Contribution of school meals to folate and associated nutrients intake among in-school adolescent girls in Sidama Region, Southern Ethiopia

This study examined the intersecting impact of structural inequalities and transactional sex on in-school adolescent girls’ risk of pregnancy and poor educational outcomes in rural northern KwaZulu-Natal. In this article, we understand structural inequalities as providing a basis for transactional relationships between adolescent girls and older men. Participatory visual research methods were employed with 18- and 19-year-old girls and boys to examine multiple systems of oppression and inequalities experienced by in-school rural adolescent girls, focusing particularly on their vulnerability to transactional sex, pregnancy and poor educational outcomes. In this context, moralising discourses on transactional sexual relationships are unhelpful if structural barriers placing girls at risk are not addressed.

Home Food Availability, Food Insecurity and Nutrition Knowledge Are Key Factors Influencing Dietary Diversity Among Adolescent Girls in Southern Ethiopia

BackgroundAdolescent girls should practice good menstrual hygiene to enhance their health and educational attainment. However, socio-cultural restrictions and limited water, sanitation, and hygiene in school environments continued to make it difficult for in school adolescent females to practice good menstrual hygiene management. So, the main aim of this study was to assess menstrual hygiene management practice and its associated factors among in-school adolescent girls in the secondary schools of Gimbi town, western Ethiopia.MethodsA school-based cross-sectional study was conducted among 378 adolescent girls in Gimbi town secondary schools. The study participants were selected by using stratified random sampling techniques. Pretested self-administered Afan Oromo questionnaire with sociodemographic characteristics, information and knowledge about menstruation, and practice of menstrual hygiene management, as well as observational checklist to assess school environment were used to collect the data. Data were cleaned, coded, and entered into Epi-info version 7.2.0.4 and exported to SPSS version 25 for statistical analysis. Multivariable logistic regression analysis was used to identify factors associated with the practice of menstrual hygiene management and P-values less than 0.05 was used to declare statistical significance.ResultsOut of 378 respondents, 163 (43.1%) (38–48) of adolescent girls had good menstrual hygiene management practice. Being urban resident (AOR = 3.48, (95% C.I:1.99–6.08), having mother with secondary level of education (AOR = 2.71, 95%CI: 1.15,6.42), having mother with educational level of college and above (AOR = 3.30, 95%CI1.28,8.50), having discussion about menstruation with parents (AOR = 2.42,95%CI:1.45,4.04), and having knowledge about menstruation (AOR = 2.94, 95% CI: 1.69–5.13) were factors associated with good menstrual hygiene management practice.ConclusionIn this study, good menstrual hygiene management practice is low among in school adolescent girls. Place of residence, maternal educational level, discussion about menstrual issue with parent, and having knowledge about menstruation were factors associated with good menstrual management practice. Stakeholders should give appropriate awareness and health education related to menstrual hygiene for adolescent girls at all levels.


 
 
 INTRODUCTION: Adolescence in girls has been recognized as a special period that signifies the transition from girlhood to womanhood. This study was conducted to assess the determinants of menstrual hygiene practices among in-school adolescent girls in private and public secondary schools in Osun State, Nigeria.
 METHODS: A descriptive, cross-sectional study (comparative) involving 650 in-school secondary students (public and private), were selected via multistage stratified sampling technique, using a self-administered structured questionnaire. Relevant data was collected via a semi-structured questionnaire and analyzed using SPSS 23.0. Appropriate univariate analysis using frequency tables and charts, while bivariate analysis was done using a chi-square table. Multivariate analysis was done using logistics regression.
 RESULTS: The modal age range was middle adolescence (14-16 years old). There was a statistically significant difference between public and private school respondents in terms of age menarche: More students in private schools (81.8%) had their menarche before the age of 13 compared to those in public schools (73.2%). More respondents in private secondary schools (67.1%) have good menstrual hygiene practices compared to their counterparts (55.4%). Almost all the respondents in public secondary schools and private secondary schools have good management on menstruation Multivariate analysis, more of the respondents in junior classes among public school respondents were approximately two times less likely (1/0.506 = 1.97) to have good hygiene practice compared to their counterparts.
 CONCLUSION: Based on the findings in this study, it could be concluded that more of the respondents in private secondary schools had good hygiene practices compared to their counterparts. Hence, the need for all stakeholders to intensify efforts to provide accurate and adequate information as well as enable the environment to promote menstrual hygiene practices among in-school adolescent girls.
 
