Unmarried Adolescent Girls Research Articles

Role of sociocultural beliefs/norms on level of access and uptake of contraceptives among unmarried adolescent girls in Nigeria: A systematic review study

Despite widespread awareness of the importance of contraceptive use in Nigeria, unintended pregnancies persist among adolescent girls, leading to events of unsafe abortion, sexually transmitted infections, maternal mortality, and disruptions to education and career, consequently resulting in economic hardships. Negative sociocultural beliefs and attitude serves as a deterrent for girls seeking contraceptives services in Nigeria. This study aimed to determine and describe how sociocultural beliefs and attitudes affect access and usage of contraceptive among unmarried adolescent Nigerian girls. This study employs a secondary research approach following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, PsycINFO, and CIHNAL were searched using relevant keywords to achieve and review studies that meet predefined criteria. Quality assessment of selected articles was done using the Critical Appraisal Skill Programme (CASP) and Mix Methods Appraisal Tools (MMAT) for qualitative and quantitative articles, respectively. Each selected article was synthesized thematically to identify patterns relevant to the research question. Thematic analysis revealed four sociocultural beliefs influencing contraceptive uptake among unmarried adolescent girls in Nigeria. Society's stigmatization of females for pregnancy prevention limits their freedom to access contraceptive services. Other factors include beliefs about sex and age, protective education, and societal intolerance for discussions about sex with adolescents. The study highlights the societal influence on contraceptive decisions for adolescent girls in Nigeria. Girls in need of contraceptives struggle with societal stigmatization perpetuated by beliefs that adolescent girls should abstain from sex until after marriage, which unfortunately does not align with current trends in sexual relationships among adolescents in Nigeria. it is therefore important to shift societal perspective about adolescent sexuality needs and promote the economic and lifelong benefits of preventing unplanned pregnancies through a multisectoral collaboration.

Perception, practices and understanding of teenage pregnancy among the adolescent girls in India: A scoping review protocol.

Teenage pregnancy is a subject of concern among adolescents. Inadequate knowledge and misperceptions about pregnancy are major contributing factors to teenage pregnancy. Without a proper understanding, adolescents are involved in unsafe sexual practices, which results in pregnancy. So, perception and understanding are important aspects to explore among adolescents. In this planned scope review, all eligible studies will be identified around the perception, practices, and understanding of teenage pregnancy among married and unmarried adolescent girls. The Arksey and O'Malley (2005) scoping review framework and the Joanna Briggs Institute Reviewers' Manual (2015) will be used for the planned scoping review. The population, concept, and context strategy (PCC) will be used to develop the research question, search strategy, and eligibility criteria. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA ScR) will be used for the findings of the study. For the literature search, authors will use Google Scholar, PubMed, and ResearchGate electronic databases with specific words such as "teenage", "adolescence", "pregnancy", "perception", "knowledge", "awareness" and "abortion". The planned scoping review will be helpful in addressing the lack of adolescent misperception, malpractices, and misunderstandings regarding teenage pregnancy. It can provide detailed information about teenage pregnancy in the Indian context. The evidence synthesis and gap analysis will be helpful in suggesting insights into the issue of teenage pregnancy, which will be helpful in future policies and programs.

Why Acute Undernutrition? A Qualitative Exploration of Food Preferences, Perceptions and Factors Underlying Diet in Adolescent Girls in Rural Communities in Nigeria.

