Medicine and Health Sciences Commons^™

Sexual And Reproductive Health Risks Amongst Female Adolescents Who Use Amphetamine-Type Stimulants And Sell Sex: A Qualitative Inquiry In Yunnan, China, Xu-Dong Zhang, Angela Kelly-Hanku, Jia-Jia Chai, Jian Luo, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: China, as other Southeast Asian countries, has witnessed an increased use in amphetamine-type stimulants (ATS) amongst urban youth. Amongst female adolescents who both sell sex and use ATS, risk behaviours are compounded resulting in even poorer health outcomes. However, limited knowledge exists on ATS use patterns and ATS-related risk behaviours, particularly in this context. This research aimed to improve the understanding of these issues amongst female adolescents who use ATS and sell sex, and to inform future programming.

Method: This study utilised monthly focus group discussions (four in total) with the same study participants in Yunnan, China. From within …

Impact Of An Educational Intervention On Breast Cancer Knowledge In Western Kenya, J. Kisuya, J. Wachira, N. Busakhala, V. Naanyu, A. F. Chite, Elkanah Omenge, G. Otieno, Alfred Keter, A. Mwangi, Thomas Inui

Obstetrics and Gynaecology, East Africa

Our objective was to assess the effectiveness of educational sessions that accompanied breast cancer screening events in three communities in western Kenya between October and November 2013. Five hundred and thirty-two women were recruited to complete a test of breast cancer-relevant knowledge and randomly allocated to ‘pre-test’ or ‘post-test’ groups that immediately preceded or followed participation in the educational sessions. The education was organized as a presentation by health professionals and focused mainly on causes of breast cancer, early and late cancer presentation signs, high-risk groups, screening methods to find early-stage breast cancer, self-breast exam procedures and treatment options for …

Monitoring Human Growth And Development: A Continuum From The Womb To The Classroom, José Villar, Aris T. Papageorghiou, Ruyan Pang, Laurent J. Salomon, Ana Langer, Cesar Victora, Manorama Purwar, Cameron Chumlea, Wu Qingqing, Sicco A. Scherjon, Fernando C. Barros, Maria Carvalho, Douglas G. Altman, Francesca Giuliani, Enrico Bertino, Yasmin A. Jaffer, Leila Cheikh Ismail, Eric O. Ohuma, Ann Lambert, J. Alison Noble, Michael G. Gravett, Zulfiqar A. Bhutta, Stephen H. Kennedy

Obstetrics and Gynaecology, East Africa

A comprehensive set of fully integrated anthropometric measures is needed to evaluate human growth from conception to infancy so that consistent judgments can be made about the appropriateness of fetal and infant growth. At present, there are 2 barriers to this strategy. First, descriptive reference charts, which are derived from local, unselected samples with inadequate methods and poor characterization of their putatively healthy populations, commonly are used rather than prescriptive standards. The use of prescriptive standards is justified by the extensive biologic, genetic, and epidemiologic evidence that skeletal growth is similar from conception to childhood across geographic populations, when health, …

Towards A New Global Strategy For Women’S, Children’S And Adolescents’ Health, Marleen Temmerman, Rajat Khosla, Zulfiqar Ahmed Bhutta, Flavia Bustreo

Obstetrics and Gynaecology, East Africa

The year 2015 marks a defining moment for the health of women, children, and adolescents. It is the end point of the United Nations’ millennium development goals, and their transition to the sustainable development goals, and also the 20th anniversary of the International Conference on Population and Development’s plan of action and the Beijing Declaration and platform of action.

This is a moment of reflection as well as celebration. Although great strides have been made in reducing maternal and child mortality, showing that change is possible, many countries are lagging behind in reaching millennium development goal 4 (to reduce the …

Sexual And Reproductive Health Research And Research Capacity Strengthening In Africa: Perspectives From The Region., Richard Adanu, Michael T. Mbizvo, Adama Baguiya, Vincent Adam, Beyene W. Ademe, Augustine Ankomah, Godwin N. Aja, Ademola J. Ajuwon, Olapeju A. Esimai, Taofeek Ibrahim, Dintle K. Mogobe, Özge Tunçalp, Venkatraman Chandra-Mouli, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Developing the capacity to effectively carry out public health research is an integral part of health systems at both the national and global levels and strengthening research capacity is recognized as an approach to better health and development in low- and middle-income countries (LMICs). Especially fields such as sexual and reproductive health (SRH) would require inter-disciplinary teams of researchers equipped with a range of methodologies to achieve this. In November 2013, as part of the International Family Planning Conference in Addis Ababa, Ethiopia, a group of African researchers came together to discuss the gaps and strategies to improve sexual and …

