Adolescent suicidal behaviour in Namibia: a cross-sectional study of prevalence and correlates among 3,152 school learners aged 12-17 years.

BACKGROUND: While adolescent suicidal behaviour (ideation, planning, and attempt) remains a global public health concern, available county-specific evidence on the phenomenon from African countries is relatively less than enough. The present study was conducted to estimate the 12-month prevalence and describe some of the associated factors of suicide behaviour among school-going adolescents aged 12-17 years old in Namibia. METHODS: Participants (n = 4531) answered a self-administered anonymous questionnaire developed and validated for the nationally representative Namibia World Health Organization Global School-based Student Health Survey conducted in 2013. We applied univariate, bivariable, and multivariable statistical approaches to the data. RESULTS: Of the 3,152 analytical sample, 20.2% (95% confidence interval [CI]: 18.3-22.2%) reported suicidal ideation, 25.2% (95% CI: 22.3-28.4%) engaged in suicide planning, and 24.5% (95% CI: 20.9-28.6%) attempted suicide during the previous 12 months. Of those who attempted suicide, 14.6% (95% CI: 12.5-16.9%) reported one-time suicide attempt, and 9.9% (95% CI: 8.1-12.1%) attempted suicide at least twice in the previous 12 months. The final adjusted multivariable models showed physical attack victimisation, bullying victimisation, loneliness, and parental intrusion of privacy as key factors associated with increased likelihood of suicidal ideation, planning, one-time suicide attempt, and repeated attempted suicide. Cannabis use showed the strongest association with increased relative risk of repeated attempted suicide. CONCLUSION: The evidence highlights the importance of paying more attention to addressing the mental health needs (including those related to psychological and social wellness) of school-going adolescents in Namibia. While the current study suggests that further research is warranted to explicate the pathways to adolescent suicide in Namibia, identifying and understanding the correlates (at the individual-level, family-level, interpersonal-level, school context and the broader community context) of adolescent suicidal ideations and non-fatal suicidal behaviours are useful for intervention and prevention programmes.

Self-reported injuries and correlates among school-going adolescents in three countries in Western sub-Saharan Africa.

BACKGROUND: Unintentional injuries among adolescents constitute a significant public health problem globally. Injured adolescents may face negative outcomes ranging from poor academic performance to short- and long-term physical and psychosocial health struggles, and even death. The aim of this study was to estimate the prevalence and describe the correlates and most frequent causes of injuries among school-going adolescents in three West African countries - Benin, Ghana, and Liberia. METHODS: We analysed self-reported data provided by 8,912 school-going adolescents who participated in the Global School-based Student Health Survey in Ghana (2012), Benin (2016), and Liberia (2017). Students responded to questions on sociodemographic factors, family involvement factors, mental health factors, school environment factors and injury behaviours. RESULTS: The overall 12-month prevalence estimate of serious injuries in adolescents was 40.9% (Benin = 27.3%; Ghana = 46.1%; Liberia = 49.2%). The most frequently reported injury type was a broken bone or dislocated joint (33% in Benin), cuts or stab wounds (31.7% in Ghana), and non-specified injuries (35.2% in Liberia). Prevalence of serious injuries was higher among males and increased with age. In the multivariable logistic regression analysis, interpersonal aggression outside the family context (bullying victimisation, engaging in physical fights, and having been physically attacked) emerged as key correlates of increased odds of serious injuries. CONCLUSION: The relatively higher prevalence estimates of serious injury reported in this study underscore the need for the included countries to develop interventions aimed at reducing and preventing physical injuries among adolescents.

The mediating role of social support in the relationship between stigma and emotional distress among homeless adolescents in Ghana.