Adolescent girls are nutritionally vulnerable due to their rapid growth and increased nutrient requirements. Nigeria has the sixth-largest population in the world. This study qualitatively explored the food preferences, perceptions of nutritive value and factors underlying food consumption of adolescent girls in rural communities in Nigeria. The data were collected via the free listing of foods and focus group sessions conducted in the Hausa language with 48 unmarried adolescent girls. The discussions were audio-recorded, transcribed, translated into English, and analyzed using a deductive thematic framework. The mean age of the respondents was 13.0 ± 2.7, and almost half (48%) had a primary school education. A total of 19 and 23 foods were identified as preferred, and perceived as nourishing, respectively. The top 10 foods present on both free lists overlapped considerably in terms of cognitive salience. The focus group themes included nutrition knowledge, food preferences, autonomy, household food allocation, courtship practices, and agricultural landscapes and economic access. The participants had minimal knowledge of nutrients and food groups, and their preferred foods were limited in diversity. The key factors in food preferences were desirable health effects, sensory attributes, and the contribution of foods to a desirable body image for marriage. Household food choices depended on parents. Thus, a desire for independence was an incentive for early marriage, mostly at 13 to 17 years. Gender inequities in household food distribution (quantity) and animal protein intake were reported. The participants believed that boys need more food for strength to impregnate girls. As part of a courtship practice, the girls received gifts of animal source foods from potential suitors. The food options were limited by financial challenges and low agricultural diversity. To interrupt the cycle of inadequate food consumption and undernutrition in these adolescent girls, policy makers need to promote nutrition education and address the underlying determinants of inequitable access to nutritious foods.

Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh

BackgroundIn Bangladesh, undernutrition and anemia are more occurrent among adolescent girls. BRAC, the largest non-governmental organization (NGO), has been implementing a community-based nutrition education service package targeting adolescent girls for reducing their undernutrition and anemia.ObjectiveWe aimed to explore the underlying factors associated with nutritional status and anemia among adolescent girls under the BRAC nutrition program areas to improve their existing intervention package.MethodologyWe conducted a cross-sectional and comparative study in 2016, in 24 upazilas of Bogra, Barguna, Comilla, Dinajpur, Feni, Jessore, and Meherpur districts where the BRAC nutrition program was implemented while the remaining 27 upazilas of those districts were selected as comparison area. We followed a multistage cluster random sampling for selecting 1620 unmarried adolescent girls aged 10–19 years for interviewing in the intervention and comparison areas. Data were collected on socio-demographic information, dietary intake, morbidity, water, sanitation, and hygiene (WASH) practice, anthropometry, and serum hemoglobin (Hb) level by using a pre-structured questionnaire. The nutritional status of the adolescent girls was expressed as height-for-age Z (HAZ) and body mass index-for-age Z (BMIZ) score, while anemia referred to the serum Hb at the level of below 12 g/dl for adolescent girls. All statistical analyses were done in STATA version 17 (Chicago Inc.).FindingsThe prevalence of stunting (22.9% vs. 22.5%), thinness (12% vs. 14%), and anemia (34.5% vs. 37.3%) exhibited similarities between the intervention and comparison regions. Stunting and thinness were predictors for each other for this population group. Our findings indicated that adolescent girls who were not washing hands with soap after defecation were likely to be stunted [AOR 1.51 (95% CI 1.12–2.04)], and who did not utilize sanitary latrines had an increased likelihood of being thin [AOR 2.38 (95% CI 1.11–5.08)]. Conversely, those who did not watch television [AOR 1.69 (95% CI 1.12–2.56)] and did not have deworming tablets [AOR 1.33 (95% CI 1.07–1.64)] in the 6 months leading up to the interview had a 69% and 33% higher probability of being anemic, respectively.ConclusionFor sustainable improvement in the undernutrition and anemia of adolescent girls, integration of WASH, consistent administration of deworming tablets and broadcasting awareness programs through television are urgent to scale up the nutrition intervention programs in similar settings like Bangladesh.

