa.Item Adolescent suicidal behaviour in Namibia: a cross-sectional study of prevalence and correlates among 3,152 school learners aged 12–17 years(BMC Psychiatry, 2023) Quarshie, E.N-B.; Dey, N.E.Y.; Asante, K.O.Background While adolescent suicidal behaviour (ideation, planning, and attempt) remains a global public health concern, available county-specific evidence on the phenomenon from African countries is relatively less than enough. The present study was conducted to estimate the 12-month prevalence and describe some of the associated factors of suicide behaviour among school-going adolescents aged 12–17 years old in Namibia. Methods Participants (n=4531) answered a self-administered anonymous questionnaire developed and validated for the nationally representative Namibia World Health Organization Global School-based Student Health Survey conducted in 2013. We applied univariate, bivariable, and multivariable statistical approaches to the data. Results Of the 3,152 analytical sample, 20.2% (95% confidence interval [CI]: 18.3–22.2%) reported suicidal ideation, 25.2% (95% CI: 22.3–28.4%) engaged in suicide planning, and 24.5% (95% CI: 20.9–28.6%) attempted suicide during the previous 12 months. Of those who attempted suicide, 14.6% (95% CI: 12.5–16.9%) reported one-time suicide attempt, and 9.9% (95% CI: 8.1–12.1%) attempted suicide at least twice in the previous 12 months. The final adjusted multivariable models showed physical attack victimisation, bullying victimisation, loneliness, and parental intrusion of privacy as key factors associated with increased likelihood of suicidal ideation, planning, one-time suicide attempt, and repeated attempted suicide. Cannabis use showed the strongest association with increased relative risk of repeated attempted suicide. Conclusion The evidence highlights the importance of paying more attention to addressing the mental health needs (including those related to psychological and social wellness) of school-going adolescents in Namibia. While the current study suggests that further research is warranted to explicate the pathways to adolescent suicide in Namibia, identifying and understanding the correlates (at the individual-level, family-level, interpersonal-level, school context and the broader community context) of adolescent suicidal ideations and non-fatal suicidal behaviours are useful for intervention and prevention programmes.Item Adolescents and parents' perceptions of best time for sex and sexual communications from two communities in the Eastern and Volta Regions of Ghana: Implications for HIV and AIDS education(BMC International Health and Human Rights, 2013-09) Asampong, E.; Osafo, J.; Bingenheimer, J.B.; Ahiadeke, C.Background: Adolescents and parents' differ in their perceptions regarding engaging in sexual activity and protecting themselves from pregnancy and sexually transmitted infections (STIs). The views of adolescents and parents from two south-eastern communities in Ghana regarding best time for sex and sexual communications were examined. Methods. Focus Group interviews were conducted with parents and adolescents (both In-school and Out-of school) from two communities (Somanya and Adidome) in the Eastern and Volta regions of Ghana with epidemiological differentials in HIV infection. Results: Findings showed parents and adolescents agree that the best timing for sexual activity amongst adolescents is determined by socioeconomic viability. In practice however, there were tensions between adolescents and parents crystallized by spoilt generation and physiological drive ideologies. Whilst one community relied on a more communal approach in controlling their children; the other relied on a confrontational approach. Sex-talk is examined as a measure to reduce these tensions, and children in both communities were ambivalent over sexual communication between their parents and themselves. Parents from the two communities however differed in their perceptions. Whilst parents in one community attributed reduced teenage pregnancies to sex education, those in the other community indicated a generalized adolescents' sexual activeness manifested in the perceived widespread delinquency in the community. Conclusion: Parents in both communities reported significant barriers to parents-adolescents sexual communication. Parents in both communities should be educated to discuss the broader issues on sexuality that affects adolescents and their reproductive health needs. © 2013 Asampong et al.; licensee BioMed Central Ltd.Item Adolescents’ Knowledge, Attitudes and Perceptions Regarding Sexual and Reproductive Health and Teenage Pregnancy in La, Greater Accra Region(University of Ghana, 2018-12) Abdul-Hamid, I.This study came about as a result the identification of the persisting problem of