Social Determinants Research Articles

Case report: Holistic approach to pregnant adolescents

Introduction: Teenage pregnancy is a global health problem with significant impacts on physical, mental, social, and economic health. In Indonesia, the prevalence of teenage pregnancy reaches 10%, with East Java recording a higher rate (12%). Factors such as lack of sexual education, limited access to contraceptives, social stigma, and low family support exacerbate this condition. Case Report: A 14-year-old adolescent girl in Surabaya experienced an unplanned pregnancy and faced limited family support and economic problems. During pregnancy, she experienced eating disorders, anxiety, and limited access to health services. A holistic approach was taken by a midwife, nutritionist, and psychologist, including family counseling, nutrition education, and planning for delivery by caesarean section to prevent complications. Discussion: Teenage pregnancy involves biological, psychosocial, and economic factors. Family and health professional support is essential to reduce the risk of complications such as anemia, preterm labor, and mental health disorders. 5 A holistic approach includes nutrition education, psychological counseling, and family and community support to improve the quality of life of mothers and babies. Continuity of Care (COC) ensures continuity of care from pregnancy, labor, to postpartum. Conclusion: A holistic approach and COC are effective in addressing the challenges of teenage pregnancy with a focus on the following aspects keywords.

The impacts of COVID-19 on mother health and pregnancy, Mini-review

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the world causing a global pandemic. During a pandemic, it becomes increasing important to evaluate the effects on specific populations at risk. In this narrative review, we analyzed the literature regarding COVID-19 infection on the pregnant population as they are at increased risk of infection. COVID-19 did seem to significantly increase the risk of obstetric complications, specifically in underserved and marginalized populations. In general, COVID-19 rarely directly infected the fetus and placenta, apart from a very rare complication called COVID placentitis. In actuality, the mothers were at greatest direct risk due to COVID-19 infection. The most important takeaway from this pandemic is the prospective lesson and effect it had on social determinants of health. Women did not have safe access to antenatal care, leading to a plethora of indirect obstetric complications due to COVID-19. In conclusion, it was women who suffered from the pandemic, not the placenta nor the fetus. It is our duty as physicians to protect pregnant women, allowing the placenta to protect the fetus.

Rethinking pharmacovigilance: Building inclusive drug safety systems for marginalized populations

Pharmacovigilance is critical in facilitating efforts targeted at closing the health gap by monitoring, assessing and preventing the occurrence of adverse drug reactions (ADRs) across diverse populations. This review aims to evaluate how pharmacovigilance systems can help mitigate healthcare inequalities specifically in low and middle-income countries (LMICs). The role of pharmacovigilance as part of the modern drug safety system integrated within a healthcare system became indispensable during the COVID-19 pandemic when drug decision-making required strong supervision systems in terms of vaccine safety. However challenges exist, such as lack of resources, training and inadequate infrastructure that is particularly apparent in LMICs. The manuscript considers the social determinants of health; structural inequities and other system factors that account for the differences in the health status and medication safety among different marginalized groups. The use of modern technology such as electronic health records coupled with data mining strategies is an effective way of enhancing pharmacovigilance. Community engagement, educating healthcare providers, and collaborating internationally appear to be strong strategies for enhancing pharmacovigilance systems. Case studies from Bolivia and Nigeria illustrate such a strategy effectively. The review concludes that healthcare professionals and drug monitoring systems must be strengthened, and improved and recommends a unified approach involving healthcare workers, policymakers, and communities to build robust, equitable drug safety monitoring systems.

A Narrative Persuasion Approach to Promoting COVID-19- Related Policy Support.

Communication scholars warn against focusing on individual behaviors when discussing health issues, arguing that doing so can reduce affect and policy support. Although COVID-19 outcomes are linked to structural barriers to treatment, policy interventions appear to improve outcomes for vulnerable groups. Thus, strategic messages must promote public understanding of social determinants and policy support related to COVID-19. Using concepts from attribution theory and narrative persuasion, we employed an experiment (N = 435) testing the effects of personal responsibility (high, moderate, and low) on affective engagement and COVID-19 policy support. Namely, the manuscript examines (a) affective responses to characters displaying varying levels of personal responsibility for COVID-19 prevention, (b) the impact of these affective responses on policy support, and (c) the moderating role of audience political ideology on these effects. Analyses revealed that a highly responsible protagonist elicited empathy and perceived similarity, increasing policy support. While participants' political ideology moderated protagonist responsibility on perceived similarity, a more responsible protagonist evoked empathy independently of political leaning. Theoretical and practical implications are offered.