Is parental engagement associated with subsequent delayed marriage and marital choices of adolescent girls? Evidence from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey in Uttar Pradesh and Bihar, India

ObjectiveThis study examines the association between parental engagement and subsequent delayed marriage of adolescent girls and, secondarily, to assess whether parental engagement is positively associated with girls’ involvement in marital decision-making regarding husband selection. MethodsThe study used longitudinal survey data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) in Uttar Pradesh and Bihar, India. We analysed 6168 unmarried adolescent girls aged 15–19 years at wave 1 (2015–16) who were interviewed in wave 2 (2018–19). Our outcomes were delayed marriage of girls (unmarried vs. married at 20–22 vs. married at 18–19 vs. married at <18) and, among those married at <18 years, girls’ involvement in husband selection (alone vs. with parents vs. not involved). Parental discussion around school performance, friendships, menstruation, pregnancy, free time, and personal issues were the exposure variables. We applied unadjusted and adjusted multinomial regression models to assess associations between our exposure variables and each outcome variable. ResultsFrom wave 1 to wave 2, 1551 girls (31.2%) married; 567 girls (12.5%) married as minors (<18 years). We found that parental discussion around school performance (relative risk ratio [RRR]: 1.33), friendship (RRR: 1.37) and personal matters (RRR: 1.29) were positively associated with remaining unmarried relative to early marriage of girls. However, discussion with parents about menstruation was negatively associated with marriage at 20–22 (RRR: 0.67) and remaining unmarried (RRR: 0.80), compared to early marriage. Discussing school performance was negatively associated with marriage at 18–19 (RRR: 0.62) and at 20–22 (RRR: 0.50), relative to early marriage. Discussing personal issues with parents was positively associated with joint parent-girl decision-making regarding husband selection, relative to parents alone selecting the husband (RRR: 1.43). ConclusionsParental engagement on school performance, friendship, and personal issues in early adolescence may help delay marriage and support marital choice for girls in India.

Examining the relationship between risky sexual behavior and suicidal thoughts among unmarried adolescents in India

Addressing the problem of suicidal thoughts in adolescents requires understanding the associated risk factors. Multiple studies have shown that risky sexual behavior affected the adolescents’ psychological health that leads to their suicidal thoughts, behaviors and attempts. This study aimed to identify the association between various risky sexual behaviours and suicidal thoughts among unmarried adolescents in India. We used data collected from 4221 unmarried adolescent boys and 5987 unmarried adolescent girls aged 10–19 years, from the two rounds of the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey. Descriptive analysis was done to observe changes in the selected variables from wave-1 to wave-2. Random effect regression analysis was used to estimate the association of suicidal thoughts among unmarried adolescents with their risky sexual behaviours. The percentage of adolescent boys having suicidal thoughts increased from 1.35% in wave 1 to 2.19% in wave 2. Among adolescent girls, the percentage increased from 2.92% in wave 1 to 5.05% in wave 2. A proportion of 3.26% adolescent boys had more than one sexual partner during wave 1 whereas in wave 2, it rose to 8.71%, while in case of adolescent girls, the estimates only increased from 0.26% at wave 1 to 0.78% at wave 2. Nearly 4.55% boys and 1.37% girls had early sexual debut. Almost five percentage boys were sexually active at wave 1 whereas in wave 2, it rose to 13.56%, while among adolescent girls, the estimates decreased from 1.54% at wave 1 to 1.51% at wave 2. Contraceptive use increased over time among both adolescent boy and girls. Also, a large proportion of adolescent boys reported watching pornography (27.08% at waive 1 and 49.39% at wave 2) compared to adolescent girls (4.46% at wave 1 and 13.10% at wave 2). Adolescents who had more than one sexual partner [Coef: 0.04; p < 0.001], exposed to early sexual debut [Coef; 0.019; p < 0.01], sexually active [Coef: 0.058; p < 0.001] and reported watching pornography [Coef: 0.017; p < 0.001] were more likely to have suicidal thoughts. Adolescent boys and girls with risky sexual behaviors are likely to be at a higher risk of suicidal ideation, and thus, they should be treated with special care and attention by local healthcare practitioners.