teenage pregnancy in La. The study sought to assess adolescents’ knowledge, perception and attitudes of sexual and reproductive health (SRH) in the La community. To achieve this purpose, 386 teenagers (15-19 years) living in La were purposively selected from schools as well as some key informants (counsellors and peer educators) through a multi stage sampling technique. Data was gathered from the students through the use of a structured questionnaire whilst data was obtained from the key informants through the use of interviews. The data that was gathered was analysed using inferential and descriptive statistics. Results from the study showed that majority of the respondents did not have much knowledge about modern family planning methods, how to use contraceptives and the menstrual cycle. Majority of them had begun consuming alcohol, watching pornographic films, engaging in sexual activities as well as not using contraceptives whilst having sex. Also, most of the respondents had the perception that becoming pregnant or impregnating someone was a way of proving one’s fertility. They also had the perception that their families would support them in case they either got pregnant or impregnated someone. In relation to the teenage pregnancy situation in La, it was found that there was an association between teenage pregnancy and the adolescents’ knowledge of STDs/STIs, how to prevent STDs/STIs, knowledge of contraceptives, entering into sexual relationships, engaging in sex, not using contraceptives whilst having sex and the perception that pregnancy proves one’s fertility. A probit regression that was run further showed that sex of the respondents, educational backgrounds of the respondents and living with non-relatives all had marginal effects on the teenage pregnancy situation in La. It also showed that there was a positive relationship between teenage pregnancy in La and the risky sexual behaviour exhibited by the teenagers of La.Item Adverse life experiences and mental health of adolescents in Ghana: a gendered analysis(International Journal of Adolescence and Youth, 2022) Adjorlolo, S.; Anum, A.; Huang, K.Adolescents living in sub-Saharan Africa have increased exposure to adverse life experiences (ALEs). The current study examines gender differences in the prevalence of ALEs, mental health outcomes and association between ALEs and mental health outcomes of school-going adolescents in Ghana, West Africa. A sample of 1,886 adolescents (1,174 females) completed mental health and ALEs self-report measures. A series of descriptive and multiple linear regression analysis were conducted. Results revealed girls report higher mental health problems than boys. However, there was gender similarity in the prevalence of ALEs, except for substance misuse and trauma to head were reported more by boys. The effect of ALEs on mental health outcomes was largely invariant across gender, substance misuse, victimization experiences and school-level stress significantly predict depressive symptoms in both boys and girls. Interventions targeting the ALEs investigated in this study would help improve the mental health of boys and girlsItem Agro-ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school-aged children and adolescents in Ghana(Maternal and Child Nutrition, 2018-07) Azupogo, F.; Aurino, E.; Gelli, A.; Bosompem, K.M.; Ayi, I.; Osendarp, S.J.M.; Brouwer, I.D.; Folson, G.Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school-aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6-9 years; n = 323) and adolescents (10-17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro-ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro-ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro-ecological zone and age were pre-dictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro-ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Item Alcohol use by school-going adolescents in Ghana: Prevalence and correlates(Mental Health and Prevention, 2019-01) Oppong Asante, K.; Kugbey, N.This study investigated the risk factors that are associated with alcohol use among a nationally representative sample of school-going adolescents in Ghana. The 2012 version of the Ghanaian Global School-based Student Health Survey on adolescents aged 11–19 years old (N = 1984) was used. Logistic regression was employed to study the relationship between alcohol use variables and socio-demographic characteristic, mental health problems, psychosocial variables and parental involvement. The prevalence of alcohol use behaviours were 6.8%, 11.1% and 12.6% for alcohol problem, lifetime drunkenness and current alcohol use respectively. Loneliness, suicidal ideation and suicidal attempts were found to independently increase the odds of alcohol use behaviours (current alcohol