Research on youth homelessness has showed a link between emotional distress and social stigma. However, the mechanisms underlying this relationship have received little empirical attention. This study was conducted to examine the mediating effect of social support that accounts for the link. Standard questionnaires that assessed emotional distress, stigma and social support were interviewer-administered to 193 homeless adolescents (50.4% male; Mean = 13.21 (SD = 2.06). The Pearson product-moment correlation coefficient and mediation analyses were used to analyse the data. The study revealed that both self-blame and general stigma were positively related to emotional distress; but negatively related to social support. In the mediation analysis, general stigma significantly predicted decreased perceived social support and had a direct positive influence on emotional problems. However, the levels of self-blame was neither significantly associated with perceived social support nor had a significant indirect influence on the level of emotional problems. Both self-blame and general stigma also did not have a significant indirect influence on the level of emotional problems through perceived social support. These findings call for further research to examine the complex mechanism underlying stigma and mental health outcomes.

Mental health policy and system preparedness to respond to COVID-19 and other health emergencies: a case study of four African countries.

As a result of a long colonial history and subsequent developmental and economic challenges, many African countries have struggled to put in place adequate policies, systems, and associated infrastructures to address the health and social needs of their citizens. With the COVID-19 pandemic threatening human lives and livelihoods, concerns are raised about the preparedness and readiness of health policies and systems in African countries to deal with these kinds of health calamities. More particularly, questions can be asked about the preparedness or even existence of mental health policies and associated systems to help individuals and communities in Africa to deal with the consequences of COVID-19 and other health emergencies. In this article, we analyse the existing mental health policies of four African countries paying attention to the capacity of these legislative provisions to enable psychology professionals to deal with psychosocial problems brought about by COVID-19. We use Walt and Gilson's Policy Triangle Framework to frame our analysis of the existing mental health policies. In line with this conceptual framework, we review the role played by the different factors in shaping and influencing these mental health policies. We further explore the challenges and opportunities associated with existing legislation and mental health policies. We also reflect on the reports obtained from each of the four countries about the role that psychologists are playing to deal with the associated psychosocial problems. Based on our policy analysis and country reports, we highlight strengths and gaps in these policies and give recommendations on how mental health policies in these countries can be strengthened to respond to COVID-19 and future health emergencies.

To Keep the Law or to Repeal It: Views of Parliamentarians On the Call to Decriminalise Attempted Suicide in Ghana.

We explored the views of members of parliament (MPs) in Ghana on the call to decriminalise attempted suicide. We applied reflexive thematic analysis to Parliamentary Hansards (2017-2020) on calls to decriminalise attempted suicide in Ghana. 11 MPs shared their stance for or against the call. We developed three major themes that entailed, often, opposing views: (1) deterrent effect of the law (against: the law punishes and deters to protect life; for: the law is insensitive and has ironic effects), (2) enforcement of the law (against: leave things as they are, the law is not enforced, anyway; for: crime is not self-inflicted) and (3) prioritisation of suicide prevention (against: focus on more pressing issues, but resource support systems; for: the law and legitimate support systems cannot co-exist). The findings indicate two needs: to extend suicide literacy to Ghanaian MPs, and to initiate a public/private member's bill on attempted suicide decriminalisation.

Depression, anxiety and quality of life among women living with breast cancer in Ghana: mediating roles of social support and religiosity.

PURPOSE: Depression and anxiety are common mental health comorbidities found among women living with breast cancer. The presence of these mental health comorbidities results in decreased quality of life among patients. However, the indirect effects of depression and anxiety on quality of life have not been fully established. This study therefore examined the direct and indirect effects of depression and anxiety on quality of life through social support and religiosity. METHODS: Using a cross-sectional survey, 205 purposively selected participants were administered measures of depression and anxiety, social support, religiosity and quality of life. The statistical package for the social sciences (SPSS) with PROCESS Macro was used for mediation analyses. RESULTS: Findings showed that there were significant direct negative effects of depression and anxiety on quality of life. Whereas depression had a significant negative indirect effect on quality of life through social support (b = - 0.247, 95% CI = - 0.482 to - 0.071), anxiety had a significant positive indirect effect on quality of life through social support (b = 0.142, 95%CI = 0.011 to 0.324). However, depression and anxiety did not have any significant indirect effect on quality of life through religiosity. CONCLUSION: These findings suggest that there is the need to examine the mental health of women living with breast cancer as part of the routine healthcare, and social support ties should be strengthened to improve their quality of life.

