Contraception determinants in youths of Sierra Leone are largely behavioral

Background: Sexual initiation occurs early in Sierra Leone. This study aims to analyze the determinants of condom and/or contraceptive use among a representative sample of young persons (10 to 24 years) in Sierra Leone. Methods: This is a secondary analysis of data from a study conducted to monitor the implementation of a UNFPA package of interventions directed to improve SRH in young people of Sierra Leone. This assessment was conducted in 2016 at the end of the Ebola outbreak. In consequence, determinants linked to healthy lifestyle behaviors and UNFPA interventions were explored in addition to the usual determinants: socio demographic and sexual lifestyle. This study is a household quantitative survey with open ended questions used to illustrate and complete the analysis. Results: A total of 1409 young people were interviewed: of these, 216 boys and 381 girls were sexually active. Those who were pregnant or wished for pregnancy were excluded, leaving 194 boys and 268 girls for the analysis of determinants. The proportion of young people using neither condom nor other contraception at their last sexual intercourse in the whole sample was 40.5% and there was no statistically significant difference between boys and girls (42.3 vs 39.2; P = 0.504). Determinants were assessed and, after multivariable analysis, results differed between boys and girls and showed the importance of behavioral aspects. Four determinants were common to boys and girls: literacy, distance, negotiation capacity and hand washing. However, the distance factor for girls was to the health facility and for boys it was to school. Three more determinants remained in the boy's model: sleeping under a bednet, number of sexual partners and knowledge of contraceptive methods. Opinions about condoms and contraception revealed important barriers; opposition to contraceptive use was the main reason for non-use for both boys and girls, while lack of access was an important reason for boys. Conclusion: There is a need to reach out to the 40% of young people who are sexually active and neither pregnant nor with pregnancy desire, and are not using condom or contraception

Actes - Atelier de capitalisation santé urbaine - Kigali ville

0Actes de capitalisation - rédigés sous la direction d'Aline Labatinfo:eu-repo/semantics/nonPublishe

Is the utilization of healthcare facilities easy for young people in Burundi?

Objective: Burundi has a very young population, with a median age of 17. Therefore, youth is a public health priority to be considered to achieve UHC. This 2019 study aims to identify the determinants and behaviors of youths (10-24years) in order to guide health policies, particularly regarding Healthcare Facilities (HF) utilization. Methods: This descriptive study is a 4-stage survey design with 110 clusters. 2085 youths were interviewed in 11 of the 18 provinces of Burundi. Results: 79,2% of respondents judged HF pleasant/nice to use as youths. However, 22,5% of respondents didn’t use HF last time they had a severe disease. This proportion is higher for boys (25,5%) than girls (20,3%) and for adolescents (10-19y: 24,0%) than young adults (20-24y: 16,4%). The 3 major reasons given, all together representing 88,9% of the responses, are lack of money, distance to the HF and self-medication. HF utilization for a severe disease is correlated to education level: 81,4% of respondents able to read went to HF while only 66,2% of those who can’t (or can’t well) did. Besides, HF utilization shows a gradient according to the level of the last class attended among respondents who do not attend school anymore (low:67,6%, middle:76,5%, high:82,7%). When a disease occurs -regardless of severity-, girls are more likely than boys to attend HF (87,9% vs 81,7%). Self-medication is more used by boys (10,4%) than girls (6,9%). Conclusion: More than 1/5 individuals of 10-24y doesn’t use HF when needed. Widespread self-medication appears as an inadequate substitution practice. Besides, gender, age and education level contribute to disparities in HF utilization. The health system provides free care for under 5 children but not much has been done to facilitate the access to care of the youths, specially for the youngest not yet able to afford their own care.info:eu-repo/semantics/publishe

Sexual and reproductive health behaviors amongst young people in Burundi

Objective: Burundi has a very young population, with a median age of 17. This study aims to identify the behaviors of youths (10-24years) in the field of sexual and reproductive health. Methods: A four-stage survey design, with 110 clusters, was conducted in 2019. 2085 youths were interviewed in 11 of the 18 provinces of Burundi. Results: Among 1902 respondents, 21.3% declared they already had a sexual intercourse (SI). First SI happens early with a median age of 17 (p25-p75: 12-18), especially for boys among whom 23.0% had their first SI before they were 10. In youngest respondents (10-14y), 42.0% of first SI happens with neighborhood members vs respectively 21.1% and 6.1% in 15-19 and 20-24y. Unexpectedly, first SI occurs earlier for individuals who are or have been to school: 34,8% had their first SI before 15 against only 12.5% for those who didn’t attend school. Use of contraceptive method is low among young people: 24.2% of respondents used a condom during last SI. This proportion grows to 38.3% including other contraception methods. Use of condom is more frequent by individuals who had first SI after 15 years of age (27.1%) than those who had first SI before (15.7%). Key reasons of not using a condom are pregnancy project (38.6%), non-planned SI (19.1%), non-return of menstrual periods after childbirth or breastfeeding (12.8%) and partner opposition for using condom (7.4%). Among girls who already had SI, 64.4% were or have been pregnant. This proportion increases to 96.8% for girls who don’t or didn’t attend school. Conclusion: This survey reveals several behaviors in youth sexual health in Burundi. Early sexual education should be strengthened to enable informed choices and improve sexual knowledge about both biological and rights aspects among young people in Burundi.info:eu-repo/semantics/publishe

Fruit consumption among young people aged 10 to 24 in Burundi: A descriptive cross-sectional survey (2019)