use, lifetime drunkenness and alcohol problems) among adolescents. Similarly behavioural problems such as truancy, current smoking of cigarette, being bullied, being physically attacked, being involved in a physical fight were found to independently increase the odds of alcohol use behaviours (current alcohol use, lifetime drunkenness and alcohol problems). Having close friends was protective of current alcohol use but not for drunkenness and alcohol problems. These results underline the need for the development of school-based health interventions for early identification of adolescents who may be at-risk for alcohol-related problems.Item Approaches to Regulating Adolescent Sexual Behavior in Ghana: Qualitative Evidence from Somanya and Adidome(Archives of Sexual Behavior, 2018-08) Langmagne, S.; Tenkorang, E.Y.; Asampong, E.; Osafo, J.; Bingenheimer, J.B.This article examines perceptions of why HIV infection is severe among adolescents in Somanya and less so in Adidome-two seemingly similar communities in Ghana-through analysis of the social control measures employed by these communities to regulate adolescent sexual initiation. Using focus group discussions with parents and caregivers of adolescent children, the study found that parents in Somanya and Adidome used different regulatory mechanisms to influence adolescent sexual initiation. While parents in Somanya relied largely on parental monitoring, parents in Adidome depended more on a combination of neighborhood monitoring and community barriers (informal rules) to control adolescent sexual onset. The study findings showed that contextual factors (socioeconomic and cultural) shaped the social realities of people in these two communities accounting for the differences in HIV prevalence.Item Assessment of Nutritional Status of Blind and Deaf School Children and Adolescents in the Eastern Region of Ghana(University of Ghana, 2019-04) Kwotua, A.F.Background: Malnutrition and disability are inter-related, preventable global developmental and human right priorities (Groce et al., 2014). Globally, about 19% of people have a disability (UN, 2015). Studies have established a high malnutrition rate among the disabled (Hume-nixon & Kuper, 2018; Reinehr, Dobe, Winkel, Schaefer, & Hoffmann, 2010). Micronutrients deficiencies such as iodine, iron, and vitamin A deficiencies cause several disabilities including blindness and deafness which could predispose the individual to a vicious cycle of disability, malnutrition, and poverty (Bailey, West, & Black, 2015; Department for International Development, 2000; Kerac et al., 2014). The study sought to determine the nutritional status (BMI-for-age and height-for-age) of blind and deaf school children and adolescents and the association of socio-demographic characteristics with nutritional status. Method: A cross-sectional study design was used to determine the nutritional status of blind and deaf students within the age group 5-19years. Three schools in the Eastern Region of Ghana were selected purposively and 313 blind and deaf students selected with a simple random sampling method. A structured pre-tested questionnaire was used to collect anthropometric and socio-demographic data of the students. Results: The prevalence of stunting (height for age <-2SD), thinness (BMI for age <-2SD), and overweight/obese (BMI for age >1SD) in both blind and deaf students (5-19years) was 17.6%, 7.3% and 8.7% respectively. The study found that the blind students had a prevalence of thinness, stunting and overweight/obese of 7.7%, 19.6%, and 14.7% respectively, whiles the deaf students had a prevalence of thinness, stunting and overweight/obese of 7.1% 15.9% and 3.5% respectively. Both disabilities (blind and deaf) had a high prevalence rate of stunting (16.9%), thinness (7.3%) and overweight/obese (6.4%) within the age group 10-19years. Disability type (blind and deaf) (p=0.002) and practiced of trimmed fingernails of students (p=0.005) were significantly associated with BMI-for-age but not with height-for-age. Age of students was also significantly associated with BMI-for-age (p=0.029). Conclusion: The study found the prevalence of stunting, thinness, and overweight/obese in both blind and deaf students (5-19years) as 17.6%, 7.3%, and 8.7% respectively. The blind students within the age group 10-19year had higher malnutrition rate (thinness and overweight/obese) as compared to the deaf students. The nutritional status (BMI-for-age) of the disabled children and adolescents was significantly associated with age, disability type, and hygiene practice of trimming of fingernails. Keywords: Nutritional status, Stunting, Thinness, Disability, Blind, and Deaf.Item The Association between Health Literacy and Obesity among Adolescents in Selected Schools in Adentan