The Association of Race, Rurality, and Neighborhood Disadvantage with Disease Severity at Initial Presentation in Cervical Spondylotic Myelopathy: A Cohort Study.

Retrospective Cohort Study. To examine the impact of neighborhood-level socioeconomic factors on the delay of care and severity of disease among DCM patients at initial presentation. Degenerative Cervical Myelopathy (DCM) is the most common etiology for spinal cord dysfunction among adults worldwide. Previous literature has suggested that social determinants of health including neighborhood-level socioeconomic status such as Area of Deprivation Index (ADI) may impact spine surgery outcomes in DCM. We performed a single-institution retrospective analysis of all patients undergoing spine surgery for the treatment of DCM from 2010 to 2022. Patients were identified using CPT and ICD9/10 codes. Data was collected via review of the electronic medical record. ADI was extracted from patients addresses. Multivariate and univariate analysis was used to assess the relationship between socioeconomic variables and myelopathy characteristics. A total of 490 patients (Mean age: 60.3±11.3y) were identified. Residence in rural areas was associated with higher Nurick score (OR 2.48,P=0.011), and lower mJOA score (OR 2.51, P=0.014) at presentation, and longer times to presentation (HR 0.48, P=0.003). Having high ADI was independently associated with shorter times to presentation (HR 1.46,P<0.001), but predicted higher Nurick score (OR 1.6, P=0.021) and lower mJOA score (OR 1.86,P=0.002). Unemployment was associated with longer times to presentation (HR 0.66,P<0.001), higher Nurick score (OR 4.5,P<0.001), and lower mJOA score (OR 4.51, P<0.001), while race was not. This is the first single institution study investigating the influence of neighborhood-level measures such as ADI on presentation status and disease burden in patients with DCM. High ADI predicts shorter disease duration but more severe DCM symptoms. Rural residence, unemployment, and non-private insurance were independently associated with prolonged and more severe DCM symptoms while race was not. 3.

Self-perceived and measured visual function, the impact of eye-disease, wellbeing, social determinants, and personality traits in Swedish 70-year-olds-results from the Gothenburg H70 Study.

To explore the potential correlation between subjective and measured visual function, as well as to analyse the influence of eye disease, socioeconomic factors and emotional dimensions. Semi-structured interviews, physical examinations and functional tests (n = 1203). Demographics covered sex, marital status, education, household economy, smoking and alcohol. Participants (born in 1944) rated their visual function (n = 533); those misjudging (n = 48) were studied. Group A (n = 18) had low presenting visual acuity (PVA) but reported good vision; Group B (n = 30) had normal PVA but reported low vision. Control group (n = 485) matched subjective and measured visual function. Ophthalmic examination tested visual acuity (VA), visual field and contrast sensitivity (CS). Psychometric tests: NEO-FFI, sense of coherence (SOC) and Montgomery-Åsberg Depression Rating Scale (MADRS). chi-square, t-tests, Mann-Whitney U test and logistic regression. Of the population, 91% made correct assumptions about their vision. The 9% who made incorrect assumptions about their vision ability (combining groups A + B) were more likely to live alone (p = 0.02) and had lower household incomes compared to the control group (p = 0.04). Additionally, the exhibited significantly lower PVA and BCVA, a higher prevalence of visual field defects (p = 0.02) and lower CS, mean 1.63 (p = 0.005). Group A (3.4%) were women (p = 0.002) with the personality of extraversion, mean 40.0 (p = 0.01). Group B (5.6%) had more self-reported eye diseases (p = 0.01), lower CS (p = 0.01), lower educational level (p = 0.03) and border significantly lower SOC (p = 0.06). The perception of visual function is shaped by awareness of an eye disease but is additionally influenced by sex, socioeconomic factors and emotional parameters.