Quality Of Care For Pregnant Women And Newborns—The Who Vision, Ӧ. Tuncalp, W. M. Were, C. Maclennan, O. T. Oladapo, A. M. Gulmezoglu, R. Bahl, B. Daelmans, M. Mathai, L. Say, F. Kristensen, Marleen Temmerman, F. Bustreo

Obstetrics and Gynaecology, East Africa

In 2015, as we review progress towards Millennium Development Goals (MDGs), despite significant progress in reduction of mortality, we still have unacceptably high numbers of maternal and newborn deaths globally. Efforts over the past decade to reduce adverse outcomes for pregnant women and newborns have been directed at increasing skilled birth attendance.1,2 This has resulted in higher rates of births in health facilities in all regions.3 The proportion of deliveries reportedly attended by skilled health personnel in developing countries rose from 56% in 1990 to 68% in 2012.4 With increasing utilisation of health services, a higher proportion of avoidable maternal …

Child Marriage Legislation In The Asia-Pacific Region, Elisa Scolaro, Aleksandra Blagojevic, Brigitte Fillion, Venkatraman Chandra-Mouli, Lale Say, Joar Svanemyr, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Child marriage is a human rights violation that robs a girl of her childhood, puts her health, growth, and development at risk, disrupts her education, limits her opportunities for empowerment and social development, and increases her risk of exposure to violence and abuse (for a review of the evidence on the negative effects of child marriage on girls and their children, see Parsons et al. 2015, in this issue). While child marriage is not mentioned specifically in the 1989 Convention on the Rights of the Child (CRC), the Convention does contain a provision requiring governments to abolish “traditional practices prejudicial …

Accelerating The Dual Elimination Of Mother-To-Child Transmission Of Syphilis And Hiv: Why Now?, James Kiarie, Chandra K. Mishra, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Even though the elimination of congenital syphilis has been on the maternal and child health (MCH) agenda for over a decade, elimination has not yet been achieved; what, then, are the factors currently facilitating the elimination of mother-to-child transmission (MTCT) of syphilis?

Accelerating The Dual Elimination Of Mother‐To‐Child Transmission Of Syphilis And Hiv: Why Now?, James Kiarie, Chandra K. Mishra, Marleen Temmerman, Lori Newman

Obstetrics and Gynaecology, East Africa

Even though the elimination of congenital syphilis has been on the maternal and child health (MCH) agenda for over a decade, elimination has not yet been achieved; what, then, are the factors currently facilitating the elimination of mother-to-child transmission (MTCT) of syphilis?

Which Role Do Midwives And Gynecologists Have In Smoking Cessation In Pregnant Women?–A Study In Flanders, Belgium, Katrien De Wilde, Inge Tency, Sarah Steckel, Marleen Temmerman, Hedwig Boudrez, Lea Maes

Obstetrics and Gynaecology, East Africa

Objectives: The objectives of our study were (1) to explore knowledge, beliefs and practice among mid-wives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women.

Method: We performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A’s frame-work (Ask–Advise–Assess–Assist–Arrange).

Results: The national smoking cessation policy seemed to be insufficiently known. “Ask” and “Advise" were part of a standard prenatal consultation, the next three …

Obstetric Transition In The World Health Organization Multicountry Survey On Maternal And Newborn Health: Exploring Pathways For Maternal Mortality Reduction., Solange Da Cruz Chaves, José Guilherme Cecatti, Guillermo Carroli, Pisake Lumbiganon, Carol J. Hogue, Rintaro Mori, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework.

Methods: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month …

Use Of The Robson Classification To Assess Caesarean Section Trends In 21 Countries: A Secondary Analysis Of Two Who Multicountry Surveys, Joshua P. Vogel, Ana Pilar Betrán, Nadia Vindevoghel, João Paulo Souza, Maria Regina Torloni, Jun Zhang, Özge Tunçalp, Rintaro Mori, Naho Morisaki, Eduardo Ortiz-Panozo, Bernardo Hernandez, Ricardo Pérez-Cuevas, Zahida Qureshi, A Metin Gülmezoglu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age.

