Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 12 num. SPE lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Adolescents in Southern Africa: Interdisciplinary research findings</b>]]> <![CDATA[<b>HIV and adolescents' educational attainment in South Africa: Disentangling the effect of infection in children and household members</b>]]> BACKGROUND. Many empirical studies have assessed the effect of adults' HIV infection on their livelihood. However, the effect of children's HIV status on their educational outcomes during adolescence has not been adequately investigated. OBJECTIVES. The study aims to evaluate the effect of household members' HIV infection and that of children on their educational outcomes (school enrolment and progression) during adolescence. METHODS. Waves 1 to 4 of the South African National Income Dynamics Study panel data collected between 2008 and 2015 were used. Analytical samples contained data for 8 835 adolescents aged 10-19 years. Analysis involved the use of descriptive statistics, logistic and linear regression as well as Oaxaca and Ransom decomposition methods. RESULTS. Of the study sample, 7 176 were currently in school and 636 were not. HIV infection had no effect on adolescent school enrolment. Adolescent HIV infection significantly reduced their school progress index by about 8.41. The explanatory variables explained 18% of the adolescents' school progress gap associated with HIV infection. The unexplained gap might have been attributable to stigmatisation and/or unobserved morbidity associated with adolescents' HIV infection. CONCLUSION. Adolescent HIV infection affects their school progression. Education support should be targeted directly at HIV-infected children instead of targeting families with infected parents only. <![CDATA[<b>Sexual harassment in South African Schools: Is there an association with risky sexual behaviours?</b>]]> BACKGROUND. Several drivers of risky sexual behaviour are known, although research has not yet examined the relationship between experiences of sexual harassment at school and risky sexual behaviours among adolescents. OBJECTIVE. To examine the association between peer- and teacher-perpetrated sexual harassment and risky sexual behaviours among adolescents in South Africa. METHODS. Cross-tabulations and logistic regression models were fitted to data from 219 456 school-going adolescents (aged 10 - 19 years) who participated in the fourth South African National HIV, Behaviour and Health Survey (2011/2012). The outcomes were lack of condom use during last sexual activity and multiple sexual partnerships. RESULTS. Of the respondents who had experienced sexual harassment by peers, 27.27% did not use a condom during their last sexual activity and 41.67% reported having had multiple sexual partnerships. Of the respondents who had experienced sexual harassment by a teacher, 5.56% reported to have had multiple sexual partnerships in the study period. Results show that respondents who had experienced peer-perpetrated sexual harassment were more likely to not have used a condom during their last sexual activity (odds ratio (OR) 1.08; 95% confidence interval (CI) 1.04 - 1.11), as were those who had experienced teacher-perpetrated sexual harassment (OR 1.37; 95% CI 1.32 - 1.43). CONCLUSION. A substantial number of school-going adolescents were found to have experienced sexual harassment and engaged in risky sexual behaviours. Sexual harassment at school should be considered as part of programmes aimed at addressing risky sexual behaviours among adolescents. <![CDATA[<b>Knowledge, risk perception and access to healthcare services for HIV and tuberculosis among university students in Johannesburg, South Africa</b>]]> BACKGROUND. An increasingly diverse body of students is entering university in South Africa. HIV and tuberculosis (TB) are pressing health issues for this vulnerable population and the university campus offers an opportunity to intervene with health promotion activities. OBJECTIVES. This study describes knowledge and risk perception of TB and HIV among high school leavers entering tertiary education. METHODS. A cross-sectional survey among first-year students, aged 18-25 years, registered at one of three universities chosen for the study in Johannesburg, South Africa. Informed consent was obtained prior to completing a self-administered, close-ended, structured questionnaire. Factors associated with poor knowledge or high risk perception were identified using modified Poisson regression. RESULTS. In total, 792 students were included; 53.3% (n=438) were categorised as having poor TB knowledge and 52.1% (n=412) poor HIV knowledge, while 43.4% (n=344) were categorised as having high TB risk perception and 39.8% (n=315) high HIV risk perception. Male students were more likely to have poor knowledge of HIV and perceive themselves at risk of acquiring HIV. Low socioeconomic status was associated with a high risk perception of HIV. One in 3 participants (30.6%) stated that they had never had an HIV test. In total, 24 students (9 male, 15 female) reported that they were HIV-positive, of whom 15 (62.5%) were on antiretroviral therapy. Only 14.1% had been screened for TB in the past 6 months. CONCLUSION. The findings indicate a need to enhance