Municipality(University of Ghana, 2017-07) Ewa, V.C.Background: Obesity is a growing public health issue even in low and middle income countries which are usually associated with issues of undernutrition. The growing prevalence is leading to what is known as the “double burden” of malnutrition (Manyanga, El-Sayed, Doku, & Randall, 2014). Adolescents are a group that are particularly vulnerable with respect to obesity because they are likely to carry obesity into their later years (Manyanga et al., 2014; Teshome, Singh, & Debebe, 2013). This is a big issue because obesity is associated with poor health outcomes. Health literacy appears to have some association with obesity. Objectives: The aim of this study was to assess health literacy, determine obesity prevalence among adolescents and then determine health literacy in relation to obesity among adolescents. The study also sought to determine associations between adolescents’ HL and behavioural risk factors for obesity. Method: This was a cross-sectional analytical study. 292 students between the ages of 10 and 15 years were randomly selected from 4 schools within the Adentan Municipality. The Newest Vital Sign (NVS) which has been developed as a tool to quickly measure health literacy and has been validated for use among adolescents was used in this study. Results: Prevalence of obesity among respondents was 9.9%. 46.6% of respondents were categorized as having adequate health literacy while 53.4% were categorized as having limited health literacy. There were no significant associations between health literacy and overweight and obesity. Conclusion: Prevalence for obesity among adolescents is high. Health literacy among adolescents warrants some improvement.Item Association between socioeconomic status and fertility among adolescents aged 15 to 19: an analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)(GMC, 2021) Munakampe, M.Z.; Fwemba, I.; Zulu, J.M.; Michelo, C.Background: Adolescents face signifcant barriers to access and utilization of sexual and reproductive health services in many low-income settings, which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections, unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contributes to these outcomes. We aimed to fnd out the factors that afect the fertility of adolescents aged 15 to 19 years in Zambia and to identify pos sible drivers of adolescents’ fertility. Methods: Secondary analysis of the ZDHS 2013/14 data was carried out to fnd out the factors that afect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n=3666). Results: Overall, 23.1% of adolescents had given birth at least once in the 5 years leading to the survey (n=3666, 99.4% response), and 49.8% were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR 6–10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to afect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (aOR = 2.4, 95% CI: 1.5, 3.7, p<0.001). Although odds of giving birth were much higher among rural-based married adolescents (aOR = 8.0, 95% CI: 5.4, 11.9, p<0.001) compared to urban married adolescents (aOR = 5.5, 95% CI: 8.3, 16.0, p<0.001), and these relation ships both statistically signifcant, higher educational attainment (aOR = 0.7, 95% CI: 0.6, 0.8 p<0.001) and abortion (aOR = 0.3, 95% CI: 0.1, 0.8, p=0.020) reduced these odds, particularly for rural-based adolescents. Conclusion: Despite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address sexual and reproductive health needs of urban-based adolescents with a lower socioeconomic status.Item Association between socioeconomic status and fertility among adolescents aged 15 to 19: an analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)(BMC Reprod Health, 2021) Munakampe, M.N.; Fwemba, I.; Zulu, J.M.; Michelo, C.Background: Adolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings, which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections, unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contributes to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility. Methods: Secondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n = 3666). Results: Overall, 23.1% of adolescents had given birth at least once in the 5 years leading to the survey (n = 3666, 99.4% response), and 49.8% were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR 6–10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (aOR = 2.4, 95% CI: 1.5, 3.7, p < 0.001). Although odds of giving birth were much higher among rural-based married adolescents (aOR = 8.0, 95% CI: 5.4, 11.9, p < 0.001) compared to urban married adolescents (aOR = 5.5, 95% CI: 8.3, 16.0, p < 0.001), and these relationships both statistically significant, higher educational attainment (aOR = 0.7, 95% CI: 0.6, 0.8 p < 0.001) and abortion (aOR = 0.3, 95% CI: 0.1, 0.8, p = 