MST-School of Public Health

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Browsing MST-School of Public Health by Subject "Adolescents"

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    Effectiveness of the Voucher Program on Modern Contraceptive Uptake among Adolescents in Kisii County, Kenya
    (Kenyatta University, 2021) Omari, Nyaiburi Alex; Margaret Keraka; Isabella Epiu
    The teenage pregnancy rate in Kenya is 18%, implying that 1 in every 5 teenage girls between the age of 15 to 19 years have begun childbearing (are pregnant with the first child or have had a live birth). The high teenage pregnancy and birth rates in Kisii County are due to the high unmet need for contraceptives in the County. A voucher program which is a demand-side financing mechanism enables clients with a voucher to access free services from accredited third-party voucher service providers. Vouchers have been hypothesized to address both informational and financial barriers. The study design that was applied was the cross-sectional study design that focused on program effects among those who accessed contraceptives services with vouchers and those who accessed services without voucher in the program clinics. A mixed methodology of quantitative and qualitative techniques was used whereby facility level data from the facilities that were purposively sampled was collected. A total of 423 respondents from Amua facilities in the study Sub County were randomly selected and their response rate was 91.7%. Two in-depth interviews, five key informant interviews and five focus group discussions were conducted. Descriptive data was analyzed by use of the Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel to analyze facility level data in the Ministry of Health (MOH) 512 tool by generating frequency tables, graphs, and piecharts. Inferential statistics was calculated using Chi-Square tests (p=0.005), at 95% confidence level and Fisher‟s Exact Test to determine the relationship between the variables. The proportion of adolescents vis-à-vis all clients in 8 services clinics before the voucher was 12% while during voucher period there was a significant increase (4 times increase) of the number adolescents‟ accessing services these clinics at 50%. There was a strong significant relationship between the perceptions of side effects and uptake of services (p=0.001). Peer support about contraception had minimal influence (p=0.038). There was a strong statistical association between the community level factors and uptake of contraceptives (p= 0.001). The Fisher‟s Exact Test also established a weak relationship between voucher use and the contraceptive method mix. (0.042). 73% of the voucher users took up Long Acting and Reversible Contraceptives (LARCs) and the uptake of Implants was the common contraceptive method at 49.12% while condoms were not utilized by voucher users at all because they were perceived not be contraceptive methods by the users. In conclusion, vouchers significantly affected the uptake of contraceptives and were effective in reaching the intended group (adolescents). Perceptions of side effects and community norms were the other major factors that affected uptake of contraceptives. With these findings, policy makers at the National and County level should expedite the process of providing medical insurance to all adolescents under EduAfya medical insurance in order to as to mitigate the cost barrier that is involved when adolescents seek contraceptive services. Currently, only the adolescents registered on National Education Management Information System (NEMIS) database in public secondary schools are covered by the EduAfya cover. In addition, the Kisii County government should prioritize community sensitization through the community dialogues to address the community norms that impede contraceptive access by adolescents.
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    Relationship between Access to Reproductive Health Information and Risky Sexual Behaviours among Secondary School Adolescents in Kiambu County, Kenya
    (Kenyatta University, 2020-02) Mureithi, Peris Murugi
    Reproductive health information is critical to adolescents in empowering them make sexual and reproductive health decisions. Studies have shown that adolescents in secondary schools lack adequate, accurate and age appropriate reproductive health information; though faced with unique sexual and reproductive health needs, making them vulnerable to risky sexual activities and behaviours. The study aimed to determine the relationship between access to reproductive health information and risky sexual behaviours among secondary school adolescents in Kiambu County, Kenya. Specifically, the study assessed the level of awareness, sources of reproductive health information, adolescent perception on reproductive health information and influence of social cultural factors on access to reproductive health information, in relation to risky sexual behaviour. This was a descriptive cross-sectional study. The study targeted 7002 adolescent students from all the 13 public secondary schools in Thika West Sub-County. The following schools were selected: Chania Girls’ Boarding School; Chania Boys’ Boarding School and Broadway mixed day school with an accessible population of 2047 students. Fisher’s formula was used to arrive at 364 respondents of which 10% was added to cater for attrition, giving a sample of 400. Stratified sampling technique was adopted in selecting participating schools; to allocate the sample in the respective strata. The study sampled 400-students, and their guidance and counselling teachers as the key