The Relationship between Knowledge and the Occurrence of Vaginal Discharge

This study aimed to investigate the relationship between knowledge of vulva hygiene and the occurrence of vaginal discharge among female students in the female boarding high school in Indonesia. A total of 48 students were selected through purposive sampling and data was collected using a questionnaire. The results showed that 31.8% of unmarried women or adolescent girls aged 12-24 years experienced vaginal discharge. Lack of knowledge about vaginal discharge among adolescents and feeling embarrassed to consult health professionals were the reasons for not seeking treatment. This puts adolescent girls at a higher risk of experiencing vaginal discharge. The analysis using the Chi-square test showed a significant relationship (p&lt;0.05) between knowledge of vulva hygiene and the occurrence of vaginal discharge, with a correlation coefficient of 0.416, indicating a moderate relationship. Therefore, it is recommended that respondents increase their knowledge of vulva hygiene, and those experiencing pathological vaginal discharge should improve genital hygiene to avoid future health issues.

Adolescent Girls’ Early Marriage Intention and its Determinants in Eastern Ethiopia: A Social Norms Perspective

This study aimed to identify the association of perceived social norms with intention of early marriage practice among unmarried adolescent girls (13–17 years) in Kersa Demographic and Health Surveillance System. A community-based cross-sectional study was conducted during September–November 2019. Adolescent girls’ marriage intention was assessed using social norm measuring tools. The log-binomial model was used to identify factors associated with girls’ intention. Adjusted prevalence ratio along with 95% CIs was executed to determine the association of main independent variables with girl’s intention. A total of 859 adolescent girls participated in the study. The prevalence of intention to marry before the age of 18 years among adolescent girls was 44.47% (95% CI [0.41%, 0.48%]). The intention for an early marriage was higher among those with positive attitude toward early marriage, in those who believe that most people in their reference group conform to early marriage norms (empirical expectation), in those who believe that most people in their reference group expect them to conform to early marriage norms (normative expectation) and who fear sanction related to early marriage practices. Moreover, residence in urban areas and high educational level by girls and their parents was associated with reduced prevalence ratio. There is strong social norm in the community that promotes intention for an early marriage among adolescent girls in the study area. Hence, interventions that aim to reduce early marriage need to address local social norms.

Anthropometry based nutritional status of unmarried adolescent girls (15-19 Y) of urban Vadodara, Gujarat, India

: The word ‘adolescence’ is derived from the Latin verb ‘adolescere’, which means “grow to maturity.” The World Health Organization (WHO) defines adolescents as young people aged 10-19 years. There are about 1.2 billion adolescents, a fifth of the world’s population. Nutrition is key to unlocking the potential of investment in the health of women, children and adolescents. After obtaining necessary permission from Vadodara Mahanagar Seva Sadan 250 unmarried adolescent girls aged 15-19 years were enrolled in the study. Data on Socio-Economic background (SES) for enrolled girls’ families, Weight and Height was collected using pre-tested semi structured questionnaire. Thinness was assessed using age and sex specific WHO cut-offs for BMI for age (5-19Y). Stunting was identified using WHO cut-offs for Height for age criteria. Mean age of the adolescent girls was 16.3 years. 62% of the adolescent girls were attending school. 70% of adolescent girls were belonging to reserve category (SC/ST/OBC). It was found that 15.2 % and 6.4% of the girls were moderately and severely thin respectively. Only 13.2 % adolescent girls had normal BMI for age. Prevalence of stunting was 80.8%. Thinness and stuntingin unmarried adolescent girls (15-19 years) of urban area is a cause of concern.

