Interventions for improving the health and socioeconomic well-being of young parents in Africa: a systematic review protocol.

INTRODUCTION: Early childbearing is highly prevalent in Africa. Despite the harmful consequences of early childbearing on young people, there is limited documentation of interventions that aim to improve the health and socioeconomic well-being of young parents on the continent. In this systematic review, we will map and provide a critical synthesis of interventions that aim to improve the health and socioeconomic well-being of young parents in Africa to inform future policy and programmatic decision-making. METHODS AND ANALYSIS: The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will conduct an electronic search of peer-reviewed articles published in six databases: PubMed, Science Direct, AJOL, JSTOR, ERIC and Google Scholar. We will also search for grey literature through Google search and organisations' websites to broaden the number of interventions retrieved. Articles will be included if (1) the study participants are young mothers and fathers aged 10-24 years, (2) the article reports on interventions targeting young mothers and fathers in Africa or individual countries in Africa, (3) the article is published in English or French, (4) the article reports on health and socioeconomic well-being outcomes and (5) the article was published between 1 January 2000 and 31 December 2023. We will extract relevant information from articles that meet the inclusion criteria and synthesise data using both quantitative and qualitative approaches. Two reviewers will independently screen articles for inclusion, extract data from included articles and assess the methodological quality of studies. ETHICS AND DISSEMINATION: Ethical approval is not required for the systematic review since we are synthesising publicly available publications. Findings from this systematic review will be published in a peer-reviewed journal and further disseminated in conferences and convenings focusing on the health and socioeconomic well-being of young parents. PROSPERO REGISTRATION NUMBER: CRD42023464828.

Poverty, childcare responsibilities, and stigma hinder adolescent mothers from returning to school in a low-income urban informal settlement in Kenya.

BACKGROUND: While a few studies have examined barriers to school re-entry among adolescent mothers, studies focusing on the experiences of girls in low-income informal settlements are scarce. We examined the factors that hindered parenting girls living in a resource-constrained urban setting from re-enrolling in school. STUDY SETTING: We conducted the study in Korogocho, a low-income urban informal settlement in Nairobi, Kenya. METHODS: Barriers to school re-entry were documented through inductive thematic analysis of 32 in-depth interviews with pregnant and parenting adolescent girls aged 15 to 19 years (N = 22), parents/guardians (N = 10), and 10 key informant interviews with teachers (N = 4), and community leaders (N = 6). RESULTS: Interviewed girls blamed their being out of school on their childcare responsibilities, poverty, stigmatizing and discriminatory attitudes from students and teachers, and withdrawal of parental support. While parents, teachers, and community leaders agreed that poverty and lack of childcare support hindered parenting girls from returning to school, they contended that robust support systems encompassing childcare and financial support, and less hostile school environments constituted facilitators of school re-entry among parenting adolescents. CONCLUSION: While the 2020 National Guidelines for School Re-entry in Kenya seek to deter the exclusion of adolescent mothers from education thereby ensuring retention, transition and completion at all basic education levels, the findings underscore the need for programs that ensure that pregnant and parenting adolescents have the requisite financial, material, and childcare support to facilitate their retention or re-enrollment in school in line with the Guidelines. School administrators and the Ministry of Education should develop and implement interventions that make the school environment less hostile for parenting girls.

Adherence to medication, dietary and physical activity recommendations: Findings from a multicenter cross-sectional study among adults with diabetes in rural South Africa.