 

BackgroundAdolescence is a pivotal stage in human development that presents unique challenges, especially for girls navigating the complexities of menstruation. Despite the importance of menstrual hygiene management for adolescent girls’ well-being, this vital aspect of personal health is often overlooked, particularly in regions where cultural stigma prevails. This study examines knowledge, attitude, and practice of menstrual hygiene management among in-school adolescent girls in Abuja, Nigeria.MethodsThe study employed a cross-sectional mixed-method design, integrating quantitative surveys with focus group discussions. A survey was conducted among 420 adolescent girls across four government junior secondary schools through a multistage sampling technique. Also, Focus Group Discussions were conducted among 80 respondents in groups of 10 discussants. The quantitative data set was subjected to descriptive and inferential statistical analysis, while the qualitative data were analysed using content analysis.ResultsFindings revealed that the majority (53.45%) of the respondents had good knowledge of menstruation and menstrual hygiene management. Junior Secondary School (JSS) 3 students [OR = 2,09; 95% CI = 1.24–3.52] and those who started menstruation at age 15 years and above [OR = 7.52; 95% CI = 1.43–39.49] were associated with increased odds of having good knowledge of menstrual hygiene management. The attitude of most respondents (70.08%) towards menstrual hygiene management was good. Those in the JSS 3 class [OR = 6.47; 95% CI = 3.34–12.54], respondents who are Muslim [OR = 2.29; 95% CI = 1.63–5.48], and those whose parents had tertiary education [OR = 3.58; 95% CI = 1.25–10.25] were more likely to demonstrate more positive attitudes compared to their counterparts whose parents do not have tertiary education. In relation to practice, about 3 in 5 (57.80%) reportedly practise good menstrual hygiene management. Respondents who practice traditional religion [OR = 0.33; 95% CI = 0.02–4.56] were less likely to practise good menstrual hygiene management, while respondents who are the third child of their parents [OR = 2.09; 95% CI = 1.04–4.23] were more likely to practise menstrual hygiene compared to respondents with other birth orders. Qualitative results showed that participants had good knowledge of menstruation and menstrual hygiene management, and mothers were the main source of menstruation-related information. Participants had mixed feelings and reactions during their first menstruation, with 3 in 5 participants reporting experiencing menstruation-related stigma restrictions when menstruating.ConclusionsIn-school adolescent girls in Abuja, Nigeria, have good menstruation-related knowledge and positive attitudes, as well as practise menstrual hygiene management. Students’ class and age at first menstruation were major factors associated with good knowledge of menstruation and menstrual hygiene management; respondents’ class, religion and parents’ educational qualification were associated with a positive attitude, while respondents’ religion and parity line were associated with menstrual hygiene practice. Future interventions should focus on conducting school and community-level awareness programs to increase knowledge and dispel myths and misconceptions about menstruation and menstrual hygiene management.

Adolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy. A self-administered questionnaire was distributed to 426 adolescent girls attending public and private school systems in Lagos, Nigeria. Multiple linear regression was used to evaluate the influence of psychosocial and demographic factors on safe sex self-efficacy. Further, stratified analysis was conducted to compare the estimates between participants attending public schools (n = 272) and those attending private schools (n = 154). Results from the study show that future orientation (β = 0.17; p < 0.05), participants age (β = 0.14; p < 0.05), and HIV knowledge accuracy (β = 0.17; p < 0.05) were associated with safe sex self-efficacy. Future orientation remained statistically significant in the sub-group analysis among participants attending public (β = 0.13; p < 0.05) and private schools (β = 0.24; p < 0.05). Among participants attending public schools, HIV accuracy (β = 0.2; p < 0.05) remained a significant correlate of safe sex self-efficacy while this association dissipated among private school attendees. These findings point to the importance of including future orientation strategies in interventions developed for in-school adolescent girls in Nigeria. School-based interventions that increase positive future orientation outcomes may be beneficial to improve safe sex intentions among adolescent girls in Nigeria.