Effect of change in individual and household level characteristics on anemia prevalence among adolescent boys and girls in India

BackgroundAnemia is a significant public health challenge that affects the population of all nations. Anemia among adolescents emerged as an alarming public health issue as it harms an individual’s physical capacity and cognitive and work performance. The study aims to determine the effect of changes in individual and household level factors on the prevalence of anemia among adolescent boys and girls.MethodThe study utilized data from two waves of the “Understanding the lives of adolescent and young adults” (UDAYA) survey, conducted in Bihar and Uttar Pradesh during 2015–16 (wave-1) and 2018–19 (wave-2). The sample size for the present study was 4216 and 5974 unmarried adolescent boys and girls aged 10–19 years in both waves. We performed descriptive analysis to observe the characteristics of adolescents during 2015–16. Further, changes in selected independent variables from wave-1 to wave-2 were examined using the proportion test. Moreover, random-effect regression models were employed to examine the association of changes in individual and household level factors with anemia prevalence among adolescents.ResultsThe prevalence of anemia decreased over time among adolescent boys (33 to 30%), whereas it increased among adolescent girls (59 to 63%). The results from the random-effect model show that adolescent boys who used shared toilets were more anemic than those who used a private restroom [β:0.05, 95% CI:(0.01, 0.08)]. Moreover, underweight [β:0.05, CI:(0.01, 0.09)] and thin [β:0.04, CI:(0.00, 0.07)] adolescent boys were more likely to be anemic compared to their normal counterparts. Additionally, boys who belonged to the poorest [β:0.08, CI:(0.02, 0.14)] households had a higher risk of anemia than the richest household.ConclusionThe anemia prevalence was higher among adolescents aged 10–19 years in Uttar Pradesh and Bihar. This study has filled an information gap by providing state-level representative estimates indicating underweight status and thinness as the common factors behind the anemia prevalence among adolescent boys than in girls. Iron deficiency anemia is the most prevalent in certain age groups in India. Hence, Anemia prevention efforts and iron-folic acid (IFA) supplementation programs are currently being strengthened in India, targeting the high-risk population.

Community structure and timing of sexual activity among adolescent girls in Nigeria.

Studies have linked the timing of sexual debut to unplanned pregnancies and sexually transmissible infections, including HIV. Current understandings of sexual debut among Nigerian adolescents focused on the roles of individual and familial characteristics. We leveraged the 2018 Nigeria Demographic and Health Survey data to examine how community features like affluence, ethnic diversity, and women empowerment may be associated with the timing of sexual debut among adolescent girls. The sample comprised 7449 adolescent girls who were usual residents in 6,505 households and 1,352 clusters or communities. Statistical associations between community characteristics and the onset of sexual debut were assessed using a two-level mixed-effects parametric survival model with Weibull distribution. We found that community affluence [aHR:0.43, 95%CI: 0.30–0.62] and community ethnic diversity [aHR: 0.63, 95%CI: 0.42–0.94] are associated with a lower hazard of sexual debut among adolescent girls. We also observed that women that married within the observation period had an earlier sexual initiation than those who were unmarried. The results disaggregated by marital status further shows that higher community level of women’s employment [aHR: 2.45, 95%CI: 1.38–4.38] and women’s education [aHR:1.85, 95%CI: 1.03–3.33] were associated with a higher hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Higher community affluence [aHR:0.40, 95%CI: 0.27–0.60] was also associated with a lower hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Our results illuminate the associated factors of the timing of sexual debut among adolescent girls that moves beyond individual characteristics to community characteristics.

Adolescent girls trapped in early marriage social norm in rural Ethiopia: A vignette-based qualitative exploration.

BackgroundEarly marriage is not uncommon in Ethiopia, particularly for adolescent girls in rural settings. Social norms are among the factors believed to perpetuate early marriage practices. This qualitative study explores social norms surrounding adolescent girls’ marriage practices in West Hararghe, Ethiopia.MethodsThis study used the qualitative inquiry method to explore social norms in rural Ethiopia. Focus group discussions were conducted with purposively sampled married and unmarried adolescent girls, adolescent boys, and parents. A total of 158 individuals participated in the study, comprising 95 adolescents and 63 parents. Data were collected using locally developed vignettes. A thematic framework analysis approach using the Social Norms Analysis Plot (SNAP) was employed to diagnose and understand social norms.ResultsAdolescent girls’ marriage was found to be mainly influenced by their peers who conform to prevailing social norms. Marrying one’s first suitor was considered an opportunity not to be missed and a symbol of good luck. Relatives, neighbors, and marriage brokers facilitate adolescent girls’ marriage in accordance with the local social norms. Girls usually accept the first marriage proposal regardless of their age, and they are highly expected to do so by their peers, parents, and influential others. Exceptions from the early marriage social norm include adolescent girls determined to continue their education and those having supportive teachers.ConclusionsIn this study context, social norms strongly encourage early marriage and are mainly perpetuated by peers of adolescent girls and influential adults. A strong determination to continue education on the part of girls, strong school performance, and supportive schoolteachers are important conditions for circumventing social norms on early marriage. As social norms evolve slowly, we recommend periodical assessment in order to develop locally appropriate interventions against early marriage.