health promotion activities among university students so as to aid preventive strategies for reducing the burden of HIV and TB infection. <![CDATA[<b>Too young to have sex: Conversations with very young adolescents about sex, dating and related decision-making</b>]]> BACKGROUND. Very young adolescents receive little research and pragmatic attention regarding their sexual and reproductive health (SRH) needs. As a result, their experiences are often overlooked. Furthermore, when this age group is included in SRH education, the dominant public health lens tends to focus on health risks associated with sex, with less emphasis on a holistic approach that considers the socio-cultural and relational contexts in which adolescents' decision-making about sex and dating occurs. OBJECTIVES. To explore the beliefs, perceptions and decision-making pathways of adolescents about heterosexual sex, dating and relationships. METHODS. The sample included 33 girls and 30 boys aged 10 - 14 years attending schools in rural Mpumalanga Province, South Africa. Data collection entailed participatory methodologies of group-based activities and individual interviews. Data were recorded and transcribed verbatim. Transcripts were coded and analysed using thematic analysis. RESULTS. The findings focused on three themes: timing of dating, relationships and sex; gendered depictions of first sex; and agency in sexual decision-making. These themes shed light on the relational context in which adolescents' decision-making takes place and highlight the pervasive influence of wider gendered norms. CONCLUSION. Very young adolescents are not sexually naive and instead are faced with complex decisions regarding sex and dating. This age group is not, however, fully supported in developing a healthy, positive sexuality when emphasis is on the negative outcomes of sex. The paper concludes with recommendations for adolescent SRH programmes to provide a supportive environment for younger adolescents to make informed choices and develop positive, healthy sexualities. <![CDATA[<b>'</b><b>They tell you about the risks': Exploring sources of sexuality education among very young adolescents in rural Mpumalanga</b>]]> BACKGROUND. Early adolescence (ages 10 - 14) is a crucial stage of development. The importance of early intervention in improving adolescent sexual and reproductive health (SRH) is increasingly acknowledged. Yet, school-based sexuality education largely focuses on older adolescents, leaving very young adolescents to contend with conflicting information from different sources. This study responds to the need for contextually nuanced research with very young adolescents, which can inform policy and programmes aimed at improving their SRH outcomes. OBJECTIVES. To explore very young adolescents' sources of SRH knowledge and investigate the implications of both formal school-based sexuality education and informal sources of information for their SRH rights. METHODS. This research was conducted with schoolgoing adolescents (aged 10 - 14) from the Gert Sibande district in rural Mpumalanga. Data were collected qualitatively using individual interviews and group-based participatory workshops, all conducted with the same participants. Transcribed data were analysed using thematic analysis. RESULTS. Findings indicate that while formal transfer of SRH information takes place through school-based sexuality education, learners' sexual knowledge is also shaped by informal sources, including household observations and sexual play. We identify three themes that cut across sources of SRH knowledge and position young adolescents in contradictory ways: prohibitive messaging, the notion of childhood innocence and everyday sexual learning. CONCLUSION. Recommendations are made for comprehensive sexuality education that is responsive to this age group's needs, draws on their everyday lived experiences and optimises the opportunities offered by foregrounding agency, while remaining cognisant of structural constraints. <![CDATA[<b>Cultural consensus modelling to understand the reproductive health needs of South African adolescent girls</b>]]> BACKGROUND. Cultural consensus modelling (CCM) is an approach whereby individuals define the boundaries regarding a set of knowledge or behaviours shared by a group within a culture using an ethnographic approach. OBJECTIVES. To provide an overview of CCM methods and the application of CCM to examine South African adolescent girls' contraceptive and HIV prevention practices. METHODS. In phase 1 of a CCM approach, individuals respond to questions about their culture rather than their individual behaviours, allowing individuals to draw upon a shared cultural knowledge. Utilising these identified group beliefs, phase 2 asks individuals to rate the extent to which factors identified in phase 1 are valued. Phase 3 utilises qualitative interviews with key informants from phase 2 to gather in-depth information regarding the identified determinants of the health behaviour. Lastly, phase 4 of this approach conducts a quantitative survey to determine the extent to which cultural consensus model types are associated with differences in actual behaviours. RESULTS. CCM data analytic approaches are described. Frequencies and descriptive statistics for the free listing are conducted. For phase 2, cultural consensus analysis is conducted to examine whether one or several consensus models exist and competence scores are calculated. Standard qualitative analysis approaches are utilised for phase 3. Phase 4 employs regression to examine the association between cultural models and an outcome of interest. CONCLUSION. CCM provides a novel, culturally sensitive understanding of reproductive health practices among South African adolescent girls; CCM also has broad applicability to other adolescent health research domains. <![CDATA[<b>Teenage pregnancy in South Africa: Where are the young men involved?