Cognitive reserve is associated with education, social determinants, and cognitive outcomes among older American Indians in the Strong Heart Study

Cognitive reserve, a component of resilience, may be conceptualized as the ability to overcome accumulating neuropathology and maintain healthy aging and function. However, research measuring and evaluating it in American Indians is needed. We recruited American Indians from 3 regional centers for longitudinal examinations (2010-13, n = 818; 2017-19, n = 403) including MRI, cognitive, clinical, and questionnaire data. We defined cognitive reserve by measuring the residual from individual regressions of cognitive tests over imaged brain volumes, adjusted for age and sex. Analyses examined three different metrics of cognitive reserve against sociodemographic, clinical, and longitudinal cognitive data in causal mediation models. Better cognitive reserve was significantly associated with more education, higher income, lower prevalence of depression, lower prevalence of diabetes, and lower prevalence of kidney disease, but we found no statistically significant evidence for an association with plasma biomarkers for Alzheimer’s disease and related dementias, APOE e4 carrier status, alcohol use, body mass, or hypertension. Better cognitive reserve was associated with better cognitive function over mean 6.7 years follow-up (range 4-9 years); and the association for education with cognition over time was mediated in part (15-24%) by cognitive reserve. Cognitive reserve, although challenging to measure, appears important for understanding the range of cognitive aging in American Indians.

Self-reported determinants for subjective financial distress: a qualitative interview study with German cancer patients

ObjectivesPatient-reported financial effects of a tumour disease in a universal healthcare setting are a multidimensional phenomenon. Actual and anticipated objective financial burden caused by direct medical and non-medical costs as...

Chronic disease prevalence and preventive care among Ontario social housing residents compared with the general population: a population-based cohort study

BackgroundOlder adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among...

Social Determinants of Health and Adverse Childhood Experiences: How Are These Intertwined to Determine Childhood Overweight and Obesity in Argentina?

Social Determinants of Health and Adverse Childhood Experiences: How Are These Intertwined to Determine Childhood Overweight and Obesity in Argentina?

Topical review: family psychosocial risk screening and social determinants of health assessment.

Social-ecological factors are highly congruent with social determinants of health (SDOH): Economic Stability; Educational Access/Quality; Healthcare Access/Quality; Neighborhood/Built Environment; and Social/Community Context. In this topical review, the correspondence of social-ecological theory with SDOH and assessment approaches is reviewed. The Psychosocial Assessment Tool (PAT) is used to show how existing tools may facilitate SDOH screening. SDOH are defined, and their link to pediatric health outcomes is presented, followed by a review of the social-ecological model. Feasible, valid, and actionable approaches to assessment of social ecology and SDOH are presented with a focus on the PAT, a brief caregiver report screener based on social-ecological theory, validated in English, Spanish, and in multiple conditions and adapted/translated internationally. Multidisciplinary healthcare providers (n = 25) completed an online survey, indicating whether each PAT item fit into SDOH categories. Despite different approaches to assessing SDOH, there are few feasible and evidence-based approaches. Most PAT items (78%) were consistent with one of the SDOH categories by the majority of raters. PAT items corresponded to all five SDOH categories. Some items about child behavior and family were not categorized as an SDOH, reflecting the broader context of screening with the PAT. The assessment of SDOH is a priority, but approaches to assessment and linking outcomes to intervention remain underdeveloped. As an evidence-based screener in pediatric healthcare, based on social-ecological and public health models, the PAT may provide a means of identifying relevant SDOH in pediatric practice.

Social determinants of student mental health before and after the Beirut port explosion: two cross-sectional studies

BackgroundStudents in Lebanon are facing the devastating impact of multiple national crises, including an unprecedented economic collapse and the Beirut port explosion that killed hundreds, injured thousands, and displaced hundreds of thousands of people. The aim of this study was to identify key social determinants of common mental health symptoms before and after the Beirut port explosion for students at the American University of Beirut, a university based around 4 km from the port.MethodsTwo cross-sectional studies were conducted using a representative sample of undergraduate and graduate students at the American University of Beirut. The study was conducted just before (Study 1) and repeated after the Beirut port explosion (Study 2).ResultsA total of 217 students participated (n = 143 in Study 1 and n = 74 in Study 2). In Study 1 before the explosion, poorer family functioning and social support were correlated with higher levels of depressive symptoms, but not with anxiety or trauma symptoms. Financial stress was correlated with depressive and trauma symptoms. In the partially adjusted regression model (adjusting for demographics), only financial stress was significantly associated with depressive symptoms. In the fully adjusted model (adjusting for adversity), financial stress was associated with depressive and anxiety symptoms. In Study 2 after the explosion, poorer family functioning and poorer social support were correlated with higher levels of depressive symptoms, while only poorer social support was correlated with higher levels of anxiety symptoms—trauma symptoms were not correlated with either. Financial stress was correlated with all symptoms. In the partially adjusted regression model, only financial stress was significantly associated with all symptom clusters. In the fully adjusted model, no variables were significant.ConclusionFindings indicate a detrimental impact of financial stress on the mental health of students in Lebanon, beyond the otherwise protective effects of family and social support, in the context of an unprecedented economic crisis and extremely high levels of distress after the explosion. Findings indicate that mental health interventions for college students in Lebanon should include addressing financial stress, and that further research is needed to identify protective factors during acute emergencies.