Methods: We studied deliveries in 287 facilities in 21 countries that …

A Cross Sectional Comparison Of Postnatal Care Quality In Facilities Participating In A Maternal Health Voucher Program Versus Non-Voucher Facilities In Kenya, Charlotte E. Warren, Timothy Abuya, Lucy Kanya, Francis Obare, Rebecca Njuki, Marleen Temmerman, Ben Bellows

Obstetrics and Gynaecology, East Africa

Background: Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women’s access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya’s programme accredited health facilities in three districts as well as in two informal Nairobi settlements.

Methods: Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 …

How To Assess Success Of Treatment When Using Multiple Doses: The Case Of Misoprostol For Medical Abortion., Armando H. Seuc, Iqbal H. Shah, Moazzam Ali, Claudia Diaz-Olavarrieta, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The assessment of treatment success in clinical trials when multiple (repeated) doses (courses) are involved is quite common, for example, in the case of infertility treatment with assisted reproductive technology (ART), and medical abortion using misoprostol alone or in combination with mifepristone. Under these or similar circumstances, most researchers assess success using binomial proportions after a certain number of consecutive doses, and some have used survival analysis. In this paper we discuss the main problems in using binomial proportions to summarize (the overall) efficacy after two or more consecutive doses of the relevant treatment, particularly for the case of …

Human Rights In The New Global Strategy., Jyoti Sanghera, Lynn Gentile, Imma Guerras-Delgado, Lucinda O’Hanlon, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The Global Strategy for Women’s and Children’s Health (2010), with its emphasis on participatory decision making processes, non-discrimination, and accountability, affirmed the importance of human rights. Despite important gains following its launch women, children, and adolescents continue to experience serious violations of their health and health related human rights, including discrimination in access to quality healthcare. A human rights based approach must thus be fully integrated throughout the Global Strategy.

The right to health is recognised by several legal tools and treaties relating to human rights, including the International Covenant on Economic, Social and Cultural Rights; the Convention on the …

Women’S Health Priorities And Interventions, Marleen Temmerman, Rajat Khosla, Laura Laski, Zoe Mathews, Lale Say

Obstetrics and Gynaecology, East Africa

Over the past decades, governments have taken steps towards improving women’s health in line with commitments made in key international summits. Progress has been made in reducing maternal mortality,1 which accelerated with the launch of the United Nations secretary general’s Global Strategy for Women’s and Children’s Health in 2010. Use of maternal healthcare and family planning has increased in some countries.2 Progress has also been seen on two determinants of women’s health—school enrolment rates for girls and political participation of women—but not for others such as gender based violence.3

However, societies are still failing women in relation to health, especially …

A Review Of Factors Associated With The Utilization Of Healthcare Services And Strategies For Improving Postpartum Care In Africa, Danielle Yugbare Belemsaga, Anne Goujon, Joel A. Kiendrebeogo, Els Duysburgh, Seni Kouanda, Olivier Degomme, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Reducing maternal mortality continues to be a major challenge for African countries. We conducted a literature review to identify the factors associated with the utilization of maternal and child healthcare services during the postpartum period and the strategies for strengthening postpartum healthcare in Africa. We carried out an electronic search in several databases of texts published between 1995 and 2012 related to maternal and child health. Seventy-five publications fitted the eligibility criteria. Our analysis shows that to a large extent the socio-economic context was dominant among the factors associated with the quality and utilization of postpartum services. The best interventions …

Assessing Predictors Of Contraceptive Use And Demand For Family Planning Services In Underserved Areas Of Punjab Province In Pakistan: Results Of A Cross-Sectional Baseline Survey, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghulam Mustafa, Waqas Hameed, Omar Farooq Khan, Ghazunfer Abbas, Marleen Temmerman, Erik Munroe

Obstetrics and Gynaecology, East Africa

Background: Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed.

Method: A cross-sectional baseline household survey …

Couple Based Family Planning Education: Changes In Male Involvement And Contraceptive Use Among Married Couples In Jimma Zone, Ethiopia, Tizta Tilahun, Gily Coene, Marleen Temmerman, Olivier Degomme

Obstetrics and Gynaecology, East Africa

Background: Family planning contributes substantially in achieving the Millennium Development Goals. Recently,male involvement has gained considerable attention in family planning programs but the implementation thereof remains a challenge. In that context, our study aimed at measuring the effect of a six-month-long family planning education program on male involvement in family planning, as well as on couples’ contraceptive practice.