All young people have the right to access comprehensive sexual and reproductive health information. However, most adolescent girls in developing countries face sexuality without adequate information. This is due to the unwritten but active traditional norm against the discussion of sex and sexuality issues with young people. This article reports a descriptive study that investigated the adolescent girls’ degree of access to reproductive health information and the barriers to accessing reproductive health information. Multistage sampling technique was used to select 18 schools, three from each of the six Local Education Districts (LEDs) in Lagos State. The study sample consisted of 1800 girls in the selected schools. Data were collected with a questionnaire. Descriptive and inferential statistics were used for data analysis. The result of the study revealed that in-school adolescent girls had limited access to reproductive health information. The findings also showed that lack of time to seek relevant information and unwillingness of parents to discuss reproductive health issues with the adolescents were major obstacles to reproductive health information access. The test of significance of relationship between access to reproductive health information and attitude towards reproductive health issues indicated significant positive relationship between access to reproductive health information and attitude towards reproductive health issues. The study concluded that access to reproductive health information exerts great influence on attitude towards reproductive health issues. The article recommends the adoption of multimedia approach for the dissemination of reproductive health information in public schools in Lagos State.

BackgroundAdolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy.MethodsA self-administered questionnaire was distributed to 426 adolescent girls attending public and private school systems in Lagos, Nigeria. Multiple linear regression was used to evaluate the influence of psychosocial and demographic factors on safe sex self-efficacy. Further, stratified analysis was conducted to compare the estimates between participants attending public schools (n = 272) and those attending private schools (n = 154).FindingsResults from the study show that future orientation (β = 0.17; p < 0.05), participants age (β = 0.14; p < 0.05), and HIV knowledge accuracy (β = 0.17; p < 0.05) were associated with safe sex self-efficacy. Future orientation remained statistically significant in the sub-group analysis among participants attending public (β = 0.13; p < 0.05) and private schools (β = 0.24; p < 0.05). Among participants attending public schools, HIV accuracy (β = 0.2; p < 0.05) remained a significant correlate of safe sex self-efficacy while this association dissipated among private school attendees.ConclusionsThese findings point to the importance of including future orientation strategies in interventions developed for in-school adolescent girls in Nigeria. School-based interventions that increase positive future orientation outcomes may be beneficial to improve safe sex intentions among adolescent girls in Nigeria.

Objective: This study investigated access to and use of reproductive health information among in-school adolescent girls in Lagos State, Nigeria. Design: Descriptive survey research design was adopted for the study. Setting: The study sample consisted of 1,800 girls randomly selected from18 public senior secondary schools in Lagos State. Method: Data were collected with a questionnaire. Descriptive and inferential statistics were used for data analysis. Result: Parents were the most accessible source of reproductive health information while the Internet was the least accessible. More than 50 per cent of the respondents were not using reproductive health-related information regularly. There is no statistically-significant difference in access to and use of reproductive health information among girls in single sex and co-educational schools in Lagos State, Nigeria. Conclusion: The National Comprehensive Sexuality Education Curriculum should be implemented in all the secondary schools in Lagos State and elsewhere in Nigeria. Access to and use of reproductive health information should be promoted through regular workshops, seminars, symposia, lectures and talks for parents, teachers, and students.

BackgroundAdolescence is a time of tremendous physical growth and mental development, with high nutrient requirements. Ethiopia is among the countries with a high prevalence of nutritional deficiencies among the women of reproductive age group, whilst adolescent girls from rural areas suffered disproportionately. However, there is a dearth of evidence regarding the barriers that hinder adolescent girls to utilize the available nutritional services.PurposeThe current study aimed to qualitatively explore the range of barriers for the uptake of nutritional interventions among adolescent girls in rural communities of Tigray, Northern Ethiopia.Methods and ParticipantsWe employed an explorative qualitative study among purposively selected adolescent girls and school teachers from rural districts of Tigray region. We conducted 11 focused group discussions with adolescent girls, 17 in-depth interviews (seven with teachers, seven with in-school adolescent girls, and three with out-of-school adolescent girls) using a semi-structured guide. Data was audio-taped, transcribed verbatim in local language, translated into English, and imported into ATLAS.ti version 7.5 qualitative data analysis software for analysis.ResultsAdolescents perceived that stunting, anemia, and thinness are among the main nutritional problems in their community. Food insecurity, limited nutrition awareness in the community, limited access to a water source, high workload, service provider’s little attention for adolescents’ nutrition, and food taboo have emerged as barriers for the uptake of adolescent girls’ nutritional interventions. Though limited in reach, available nutritional interventions include awareness creation, nutritional supplementation, and disease prevention.ConclusionFood insecurity poses a strong challenge to adolescent girls’ nutrition. As access to safe drinking water continues to be a considerable bottleneck for nutritional interventions, a multi-sectoral response to integrate water, sanitation, and hygiene (WASH) services is required. Bounded by food taboo, high burden of workload among the adolescent girls, women empowerment and nutritional status seem to be the unfinished agenda in resource limited settings such as the rural areas of Tigray region.

