Rural-Urban Migration, Childbearing Decision-Making, Fertility and Contraceptive Perspectives of Street Adolescents and Youth in Kampala, Uganda.

Introduction: This paper aims to describe and assess social demographic factors associated with childbearing decision-making, fertility and contraceptive intentions among street adolescents and youth in Kampala, Uganda while considering rural-urban migration as an explanatory factor. Materials and Methods: A cross-sectional survey of 513 adolescents and youth aged 12-24 years self-identifying as street adolescents and youth were interviewed with a structured questionnaire in 2019. Street adolescents and youth who migrated from other rural districts to Kampala were compared with those from the city. Logistic regression was performed to assess associations between the independent factors and personal childbearing decision-making, fertility and contraceptive intentions. Results: Overall, 80.31% of the street adolescents and youth had a rural-urban migration experience. Fifty six percent (56.32%) of the street adolescents and youth made personal childbearing decisions, 94.15% expressed intentions to have children in the future and 42.88% expressed intentions to use contraceptives in the future. Intentions to use contraceptives were significantly higher among males (58.75%) than females (20.00%), and higher among migrants (65.91%) compared to non-migrants (34.09%). Contraceptive intentions were positively associated with self-perceived permanent residential status (aOR = 10.26, 2.70-39.08), intra-urban mobility (aOR = 4.99, 95%CI 1.50-6.59) and intentions to migrate to other towns within the country (aOR = 5.33, 95%CI 1.59-17.80). Being married (aOR = 0.13, 95%CI 0.02-0.85), a large shelter population size (aOR = 0.13, 95%CI 0.03-0.63) and having repeat migrations between the city and home district (aOR = 0.23, 95%CI 0.05-0.94), including migration-associated challenges reduced the odds of street youth's personal childbearing decision-making, while belonging to a social support group increased the odds of childbearing decision-making. We found no significant association between social demographic characteristics and fertility intentions. Discussion: Factors that influenced personal childbearing decision-making and contraceptive intentions among street adolescents and youth in Kampala operate mainly at the interpersonal and community levels, with marital status, shelter population size, rural-urban migration and its associated challenges associated with childbearing decision-making. Interventions to promote childbearing decision-making and contraceptive use among street adolescents and youth should take into consideration their migration and intra-urban mobility patterns.

Migration, personal physical safety and economic survival: drivers of risky sexual behaviour among rural-urban migrant street youth in Kampala, Uganda.

BACKGROUND: Despite the vulnerabilities associated with the youth migration process, knowledge on the drivers of risky sexual behaviour among migrant street youth is limited. This study sought to explore the pathways driving risky sexual behaviour among rural-urban migrant street youth in Kampala, Uganda. METHODS: We conducted 11 focus-group discussions composed of 8-10 participants each, and 15 in-depth interviews with urban street adolescents and youth aged 12-24 years. We purposively recruited street youth who had migrated from other districts to Kampala, Uganda, and who identified themselves as street youth. Data were analysed thematically using an inductive approach facilitated by Dedoose software. RESULTS: The migration journey acted as a catalyst for risky sexual behaviour among the adolescents and youth moving from rural districts to Kampala. Three primary pathways were found to drive risky sexual behaviour of street youth: 1) rural-urban migration itself, through sexual exploitation of and violence toward street youth especially young girls during movement, 2) economic survival through engaging in casual jobs and sex work upon arrival in the city, and 3) personal physical safety through friendships and networks, which consequently lead to having multiple sexual partners and unprotected sex. Engagement in risky sexual behaviour, especially sex work, was found to be an adaptation to the challenging and complex street life within the city. CONCLUSIONS: This study highlights the migration process, personal physical safety and economic survival as major pathways driving risky sexual behaviour among rural-urban street youth in Kampala. Interventions to improve sexual health, physical safety and protection of street youth during the migration process and within the city spaces should be prioritised.

Demographic and behavioural drivers of intra-urban mobility of migrant street children and youth in Kampala, Uganda.

While research on the nexus of migration and wellbeing of individuals has gained recognition in recent years, far less attention has been devoted to intra-urban mobility especially among the urban poor young populations. We assess the drivers of intra-urban mobility using a random sample of 412 migrant street children and youth in Kampala city, Uganda. This paper draws from a larger cross-sectional survey of circular migration and sexual and reproductive health choices among street children in Kampala, Uganda. We define 'migrants' as street children and youth with a rural-urban migration experience and 'intra-urban mobility' as the number of places stayed in or moved since migrating to the city, measured on a continuous scale. More than half (54.37%) of the migrant street children and youth had lived in two or more places since migrating to the city. Multivariate negative binomial regression analysis reveals migrant street children and youth's intra-urban mobility to be associated with gender (aIRR = 0.71, 95%CI 0.53-0.96), sex work (aIRR = 1.38, 95%CI 1.01-1.88), a daily income of one USD or more (aIRR = 1.57, 95%CI 1.16-2.13) and duration of stay in the city (aIRR = 1.54, 95%CI 1.17-2.01). Other drivers of intra-urban mobility included availability of causal work, personal safety and affordability of rental costs. Our findings suggest the need for urban housing and health policies to take into account street children and youth's intra-urban mobility and its drivers. Future research on all drivers of street children and youth's intra-urban mobility and its linkage with their health outcomes is recommended.

HIV prevalence and TB in migrant miners communities of origin in Gaza Province, Mozambique: The need for increasing awareness and knowledge.

BACKGROUND: As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. METHODS: A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. RESULTS: A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6-27.0) and was higher in the rural community (31.6%; 95% CI: 27.0-35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. CONCLUSION: The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.