BACKGROUND: Diabetes is a complex health condition requiring medical therapy and lifestyle modifications to attain treatment targets. Previous studies have not fully explored factors associated with adherence to medication, diets and physical activity recommendations among individuals living with diabetes in rural South Africa. We examined the association between knowledge, health belief and adherence to medication, dietary, and physical activity recommendations and explored self-reported reasons for non-adherence. METHODS: This cross-sectional study was conducted among 399 individuals living with diabetes recruited over 12 weeks from six randomly selected primary healthcare centres in rural South Africa. Sociodemographic and clinical data were obtained by self-report. Health beliefs, knowledge, and adherence were assessed using validated measures. Descriptive and inferential statistics were carried out. RESULTS: The majority (81.7%) of the participants were females, with a mean age of 62 ± 11 years. Only 39% reported adhering to their prescribed medication regimen, 25% reported adhering to dietary recommendations, and 32% reported adhering to physical activity recommendations. The most cited reasons for non-adherence were lack of access to (n = 64) and cost of drugs (n = 50), perceived high costs of healthy diets (n = 243), and lack of time (n = 181) for physical activity. Level of education was an independent predictor of medication adherence [odds ratio, OR = 2.02 (95% confidence interval, CI: 1.20-3.40)] while diabetes knowledge was independently associated with both medications [OR = 3.04 (95% CI: 1.78-45.12)]; and physical activity adherence [OR = 2.92 (95% CI: 1.04-2.96). Positive health belief was independently associated with adherence to medications [OR = 1.72 (95% CI: 1.15-2.57) and dietary recommendations [OR = 1.75 (95% CI: 1.04-2.96)]. CONCLUSION: Adherence to three important self-care practices, medication, diet, and physical activity, was suboptimal in this study setting. Socioeconomic reasons and access barriers were significant drivers of non-adherence, while increased knowledge and positive health beliefs were potential facilitators. Efforts to improve medication adherence and foster engagement in healthy lifestyle behaviours must consider patients' knowledge and health beliefs. Primary healthcare providers should create awareness on the importance of adherence on health outcomes for people with diabetes. Likewise, efforts to increase the availability and affordability of medications for socioeconomically disadvantaged populations should be prioritised by the key health stakeholders.

Female genital mutilation/cutting among girls aged 0-14: evidence from the 2018 Mali Demographic and Health Survey data.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is considered a social norm in many African societies, with varying prevalence among countries. Mali is one of the eight countries with very high prevalence of FGM/C in Africa. This study assessed the individual and contextual factors associated with female FGM/C among girls aged 0-14 years in Mali. METHODS: We obtained data from the 2018 Mali Demographic and Health Survey. The prevalence of FGM/C in girls was presented using percentages while a multilevel binary logistic regression analysis was conducted to assess the predictors of FGM/C and the results were presented using adjusted odds ratios with associated 95% confidence intervals (CIs). RESULTS: The results indicate that more than half (72.7%, 95% CI = 70.4-74.8) of women in Mali with daughters had at least one daughter who has gone through circumcision. The likelihood of circumcision of girls increased with age, with women aged 45-49 having the highest odds compared to those aged 15-19 (aOR = 17.68, CI = 7.91-31.79). A higher likelihood of FGM/C in daughters was observed among women who never read newspaper/magazine (aOR = 2.22, 95% CI = 1.27-3.89), compared to those who read newspaper/magazine at least once a week. Compared to women who are not circumcised, those who had been circumcised were more likely to have their daughters circumcised (aOR = 53.98, 95% CI = 24.91-117.00). CONCLUSION: The study revealed the age of mothers, frequency of reading newspaper/magazine, and circumcision status of mothers, as factors associated with circumcision of girls aged 0-14 in Mali. It is, therefore, imperative for existing interventions and new ones to focus on these factors in order to reduce FGM/C in Mali. This will help Mali to contribute to the global efforts of eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030.

Intimate Partner Violence, Partner Risk, and Depression as a Predictor for PrEP Uptake Among African-American Women in the United States.

African-Americans bear a disproportionate burden of HIV infections in the United States and African-American women make up 64% of new HIV infections. Therefore, this study aimed to explore the predictors of those who are more likely to use Pre-Exposure Prophylaxis (PrEP) among women reporting IPV, depression, and partner risk. This study used secondary data analysis to explore IPV, depression, and increased partner risk as predictors of PrEP use among 768 women (506 African-American women and 262 White women in the United States) who responded to survey questions regarding potential PrEP use and barriers to uptake. The parent data had been collected at Emory University Rollins School of Public Health. Results of the data analysis of the sample (N = 768) indicated that women who reported high levels of partner risk (p < 0.05), depression (p < 0.01), and/or experienced IPV (p < 0.01), were more likely to use PrEP. In addition, younger women aged 20-35 were more likely to use PrEP, compared to women older than 36 years. Furthermore, college educated African-American women were more likely to use PrEP than White women. Despite limitations, findings indicated that IPV, depression, and partner risk are predictors of PrEP use. There is need for a multi-modal approach in addressing these predictors of PrEP use among African-American women in the United States.