informants. The Researcher administered questionnaires, interview schedules (KII) and focus group discussion guides (FGD) were used in data collection. Descriptive statistics included mean, mode and percentages, while for inferential statistics chi square and binary logistic regression was applied. A p value ≤ 0.05 was considered statistically significant. The findings from the chi square relationship revealed that the risky sexual behaviour was low at 44.7% as indicated by the students who had had sexual relationships. The study found that there is less likelihood of risky sexual behaviour (by 0.571 times and by 0.349 times) for those students who received information from teachers, school counsellors and parents respectively. The relationship was found to be significant represented by a p value of 0.001. The findings also revealed that there is less likelihood of risky sexual behaviour (by 0.626 times, 0.648 times and by 0.629 times) for students who listened to information, on contraceptives, safe sex and STIs respectively. This relationship was found to be significant represented by a( p value of 0.020, 0.003 and 0.019) respectively. The study found that there is less likelihood of risky sexual behaviour (by 0.2012 times, by 0.591 times, by 0.6211 times and by 0.359 times) for those students who found reproductive health information easily available, very useful, and easy to understand and apply respectively. The conclusion of the study was that access to reproductive health information among adolescents in Thika sub-county was statistically significant in relation to risky sexual behaviours. The study recommends that adolescents should be equipped with adequate age appropriate reproductive health information as early as possible, and consistently made accessible throughout their lives to enable them in make sound sexual and reproductive health decisions thus reducing risky sexual behaviour.
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    Utilization of Post-Abortion Contraception among Adolescents in Makueni County, Kenya
    (Kenyatta University, 2022) Ngugi, Rachel Njeri; Wacuka Gathigia Njoroge
    Correct and consistent use of contraceptives has the potential to reduce the maternal mortality rate (MMR) arising from clandestine abortions by 25-35% and linking post-abortion care (PAC) clients to the family planning clinic in a hospital can reduce the MMR by a further 15%. Despite this, counselling clients on the variety of family planning methods available and allowing them to make informed choice is often overlooked during post-abortion care. Majority of healthcare providers dwell on offering emergency services and removing the retained products of conception and leave out counselling and provision of contraceptives. The main objective of this study was to investigate the utilization of post-abortion contraceptives among adolescents who had received post-abortion care in Kibwezi East sub-county, Makueni County. The specific objectives were to describe the demographic parameters that influence the use of post-abortion contraception, determine the health-care-related factors that influence the use of post-abortion contraception, and assess the impact of contraceptive perception on use. Purposive sampling was employed to identify the facility, and systematic sampling was utilized to choose the study participants in a descriptive, cross-sectional design. Self-administered semi-structured questionnaires were used to collect data. IBM SPSS® 21.0 was used for quantitative data analysis. The significance of the link between the dependent and independent variables was tested using Chi-square values, and the Spearman's Rho test was employed to see if there was any correlation between the variables. Overall, 100 adolescent girls aged 13-19 years (Mean age 17.17 yrs, sd=1.457) who had received post-abortion care at Kibwezi level 4 hospital participated in the study. Findings showed that contraceptive counselling remains an overlooked element of post-abortion care. Only 41% (n=41) of participants were counselled on contraception during their post-abortion care. Contraceptive counselling is an integral part of post-abortion care and in this study, it was found to have a positive correlation with the utilization of post-abortion contraceptives (rs=0.412, p=0.000). The more adolescent girls were counselled on contraceptives, the more likely they were to use post-abortion contraceptives. The level of education, age of the respondents and religion had a significant influence on the utilization of post-abortion contraception (X2=9.511, p-value=0.038), (X2=4.775, p-value=0.0042), (X2=1.828, p-value=0.001) respectively. The study participants perceived that contraceptives had negative side effects (42%) and believed myths that they led to decreased libido and caused infertility (47%) and these were barriers to their utilization of post-abortion contraception. In addition, 10% listed attitude of health care providers as a barrier and a minority of 1% listed spouses as a barrier.44% of study participants had a positive perception of contraceptives while 56 % had a negative perception but this had no significant influence on their utilization of post-abortion contraception (x2=1.813 CI 95% p=0.404). This study concluded that contraceptive counselling remains an important element of post-abortion care but is often overlooked as only 41% of the study participants received contraceptive counselling services and gave recommendations for more research to be done on the impact of sex education on teenage sexual debut age, contraceptive use, and utilization of youth friendly reproductive health services.