The purposes of the study was to determine the effectiveness of peer-led and parent-led education on menstrual hygiene-related knowledge of in-school adolescent girls in Ogun state, Nigeria, which was conceptualized using the Health Belief Model. The study employed a quasi-experimental design with 120 in-school adolescent girls selected through a multistage sampling technique from four (4) secondary schools within Ogun East. A validated instrument was used for data collection. The findings showed that the adolescent girls' level of menstrual hygiene knowledge had a significant increase after the intervention. The peer-led group better predicted higher knowledge scores (mean diff = 7.13; effect size = 4.34; t = 19.091; p = 0.000). In conclusion, the peer-led education intervention was more effective in improving the level of adolescent girls' menstrual hygiene knowledge in Ogun State. It is recommended that peer educators be recruited for future interventions to change the reproductive health behaviors of adolescent girls nationally.

BackgroundCervical cancer is a major public health problem in Malawi. The age-standardized incidence and mortality rates are estimated to be 75.9 and 49.8 per 100,000 population, respectively. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to reduce the morbidity and mortality associated with cervical cancer. In 2013, the country introduced a school-class-based HPV vaccination pilot project in two districts. The aim of this study was to evaluate HPV vaccine coverage, lessons learnt and challenges identified during the first three years of implementation.MethodsThis was an evaluation of the HPV vaccination project targeting adolescent girls aged 9–13 years conducted in Malawi from 2013 to 2016. We analysed programme data, supportive supervision reports and minutes of National HPV Task Force meetings to determine HPV vaccine coverage, reasons for partial or no vaccination and challenges. Administrative coverage was validated using a community-based coverage survey.ResultsA total of 26,766 in-school adolescent girls were fully vaccinated in the two pilot districts during the first three years of the programme. Of these; 2051 (7.7%) were under the age of 9 years, 884 (3.3%) were over the age of 13 years, and 23,831 (89.0%) were aged 9–13 years (the recommended age group). Of the 765 out-of-school adolescent girls aged 9–13 who were identified during the period, only 403 (52.7%) were fully vaccinated. In Zomba district, the coverage rates of fully vaccinated were 84.7%, 87.6% and 83.3% in year 1, year 2 and year 3 of the project, respectively. The overall coverage for the first three years was 82.7%, and the dropout rate was 7.7%. In Rumphi district, the rates of fully vaccinated coverage were 90.2% and 96.2% in year 1 and year 2, respectively, while the overall coverage was 91.3%, and the dropout rate was 4.9%. Administrative (facility-based) coverage for the first year was validated using a community-based cluster coverage survey. The majority of the coverage results were statistically similar, except for in Rumphi district, where community-based 3-dose coverage was higher than the corresponding administrative-coverage (94.2% vs 90.2%, p < 0.05), and overall (in both districts), facility-based 1-dose coverage was higher than the corresponding community-based (94.6% vs 92.6%, p < 0.05). Transferring out of the district, dropping out of school and refusal were some of the reasons for partial or no uptake of the vaccine.ConclusionIn Malawi, the implementation of a school-class-based HPV vaccination strategy was feasible and produced high (>80%) coverage. However, this strategy may be associated with the vaccination of under- and over-aged adolescent girls who are outside of the vaccine manufacturer’s stipulated age group (9–13 years). The health facility-based coverage for out-of-school adolescent girls produced low coverage, with only half of the target population being fully vaccinated. These findings highlight the need to assess the immunogenicity associated with the administration of a two-dose schedule to adolescent girls younger or older than 9–13 years and effectiveness of health facility-based strategy before rolling out the programme.