Addressing Social Determinants of Health to Achieve Equity in Liver Transplantation: Moving From Identification to Implementation

Addressing Social Determinants of Health to Achieve Equity in Liver Transplantation: Moving From Identification to Implementation

Scalable information extraction from free text electronic health records using large language models

BackgroundA vast amount of potentially useful information such as description of patient symptoms, family, and social history is recorded as free-text notes in electronic health records (EHRs) but is difficult to reliably extract at scale, limiting their utility in research. This study aims to assess whether an “out of the box” implementation of open-source large language models (LLMs) without any fine-tuning can accurately extract social determinants of health (SDoH) data from free-text clinical notes.MethodsWe conducted a cross-sectional study using EHR data from the Mass General Brigham (MGB) system, analyzing free-text notes for SDoH information. We selected a random sample of 200 patients and manually labeled nine SDoH aspects. Eight advanced open-source LLMs were evaluated against a baseline pattern-matching model. Two human reviewers provided the manual labels, achieving 93% inter-annotator agreement. LLM performance was assessed using accuracy metrics for overall, mentioned, and non-mentioned SDoH, and macro F1 scores.ResultsLLMs outperformed the baseline pattern-matching approach, particularly for explicitly mentioned SDoH, achieving up to 40% higher Accuracymentioned. openchat_3.5 was the best-performing model, surpassing the baseline in overall accuracy across all nine SDoH aspects. The refined pipeline with prompt engineering reduced hallucinations and improved accuracy.ConclusionsOpen-source LLMs are effective and scalable tools for extracting SDoH from unstructured EHRs, surpassing traditional pattern-matching methods. Further refinement and domain-specific training could enhance their utility in clinical research and predictive analytics, improving healthcare outcomes and addressing health disparities.

Navigating barriers and embracing facilitators of connection: insights from peer recovery specialists working with individuals with substance use disorder and criminal justice involvement: a qualitative analysis

BackgroundSubstance use disorder affects over half of incarcerated individuals, with 23% experiencing opioid use disorder specifically. Addressing opioid use disorder in jails is crucial due to its association with increased recidivism and overdose. This study investigates the experiences of peer recovery specialists working with individuals with opioid use disorder and criminal justice involvement, focusing on barriers and facilitators to client connections. Qualitative interviews were conducted and thematically analyzed using a hybrid inductive and deductive coding approach. The sample involved five peer recovery specialists, who were interviewed multiple times, across three sites in Virginia between August 2022 to December 2023.ResultsThis analysis categorized findings into two main domains: barriers to connection and facilitators of connection. Within the barriers to connection, six themes emerged: jail specific restrictions, client in withdrawal, social determinants of health insecurities, lack of client engagement, disconnection, and adverse peer recovery experience. Jail-specific restrictions was the most common barrier to connection with 91.30% of transcripts referencing at least one code for jail-specific restrictions; 73.91% of all transcripts indicated social determinants of health insecurities; 56.52% of all peer recovery specialist transcripts experienced clients in withdrawal; 52.17% of all transcripts identified lack of client engagement; 43.48% of all transcripts identified disconnection as a barrier; and 34.78% of all transcripts indicated adverse peer recovery specialist experiences. Three themes were identified as facilitators of connection: peer communication skills, connection to services, and positive peer recovery specialist experience. Peer communication skills were by far the most prominent, with 100% of all transcripts indicating a code related to peer communication skills; 60.87% of all transcripts indicated positive peer recovery specialist experience; and 56.52% of all transcripts identified connection to services as a facilitator. Notable discrepancies in code frequency were observed across different sites, suggesting site specific challenges.ConclusionThis study offers valuable insights into enhancing peer-based support programs within the justice system for individuals with opioid use disorder. Barriers such as jail specific restrictions, client withdrawal, and social determinants of health insecurities pose significant challenges, while effective communication emerges as a critical facilitator. Findings emphasize the need for collaborative efforts between justice and recovery partners to optimize the impact of peer-based support services.