Methods: We conducted a quasi-experimental research among 811 married couples in Jimma Zone, southwest Ethiopia. Our study consisted of an intervention and a control group for comparative purpose; and surveyed before and after the implementation of the intervention. The intervention consisted of …

Challenges And Opportunities For Implementing Evidence-Based Antenatal Care In Mozambique: A Qualitative Study, Adriano Biza, Ingeborg Jille-Traas, Mercedes Colomar, Maria Belizan, Jennifer Requejo Harris, Beatrice Crahay, Mario Merialdi, My Huong Nguyen, Fernando Althabe, Alicia Aleman, Eduardo Berge, Alicia Carbonell, Leonardo Chavane, Therese Delvaux, Diederike Geelhoed, Metin Gülmezoglu, Celsa Regina Malapende, Armando Melo, Nafissa Bique Osman, Mariana Widmer, Marleen Temmerman, Ana Pilar Betrán

Obstetrics and Gynaecology, East Africa

Background: Maternal mortality remains a daunting problem in Mozambique and many other low-resource countries. High quality antenatal care (ANC) services can improve maternal and newborn health outcomes and increase the likelihood that women will seek skilled delivery care. This study explores the factors influencing provider uptake of the recommended package of ANC interventions in Mozambique.

Methods: This study used qualitative research methods including key informant interviews with stakeholders from the health sector and a total of five focus group discussions with women with experience with ANC or women from the community. Study participants were selected from three health centers located …

Barriers To Modern Contraceptive Methods Uptake Among Young Women In Kenya: A Qualitative Study, Rhoune Ochako, Mwende Mbondo, Stephen Aloo, Susan Kaimenyi, Rachel Thompson, Marleen Temmerman, Megan Kays

Obstetrics and Gynaecology, East Africa

Background: Young women in Kenya experience a higher risk of mistimed and unwanted pregnancy compared to older women. However, contraceptive use among youth remains low. Known barriers to uptake include side effects, access to commodities and partner approval.

Methods: To inform a youth focussed behaviour change communication campaign, Population Services Kenya developed a qualitative study to better understand these barriers among young women. The study was carried out in Nyanza, Coast, and Central regions. Within these regions, urban or peri-urban districts were purposively selected based on having contraceptive prevalence rate close to the regional average and having a population with …

Underuse Of Modern Methods Of Contraception: Underlying Causes And Consequent Undesired Pregnancies In 35 Low- And Middle-Income Countries, Saverio Bellizzi, Howard L. Sobel, Hiromi Obara, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Study question: What is the contribution of the underuse of modern methods (MM) of contraception to the annual undesired pregnancies in 35 low- and middle-income countries?

Summary answer: Fifteen million out of 16.7 million undesired pregnancies occurring annually in 35 countries could have been prevented with the optimal use of MM of contraception.

What is known already: Every year, 87 million women worldwide become pregnant unintentionally because of the underuse of MM of contraception.

Study design, size, duration: Demographic and health surveys (DHS) of 35 countries, conducted between 2005 and 2012, were analysed.

Participants/materials, setting, methods: Contraceptive use of 12 …

Twenty Years After International Conference On Population And Development: Where Are We With Adolescent Sexual And Reproductive Health And Rights?, Venkatraman Chandra-Mouli, Joar Svanemyr, Avni Amin, Helga Fogstad, Lale Say, Françoise Girard, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The International Conference on Population and Development in Cairo in 1994 laid out a bold, clear, and comprehensive definition of reproductive health and called for nations to meet the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality. In the context of the ongoing review of the International Conference on Population and Development Programme of Action and the considerations for a post-2015 development agenda, this article summarizes the findings of the articles presented in this volume and identifies key challenges and critical answers that need to be tackled in …

Induced Abortion In 30 Chinese Provinces In 2013: A Cross-Sectional Survey, Shangchun Wu, Marleen Temmerman, Kun Wang, Shuchen Wang, Jiong Li, Wei-Hong Zhang

Obstetrics and Gynaecology, East Africa

Background: Galloping economic growth and reform in China in the past 30 years has led to dramatic social changes. Attitudes towards sex and sexual behaviour have changed, and premarital sex has become more acceptable. The methods of contraception have changed, and the use of highly effective or long-acting contraceptive methods tends to be decreasing, especially in urban areas. Abortion is commonly used to end unintended pregnancy. The aim of this study was to survey the current situation of induced abortions in selected hospitals in 30 provinces in China.