Exploring the Therapeutic Effect of Yoga to Enhance Psychological Well-being among Adolescent Girl Students

Background: Globally, Yoga is known as the wealth of India, the most oldest and powerful interventional method to develop healthy physical, mental/psychological, and spiritual up liftmen.&#x0D; Aim: The present study’s aim is to see the role of yogic practices in enhancing psychological well-being among adolescent girl students.&#x0D; Methodology: A total of 60 unmarried adolescent girls were selected according to inclusion and exclusion criteria, between the age group 13-15 years and randomly divided into 02 groups (30-30 in experimental and control group). A Checklist for Psychological well-being prepared by the researcher at RINPAS has been used to assess adolescents’ psychological well-being. All participants were assessed at the beginning (pre) and after 03 months (post). The experimental group received a structured yogic intervention program (techniques included Surya-Namaskara, Pranayama, and Yoga-Nidra; 24 sessions).&#x0D; Result: Result has found significant changes on experimental group participants on various domains of psychological well-being at 0.01 and 0.05 levels as compared to control group participants.&#x0D; Conclusion: The result found that yogic practice is quite effective to enhance psychological well-being among adolescent girl students. As an intervention yoga and its techniques have the potential to develop positive healthy mental health, self-awareness as well as mental relaxation.

A study of awareness on HIV/AIDS among adolescents: A Longitudinal Study on UDAYA data

Acquired Immunodeficiency Syndrome caused by Human Immunodeficiency Virus (HIV) poses a severe challenge to healthcare and is a significant public health issue worldwide. This study intends to examine the change in the awareness level of HIV among adolescents. Furthermore, this study examined the factors associated with the change in awareness level on HIV-related information among adolescents over the period. Data used for this study were drawn from Understanding the lives of adolescents and young adults, a longitudinal survey on adolescents aged 10–19 in Bihar and Uttar Pradesh. The present study utilized a sample of 4421 and 7587 unmarried adolescent boys and girls, respectively aged 10–19 years in wave-1 and wave-2. Descriptive analysis and t-test and proportion test were done to observe changes in certain selected variables from wave-1 (2015–2016) to wave-2 (2018–2019). Moreover, random effect regression analysis was used to estimate the association of change in HIV awareness among unmarried adolescents with household and individual factors. The percentage of adolescent boys who had awareness regarding HIV increased from 38.6% in wave-1 to 59.9% in wave-2. Among adolescent girls, the percentage increased from 30.2 to 39.1% between wave-1 & wave-2. With the increase in age and years of schooling, the HIV awareness increased among adolescent boys ([Coef: 0.05; p < 0.01] and [Coef: 0.04; p < 0.01]) and girls ([Coef: 0.03; p < 0.01] and [Coef: 0.04; p < 0.01]), respectively. The adolescent boys [Coef: 0.06; p < 0.05] and girls [Coef: 0.03; p < 0.05] who had any mass media exposure were more likely to have an awareness of HIV. Adolescent boys' paid work status was inversely associated with HIV awareness [Coef: − 0.01; p < 0.10]. Use of internet among adolescent boys [Coef: 0.18; p < 0.01] and girls [Coef: 0.14; p < 0.01] was positively associated with HIV awareness with reference to their counterparts. There is a need to intensify efforts in ensuring that information regarding HIV should reach vulnerable sub-groups, as outlined in this study. It is important to mobilize the available resources to target the less educated and poor adolescents, focusing on rural adolescents.