</b>]]> BACKGROUND. The level of unintended pregnancies among teenage girls in South Africa (SA) has remained a public health concern. However, studies and interventions generally do not consider young men's involvement in teenage pregnancies. OBJECTIVE. To investigate the sociodemographic and sexual behaviour characteristics of young men who have impregnated at least one teenage girl. METHODS. The study used data from the Centre for Justice and Crime Prevention (2009), which included responses from young men (aged 12 - 22 years) across all SA provinces. Univariate and bivariate analyses and binary logistic regression were performed. RESULTS. The results showed that 93.2% of the sample had >2 lifetime sexual partners, 22.4% rarely used condoms and 11.5% had never used condoms. Teenage pregnancy incidence was >35% in all provinces except Gauteng and the Western Cape. The likelihood of being involved in a teenage pregnancy was higher among respondents who reported having >2 lifetime sexual partners (odds ratio (OR) 2.510; 95% confidence interval (CI) 0.43 - 14.77). Respondents with a higher education were less likely to be involved in a teenage pregnancy (OR 0.819; 95% CI 0.36 - 1.84) than those with a lower education (OR 1.219; 95% CI 0.59 - 2.50). CONCLUSION. Engaging in multiple sexual partnerships could increase the vulnerability of young people to sexually transmitted infections or teenage pregnancies. Initiatives to create awareness among SA youth regarding the consequences of sexual behaviour are recommended, with a specific focus on addressing young men's involvement in teenage pregnancy. <![CDATA[<b>Pathways to school completion for young mothers: Are we winning the fight?</b>]]> BACKGROUND. Policy initiatives in South Africa are directed at promoting the educational and developmental outcomes of girls and young women (age 15 - 24 years). These include decreasing the incidence of HIV infection, teenage pregnancy and gender-based violence, and increasing school attendance and economic empowerment. This article explores the contexts of pregnancy, motherhood and schooling in a sample of young mothers in an urban area in Johannesburg, South Africa. METHODS. This ethnographic study, based in a poor urban area in Johannesburg, South Africa, recruited 30 young mothers aged 18 - 20 years with whom open-ended interviews were conducted. Each mother was contacted 3 months after the first interview, and again 3 months later. In addition to the first round of 30 interviews, 9 young mothers were interviewed in the second round, and 6 young mothers in a third round. A total of 45 interviews were conducted. RESULTS. The findings illustrate how young mothers mediate constraints and challenges to continue and complete their schooling when confronted with a mistimed and unintended pregnancy. A combination of factors converge to facilitate or impede school continuation and completion. Key barriers include school policy and discrimination against pregnant learners, limited options for childcare, and high levels of poverty and unemployment that strain existing scarce family resources. CONCLUSIONS. The pathway to school completion is complex and non-linear. Three particular interventions that support school attendance and completion for young mothers have value: the child support grant, the availability of crèches in the community, and a school policy that upholds the principle of inclusivity for pregnant learners and young mothers. <![CDATA[<b>The influence of adolescent age at first union on physical intimate partner violence and fertility in Uganda: A path analysis</b>]]> BACKGROUND. Uganda has a high fertility rate, high levels of intimate partner violence (IPV) and also very young ages at first union. Experiencing IPV has previously been shown to increase fertility rates. Entering marriage at a later age has been shown to decrease fertility rates in some countries. Given that a large proportion of Ugandan women are married by the end of adolescence, marital age may be a key proximate determinant of fertility in Uganda. OBJECTIVE. To examine the effect of age at first union on fertility, via the intermediate effect of physical IPV, among Ugandan women of reproductive age. METHODS. Data from the 2011 Ugandan Demographic and Health Survey were used to create an integrated path model to investigate the effects of age at first union on fertility. Known factors that influence fertility were included in the model. The interaction with age at first union in increasing fertility differentials, via the intermediate effect of physical IPV, was assessed. RESULTS. Results show that