Factors Influencing Pregnant Women's Participation in Randomised Clinical Trials in India: A Qualitative Study.

To explore factors affecting participation of pregnant women in randomised clinical trials in Belagavi, Karnataka, India. A qualitative study using semi-structured in-depth interviews and focus group discussions as data collection methods. Primary, secondary and tertiary health facilities and their community catchment areas in Belagavi district. Thirty-three in-depth interviews with health workers and previous participants of a pregnancy-focused trial, and 12 focus group discussions with currently pregnant women who had not previously participated in a clinical trial, family and community members, and accredited social health activists. Inductive thematic analysis with a team-based approach to interpretation in the study context. Pregnant women were often unable to distinguish between maternal health programmes and trial interventions. Among previous trial participants, expectations of higher quality care were a key motivation for trial participation. Household gendered power relations and trust in the health workforce influenced decisional dynamics regarding participation. Health workers vouched for trial safety, once they assessed the intervention as acceptable. Trial Implementation by the health workforce required understanding and navigating pregnancy-related beliefs and practices in communities. Anticipated health benefits, improved healthcare access, and trust in health workers are facilitators of trial participation. Engaging primary decision-makers is essential due to household gender dynamics. Trials must integrate strategies that clarify the distinct goals of research versus clinical care.

Associations of Faith Community Rejection with Social Support and Health Outcomes among LGBTQ+ Older Adults.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults have varied experiences with faith communities, ranging from affirmation to religious trauma. We investigate how faith community rejection impacts social support and health outcomes among LGBTQ+ older adults in the Southern United States. We analyze Wave 1 data from the LGBTQ+ Social Networks, Aging, and Policy Study (QSNAPS), collected between April 2020 and September 2021. This sample included 1,256 LGBTQ+ adults aged 50+ residing in four Southern U.S. states. Bivariate and Poisson regression analyses were conducted to examine associations of LGBTQ-related faith community rejection with social support and health outcomes. Nearly half (44%) of QSNAPS respondents reported LGBTQ-related faith community rejection. Respondents who reported rejection were more likely to be: transgender or gender diverse (p<0.01) and from a minoritized racial/ethnic background (p<0.01). Compared with respondents who never experienced faith community rejection, respondents who experienced LGBTQ-related faith community rejection reported a lower prevalence of family support (APR=0.80; p<0.001); higher prevalence of symptoms related to moderate to severe psychological distress (APR=1.27; p<0.001); higher prevalence of poor sleep quality (APR=1.17; p<0.05) and high blood pressure diagnosis (APR=1.13; p<0.05). We also find a marginally statistically significant association between faith community rejection and higher prevalence of symptoms related to subjective cognitive decline (APR=1.35; p<0.10). Experiences of faith community rejection come with substantial social support and health costs for LGBTQ+ older adults. Our findings highlight the importance of integrating faith and promoting inclusion within affirming faith communities for LGBTQ+ aging-related care and prevention.

Impact of Race/Ethnicity on Clinical and Genomic Characteristics, Trial Participation, and Genotype-Matched Therapy among Patients with Metastatic Breast Cancer.

