The purpose of the study was to explore and describe young people’s perceptions of access to sexual and reproductive health (SRH) services in Swaziland. The study provided insights into the SRH services currently available to the young people of Swaziland and reveals the opportunities that can be used to improve accessibility and utilisation of the current reproductive health services. The findings will inform policy-making and appropriate future interventions for young people’s sexual and reproductive needs and services. Data were collected through a descriptive exploratory study design. Colaizzi’s seven steps of data analysis were used. The study provides ample evidence that young people face sexual health risks that justify their need to access and utilise SRH services. The findings revealed that access to service is an important but complex element of quality care, as it determines whether a client gets to the service provider. / Health Studies / M.A. (Health Studies)

The understanding of the patterns of association between positive sexual behaviours and protective factors that have greater impact helps to design appropriate strategies not only on positive sexual behaviour but also for reproductive health outcomes. The purpose of the study was to explore the protective factors and develop strategies to support positive sexual behaviours among high school adolescents. A concurrent mixed method research design was employed to explore the protective factors for positive sexual behaviours. A total of 990 adolescent students attending regular classes were selected using systematic sampling technique for the quantitative study and 33 focus group participants for qualitative study. Pre-tested, self-administered questionnaire was used for the quantitative whereas focus group discussions were employed for the qualitative phase. Protective factors were assessed at family, community/ neighbourhood, school, peer and individual levels. Quantitative data was analyzed using SPSS version 23. Descriptive statistics and binary logistic regression analysis were employed to identify protective factors. Variables with significant association in bivariate analysis were entered into logistic regression to control confounding effects. The qualitative data management, analysis and interpretation followed thematic analysis principles. Illuminating verbatim quotations used to illustrate findings. RESULTS: adolescents follow parents' rules about sexual activities [AOR=0.462, 95%CI: 0.285-0.748], authoritative [AOR=0.075, 95%CI: 0.021-0.265] and authoritarian [AOR=0.091, 95%CI:0.025-0.331] parenting styles were protective factors. Adolescents’ communication with parents was more likely to have positive association [AOR=0.56, 95%CI:0.31-0.94] than counterparts. Parental greater monitoring [AOR=0.604, 95%CI:0.38-0.959], clear rules and consequences [AOR=0.378, 95%CI: 0.233-0.613] and need for permission to go anywhere [AOR=0.387; 95%CI: 0.235-0.637] were significantly associated. School performance [AOR=0.141, 95%CI:0.055-0.362], perception that teachers are supportive [AOR=0.447, 95%CI:0.266-0.752], sex education [AOR=0.424, 95%CI: 0.243- 0.742], people approved contraceptive use [AOR=0.319, 95%CI: 0.165-0.619] and discussion with health workers on sexuality AOR=0.545, 95%CI:0.318-0.932] were strongly associated with positive sexual behaviour. Positive sexual behaviour associated with peer influence resulted in preferred later sexual debut [AOR=0.444, 95%CI: 0.248- 0.797] and bonding with peers AOR=0.531, 95%CI: 0.327-0.862]. / Health Studies / D. Lit. et Phil. (Health Studies)

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that affects women’s menstrual cycles and their levels of androgens (male hormones) and cysts on the ovaries. There is a variety of symptoms that come with this endocrine disorder, but insulin resistance is a hallmark symptom of the disorder. It’s shown that 65-70% of women with PCOS have insulin resistance and hyperinsulinemia, this is in women that are overweight, obese, or lean (Marshall & Dunaif, 2012). A lot of women with PCOS find themselves struggling to lose weight because their excess weight is tied to lifestyle and not properly nourishing their bodies, as well as their imbalanced hormones. The understanding of PCOS being a metabolic disorder led to the investigation of the need for registered dietitian nutritionists on the health team of women with PCOS could change the quality of life in women. We developed a survey based on the literature available on the topic of PCOS, diet/nutrition interventions, and the role of RDNs in the healthcare team of PCOS women of childbearing age. Only childbearing-age women (18-44) that have been diagnosed with PCOS were allowed to complete the survey. The survey was comprised of three sections and was designed to be a needs assessment on the need for registered dietitian-nutritionists to be included in the healthcare team of PCOS women. The questions were designed also show any gaps of knowledge or misconceptions about nutrition that these women may have. Lastly, it was designed to examine if women understand how nutrition relates to the management of their symptoms of PCOS and future disease risks. The data from this survey will show the need for RDNs in the healthcare team of PCOS women, and give us an understanding of nutrition education and intervention that could be developed for future studies. This understanding of how RDNs could play a role in symptom management could lead to a better quality of life in PCOS women.

