"These issues aren't talked about at home": a qualitative study of the sexual and reproductive health information preferences of adolescents in Vanuatu.

BACKGROUND: Onset of sexual activity during adolescence is common in Vanuatu, however access to comprehensive sexual and reproductive health (SRH) information is limited. Improving adolescents' knowledge about SRH is necessary to improve health outcomes, however little is known about the information needs and preferences of adolescents in the Pacific to inform policy and programs in this region. METHODS: Sixty-six focus group discussions were conducted with 341 male and female adolescents aged 15-19 years from rural and urban communities on two islands of Vanuatu. Twelve key-informant interviews were also conducted with policymakers and health service providers. Data were analysed thematically using an inductive approach. RESULTS: Much of the SRH information targeting adolescents focused on sexually transmitted infections and HIV. While this information was valued, important gaps were identified including prevention of pregnancy, condom use, puberty, sexuality and relationships. Peer educators and health workers were adolescents' preferred sources of information because they were considered knowledgeable and trustworthy. Parents were not a common source but were preferred, particularly by girls, despite considerable socio-cultural barriers. Schools were an important but underutilised source of information, as were a range of media sources. CONCLUSIONS: Providing adolescents with comprehensive SRH information can have life-long protective benefits, however there are important content gaps in information currently provided in Vanuatu. The broad range of sources preferred by adolescents highlights the need to strengthen information provision through multiple channels to reach in and out-of-school youth and respond to individual needs and contexts.

"Be kind to young people so they feel at home": a qualitative study of adolescents' and service providers' perceptions of youth-friendly sexual and reproductive health services in Vanuatu.

BACKGROUND: Sexual activity during adolescence is common in Vanuatu, however many adolescents lack access to sexual and reproductive health (SRH) services and subsequently suffer a disproportionate burden of poor SRH. There is limited peer-reviewed research describing adolescents' SRH service delivery preferences in Vanuatu to inform policy and programs. The aim of this qualitative study was to explore the barriers preventing adolescents from accessing SRH services in Vanuatu and the features of a youth-friendly health service as defined by adolescents. METHODS: Sixty-six focus group discussions were conducted with 341 male and female adolescents aged 15-19 years in rural and urban communities. Additionally, 12 semi-structured interviews were undertaken with policymakers and service providers. Data were analysed using thematic analysis. RESULTS: Socio-cultural norms and taboos regarding adolescent sexual behaviour were the most significant factors preventing adolescents from accessing services. These contributed to adolescents' own fear and shame, judgmental attitudes of service providers, and disapproval from parents and community gate-keepers. Lack of confidentiality and privacy, costs, and adolescents' lack of SRH knowledge were also important barriers. Adolescents and service providers identified opportunities to make existing services more youth-friendly. The most important feature of a youth-friendly health service described by adolescents was a friendly service provider. Free or affordable services, reliable commodity supply, confidentiality and privacy were also key features. The need to address socio-cultural norms and community knowledge and attitudes was also highlighted. CONCLUSIONS: There are significant demand and supply-side barriers contributing to low utilisation of SRH services by adolescents in Vanuatu. However, there are many opportunities to make existing SRH services more youth-friendly, such as improving service provider training. Investment is also required in strategies that aim to create a more supportive environment for adolescent SRH.

Avoidable hospitalisation in Aboriginal and non-Aboriginal people in the Northern Territory.

OBJECTIVES: To analyse rates of avoidable hospitalisations in Aboriginal and non-Aboriginal residents of the Northern Territory, 1998-99 to 2005-06, and to consider the implications for primary care interventions. DESIGN AND SETTING: Retrospective descriptive analysis of inpatient discharge data from NT public hospitals. MAIN OUTCOME MEASURES: Avoidable hospitalisations by age, sex, Aboriginality and condition, with annual time trends. RESULTS: Between 1998-99 and 2005-06, Aboriginal people in the NT had an avoidable hospitalisation rate of 11 090 per 100 000 population, nearly four times higher than the Australian rate of 2848 per 100 000. The rate for non-Aboriginal NT residents was 2779 per 100 000. During this period, the average annual increase in avoidable hospitalisations was 11.6% (95% CI, 11.0%-12.1%) in the NT Aboriginal population and 3.9% (95% CI, 3.3%-4.5%) in the non-Aboriginal population. The greatest increase occurred in those aged > or = 45 years, and was primarily attributable to diabetes complications. CONCLUSIONS: The significantly higher rates of avoidable hospitalisations in NT Aboriginal people reflect the emerging epidemic of chronic disease in this population, highlight barriers to Aboriginal people accessing effective primary care, and emphasise the extent of potential health gains with appropriate interventions.

Tuberculosis in illegal foreign fishermen: whose public health are we protecting?

OBJECTIVE: To document demographic details, prevalence of tuberculosis (TB), and completion of TB treatment in illegal foreign fishermen detained in Australia. DESIGN AND PARTICIPANTS: Clinical audit of 1471 illegal foreign fishermen who underwent health assessments in Darwin between 28 September 2005 and 31 December 2006. MAIN OUTCOME MEASURES: Demographic details, diagnoses of smear-positive and culture-positive TB, drug sensitivity results and treatment completion. RESULTS: 1471 illegal fishermen underwent health assessments, including chest x-ray screening. All were male and 93.8% were from Indonesia. Of the 31 fishermen (2.1%) admitted to hospital with chest x-rays suggestive of TB, 20 were diagnosed with TB (15 culture-proven; 5 according to clinical and radiological criteria) and 18 commenced treatment. There were 8 smear-positive cases and one multidrug-resistant TB case. The prevalence of culture-positive TB was very high at 1020 per 100 000 patients. All fishermen were deported before treatment completion, and all were lost to follow-up. CONCLUSIONS: The health assessment process successfully detected cases of TB in illegal foreign fishermen, enabling treatment to commence and the local public's health to be protected. Treatment completion in illegal foreign fishermen may be as low as zero; deporting fishermen before curative treatment is completed undermines TB control efforts and may lead to an emergence of drug resistance and an increased burden of active TB disease in our region.