Objective: Fruit consumption is very important because they are rich in vitamins, minerals and antioxidants and are valuable allies in reducing the risk of cancer, obesity and cardiovascular disease. This study assesses eating behaviors and associated factors in 1,964 young people aged 10 to 24 in Burundi. Methods: This is a four-stage cross-sectional cluster survey carried out in 11 of Burundi's 18 provinces, where 110 enumeration areas were randomly selected. The data were collected using a questionnaire on the ODK platform and the results analyzed using Stata 15.0. Results: 25.3% of respondents say they rarely (less than once a week) consume fruit; girls being more concerned (27.0%) than boys (22.9%). A decreasing gradient is observed across the age groups; young adolescents (10-14 years) and adolescents (15-19 years) being relatively more affected (25.4% and 23.7% respectively) than young adults (20-24 years) of which only 18.4% rarely consume fruits. In addition, frequency of fruit consumption appears to be linked to nutritional status as 39.2% of all overweight and obese young people (2.6% of respondents) rarely consume fruits compared to only 24% in young people of normal weight. Conclusion: One in four young people rarely consume fruits with a gender dimension. Could the fact that the youngest are the most affected be related to their low autonomy in the choice of diet? Further investigations are needed to better understand this phenomenon. Our results are consistent with the idea that increasing the frequency of fruit consumption helps improve nutritional status in young people. Therefore, it would be interesting to identify in young Burundians the barriers to fruit consumption despite their relatively good physical availability throughout the country.info:eu-repo/semantics/publishe

Actes - Forum de capitalisation des résultats de recherche en santé et acquis des interventions du MSP appuyées par le Projet d’Appui Institutionnel

Actes de conférence, rédigés sous la direction de Aline Labatinfo:eu-repo/semantics/nonPublishe

A bottom-up approach to strengthen health systems through health system research training

Introduction: The ULB school of public health organizes a two-month research training in health system strengthening. The targeted audience includes healthcare professionals, ministries’ executives, researchers, lecturers, program managers… active in low-and-middle-income countries. They come from various fields of expertise: medicine, sociology, economy, management… The course aims at increasing the individual reflection capacity through an in-depth analysis of the participant’s health system and the formulation of innovative interventions to improve its performance.Aim: The research aims at evaluating this training benefit with a specific focus on the improvement of the participants’ professional practice.Methods: A qualitative survey based on focus group discussions have been conducted in Burundi, Senegal, Burkina Faso and Niger among past students of the previous ten years. The theoretical saturation was reached after six focus groups (5 to 18 people each).Results: The audience selection appears to be a strong strength of the training due to the professional and cultural/geographical diversity combine with a neutral training environment (Brussels). This enable free expression and critical thinking, on participant’s own system which is an unusual exercise.Even if some participants implemented their research project planned during the course, most of them reported that they mainly used their new knowledge to better analyze a problematic situation and to imagine a field solution with their team. They explained that they also feel more confident to raise their voices in meetings with decision makers or technical and financial partners. They are prepared to provide “evidence” to support their ideas or findings.Most of them are part time lecturers in universities or paramedical schools, and they reported to have changed their teaching approach to adopt participatory pedagogy that they never have experimented before. Conclusion: The training, based on a bottom-up approach, reinforce the foundations of health systems by developing not only the critical thinking of its actors, but also their willingness to engage in its improvement. The diversity among students’ helps them to realize the complexity of their professional environment and the need to combine clinical/technical knowledge with a systemic approach to implement efficient and sustainable interventions and serve as an agent of change.info:eu-repo/semantics/nonPublishe

A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men

AbstractWhile stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM)is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. Thissystematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced inrelation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions toinclude in our preliminary model constructed from programme frameworks and recommendations. We refined thepreliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Ourreview showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Selfacceptance,leadership, and motivational activation for behaviour change from intrapersonal strategies, such as educationand mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing,and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3)community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders’sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarilyand can be activated in different contexts in which MSM exposed to and infected with HIV are living.info:eu-repo/semantics/publishe

Towards Universal Health Coverage in Benin: obstacles to using rehabilitation services by disabled people

Context: Rehabilitation care is essential after the onset of a disability, and help to improve Disabled People's (DP) functional autonomy. In Benin, access to care is not guaranteed for all, and very few of the DP who access it manage to complete care. For the effectiveness of UHC, it is important to know the factors that influence their use of rehabilitation care.Methods: This cross-sectional study with an analytical aim, carried out in 2019, included 318 DP received in rehabilitation in 2018 at the hospital and/or in a community-based rehabilitation district. Interviewed by questionnaire, the DP presented cerebral palsy (37.4%); severe hemiplegic sequelae (30.8%); spinal cord injuries (11.3%); and amputations (11%). Single and multiple logistic regressions were performed to identify significant factors influencing the optimal use of rehabilitation care, defined as the ability to complete rehabilitation treatment as planned and without interruption.Results: Over the 228 DP who received care at hospital, 46.0% had a suboptimal use of rehabilitation care and only 17.2% benefit from a healthcare coverage measure (insurance or other measures). The significant factors that influence the optimal use of rehabilitation care are: age (OR:0.67, p=0.034), level of education (OR:1.47, p=0.007), coverage of care (OR:0.29, p=0.002), socio-economic level (OR:0.45, p<0.0001), dependence to go to care (OR:2.58, p=0.004), level of dependence (OR:1.86, p=0.001), to benefit of an appropriate/personal mean of transport to go to care (OR:2.05, p=0.015), and postponement of care for financial reasons (OR:4.55, p<0.0001). After adjustment for the other variables, the multiple regression only shows as significant: the socio-economic level (OR:0.46, p=0.022) and the postponement of care for financial reasons (OR:4.93, p<0.0001).Conclusion: In this study, too few DP benefit from healthcare coverage. The impact of the socio-economic level being important and noted, the Beninese authorities have some elements from this study to better address this problem.info:eu-repo/semantics/publishe