Race/ethnicity may affect outcomes in metastatic breast cancer (MBC) due to biological and social determinants. We evaluated the impact of race/ethnicity on clinical, socioeconomic, and genomic characteristics, clinical trial participation, and receipt of genotype-matched therapy among patients with MBC. A retrospective study of patients with MBC who underwent cell-free DNA testing (cfDNA, Guardant360â, 74 gene panel) between 11/2016 and 11/2020 was conducted. Receipt of genotype-matched therapy targeted at a cfDNA actionable mutation was determined. Pearson's chi-squared and Wilcoxon rank-sum tests were used to compare categorical and continuous variables between groups. Multivariable logistic regression was used to assess the association of race and receiving matched therapy. 425 patients with MBC and cfDNA results were identified (White: 369, Black: 27, Hispanic 15, and Asian 14). White patients traveled further for cancer care than other groups (p<0.001). White patients had the highest rates of commercial insurance, Black patients had the highest rates of state-supported insurance, and Asian patients had the highest uninsured rates (p<0.001). Clinical trial enrollment did not differ by race/ethnicity (p=0.34). The proportion of patients with ≥1 actionable mutation in cfDNA did not vary by race/ethnicity (p=0.18). The highest rates of matched therapy were observed in White patients (p<0.001). After multivariable logistic regression adjusting for subtype, commercial vs. other insurance, Charlson comorbidity index, and distance to center, White patients remained more likely to receive matched therapy (p=0.024). Racial/ethnic minority patients were less likely to receive matched therapy. Further research is needed to identify barriers to precision medicine.

Common features of environmentally and socially engaged community programs addressing the intersecting challenges of planetary and human health: mixed methods analysis of survey and interview evidence from creative health practitioners

Depending on environmental and social determinants, planetary health impacts unequally on human health. As it is likely that creativity and culture are under-tapped resources, the potential to address community and environmental issues to tackle health inequalities, especially those resulting from climate injustice, has not yet been fully realized. The study aimed to identify common features of environmentally and socially engaged UK community programs addressing the intersecting challenges of planetary and human health. A short survey was used to screen participants for in-depth semi-structured interviews. Inclusion criteria comprised adult practitioners offering environmentally and socially engaged community programs of creative and cultural activities leading to health and environmental outcomes. Thematic analysis of 19 surveys and eight interviews identified 146 responses, from which 12 themes with 98 subthemes were derived. Seventy per cent of responses were distributed across five major themes: ‘Collaboration and partnerships’, ‘Community health and wellbeing’, ‘Connection to nature’, ‘Funding’ and ‘Mental health’. Within these five themes, 10 subthemes which resulted from three or more similar responses by different participants were deemed common features of community programs. Two of the 10 subthemes: ‘Connection to nature in children’ and ‘Relationship with natural world’ within the major theme: ‘Connection to nature’ addressed planetary and human health directly through practices recognizing environmental and human interdependency. Four of the 10 subthemes: ‘Influencing wider systems’ within the major theme ‘Collaboration and partnerships’; and ‘Looking after our staff’, ‘Preventative measures’ and ‘Research evidence’ within the major theme ‘Mental health’; addressed planetary and human health indirectly through practitioner partnership influence over policies relating to climate change and by addressing concern for the environment manifesting in eco-anxiety. The study indicates the need for inclusive practice, partnership work, and sustainable funding that can support practitioner wellbeing and the process, outputs and impacts of natural and sustainable environment-based health interventions and other resources instrumental in preventative healthcare.

Postnatal experiences of teenage mothers in selected communities in Central Region, Ghana: a phenomenological study

BackgroundTeenage childbirth is an issue of social and public health concern in Ghana, with high prevalence in some regions, including the Central Region. There is a dire need to understand the experiences of teenagers beyond pregnancies to facilitate comprehensive sexual and reproductive health information and service provision. We explored the postnatal experiences of teenage mothers in five communities in the Central Region of Ghana.MethodsWe adopted a descriptive phenomenological design. Using in-depth interview guides and pictorial diaries/guides, 30 teenage mothers who had given birth less than two years before our study, were recruited. Data were analysed thematically using a systematic qualitative-oriented text analysis with QSR NVivo 12 Pro software.ResultsTeenage mothers experienced pregnancy and childbirth related complications such as postpartum haemorrhage, preterm births, and low birth weight of their babies. Socio-cultural, psychological, and economic-related experiences were also observed. Teenage mothers were inexperienced and lacked financial support after childbirth. They often depended on the microsystem consisting of the family, friends, and the children’s fathers as major source of support to enable them and their babies to survive, develop, and become healthy and happy in life.ConclusionsTeenage mothers are confronted with challenges that require the assistance of actors within the microsystem to address. We recommend that stakeholders including healthcare professionals, traditional birth attendants (TBAs), and parents be sensitive to the postnatal challenges faced by teenage mothers so that they can work at providing the necessary skills and support to enable them to cope better with motherhood.