Department of Population, Family and Reproductive Health

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    Determinants of Adherence and Treatment Outcomes Among Adolescents Living with HIV in Cameroon
    (University of Ghana, 2019-07) Bongfen, M.C.
    Background: Despite over three decades of HIV, its prevalence especially among adolescents remains a public health concern. In 2015, there were more than two million adolescents living with HIV, with a higher proportion coming from sub-Sahara Africa. In Cameroon, there are over 40,000 adolescents living with HIV and there are still concerns about the provision of care to them as adolescents are trapped between paediatric and adult services which are unable to address their specific needs. However, there are limited studies in Cameroon that have examined adherence to antiretroviral treatment and associated factors as well as treatment outcomes among adolescents. It is therefore essential to clearly understand the determinants of adherence of these adolescents and their treatment outcomes. Objectives: The main objective of the study was to assess the determinants of adherence to Anti-Retroviral Therapy and treatment outcomes among adolescents living with HIV in Cameroon. Methods: The study was an analytical cross-sectional Study with a record review component. A total of 460 respondents were recruited from nine health facilities. A systematic random sampling procedure was used to select the required participants. Pretested questionnaires were administered to participants to collect data. The main outcome of interest (adherence) was measured in two ways: self-report adherence, and medication possession ratio (MPR). Three treatment outcome measures that were assessed included viral load suppression, retention in treatment, and CD4 counts. Finally, health facility readiness towards care for adolescents on ARV was assessed using the John Snow Inc. (JSI) tool. Descriptive (frequencies and proportions) and inferential (chi square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p<0.05 at a 95% confidence level. Results: A total of 455 questionnaires were retained and this gave a response rate of 99%. The average age of the adolescents was 14.8years (SD= ±2.9years). There were more females (55%) than males (45%) in the study. A larger proportion of the respondents were on first line treatment (77%) and had been on treatment for an average of five years. Self report adherence was 83% while MPR was 73%. The difference in adherence between self report and the Medication Possession ratio was not statistically significant (p=0.97). Regarding the determinants of adherence, 12 out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In multivariable logistic regression analyses however, only two variables significantly predicted adherence, namely experiencing side effects (AOR= 2.63; 95%CI=1.14, 6.09; p = 0.02) and internalized stigma (AOR=2.51; 95%CI =1.04, 6.04; P = 0.04). The major challenges to adherence were stigma (59%) and forgetfulness to take medications (59%) while sending reminder messages and having friendlier health providers were the main suggestions to help improve on adherence. In terms of treatment outcomes, 70% of the respondents had their viral load suppressed. The retention rates were observed to decrease over time: 88%, 72% and 58% at 6months, 12 months and 24 months respectively. All the selected facilities were shown to be ready to receive adolescents into treatment as 7 out of the 9 facilities were in stage 5 of the facility readiness assessment. Conclusion: The determinants of adherence among adolescents are more psychological than the physical characteristics that differentiate them. There is therefore a need for more individual-targeted counselling for adolescents and their guardians to improve adherence levels among adolescents on antiretroviral treatment.
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    Factors of Rapid Repeat Pregnancy and Its Consequences on Depression among Adolescents in the Greater Accra Region, Ghana.
    (University Of Ghana, 2018-07) Amuasi, S.A.
    Rapid repeat pregnancy (RRP) is defined as pregnancy onset within 24 months of the previous pregnancy outcome. RRP has been identified to result from different situations and as such might create different risks to the individual. Several studies have shown an association between RRP and mental health issues such as anxiety, emotional stress, depression, aggression and poorer education attainment. There is a pint-size consensus as to which risk factors are the very key predictors of RRP and whether the outcome (RRP) may lead to depression. This study seeks to identify the main risk factors that could lead to RRP and its consequences on depression among adolescents. METHODS: A mixed method approach (quantitative and qualitative) was used for this study which was conducted in 12 public health facilities in the Greater Accra Region. An unmatched case-control study design was used for the study. The cases were adolescent girls aged between 15 and 19 years who have had more than one pregnancy within two years. Controls were adolescent girls aged between 15 and 19 years who have had one pregnancy which either ended an abortion or delivery with more than twenty-four months spacing. The sample size for the quantitative method was n= 417 with 209 controls and 208 cases. Both the qualitative and quantitative components were hospital-based. Six FGDs were conducted among the control group in six of the selected hospitals and involved a total of forty-six adolescents. Eleven In-depth Interviews (IDI) were also held with every eligible adolescent who had experienced RRP (case) in six of the twelve health facilities selected for the research. STATA 15 MP (StataCorp, College Station, TX, USA) was used to analyze the quantitative aspect of the work. Univariate, bivariate and multivariate logistic regression analyses were conducted with p-value of <0.05 considered as significant. Composite score analysis was used in estimating the level of depression among the participants using Beck’s Depression Inventory scale. The qualitative data were audio recorded, translated into English and transcribed verbatim. Thematic content analysis was adopted for the analysis. Data triangulation was done to support the quantitative data using the qualitative data. RESULTS: There were two outcome variables in the study. The first one was the risk factors for RRP and the second was the effect of RRP on depression. Risk factors for RRP: The median ages at menarche between cases and controls were 12 and 13 years respectively and it was observed that most of the girls who experienced menarche at age 12 years and below were involved in early sexual activity (age at first sexual intercourse) than those who did not. It was also revealed in the study that the number of times a pregnant adolescent visits the hospital for ANC had some form of influence on the risk of RRP. The peers of the adolescents were the main source of information on issues of sex among the cases as compared with the control group. Transactional sex was more common among the cases than the controls. In a univariate analysis variables that showed significance as risk factors for RRP were planning of last pregnancy, history of miscarriage, married or living with partner, parental care, and at least 4 ANC visits. All these variables were significantly associated with odds of RRP. There was an evidence that the odds of RRP for the adolescents who have ever had a miscarriage was about eight times more than that among those who have never had a miscarriage (aOR=7.92; 95%CL: 3.18-19.71; p<0.0001). Effect of RRP on depression: The risk of being depressed among cases were 19% higher than the control group (crude RR=1.19; 95%Cl=0.99 to 1.43; p=0.070). After adjusting for the confounding variables, this increased significantly to 36% higher risk of being depressed (adjusted RR=1.36; 95%Cl=1.11 to 1.67; p=0.003) suggesting an evidence of association between RRP and depression. CONCLUSION: This research has identified the main risk factors of RRP to be, age at menarche, marital status, parental care and support, number of times of ANC visits, sex education and transactional sex. Again the study has investigated the extent to which having subsequent birth in less than 24 months (Rapid Repeat Pregnancy) could adversely affect psychological state of an adolescent mother. The results from this study could provide an insight into designing targeted interventions by policy makers and other stakeholders. Key words: Rapid Repeat Pregnancy, depression, unmatched case-control, mixed method, Antenatal visits transactional sex, menarche, cases, controls.