BackgroundTo successfully develop and implement school-based sexual health interventions for adolescent girls, such as screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, it is important to understand parents’ and teachers’ attitudes towards sexual health education and acceptability of sexually transmitted infection (STI) screening interventions.MethodsIn this qualitative study, we approached parents and teachers from three high schools to participate in in-depth interviews (IDIs) and focus-group discussions (FGDs). Parents and teachers were asked about their general knowledge of STIs and sexual health education. In addition, they were asked whether they would support utilizing outreach to schools to facilitate provision of sexual health education and screening for STIs in adolescent girls. Data were audio-recorded, transcribed, and translated into English. An initial coding matrix was developed and refined throughout the coding process. Transcripts were coded by two researchers and analyzed using the content analysis approach.ResultsWe conducted 10 IDIs (5 parents and 5 teachers) and 4 FGDs (2 with parents, 2 with teachers, total of 26 participants). Most parents reported few or no discussions regarding STIs with their adolescent girls. Parents were more comfortable discussing consequences of sexual activity including loss of virginity and the potential for pregnancy. Parents tended to place responsibility for sexual health education with teachers. The teachers, in turn, provided basic sexual and reproductive health education including puberty, abstinence, and overview of STIs. Both parents and teachers found the idea of screening for STIs in adolescent girls to be acceptable, and were comfortable with research staff contacting girls through informational meetings at schools. Parents felt that adolescents’ STI screening results should be shared with their parents.ConclusionIn this African setting, parents and teachers provide limited sexual health education, with a focus on negative consequences including loss of virginity, pregnancy, and risk for STIs. Nonetheless, both parents and teachers were supportive of STI screening for adolescent girls, beginning with school-based informational meetings for the girls. Research and programs that aim to provide STI screening in this setting must offer treatment and address the issue of whether results will be disclosed to parents.

In low and middle-income countries, menstruation is impeded by several misconceptions, taboos and shrouded in secrecy. This serves as a major challenge to proper Education regarding menstrual hygiene and has blocked the access of adolescent girls to the right kind of information, thereby influencing a negative outcome associated with harmful behaviours. The objective of the study was to investigate the assessment of an educational intervention on the perception of adolescent girls towards menstrual hygiene in Ogun state, Nigeria. The study utilized a quasi-experimental design. One hundred and twenty (120) in-school adolescent girls were selected through a multistage sampling technique from four (4) secondary schools within four (4) local government areas in Ogun State, Nigeria. A validated 23-items questionnaire measured on a 69-point rating scale with a Cronbach Alpha scores 0.79 was used for data collection. The mean ±SD age and age at menarche of adolescent girls was 14.92±1.82; 12.73±1.38. The majority of respondents had low scores of perceptions. The educational intervention had an effective change in the level of perception of adolescent schoolgirls between baseline and the 6th-week follow-up, indicating a mean difference of 26.70 (p&lt;0.01) for the peer-led, 26.54(p&lt;0.01) parent-led, 20.16(p&lt;0.01) parent and peer-led and a decrease in mean in the control group (-0.17; p=0.866). The peer-led educational approach had a better impact on adolescent girls’ perception compared to other educational approaches. Hence, this is an indication that peer-education strategies should be utilized for further interventions and in reaching out to adolescents.

Background and Objectives: Menstruation is a natural occurrence marked by the periodic release of endometrial cells within the uterine lining from the female genital area. Menstruation knowledge remains highly essential for young adolescents. Inadequate awareness and understanding of menstruation have far-reaching consequences on the overall wellbeing and health outcomes of young adults worldwide. Adolescent girls make up a large percentage of high school students in Nigeria. Girls in countries with low to middle incomes are frequently misled or uneducated regarding menstruation. Menstrual health literacy (MHL) is the level of knowledge concerning matters related to menstrual health. It is observed that a lack of menstrual health literacy is seen among young adults. This systematic review aimed to examine menstruation literacy, attitudes, and adolescent girls’ practices in Nigeria. Materials and Methods: This systematic review included quantitative, cross-sectional, quasi-experimental, and qualitative primary research studies relating to menstruation literacy, attitudes, and practices of adolescents in Nigeria. Articles for this study were searched for on databases such as PubMed and BioMed Central using keywords. These studies were subjected to stringent inclusion and exclusion criteria where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used, and 13 articles were included after critical appraisal. Data extracted were analysed using narrative synthesis. Results: Findings indicated that knowledge regarding menstruation among adolescents (82.6%) was poor. Menstruation information was obtained from mothers, which was positive as some adolescents reported their closeness to their mothers. Regarding attitudes towards menstruation among adolescents, it was reported that more respondents (70.3%) had negative attitudes towards menstruation. Conclusions: Most of the respondents in Nigeria were not adequately prepared for the onset of their first menstrual period. Knowledge and attitude levels were low regarding periods for adolescents. The only exception was their positive attitude towards using water and soap to wash their hands during menstruation. The review shows a significant gap between adolescents’ menstruation knowledge and actual hygienic methods during menstruation. It is therefore required for educational awareness programmes and campaigns to be put in place to educate adolescents about menstruation.