0.020) reduced these odds, particularly for rural-based adolescents. Conclusion: Despite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address sexual and reproductive health needs of urban-based adolescents with a lower socioeconomic status.Item Attitude of Parents and Adolescents towards Contraceptive Use by Adolescents in Alajo, Ayawaso Central Submetro of Accra(University of Ghana, 2009-08) Maya, E.T.; Ahiadeke, C.; Adanu, R.; University of Ghana, College of Health Sciences, School of Public HealthIntroduction Despite high knowledge about contraceptives among adolescents its use is low. Parental attitude towards adolescent contraceptive can adversely affect contraceptive use by adolescents. Objectives: 1. To describe the general knowledge of parents and adolescents on contraceptives 2. To determine the proportion of parents and adolescents who are in favour of contraceptive use among adolescents 3. To determine the proportion of parents and adolescents who discuss contraception 4. To describe how selected sociodemographic factors affect the attitude of parents and adolescents towards contraceptive use among adolescents. Methods A cross-sectional survey was done employing both quantitative and qualitative methods. A face-to-face interview using a structured questionnaire was conducted with a simple randomly selected sample of adolescents and parents. Focus group discussions were held with some parents. The quantitative data was analysed using SPSS 16.0. The qualitative data was analysed in themes according to study objectives. Results Two hundred and seventy seven adolescents and 264 parents were interviewed. More than 99% knew about modern contraceptives. Over 95% of them knew sexually transmitted infections can be prevented by using condoms. About 60% approve of contraceptive use by adolescents. However, only about 12 - 18% of parents who agreed to adolescent contraceptive use will encourage this when faced with the reality. Less than 10% of the adolescents had on their own initiated a discussion that involved contraception with their parents. About 30 – 40% of parents indicated that they have on their own discussed contraception with adolescents but the qualitative study indicated that such discussions were rare. Both parents and adolescents had misconceptions about contraceptive use among adolescents. For the adolescents, being sexually active, and for the parents, belief that contraceptive use has advantages for adolescent users and their own prior contraceptive use were significantly associated with agreeing that sexually active adolescents should use contraceptives. Conclusion and recommendations Both parents and adolescents have high knowledge about modern contraceptive use in preventing both sexually transmitted infections and pregnancy. However, misconceptions and fear of side effects is preventing parents from discussing contraception with adolescents. Parents do not have the will to also encourage adolescents to use contraceptives. There is the need to educate both parents and adolescents to dispel the misconceptions about contraceptives. Contraceptive use among adults should be encouraged as adults on contraceptives are more likely to encourage adolescent contraceptive use.Item Attitudes towards abortion and decision-making capacity of pregnant adolescents: perspectives of medicine, midwifery and law students in Accra, Ghana(The European Journal of Contraception & Reproductive Health Care, 2020-02-28) Amoakoh-Coleman, M.; Bain, L.E.; Tiendrebeogo, K-S.T.; Zweekhorst, M.B.M.; Buning, T.D-C.; Becquet, R.Objectives: Because medical, midwifery and law students in Ghana constitute the next generation of health care and legal practitioners, this study aimed to evaluate their attitudes towards abortion and their perceptions of the decision-making capacity of pregnant adolescents. Methods: We conducted a cross-sectional survey among 340 medical, midwifery and law students. A pretested and validated questionnaire was used to collect relevant data on respondents’ sociodemographic characteristics, attitudes towards abortion and the perceived capacity and rationality of pregnant adolescents’ decisions. The v2 test of independency and Fischer’s exact test were used where appropriate. Results: We retained 331 completed questionnaires for analysis. Respondents’ mean age was 21.0 ± 2.9 years and the majority (95.5%) were of the Christian faith. Women made up 77.9% (n¼258) of the sample. Most students (70.1%) were strongly in favour of abortion if it was for health reasons. More than three-quarters (78.0%) of the students strongly disagreed on the use of abortion for the purposes of sex selection. Most respondents (89.0%) were not in favour of legislation to make abortion available on request for pregnant adolescents, with medical