published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

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Background: Adolescents in Botswana, especially women, face many sexual and reproductive health (SRH) challenges including high maternal mortality, sexually transmitted infections (STIs) including HIV, and unintended pregnancies, despite available SRH services. The youth friendly service (YFS) concept has been initiated and various strategies developed to address adolescents concerns. However, services remain underutilized and barriers to accessing services still exist. Aim: The aim of this study was to determine patterns of utilization of sexual and reproductive health services by adolescents attending senior secondary schools in Gaborone in 2012. The specific objectives were to: identify SRH services utilized by adolescents in the district; identify factors associated with adolescent utilization of YFS in the district; and determine barriers and facilitators to utilization of available YFS by adolescents. Design: This was a health systems research, which was conducted through an observational study, with descriptive and analytic components. Methods: 506 adolescents attending at the three (3) senior secondary schools in Gaborone were sampled through a simple random sampling strategy in each school. Parental consent and assent from participants was requested before respondents completed a self-administered questionnaire which was designed for the data collection. The questionnaire was pilot tested prior to the study. SPSS version 16 was used to analyse the data. A chi-squared test and logistic regression were used investigate association, and a p-value <0.05 was considered as statistically significant. Results: The findings of this study revealed that utilization of SRH by adolescents was low and the level of awareness of youth friendly services was also low. The study revealed that utilization of SRH was higher among female adolescents compared to their male counterparts. The study identified factors which hinder adolescents YFS utilization, which include: location of the facility, no interest in YFS, staff attitudes and behaviours, and inconvenient hours of operation. Conclusion: Identifying patterns of utilization of SRH services by adolescents attending senior secondary schools in Gaborone can help strengthen programmes at all levels of service delivery and the country at large. The Botswana Ministries of Health, and Education and Skills Development can re-orientate, or develop new initiatives that will deal with barriers to access and assist adolescents to fully utilize the available services. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2014.

Research has identified the important role that effective parent-adolescent communication about sex and relationships signifies in reducing the chances of adolescents engaging in risky sexual behaviour. However, many parents find it difficult to discuss issues related to HIV prevention at family level because HIV prevention is inherently linked to sex, which is still regarded as a taboo in some countries, including the country of the study, Swaziland. In addition to cultural barriers related to effective parent-adolescent communication, parents seem to lack the knowledge, approach as well as the confidence regarding communication about sex and relationships. The purpose of the study was to use appreciative inquiry (AI) to engage parents of adolescents in the design of interventions to prevent HIV among adolescents in Swaziland. Non-probability, purposive sampling was used to select parents of adolescent children (10-19 years) attending school at the two purposively selected high schools in Manzini. Twenty-four (24), 23 female and 1 male parents took part in AI. Participatory action research was conducted to involve participants actively in the process of initiating interventions for preventing HIV among adolescents. The process was guided by appreciative inquiry. Data was collected by means of appreciative interviews, comprising paired and focus group interviews according to different phases of the 4-D cycle of AI. Thematic analysis of data was done throughout the 4-D cycle of AI. The themes that emerged from appreciative stories of exceptional experiences shared during the discovery phase were perceived gains and open communication. The findings of the dream phase included expressed wishes for open parent-adolescent sexual health communication, support for parents and a community of HIV free adolescents. In the design phase, parents constructed and initiated interventions for effective parent-adolescent sexual health communication and parental comfort with communication about sex. In the destiny phase, parents made statements, which were based on what they committed to do to prevent HIV among adolescents. / Lucwaningo lukhombisa bumcoka bekukhumisana kahle kwemtali nemtfwana loyinsha ngetindzaba tebundlelwane bebantfu labatsandzanako netekulalana kuze kutsi kunciphe kutsi intsha ingabi sengotini yekutfola ligciwane HIV. Kodvwa kubatali labanyenti kulukhuni kukhulumisana nentsha ngetindzaba tekutivikela kuHIV emakhaya ngoba kukhuluma ngalendzaba kufaka ekhatsi tekulalana lokuselichilo kukhuluma ngako emaveni lamanyeti lokufaka ekhatsi leSwatini lapho kwetiwa khona lolucwaningo. Lokunye lokuvimbela kutsi batali bangakhulumi ngalendzaba ngaphandle kwekutsi kulichilo, kutsi batali baswele lwati nekutsi abati kutsi bangayingena njani intsha, kanye nekutsi abatetsembi kutsi bangakhona kukhuluma ngebudlelwane bebantfu labatsandanako kanye nekulalana. Injongo yalolucwaningo bekukusebentisa indlela yekubuketa lokuhle kubatali labakwentako mayelana nekukhulumisana nentsha kuze kutsi bakhe tindlela letingito tokutivikela intsha kuHIV Eswatini. Indlela labakhetfwe ngayo batali labangene lolucwaningo bakhetfwe ngokutsi banebantfwana bentsha labaneminyaka lelishumi kuya kulabo labanelishumi nemfica labafundza etikolweni letimbili letiphakeme letikhetsiwe kaManzini. Babangemashumi lamabili nesine batali labatfolakala kungenela lolucwaningo. Batali babamdzibi munye nebacwaningi kuloluhlelo lokuhlela tindlela tekuvikela iHIV kubantfwana labayintsha. Kwakusetjentiswa tindlela letibuka lokuhle lokwetiwe batali. Imibuto beyihlose kubuta ngalokuhle kodvwa. Imivo yebatali yatfolakala nekutsi bacale babutana bodvwana besebakhulunyiswa baticagogwana ngekwehlukana kwaletigaba letine talolucwaningo. Kuhlanganisa kwemivo kwentiwa ngekutsi kubuketwe tingcikitsi kutotonkhe tigaba talolucwaningo. Tingcikitsi letaphuma kuletingcoco esigabeni sekucala lapho bebakhuluma ngetikhatsi letinhle letabayimphumelelo lapho bebakhumisana nentsha ngekulalana nangeHIV, batsi bevakunemphumelelo nekubhobokelana ekhatsi kwebatali nebantfwana. Ngalesikhatsi sesigaba sekubeka emaphupho abo basho batsi bafisa kube nekubhobokelana phakatsi kwebatali nentsha mayelana nekulhulumisana ngekulalana. Lokunye labakufisile kutsi basekelwe basitwe ngekutsi intsha ikhulunyiswa njani. Ngesikhatsi sesigaba sesitsatfu sekubuketwa kutsi kungentiwani kutsi batali nebantfwana bakhulumisana ngetindzaba tekutsandzana kanye nekulalana batali babhala imivo labo. Ngemuva kwaloko benta tivumelwano tekutsi batakwentanjani uma sebabuyela emakhaya kuze bakhone kuvikela bantfwana bentsha kuHIV. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to examine the relationship between adolescents' perceptions of their parents' encouragement to lose weight and physical activity habits (i.e., exercise habits and sedentary behaviors) and their own physical health-related fitness (HRF) and psychological well-being. Results of structural equation modeling revealed both similarities and differences between boys and girls. Specifically, parental sedentary behavior and encouragement to lose weight related to girls HRF. Among boys, only encouragement to lose weight related to HRF. When inspecting the relationship between HRF and psychological well-being, HRF related to body satisfaction, but not depressive symptoms, among both boys and girls. Results of this study highlight the complex influence that parental perceptions have during adolescent development.