The concept of youth activity centre (YAC) has not yet been evaluated. The purpose of this study was to evaluate the YAC in Botswana. Accordingly, the researcher explored and described the lived experience of young people utilising the YAC as well as the perceptions of service providers at the Mochudi Centre in the Kgatleng District, in Botswana. Furthermore, the objective was to develop and describe guidelines for the facilitation of youth-friendly services (YFS) at YAC. A phenomenological, qualitative, explorative, descriptive and contextual research design was used to extract young people’s experiences and perceptions of service providers. Thirty-two young people and 27 service providers (peer educators and service delivery officers [SDOs]) were purposefully selected. Methods of data collection used were unstructured individual in-depth interviews, focus group discussions and observations in the forms of field notes. The data, mainly tape-recorded interviews and field notes were transcribed verbatim for data analysis. Tesch’s eight-step data analysis model (Creswell 1994:155) was used. One major theme, youth friendliness emerged with three categories, namely: physical, administrative, and psychological aspects of youth-friendly services. All the respondents indicated that they benefited and affirmed they were empowered and better people after using the facility. However, limited access to the facility by the target group due to location, cost of reaching the facility, and attitudes of service providers as well as failure to implement planned activities due to financial and staff shortage were obstacles to youth friendliness of the YAC. Based on the findings and literature review, the researcher developed guidelines to facilitate YFS and improved access to the YAC. Recommendations made are for practise in the YAC, education of SDOs and for further research. / Health Studies / D. Litt. et Phil. (Health Studies)

The concept of youth activity centre (YAC) has not yet been evaluated. The purpose of this study was to evaluate the YAC in Botswana. Accordingly, the researcher explored and described the lived experience of young people utilising the YAC as well as the perceptions of service providers at the Mochudi Centre in the Kgatleng District, in Botswana. Furthermore, the objective was to develop and describe guidelines for the facilitation of youth-friendly services (YFS) at YAC. A phenomenological, qualitative, explorative, descriptive and contextual research design was used to extract young people’s experiences and perceptions of service providers. Thirty-two young people and 27 service providers (peer educators and service delivery officers [SDOs]) were purposefully selected. Methods of data collection used were unstructured individual in-depth interviews, focus group discussions and observations in the forms of field notes. The data, mainly tape-recorded interviews and field notes were transcribed verbatim for data analysis. Tesch’s eight-step data analysis model (Creswell 1994:155) was used. One major theme, youth friendliness emerged with three categories, namely: physical, administrative, and psychological aspects of youth-friendly services. All the respondents indicated that they benefited and affirmed they were empowered and better people after using the facility. However, limited access to the facility by the target group due to location, cost of reaching the facility, and attitudes of service providers as well as failure to implement planned activities due to financial and staff shortage were obstacles to youth friendliness of the YAC. Based on the findings and literature review, the researcher developed guidelines to facilitate YFS and improved access to the YAC. Recommendations made are for practise in the YAC, education of SDOs and for further research. / Health Studies / D. Litt. et Phil. (Health Studies)

Despite all the legislative efforts regarding child protection and campaigns to prevent and combat early marriage and maternity, Mozambique was ranked 9th globally in terms of the prevalence of early marriage, with 48% of girls aged 20-24 marrying before the age of 18 years. The aim of this study was to develop a strategic alignment framework for the prevention and combat of early marriage and maternity in Zambézia Province, Mozambique. This study used a two-stage equal-status concurrent sequential mixed-method design. Data were collected through a cross-sectional survey, administered to 383 early married, maternity and pregnant girls; life story interviews with early married, maternity and pregnant girls (25) aged 10-19 years; semi-structured interviews with professionals from the education and health sectors, local authorities, families of the early married, maternity and pregnant girls (37), and group discussions with members of a child committee (16). The results indicated that the majority of early married, maternity and pregnant girls only completed primary education (55.9%), followed by secondary education (39.9%), and higher education (2.9%). About 65% of adolescent girls became pregnant at the age of 15-17. Among adolescent girls, 18.8% had their first baby before the age of 15 years and 99.2% had their first baby before they were 18 years old. Among the early maternity girls (362), 24.3% responded “yes” to the questions about health complications during their first baby’s birth and 75.7% of the respondents said “no”. Socio-cultural meanings, such as socialisation into roles, legitimising having children, the value and benefits of the bridewealth, the role of initiation, the social meaning of the first menstruation, geographical and transport issues were the main drivers for school dropout, forcing adolescent girls to marry. Engaging in sexual practices was found to provide the girls a sense of meaning and purpose, or as a result of poverty. Physical aspects, interpersonal relations, education, work, and emotional distress were some of the negative consequences of early marriage and maternity. There were some relevant interventions and efforts to prevent and combat early marriage and maternity in Maganja da Costa and Morrumbala districts in Zambézia Province, Mozambique. However, the alignment of the activities implemented by different NGOs and CBOs to MNSPCM (2016-2019) was still a challenge. Only World Vision was implementing programmes aligned to the National Strategy. Based on the results, I developed a strategic alignment framework for the prevention and combat of early marriage and maternity in Zambézia Province, Mozambique. / Health Studies / D. Litt. et Phil. (Health Studies)