students expressing a more negative attitude compared with law and midwifery students (p<0.001). Over half of the midwifery students (52.6%) believed that adolescents should have full decision-making capacity regarding their pregnancy outcome, compared with law and medical students (p<0.001). Conclusion: Tensions between adolescent reproductive autonomy, the accepted culture of third party involvement (parents and partners), and the current abortion law may require keen reflection if an improvement in access to safe abortion services is envisioned.Item Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese(Pediatric Physical Therapy, 2019-10-01) Bonney, E.; Ferguson, G.; Burgess, T.; Smits-Engelsman, B.Purpose: The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese. Methods: This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions. Results: Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes. Conclusions: Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.Item Body Image, Socio-Cultural Factors and Psychological Health among Adolescents in Accra, Ghana Ghana(University of Ghana, 2017-07) Asah-Ayeh, V.This thesis examines how socio-cultural factors influence body dissatisfaction, body image, self-esteem and psychological distress among adolescents in Accra, Ghana. Mixed-method approach was used to gather data through cross-sectional survey and focused group discussions. Sample for the survey and the focused group discussions consisted of 358 and 62 adolescents respectively. They were conveniently sampled from selected districts in the Greater Accra region. The quantitative data was analysed using ANOVA, Pearson r and MANOVA and the qualitative data was analysed using thematic analysis. Findings from the quantitative component showed that body dissatisfaction increases psychological distress and decreases body esteem among the adolescents. Adolescents who were satisfied with their body adopted three coping strategies (i.e. avoidance, positive-rational and appearance fixing); whereas those who were dissatisfied with their bodies adopted two (i.e., avoidance and appearance fixing). The qualitative findings showed that family posed as a severe stressor to adolescents’ body image perceptions and pressured them to engage in body fixing. Adolescents also engaged in Selfie-taking mainly for social comparison and self-evaluations. In conclusion, socio-cultural factors influenced body image perceptions and psychological health among the adolescents at different levels of analysis, ranging from intra-personal level, interpersonal level, family and societal levels. The implications of the results of the study are discussed in relation to creating safe social spaces for improving mental health of adolescents within the context of how they experience their bodies.Item Boys should not be overlooked: Sexual violence victimization and associated factors among school-going adolescents in urban Ghana(Child Abuse & Neglect, 2021) Quarshie, E.N-B.Background: Adolescent sexual violence victimization is still less researched in countries within sub-Saharan Africa, including Ghana. Objectives: To estimate the 12-month prevalence of sexual violence victimization and describe the differences and commonalities in the associated factors between school-going boys and girls in urban Ghana. Participants and setting: Students (n = 1692) aged 13–19 years attending Second Cycle Schools in the Greater Accra Region of Ghana participated in this study. Methods: This is a cross-sectional survey involving the use of a self-report anonymous questionnaire. Items measuring sexual violence victimization and correlates were adopted from the 2012 WHO–Global School-based Student Health Survey. Data analysis involved bivariable and multivariable approaches. Results: Overall, 17.6% (95% confidence interval [CI] 15.7, 19.4) adolescents (males = 10.4% [95% CI 8.3, 13.6]; females = 24.3% [95% CI 21.5, 27.3]) reported sexual violence victimization during the previous 12 months. Girls (compared to boys) were nearly three times more likely to report sexual violence victimization (aOR = 2.74, 95% CI 2.01, 3.74, p < 0.001). Breakup, sexual minority status, and conflict with parents were uniquely associated with sexual violence victimization among females. Regardless of gender, adolescents who were in a romantic relationship (aOR = 1.63, 95% CI 1.19, 2.24, p = 0.002) and reported physical abuse victimization (aOR = 1.84, 95% CI 1.36, 2.49, p < 0.001) were more likely to report sexual violence victimization. Conclusions: The prevalence of sexual violence victimization among school-going adolescents in urban Ghana compares with estimates from sub-Saharan Africa, but also warrants the need for universal and targeted prevention regimes against the offence in both boys and girls.