Do parents and young people communicate on sexual matters? The situation of Family Life Education (FLE) in a rural town in Ethiopia

Abstract: As a result of a cultural taboo, adolescents in many developing countries rarely discuss sexual matters explicitly with their parents. Most information for their patchy knowledge often comes from peers of the same sex, who may themselves be uninformed or incorrectly informed. This report is a summary of two surveys carried out on two occasions (November 1996 and October 1997, respectively) on 343 high school students and 246 families who had children 10-24 years of age in a rural town 160 Km south of Addis Ababa. The purpose was to assess the awareness and attitude of both study groups on major Family Life Education (FLE) components and know the level of parent-adolescent communication on matters related to young people’s sexuality. Findings suggest that young people’s knowledge on aspects of their sexuality is incomplete and not enough to minimise risk-taking. Yet, more than half of them believed that is unacceptable to discuss growth changes and sexual issues with parents during adolescence. Different grade and age levels did not influence the consensus except for a female sex, which significantly favoured this negative attitude. For some who approved discussion (sexual matters and contraception), peers were preferred most. Furthermore, 31.5% of the students were sexually active, and 65.7% of the sexually active ones reported use of some contraception (including calendar method) in the past. Likewise, parents had a partial knowledge regarding adolescent sexual maturation and behaviour or complication of teenage pregnancy. Nonetheless, 93% did not approve premarital sex and ironically, not more than 20% of them reported discussion of growth changes during adolescence, sexuality, and contraception in the past. However, parental education and lower family size positively influenced this attitude and practice. Implications of the study were discussed and recommendations made on future needs to initiate a comprehensive FLE in the school system and increase the responsibility of parents in adolescent sexuality. [Ethiop. J. Health Dev. 1999;13(3):205-210

Validation of AIDS-related mortality in Botswana

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Sexual activity of out-of-school youth, and their knowledge and attitude about STDs and HIV/AIDS in Southern Ethiopia

Abstract: A cross-sectional survey on sexual activity of out-of-school youth (15-24 years), and their knowledge and attitude towards STDs and HIV/AIDS was done in Awassa in June 1995. Most (94.4%) study subjects knew about HIV/AIDS, whereas, a lesser proportion of them knew the common STDs other than HIV/AIDS. Few of them were aware that the two are inter-related, one facilitating the transmission of the other. Forty-nine percent of the respondents (mean age 17+2 years) claimed to have started sex before the study date. Of these, 27.6% reported condom use during their most recent coitus. Thirty-six percent of the sexually active subjects admitted to have had more than one sex partner during the past 6 months (mean = 2.9+2). Lack of adequate knowledge, being careless often times, fear that condom will reduce sexual excitement, and pressure from sex partners appeared to be the common reasons for less use of condom during sex. The majority (91.0%) agreed that sex education and family life education for young people should be started early in life; in fact a quarter of them suggested as early as 10-12 years. It was concluded that out-of-school youth are sexually active; a considerable number of the sexually active are not practicing safe sex; and even if they have information about HIV/AIDS and STDs, it was not strong enough to bring about any significant behavioral change. This warrants the need for a continued expansion of Information, Education and Communication (IEC) linked with services to the youth, particularly the out-of-school youth which are at a higher risk. [Ethiop. J. Health Dev. 1998;12(1):17-22

Pregnancy and child heath outcomes among adolescents in Ethiopia

Background: Adolescent mothers and their children in developing countries fare less in most social and economic outcomes of early childbearing. Clinic-based non-representative data is the mainstream source of our current knowledge on these outcomes. Objectives: The study compared teenage (below 20 years of age) and adult (20-34 years of age) mothers on sociodemographic characteristics, pregnancy outcomes, and child survival from a population-based national data. Methods: Demographic and health survey (DHS) data was used to conduct the comparison. A total of 663 teenage and 721 adult mothers who gave birth to their first child within five years preceding the survey were identified from the dataset. Results: Significantly larger proportion of the teenage mothers, were from rural areas, were poorer, less educated, and gave a history of no marriage. Controlling for potential socio-demographic confounders cancelled the difference between teenage and adult mothers in the rate of pre-natal care attendance, and operative and low birth weight deliveries. A larger percentage of home delivery was reported among teenage mothers. Children of teenage and adult mothers were likely to have comparable vaccination and morbidity status and received equivalent level of care during illness episodes. Maternal age was strongly associated with child survival. The result was contrasted with recent DHS data from Kenya and Uganda, which also showed similar pattern of pregnancy and child health outcomes. Conclusions: Most factors affecting child survival might be associated with the poor socio-economic achievements of teenage mothers than with their age at childbirth. [Ethiop.J.Health Dev. 2004;18(2):90-95

