Naïve, uninformed and sexually abused : circumstances surrounding adolescent pregnancies in Malawi

Background: Pregnancy and childbearing in adolescence could negatively affect girls' health and socio-economic wellbeing across the life course. Previous studies on drivers of adolescent pregnancy in Africa have not fully considered the perspectives of parents/guardians vis-à-vis pregnant and parenting adolescents. Our study addresses this gap by examining pregnant and parenting adolescents' and parents/guardians' narratives about factors associated with early and unintended pregnancy. Methodology: The descriptive study draws on qualitative data collected as part of a larger mixed-methods cross-sectional survey on the lived experiences of pregnant and parenting adolescents. Data were collected between March and May 2021 in Blantyre, Malawi, using semi-structured interview guides. We interviewed 18 pregnant and parenting adolescent girls, 10 parenting adolescent boys, and 16 parents/guardians of pregnant and parenting adolescents. Recorded interviews were transcribed verbatim into the English language by bilingual transcribers. We used the inductive-thematic analytical approach to summarize the data. Findings: The data revealed several interconnected and structural reasons for adolescents’ vulnerability to early and unintended pregnancy. These include adolescents’ limited knowledge and access to contraceptives, poverty, sexual violence, school dropout, COVID-19 school closures, and being young and naively engaging in unprotected sex. While some parents agreed that poverty and school dropout or COVID-19 related school closure could lead to early pregnancies, most considered stubbornness, failure to adhere to abstinence advice and peer influence as responsible for adolescent pregnancies. Conclusion: Our findings contribute to the evidence on the continued vulnerability of girls to unintended pregnancy. It highlights how parents and adolescents hold different views on reasons for early and unintended pregnancy, and documents how divergent views between girls and their parents may contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unintended pregnancies will require altering community attitudes about young people's use of contraceptives and engaging parents, education sector, civil society organizations and community and religious leaders to develop comprehensive sexuality education programs to empower in- and out-of school adolescents

Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls : findings from a cross-sectional study in Burkina Faso and Malawi

Pregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighbourhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls

Clients’ Perception of Quality of Multidrug-Resistant Tuberculosis Treatment and Care in Resource-Limited Setting: Experience from Nigeria

Background: Quality care is essential to the well-being and survival of people with multidrug-resistant tuberculosis (MDR-TB). The aim of this study is to explore how MDR- TB patients, who were voluntarily hospitalized, perceived care and treatment strategy and to assess the influence of psychosocial factors on their perception of care and treatment strategy in Nigeria. Methods: The study enrolled 98 MDR-TB patients on voluntary confinement in four MDR-TB hospitals in Nigeria. Patients’ perceptions of quality of care and treatment strategy were evaluated with 28-item and 6-item instruments, respectively. Bivariate analysis was used to test for an association and multivariate analysis for factors that might contribute to the perceived quality of care. Results: Seventy-eight per cent (78%) of the participating patients perceived the quality of care to be good. Patients with better psychosocial well-being had five times higher odds to report good quality of care. Conclusion: The majority of MDR-TB patients perceived the quality of inpatient care to be good in Nigerian hospitals; however, their psychological health influenced their perception significantly. Health care providers need to improve treatment strategies to encourage acceptance of care as poor perception to health care service delivery may deter treatment completion and also cause relapse among clients on treatment

Examining inequalities in access to delivery by caesarean section in Nigeria.

BackgroundMaternal deaths are far too common in Nigeria, and this is in part due to lack of access to lifesaving emergency obstetric care, especially among women in the poorest strata in Nigeria. Data on the extent of inequality in access to such lifesaving intervention could convince policymakers in developing an appropriate intervention. This study examines inequality in access to births by caesarean section in Nigeria.MethodsData for 20,468 women who gave birth in the five years preceding 2013 Nigerian Demographic and Health Survey (DHS) were used for this study. Inequality in caesarean delivery was assessed using the concentration curve and multiple logistic regression models.ResultsThere was a high concentration in the utilisation of caesarean section among the women in the relatively high wealth quintile. Overall, delivery by caesarean section was 2.1%, but the rate was highest among women who had higher education and belonged to the richest wealth quintile (13.6%) and lowest among women without formal education and who belonged to the poorest wealth quintile (0.4%). Belonging to the poorest wealth quintile and having no formal education were associated with lower odds of having delivery by caesarean section.ConclusionIn conclusion, women in the richest households are within the WHO's recommended level of 10-15% for caesarean birth utilisation, but women in the poorest households are so far away from the recommended rate. Equity in healthcare is still a promise, its realisation will entail making care available to those in need not only those who can afford it

Distribution of respondents according to whether they presented at a hospital and had prescriptions.

<p>Distribution of respondents according to whether they presented at a hospital and had prescriptions.</p

Reasons given by respondents who had prescriptions for using for-profit pharmacies.

<p>(n = 1084).</p

User’s attitude towards medicine non-availability in hospitals.

<p>User’s attitude towards medicine non-availability in hospitals.</p

Overdependence on For-Profit Pharmacies: A Descriptive Survey of User Evaluation of Medicines Availability in Public Hospitals in Selected Nigerian States

<div><p>Objective</p><p>Lower availability of medicines in Nigerian public health facilities—the most affordable option for the masses—undermines global health reforms to improve access to health for all, especially the chronically ill and poor. Thus, a sizeable proportion of healthcare users, irrespective of purchasing power, buy medicines at higher costs from for-profit pharmacies. We examined user evaluation of medicine availability in public facilities and how this influences their choice of where to buy medicines in selected states—Cross River, Enugu and Oyo—in Nigeria.</p><p>Methods</p><p>We approached and interviewed 1711 healthcare users using a semi-structured, interviewer-administered questionnaire as they exited for-profit pharmacies after purchasing medicines. This ensured that both clients who had presented at health facilities (private/public) and those who did not were included. Information was collected on why respondents could not buy medicines at the hospitals they attended, their views of medicine availability and whether their choice of where to buy medicines is influenced by non-availability.</p><p>Principal Findings</p><p>Respondents’ mean age was 37.7±14.4 years; 52% were males, 59% were married, 82% earned ≥NGN18, 000 (US$57.19) per month, and 72% were not insured. Majority (66%) had prescriptions; of this, 70% were from public facilities. Eighteen percent of all respondents indicated that all their medicines were usually available at the public facilities, most (29%), some (44%) and not always available (10%). Reasons for using for-profit pharmacies included: health workers attitudes (43%), referral by providers (43%); inadequate money to purchase all prescribed drugs (42%) and cumbersome processes for obtaining medicines.</p><p>Conclusions</p><p>Lower availability of medicines has serious implications for healthcare behavior, especially because of poverty. It is crucial for government to fulfill its mandate of equitable access to care for all by making medicines available and cheap through reviving and sustaining the drug revolving fund scheme and encouraging the prescription of generic drugs in all public health facilities.</p></div

Reasons given by respondents whose relatives were on admission in public facilities for using for-profit pharmacies.

<p>(n = 265).</p