Methods: This cross-sectional study was conducted in 295 randomly selected hospitals in …

Quality At The Centre Of Universal Health Coverage, Howard L. Sobel, Dale Huntington, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) …

Determinants Of Method Switching Among Social Franchise Clients Who Discontinued The Use Of Intrauterine Contraceptive Device, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Wajahat Hussain, Ghulam Mustafa, Muhammad Ishaque, Safdar Ali, Aftab Ahmed, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Introduction: Women who do not switch to alternatemethods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether.

Methods: The data used for this study comes from a larger cross-sectional survey conducted in nine

(9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who …

Advancing The Sexual And Reproductive Health And Human Rights Of Women Living With Hiv: A Review Of Un, Regional And National Human Rights Norms And Standards, Rajat Khosla, Nuna Van Belle, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Introduction: The right to sexual and reproductive health (SRH) is an essential part of the right to health and is dependent upon substantive equality, including freedom from multiple and intersecting forms of discrimination that result in exclusion in both law and practice. Nonetheless, general and specific SRH needs of women living with HIV are often not adequately addressed. For example, services that women living with HIV need may not be available or may have multiple barriers, in particular stigma and discrimination. This study was conducted to review United Nations Human Rights Council, Treaty Monitoring Bodies and Special Rapporteur reports …

Male Partners' Involvement In Prevention Of Mother-To-Child Hiv Transmission In Sub-Saharan Africa: A Systematic Review, Rosa Marlene Manjate Cucoa, Kha´Tia Munguambe, Nafissa Bique Osman, Olivier Degomme, Marleen Temmerman, Mohsin M. Sidat

Obstetrics and Gynaecology, East Africa

In sub-Saharan Africa (SSA), male partners are rarely present during prevention of mother-to-child transmission (PMTCT) services. This systematic review aims to synthesize, from a male perspective, male partners' perceived roles, barriers and enablers of their involvement in PMTCT, and highlights persisting gaps. We carried out a systematic search of papers published between 2002 and 2013 in English on Google Scholar and PubMed using the following terms: men, male partners, husbands, couples, involvement, participation, Antenatal Care (ANC), PMTCT, SSA countries, HIV Voluntary Counseling and Testing and disclosure. A total of 28 qualitative and quantitative original studies from 10 SSA countries were …

Opportunities To Improve Postpartum Care For Mothers And Infants: Design Of Context-Specific Packages Of Postpartum Interventions In Rural Districts In Four Sub-Saharan African Countries, Els Duysburgh, Birgit Kerstens, Seni Kouanda, Charles Paulin Kaboré, Danielle Belemsaga Yugbare, Peter Gichangi, Gibson Masache, Beatrice Crahay, Gilda Gondola Sitefane, Nafissa Bique Osman, Severiano Foia, Henrique Barros, Sofia Castro Lopes, Susan Mann, Bejoy Nambiar, Tim Colbourn, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Postpartum maternal and infant mortality is high in sub-Saharan Africa and improving postpartum care as a strategy to enhance maternal and infant health has been neglected. We describe the design and selection of suitable, context-specific interventions that have the potential to improve postpartum care.

Methods: The study is implemented in rural districts in Burkina Faso, Kenya, Malawi and Mozambique. We used the four steps ‘systems thinking’ approach to design and select interventions: 1) we conducted a stakeholder analysis to identify and convene stakeholders; 2) we organised stakeholders causal analysis workshops in which the local postpartum situation and challenges and …

Sexual Onset And Contraceptive Use Among Adolescents From Poor Neighbourhoods In Managua, Nicaragua, Peter Decat, Sara De Meyer, Lina Jaruseviciene, Miguel Orozco, Marcia Ibarra, Zoyla Segura, Bernardo Vega, Kristien Michielsen, Marleen Temmerman, Olivier Degomme

Obstetrics and Gynaecology, East Africa

Background and objectives: The prevalence of teenage pregnancies in Nicaragua is the highest in Latin-America. This study aimed to gain insight into factors which determine the sexual behaviours concerned.

Methods: From July until August 2011, a door-to-door survey was conducted among adolescents living in randomly selected poor neighbourhoods of Managua. Logistic regression was used to analyse factors related to sexual onset and contraceptive use.

Results: Data from 2803 adolescents were analysed. Of the 475 and 299 sexually active boys and girls, 43% and 54%, respectively, reported contraceptive use. Sexual onset was positively related to increasing age, male sex, alcohol consumption …