women who are preadolescent or adolescent at first union have a higher likelihood of experiencing IPV, indicated by both direct and indirect pathways that work via known intermediate and proximate factors. Furthermore, age at first union increases fertility, expressed as the number of children born to a woman, via a direct interaction. CONCLUSION. Most Ugandan women enter their first union during adolescence (<19 years), which exposes them to a higher risk of IPV and a longer period of childbearing, thereby increasing fertility rates. <![CDATA[<b>Speaking through pictures: Canvassing adolescent risk behaviours in a semi-rural community in KwaZulu-Natal Province, South Africa</b>]]> BACKGROUND. Adolescent risk behaviours, such as substance abuse and unprotected sex, are leading social and health challenges in South Africa (SA). OBJECTIVE. To investigate adolescents' perspectives on the prevalence of adolescent risk behaviours in rural settings in SA. METHOD. Using a qualitative photovoice methodology, the current study explored adolescents' perspectives and experiences of living in a peri-urban community in KwaZulu-Natal Province. KwaZulu-Natal is the epicentre of the South African HIV epidemic, and adolescents - especially young girls - are at heightened risk for HIV infection. Male and female participants aged 15 - 18 years (N=33) were asked to respond to a series of questions by taking photographs that best describe their perspectives or experiences. RESULTS. The photovoice methodology allowed adolescents to represent their perspectives and experiences as experts on their lives and needs. The participants reported that adolescents in their community engage in various risky behaviours, of which risky sexual behaviours and hazardous substance use emerged as significantly problematic. Risky sexual behaviours entailed unprotected sex, having multiple sexual partners, cellphone sharing of pornography, and sex while intoxicated. Problematic substance use involved harmful drinking behaviours such as binge drinking and illicit drug use. CONCLUSION. Contextually relevant interventions aimed at reducing adolescent engagement in risky sexual behaviours and harmful substance use need to be prioritised. Additional recommendations are discussed. <![CDATA[<b>Cervical cancer screening among adolescent girls in Lesotho: Levels and determinants</b>]]> BACKGROUND. International guidelines have discouraged screening of young women under the age of 21 for cervical cancer. However, a high screening rate is still evident among adolescent girls in Lesotho. OBJECTIVE. To explore the levels and determinants of cancer screening among adolescent girls in Lesotho. METHODS. This cross-sectional study used secondary data from the 2014 Lesotho Demographic and Health Survey collected from 1 542 adolescent girls aged 15 - 19 years. Descriptive statistics, the chi-square test and a binary logistic regression model were used to analyse the data. RESULTS. Despite recommendations that adolescents should not screen for cervical cancer, results show that 15% of adolescent girls in Lesotho attend screening services. Adolescent girls from rural areas are less likely to screen than those from urban areas (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.07 - 0.68; p=0.009). Marital status and level of education were significantly associated with cervical cancer screening among respondents; however, age at first sex was not statistically associated with screening among adolescent girls. CONCLUSION. With reference to international guidelines, the screening rate for cervical cancer is high among adolescents in Lesotho. Future studies should focus on why adolescents in Lesotho still screen for cervical cancer despite international recommendations discouraging screening before the age of 21. <![CDATA[<b>Disease prevalence and grade repetition among adolescents in South Africa: Is there any relationship?</b>]]> BACKGROUND. A universal goal of public health is to ensure that adolescents have a healthy transition to adulthood. In developing countries, a host of social, economic and political factors inhibit this from happening. The results of these challenges include an increasing disease prevalence among an age group (10 - 19-year-olds) that should be healthy.OBJECTIVES. The purpose of this study is to identify the most prevalent diseases and assess the relationship between disease and grade repetition among adolescents in South Africa (SA), and to assess the impact of disease on grade repetition.METHODS. Data from the SA General Household Surveys (2009 - 2016) were analysed, and both adolescent (10 - 19 years) sexes from all geographical and racial groups were included. Frequencies, percentages and rates of infectious, non-communicable diseases (NCDs) and mental health outcomes were estimated. The relationship between disease and grade repetition was determined using logistic regression.RESULTS. Infectious diseases, NCDs and mental illnesses are increasing in adolescents over time. In urban areas, rates of NCDs are higher than those of infectious diseases, while in rural areas a high burden of infectious disease persists. Among adolescents who repeated a grade, 7.07% had an infectious disease. In addition, infectious disease (odds ratio (OR) 