Suicidal behaviours among adolescents in Liberia.

BACKGROUND: Whereas suicide remains in the top 12 leading causes of death among young people aged 10-24 in sub-Saharan Africa, little is known about suicidal behaviours among adolescents in Liberia. We aimed to estimate the 12-month prevalence and describe some of the correlates of suicide behaviours (ideation, planning, and attempt) among school-going adolescents in Liberia. METHODS: We analysed data from the 2017 Liberia Global School-based Student Health Survey conducted nationwide among secondary school students. We performed bivariate and multivariable analyses to assess the correlates of suicidal ideation, planning, and attempt in the previous 12 months. RESULTS: Of the 2744 students, 26.8% reported suicidal ideation, 36.5% made a specific plan to attempt suicide and 33.7% attempted suicide during the 12 months preceding the survey. In the final adjusted logistic models, bullying victimisation and food insecurity were associated with increased odds of ideation, planning, and attempt. Whereas no factor was uniquely associated with suicidal ideation, having many close friends, and parental monitoring were associated with the increased odds of suicidal planning only. Leisure-time sedentary behaviour was associated with increased odds of suicidal planning and attempt. Cannabis use, alcohol drunkenness, being physically attacked, and parental supervision were uniquely associated with increased odds of suicidal attempt, while parental understanding and having a smaller number of close friends were uniquely associated with reduced odds of suicidal attempt. CONCLUSIONS: The relatively high prevalence estimates of suicide behaviours and the multi-contextual nature of the associated factors warrant the need for the design and implementation of universal and multi-level, collaborative targeted intervention efforts towards the prevention of the onset of ideation, planning, and attempt, and the possible transition to deaths by suicide among school-going adolescents in Liberia.

Perceived seriousness mediates the influence of cervical cancer knowledge on screening practices among female university students in Ghana.

BACKGROUND: Cervical cancer knowledge and awareness, as well as an individual's perceptions about cervical cancer have been shown to significantly influence the screening practices of female students. Despite these studies, the mechanisms linking cervical cancer knowledge to screening practices among female students remain unexplored in the literature. Thus, this study examined the direct and indirect influences of cervical cancer knowledge on screening practices through perceptions about cervical cancer as informed by the health belief model. METHODS: A cross-sectional survey design with a purposive sample of 200 female students were used in the study. Standardized questionnaires were used to measure cervical cancer knowledge, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers and cervical cancer screening behaviours. The Pearson product-moment correlation co-efficient and mediation analyses were used to analyse the data. RESULTS: Our findings showed that cervical cancer knowledge, perceived susceptibility, perceived seriousness and perceived benefits were significant and positively correlated with increased screening behaviours. However, only perceived seriousness significantly mediated the relationship between cervical cancer knowledge and screening behaviour. Cervical cancer knowledge remained a significant direct predictor of screening behaviour in all the models. CONCLUSION: These findings underscore the need for increased awareness with emphasis on the seriousness of cervical cancer among female university students as it plays a key role in influencing their screening behaviours.

Mental adjustment to cancer and quality of life among women living with breast cancer in Ghana.