Child morbidity and healthcare utilization in the slums of Nairobi, Kenya

Rapid urbanization and inequitable distribution of social services in African cities significantly contribute to the current deterioration of child health indicators in the region. Determinants of child morbidity and healthcare utilization among slum residents in Nairobi City, Kenya were assessed. Using a morbidity surveillance system, we visited 1691 households every 90?days for 9?months and registered 696 children below 5?years. 264 (37.9 per cent) children were reported to have been sick or injured at least once during the study period. A total of 447 illness episodes were reported among the 264 children (an average of 1.7 episodes per child). Cough, fever, diarrhea, skin problems and eye diseases made up the top five causes of morbidity. Child age below 1 year (OR = 2.7; 95 per cent CI = 1.33, 5.49) and having a working-mother (OR = 2.0; 95 per cent CI = 1.19, 3.31) were significantly associated with child morbidity report. About half of the mothers sought proper medical care for their sick children mostly from health institutions located outside the slum. Healthcare seeking within the slum heavily relied on informal private clinics. Working mothers sought medical care more often than non-working mothers (OR = 0.29; 95 per cent CI = 0.12, 0.7) and infants got priorities compared to older sick children (OR = 0.2; 95 per cent CI = 0.05, 0.83). We conclude that maternal engagement in non-formal low-paying jobs might in the long-run have a questionable gain in child survival among slum resident

Size of newborn and caesarean section deliveries among teenagers in sub-Saharan Africa: evidence from DHS

This paper uses DHS data from 20 countries in sub-Saharan Africa, collected in the late 1990s and early 2000s, to examine perceived size of newborn and Caesarean section deliveries among teenagers in the region. A comparison between teenagers and older women, based on logistic regression analyses for individual countries, as well as multilevel logistic analyses applied to pooled data across countries, and controlling for the effects of important socioeconomic and demographic factors, shows that in general, births to teenagers are more likely to be small in size but are less likely to be delivered by Caesarean section compared with births among older women. An examination of the country-level variations shows significant differences in perceived size of newborn and Caesarean section deliveries between countries. However, the observed pattern by maternal age does not vary significantly between countries, suggesting that these patterns are generalizable for the region. For teenagers with characteristics associated with higher odds of Caesarean section, being in a country with an overall higher rate particularly amplifies their individual probability

Comparing maternal health indicators between teenagers and older women in sub-Saharan Africa: evidence from DHS

DHS data from 21 countries in sub-Saharan Africa are used to examine maternal health indicators among teenagers. A comparison is made between teenagers and older women, based on logistic regression analyses for individual countries and multilevel logistic analyses applied to merged data, controlling for the effect of socio-economic and demographic factors. Teenagers are found more likely to report unintended fertility (especially mistimed), receive inadequate antenatal care (start late and attend fewer visits), have non-facility delivery, and have a small baby at birth. However, teenagers are less likely to have had Caesarean section deliveries compared to older women. There are significant differences in maternal health indicators between countries but the observed pattern by maternal age does not vary significantly between countries, suggesting that these patterns are generalizable for the region. For teenagers with characteristics associated with higher Caesarean section or unwanted fertility rates, being in countries with overall higher risks of these outcomes particularly amplifies their chances of experiencing them

HIV prevalence and socio-cultural contexts of sexuality among youth in Addis Ababa, Ethiopia

Background: Periodic cross-sectional studies that combine data on HIV/AIDS prevalence with behavioural survey can help assess the extent of disease prevention and control efforts overtime. Objectives: Estimate the prevalence of HIV infection and examine the contexts of sexuality among youth (15-24 years) in the city of Addis Ababa, Ethiopia. Methods: Unlinked, anonymous screening of air-dried saliva for HIV-1 IgG antibodies using BionorTM HIV-1&2 rapid ELISA kit and focus group discussions on young peoples sexuality. Results: Of the 677 study subjects, 20 (3.0%) tested positive for HIV-1 antibodies. Of the 319 youth in school, 1 (0.3%) was positive, while of the 358 youth out-of-school, 19 (5.3%) were positive. In the focus groups, parents were blamed for their stereotype attitudes towards young people's sexuality and for failing to provide vital information and support. Young people were faced with enormous pressure to engage in sex, especially from peers, exposure to unlicensed erotic video films and the desire for economic gain. Love relationships lacked adequate romantic period for partners to learn more about each other and negotiate condom use. Cultural shaping of young people's sexuality gave privileges for males to be sexually active, be in control of sexual relationships and be less responsible for precautions to prevent HIV/AIDS. The youth in general sensed their excessive vulnerability to HIV/AIDS but lacked individual motivation and skills to practice safe sex behaviour. Conclusion: HIV is significantly prevalent among youth in Addis Ababa, particularly out-of-school and female youth. Different socio-cultural contexts of sexuality and gender norms underpin this excess vulnerability. [Ethiop.J.Health Dev. 2002;16(2):139-145