This study aimed at exploring perceptions of young adults with regard to condom use in Vhembe district, Limpopo province. With the help of a quantitative, cross sectional descriptive design approach, data were collected using structured questionnaires administered to 372 young adults who came for healthcare services at a selected clinic. The findings indicated that there is a relationship between positive perceptions toward condom use and actual condom use. It means that people who have positive attitudes toward condoms are also more likely to use them. In contrast, people with a negative attitude towards condoms are less likely to use them during sexual intercourse. Negative attitudes of health care providers were found to be the barrier that prevents sexually active individuals to access condoms in primary health care facilities. Re-training of health care providers to address negative attitude is a matter of priority. Mass media can also be used as an avenue to communicate consistent and correct condom use. / Health Studies / M. A. (Nursing Science)

The purpose of this study was to identify and describe factors that affect the utilisation of antenatal services by pregnant adolescents in Muheza district, Tanzania. Quantitative, descriptive study was used. The Andersen and Newman Framework of Health Services Utilisation were used as a conceptual framework. The study population consisted of 235 adolescents who delivered in the Muheza district while attending postnatal clinics and health centres providing reproductive health services between January 2012 and March 2012. The findings revealed a high percentage of under- utilisation of ANC due to low level of education, low individual and household income, inadequate knowledge about sexuality and poor attitudes towards reproductive health services as exemplified by low prevalence of contraceptive use. The distance from clinic, the use of family planning methods, source of antenatal care and having more than four children under 16 years were associated with adequate utilisation of antenatal services. Recommendations were made to promote antenatal services usage by pregnant adolescents in Tanzania. / Health Studies / M.A. (Public Health)

Preventing teenagers’ pregnancies and improving teenagers’ reproductive health are important as pregnancies in teenagers still represent an important health challenge in Cameroon. The purpose of this dissertation of a limited scope was to describe the perception of peer educators who underwent the ‘100% young’ peer education training and the effect it had on their own sexual behaviour. A qualitative descriptive, explorative and contextual research design was conducted. Data collection was done using in-depth interviews. Fifteen peer educators were purposively selected. Two questions were asked namely; please describe how you perceived the peer education training that you underwent and, describe how this training affected your own sexual behaviour. Findings revealed that participants had a positive education experience, positive personal growth and for many, that was enough to become mentors for their peers and build awareness. Recommendations propose that interventions such as the ‘100% young’ are urgently required to prevent teenage pregnancy. / Health Studies / M.P.H.

The purpose of this study was to identify and describe factors that affect the utilisation of antenatal services by pregnant adolescents in Muheza district, Tanzania. Quantitative, descriptive study was used. The Andersen and Newman Framework of Health Services Utilisation were used as a conceptual framework. The study population consisted of 235 adolescents who delivered in the Muheza district while attending postnatal clinics and health centres providing reproductive health services between January 2012 and March 2012. The findings revealed a high percentage of under- utilisation of ANC due to low level of education, low individual and household income, inadequate knowledge about sexuality and poor attitudes towards reproductive health services as exemplified by low prevalence of contraceptive use. The distance from clinic, the use of family planning methods, source of antenatal care and having more than four children under 16 years were associated with adequate utilisation of antenatal services. Recommendations were made to promote antenatal services usage by pregnant adolescents in Tanzania. / Health Studies / M.A. (Public Health)

This study aimed at exploring perceptions of young adults with regard to condom use in Vhembe district, Limpopo province. With the help of a quantitative, cross sectional descriptive design approach, data were collected using structured questionnaires administered to 372 young adults who came for healthcare services at a selected clinic. The findings indicated that there is a relationship between positive perceptions toward condom use and actual condom use. It means that people who have positive attitudes toward condoms are also more likely to use them. In contrast, people with a negative attitude towards condoms are less likely to use them during sexual intercourse. Negative attitudes of health care providers were found to be the barrier that prevents sexually active individuals to access condoms in primary health care facilities. Re-training of health care providers to address negative attitude is a matter of priority. Mass media can also be used as an avenue to communicate consistent and correct condom use. / Health Studies / M. A. (Nursing Science)