OBJECTIVE: This study examined whether cancer-specific coping strategies have any significant influence on the quality of life of 205 women living with breast cancer in Ghana. METHODS: Using a cross-sectional survey design, participants were administered questionnaires which measured their cancer-specific coping strategies and health-related quality of life. RESULTS: Correlation analysis showed that helplessness-hopelessness negatively correlated with physical wellbeing, emotional wellbeing, functional wellbeing, and breast cancer additional concerns. Anxious preoccupation negatively correlated with all the domains of quality of life, whereas fighting spirit was positively correlated with emotional and functional wellbeing. Cognitive avoidance was positively correlated with functional wellbeing, while fatalism was positively related with all the domains of quality of life. Regression analysis revealed that anxious preoccupation predicted significant decreases in all the domains of quality of life, while helplessness-hopelessness predicted significant decreases in emotional and functional wellbeing domains. However, cognitive avoidance predicted significant increase in the functional domain of quality of life. CONCLUSION: These findings underscore the need for psychosocial support for breast cancer patients to adopt effective coping strategies to deal with their challenges in managing their illness.

Healthcare service delivery to refugee children from the Democratic Republic of Congo living in Durban, South Africa: a caregivers' perspective.

BACKGROUND: Refugees are generally considered a vulnerable population, with refugee children (newborn and young children) being particularly so. Access to healthcare for this population remains a challenge. The main purpose of this study was to explore refugee caregivers' perceptions of their children's access to quality health service delivery to their young children in Durban, South Africa. METHODS: This study used an explanatory mixed methods design, purposively sampling 120 and 10 participants for the quantitative and qualitative phases, respectively. Participants were administered a self-developed questionnaire that assessed demographic information of participants, socioeconomic status and living standard, medical history of children, satisfaction and experiences with healthcare services and refugees' networks and social support. A semi-structured interview schedule was developed to elicit in-depth and more detailed information from the participants on the quantitative areas that were investigated. Frequencies were calculated and a χ2 test was used to explore the factors associated with refugees' satisfaction of the healthcare provided and thematic analysis was used to analyse the qualitative data. RESULTS: The majority (89%) of caregivers were women, with over 70% of them aged between 30 and 35 years. Over 74% of caregivers visited public clinics for their children's healthcare needs. The majority of caregivers (95%) were not satisfied with healthcare services delivery to their children due to the long waiting hours and the negative attitudes and discriminatory behaviours of healthcare workers, particularly in public healthcare facilities. CONCLUSION: These findings underscore the need to address health professionals' attitudes when providing healthcare for refugees. Attitudinal change may improve the relationship between service providers and caregivers of refugee children in South Africa, which may improve the health-related outcomes in refugee children.

International note: Analysis of risk and protective factors for risky sexual behaviours among school-aged adolescents.

This study examined the prevalence and associated factors of risky sexual behaviours among 1648 school-going adolescents using the 2012 Ghana Global School-based Student Health Survey. Our findings showed 33.5% of the participants had ever had sex 32.5% had multiple sexual partners and only 26.2% reported using condom during their last sexual intercourse. Being male, older age, anxiety, loneliness, suicidal ideation, being bullied, food insecurity (hunger), current alcohol and marijuana use were significant risk factors for being sexually experienced, multiple partners, but not condom use. Parental knowledge of activity was a significant protective factor against adolescents' sexual experience. These findings underscore the need to develop school-based interventions that would help reduce risky sexual behaviours among school-going adolescents.

Prevalence and predictors of suicidal ideations and attempts among homeless children and adolescents in Ghana.

OBJECTIVE: This study aimed to determine the prevalence and risk factors associated with suicidal ideations and attempts among a sample of homeless street children and adolescents found in Accra, Ghana. METHODS: A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana. An interviewer-administered questionnaire was used to collect data due to a low level of literacy among the study population. Bivariate and multivariate logistic regressions were fitted to analyse the data. RESULTS: The results indicated that 26.4% and 26.0% of the participants had attempted suicide and reported suicidal ideations respectively. The multivariate logistic regression showed that smoking, past and present use of alcohol, use of marijuana, and engagement in prostitution, were associated with suicidal ideations and suicide attempts. Suicidal ideations were associated with having been physically beaten, robbed, and assaulted with a weapon; while a suicide attempt was predicted by having been robbed and physically beaten. CONCLUSION: This study increased our understanding of the determinants of suicidal ideations and attempts among homeless youth. These findings suggest urgency to up-skill mental health workers to assess for risk factors and offer pathways to care for this vulnerable group.