Adolescent girls’ recommendations for designing Human Papillomavirus Vaccination Program in Pakistan

Abstract In Pakistan, cervical cancer is the third most frequent cancer among women. Most cases are caused by sexually-acquired infection with human papillomaviruses (HPV). Vaccination of adolescent girls against HPV significantly reduces the incidence of cervical cancer. HPV vaccination is available in Pakistan, but plans to develop a HPV vaccination program are currently at a very early stage. We conducted a formative study to explore adolescent girls' perspectives on HPV and cervical cancer, and collected their recommendations for implementing an HPV vaccination program. We conducted qualitative focus group discussions (FGDs), with unmarried adolescent girls aged 16-19 years, residing in Karachi. We conducted four FGDs with 12 participants each. The topic guide assessed i) girls' knowledge of cervical cancer and HPV vaccination, ii) vaccination decision-making dynamics within families, and iii) factors girls would consider essential for the successful implementation of HPV vaccination program. Overall, participants displayed a positive attitude towards the HPV vaccine. However, many basic concepts related to female reproductive health were unfamiliar to them. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as the definitive decision-making authority on vaccination. Girls gave critical input for the development of a HPV vaccination program. Eligible girls should be recruited through individual household visits and the vaccine should be administered at community-based camps, which would ensure both good accessibility and a large outreach. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. Adolescents demonstrated great capacity and shared recommendations for a future program's acceptability. Integrating their perspectives will be essential to design an effective program in local context. Key messages Adolescent girls’ perspectives should be incorporated to develop context-specific recommendations for the implementation of a HPV vaccination program. Community-based camps and household visits by adolescent girls to recruit the target population could potentially increase program penetration among communities.

English

BACKGROUND Dysmenorrhoea is the most common gynaecological problem. Almost half of the female adolescents suffer from it resulting in a major cause of school / college absenteeism. We tried to find out the prevalence of dysmenorrhoea among female adolescents in a suburban population and investigate a potential association between the body mass index, dietary habits and behavioural factors and its correlation with absenteeism. METHODS A cross sectional study was done on 270 adolescent females attending outpatient department of a suburban medical college. We interviewed the selected adolescent girls using a pretested semi structured questionnaire after obtaining their or their parents consent. Statistical analysis was done using frequencies, percentages and chi square test with statistical software package SPSS version 20. RESULTS Total 270 unmarried adolescent girls were interviewed. Among them 51.1 % girls suffered from dysmenorrhoea. 58.7 % patients suffered from mild dysmenorrhoea whereas 27.5 % and 13.8 % suffered from moderate and severe dysmenorrhoea respectively. 59.02 % of girls with normal BMI and 54.55 % of obese girls suffered from dysmenorrhoea. Only 16 % patients with mild dysmenorrhoea were absent from their school or college whereas 63.1 % and 84.2 % of patients with moderate to severe dysmenorrhoea had school or college absenteeism respectively. 74.47 % of patients used to take self-medication. CONCLUSIONS Dysmenorrhoea was a significant cause of absenteeism and habit of self-medication was prevalent. Introduction of a school health program for menstrual health might improve the issues. KEY WORDS Menstruation, Dysmenorrhoea, Adolescents

Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

BackgroundThe use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys.MethodsWe used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status.ResultsOverall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique.ConclusionDespite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

A vignette-based approach to understanding social norms around family planning in three Nigerian cities