1.17, p<0.05), younger adolescents, 15 - 19-year-olds (OR 1.52, p<0.05) and urban residence (OR 1.12, p<0.05) are associated with increased likelihood of grade repetition.CONCLUSION. Policies and programmes in SA which address the health of adolescents need to be more aware of the disease prevalence among school pupils in the country. Prolonged disease occurrences are contributing to the slow school progression and eventual matriculation of pupils. <![CDATA[<b>Rural-urban differences in the prevalence and predictors of depression among adolescents in South Africa</b>]]> BACKGROUND. Mental health is part of overall health, but there is dearth of research on the rural-urban differences of depression among adolescents in South Africa (SA).OBJECTIVES. To present an analysis of rural-urban differences in the prevalence of depression and to assess the sociodemographic predictors of depression among adolescents in SA.METHODS. Data were obtained from the National Income Dynamics Study (NIDS), wave 4 of 2014, which was conducted on a nationally representative sample of 3 751 respondents (15 - 19 years). Univariate analysis was used to describe the study population while bivariate analysis was used to test for significant differences in the depression status of the population. Finally, binary logistic regression was used to estimate the predictors of depression.RESULTS. Urban adolescents (14.64%) were more depressed than their rural counterparts (9.40%). Gender, income levels and province of residence also showed significant differences in both rural and urban areas. The significant predictors of depression in both rural and urban areas were race, age, income and province of residence.CONCLUSION. Counselling and rehabilitation programmes should be targeted more at urban, more educated and higher-earning adolescents, especially in provinces with a relatively higher prevalence of depression. <![CDATA[<b>'We were our parents' ears and mouths': Reflecting on the language brokering experiences of hearing children born to deaf parents</b>]]> BACKGROUND. Hearing children born to deaf parents, or children of deaf adults (CODAs), are often bicultural and bilingual members of the deaf and hearing communities. They are often expected to fulfil very adult roles, especially as the communication link between their deaf parents and the hearing society. Assuming adult roles may place CODAs in difficult situations, potentially affecting their wellbeing and development. In SA, little is known about CODAs and the dynamics of growing up hearing in deaf-parented homes.OBJECTIVE. To reflect on the childhood experiences of language brokering in deaf-parented families.METHODS. Two male and eight female participants (21 - 40 years), identified through purposive and snowball sampling, participated in this study. A phenomenological, qualitative approach was employed using semi-structured, open-ended interviews. Thematic analysis revealed inductive themes.RESULTS. The findings indicate that the interviewed CODAs acted as language brokers and interpreters between their families and the hearing community from a very young age. As children, they were placed in demanding situations, for which they were not developmental^ ready. CODAs found balancing the demands from both communities emotionally draining, especially at a young age.CONCLUSION. A multidisciplinary approach is suggested to address the mental health, wellbeing and development of young CODAs. <![CDATA[<b>Substance use among adolescents in sub-Saharan Africa: A systematic review and meta-analysis</b>]]> BACKGROUND. In sub-Saharan Africa, substance use among adolescents has continued to be a major public health concern, albeit poorly documented across many settings.OBJECTIVE. To estimate the prevalence of substance use among adolescents in sub-Saharan Africa.METHODS. We searched Pubmed, EMBASE, AJOL and Google Scholar for population-based studies on adolescents (age 10 - 19 years) and reporting on the prevalence of substance use across sub-Saharan Africa. Search dates were from January 2000 to December 2016. A random effects meta-analysis was conducted with pooled prevalence rates (and 95% confidence interval (95% CI)) of estimated substance abuse among adolescents in sub-Saharan Africa.RESULTS. Twenty-seven studies across sub-Saharan Africa including 143 201 adolescents (mean age 15.6 years) were selected. The overall prevalence of 'any substance use' in sub-Saharan Africa was 41.6%, with the highest rate in Central Africa at 55.5%. The use of caffeine-containing products (including coffee or kola nut) was most predominant at 41.2% (95% CI 24.3 - 58.1) but limited to West Africa. These were followed by alcohol at 32.8% (95% CI 26.0 - 39.5), tobacco products 23.5% (95% CI 17.7 - 29.3), khat 22.0% (95% CI 12.5 - 31.5) and cannabis 15.9% (95% CI 12.2 - 19.1). Other abused substances included depressants at 11.3% (95% CI 6.5 - 16.1), amphetamines 9.4% (95% CI 6.0 - 12.9), heroin 4.0% (95% CI 3.5 - 4.5) and cocaine 3.9% (95% CI 1.4 - 6.5).CONCLUSION. Our study reflects a high use of psychoactive substances and drugs among adolescents in sub-Saharan Africa. It is important that interventions and rehabilitation programmes are comprehensive and targeted at adolescents and parents in these settings.