The Role of Condom Use Self-Efficacy on Intended and Actual Condom Use Among University Students in Ghana.

Little attention has been paid to the dimensions that help to predict and understand condom use among university students within an African context. A cross-sectional study involving 518 university students in Accra, Ghana was conducted to determine how the Condom Use self-Efficacy Scale-Ghana (CUSES-G) can predict both actual condom use and future condom use. Of all the participants, 84% were sexually active but less than half of the sample (48%) reported to have used condom during their last sexual intercourse. A hierarchical regression analysis showed that components of the Condom Use Self-Efficacy Scale (CUESE-G) such as appropriation, assertiveness, pleasure and intoxication, and STDs predicted condom use and condom use intentions. Behavioural change campaigns targeting university students should encourage condom use self-efficacy, as this would strengthen condom use, which is economically cheap and practically effective means of preventing STIs including HIV.

International note: association between perceived resilience and health risk behaviours in homeless youth.

Homeless youth are regarded as an extremely high risk group, susceptible to suicidal ideation substance abuse, and high rates of mental illness. While there exists a substantial body of knowledge regarding resilience of homeless youth, few studies has examined the relationship between perceived resilience and health risk behaviours. The present study describes the findings from a quantitative examination of street-related demographics, resilience, suicidal ideation, substance abuse, sexual risk behaviours and violent related behaviours among 227 homeless youth. The findings revealed that perceived resilience was negatively related to suicidal ideation, substance abuse and violence. Suicidal ideation was positively related to both substance abuse and violence, whilst violence and substance abuse were positively correlated. Multiple regressions showed that perceived resilience served as a protective factor for suicidal ideation and having multiple sexual lifetime partners, suggesting that youth with lower level of perceived resilience were more likely to engage in various health risks behaviours.

Using reflective poems to describe the lived experiences of street children and adolescents in Ghana.

These two poems emerged from my qualitative research with homeless youth in Accra Central, Ghana. I was overwhelmed at how this method of research rarely used in Ghana offers a researcher the opportunity to capture participants' subjective feelings, and the complexities of their perceptions and experiences of a phenomenon. The aim of the study was to examine the lived experiences of street youth and to explore factors that enhance their survival on the street. These reflective poems shed light on the experiences of both the street youth and researcher, as captured in my reflective journal during the research. It was difficult winning the trust of the street youth, but when the trust was won, it became a worthy journey to understanding the complexities of their daily lives.

An exploratory study of the socio-cultural risk influences for cigarette smoking among Southern Nigerian youth.

BACKGROUND: The increase in smoking prevalence in developing countries including Nigeria has been mainly blamed on the aggressive marketing strategies of big tobacco companies. There is a paucity of research on other socio-cultural risk factors for smoking among the youth. The main objective of this study is to explore and describe socio-cultural risk factors influencing cigarette smoking among the youth in Southern Nigeria. METHODS: A total of 27 respondents (5 community leaders, 4 political analysts and 18 young cigarette smokers) were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyse the data. RESULTS: Social-cultural practices fuelling early usage and exposure of children to cigarettes and the promotional activities of tobacco companies were identified as possible factors influencing youth's smoking behaviour in Southern Nigeria. CONCLUSION: Tobacco control policies should include cultural interventions to modify current traditional practices and social norms which fuel the use of tobacco in the society. Such interventions must target specific groups, subpopulations and subcultures more exposed to the cultural risk influences for smoking.

Consistent condom use among sexually active young adults in Ghana: an analysis of prevalence and associated factors.