ABSTRACT Understanding the mechanisms through which social norms shape contraceptive use can help prevent unintended pregnancies in low-income countries. The Nigerian Urban Reproductive Health Initiative (NURHI) aimed to increase contraceptive uptake through advocacy, service delivery, and demand generation. Using data from focus group discussions, we examined whether social norms around family planning (FP), and specifically use of modern contraception (MC), varied among women and girls of reproductive age exposed to varying levels of the programme in three Nigerian cities. Injunctive social norms were generally unfavourable of unmarried adolescent girls’ use of MC, though participants often shared exceptions for certain types of adolescents whose use of MC would be acceptable. There was greater acceptability for MC use by women who wanted to space or limit pregnancies. Participants reported that norms around FP and MC use have become more accepting in their communities over time. Normative differences between cities were identified. Participants’ perceptions of religious leaders’ support for FP use may have contributed to positively influencing social norms.

Knowledge and Practices About Sexual Health and Its Socioeconomic Correlates Among Adolescent Girls in Sikkim, India

Adolescents constitute a quarter of total Indian population. Many of them become sexually active despite being informed of the risks which they may encounter. The present study aims to address knowledge and perception on HIV/AIDS, STIs, and safe sex among adolescent girls (15 to 19years) in Sikkim, India. The study also evaluates their attitudes, and practices of sexual activities among their peer groups. The study is based on randomly selected 1031 unmarried adolescent girls residing in Gangtok, the capital town of Sikkim, and also in different blocks of the other three districts. The self-administered questionnaire was completed by participant girls to obtain data on socioeconomic characteristics, knowledge, awareness, and practices about sexual health issues such as HIV/AIDS, STIs, safe sex. Bivariate and multivariate analyses have been used for data analysis. Higher number of urban girls reported sexual activities among their peer group as compared to rural ones. However, unprotected sexual activity was reportedly higher among rural girls (10.26%). Results of multivariate analysis establishes role of media in raising sexual health awareness among girls in the study area. Role of socioeconomic characteristics of adolescents is important in raising awareness, building attitudes, and determining practices pertaining to sexual and reproductive health among them. Health care institutions along with media can raise awareness about sexuality and also can inculcate responsible sexual attitudes and practices among adolescents.

Gender inequities in treatment-seeking for sexual and reproductive health amongst adolescents: Findings from a cross-sectional survey in India.

ContextIndia's adolescent health policy aims to improve sexual and reproductive health, especially amongst the most vulnerable. There is limited evidence on how gender influences treatment-seeking patterns amongst unmarried adolescents.MethodsWe analyzed data from 11,651 unmarried adolescent boys and girls aged 15–19 from a cross-sectional survey conducted in two large states of India. We conducted sex-disaggregated analyses to estimate the prevalence of symptoms of genital infections and compare treatment-seeking patterns. We identified correlates through multivariable regression and used a conceptual framework to explore structural, household, social and individual factors that influence gender inequities in adolescent sexual and reproductive health.ResultsOne in five unmarried adolescents reported symptoms of genital infections, such as burning or discharge, in the past three months. Factors associated with reporting symptoms varied between boys and girls, except for a common correlation with symptoms of depression. At least two-thirds of boys sought treatment, compared to approximately one in four girls (rural: 66.2% boys, 23.1% girls; urban: 69.4% boys, 30.7% girls). Boys primarily sought care from medical shops or private facilities, while girls used both private and government services. Amongst boys, having friends and being in school was associated with seeking treatment (aOR: 11.47; 95% CI: 2.75, 47.87; aOR: 1.95; 95% CI: 1.24, 3.07, respectively). Odds of seeking treatment were higher amongst girls with exposure to any mass media (aOR: 1.93; 95% CI: 1.25, 2.99) and who had discussed puberty with a parent (aOR: 1.98; 95% CI: 1.32, 2.98).ConclusionStark sex differentials in factors associated with symptoms and in treatment-seeking illustrate how structural gender inequities, such as access to economic resources and education, influence sexual and reproductive health amongst adolescents. Along with health system interventions, addressing gender inequities calls for strategies to strengthen parental engagement, social support and girls’ access to resources.