Consistent and proper condom use offers a safer, economically cheap and practically effective means of preventing HIV infection. Using the 2014 Ghana Demographic and Health Survey with a sample of 2779 sexually active youth (males = 682 and females = 2,097) in the age range 15-24, this study explored the prevalence of, and factors associated with consistent condom use among sexually active young adults in Ghana. Multivariate logistic regression was used to analyse the data. Our results showed that approximately 11% of the respondents reported consistent condom use in their previous sexual activity. Females were more likely than males to have used a condom consistently. The logistic regression results showed that females who had tested for HIV were less likely to use a condom consistently. However, those who have obtained family planning information from print media and those from the northern part of Ghana were more likely to practise consistent condom use. Furthermore, males who professed the Traditional African religion were less likely to use a condom consistently. In contrast, males in the rich wealth category were more likely to use a condom consistently. These findings underscore the need for behavioural change campaigns targeting young adults, particularly those who are sexually active, to encourage consistent condom use. These interventions should target young adults with less family planning knowledge, those who know their HIV status and those who profess the Traditional African religion.

HIV/AIDS knowledge and uptake of HIV counselling and testing among undergraduate private university students in Accra, Ghana.

BACKGROUND: HIV Counselling and Testing (VCT) and knowledge about HIV are some key strategies in the prevention and control of HIV/AIDS in Ghana. However, HIV knowledge and utilization of VCT services among university students is low. The main objective was to determine the level of HIV/AIDS knowledge and to explore factors associated with the use HIV counselling and testing among private university students in Accra, Ghana. MATERIALS AND METHODS: A cross-sectional study was conducted using structured questionnaires among 324 conveniently selected students enrolled at a privately owned tertiary institution in Accra, Ghana. RESULTS: The respondents consisted of 56.2% males and 43.8% females aged 17 - 37 years. The mean HIV/AIDS knowledge score of was 7.70. There was a significant difference in knowledge of HIV/AIDS by gender where female students had more knowledge about HIV/AIDS than males [t (322) = 2.40, p = 0.017]. The ANOVA results showed that there was a significant difference in HIV/AIDS knowledge according to the age groups [F (3, 321) = 6.26, p = 0. 0001] and marital status [F (3, 321) = 4.86, p = 0. 008] of the sample. Over half of the participants had not tested for HIV, although over 95% of them knew where to access counseling and testing services. The study also revealed a significant association between demographic variables, testing for HIV and intention to test in the future. Participants who were never married (single), aged 17 - 20 years and had knowledge of two routes of HIV transmission were more likely to have taken an HIV test. Males were more likely to take an HIV test in the future than females. Majority of the students receive HIV/AIDS information from both print and electronic media, but few of them received such information from parents. CONCLUSION: The students HIV knowledge was very good, yet HIV testing were low. Health education and HIV intervention programmes must not only provide accurate information, but must be made to help to equip private university students, especially females to test for HIV consistently.

Mental health literacy of school-going adolescents in sub-Saharan Africa: a regional systematic review protocol.

INTRODUCTION: Assessing mental health literacy has implications for the identification and treatment of mental health problems. Adolescents have been identified as a particularly important target group for initiating and improving mental health literacy. However, much of what we know about adolescent mental health literacy comes from high-income countries. This proposed review seeks to synthesise the available published primary evidence from sub-Saharan Africa on the status and measurement of mental health literacy among school-going adolescents. METHODS AND ANALYSIS: We will perform a systematic review reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020). We will systematically search selected global databases (EMBASE, PsycINFO, PubMed and MEDLINE) and regional electronic databases (African Index Medicus and African Journals OnLine) up to December 2021 for observational and qualitative studies published in English and French. The standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst criteria) will be used to appraise the methodological quality of the included studies. The Petticrew-Roberts 3-step approach to narrative synthesis will be applied to the included studies. ETHICS AND DISSEMINATION: We will not seek ethical approval from an institutional review board, as this is a systematic review of available and accessible literature. When completed, the full report of this review will be submitted to a journal for peer-reviewed publication; the key findings will be presented at local and international conferences with-partial or full-focus on (adolescent) mental health (literacy). PROSPERO REGISTRATION NUMBER: CRD42021229011.

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

BACKGROUND: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.