Pregnant adolescents and nurses perspectives on accessibility and utilization of maternal and child health information in Ohangwena Region, Namibia

Background The reasons for the inability of most pregnant adolescent girls to access and utilize maternal and child health information (MCHI) are not well-documented. This is despite the policy guidelines promoting the provision of this necessary information to pregnant adolescents in order to prepare them for delivery. This provision is one of the strategies envisaged to improve their attendance of ANC visits and their maternal and child health. Method Data for this study were collected using semi-structured in-depth interviews. These were conducted with 12 adolescent pregnant girls between the ages of 15 and 19 and eight nurses from four different health centres in the Ohangwena Region of Namibia. The study was conducted over the period of three months (December 2018 to March 2019). The data was grouped into clusters aided by NVivo computer software version 12. Data were organized and condensed in small units, prior to being coded, categorized, and finally grouped into main themes and sub-themes. Results Results revealed that long travel hours to reach the nearest clinics was amongst the leading challenges affecting accessibility and utilization of MCHI for pregnant adolescent girls. This was exacerbated by poor support with transport fare, poor road infrastructure and non-availability of transport, and these factors were key barriers to accessibility and utilization of clinic services. Other barriers pertained to the family dynamics, such as disclosing the pregnancy to the family members prior to commencing antenatal care (ANC) visits and harsh treatment from family members after the disclosure. Conclusion The pregnant adolescent girls were concerned about their inability to access and utilize MCHI. The challenges identified made them susceptible to maternal complications, hence their inability to access relevant MCHI to prepare them for pregnancy. Health educational interventions should prioritize both the adolescent girls and their families for proper support, especially since the reactions of families on the pregnancy of their adolescent girls often negatively affect accessibility and utilization of maternal and child health services. Moreover, further research on adolescents' needs during pregnancy should be expanded to include their parents, in order to better inform policymakers.

ARTICLE ON ADOLESCENT NUTRITIONAL ANEMIA WITH SPECIAL REFERENCE TO GIRLS

Nutritional anaemia is a major health problem worldwide. Adolescent girls are the most vulnerable group of the population due to different reasons. Adolescence is a stage of transition from childhood to adulthood. Adolescence is a physiological & social process through which a child matures into an adult adolescent, comprised of 10-19 years old, from the largest generation of young people in our history. Nutritional anaemia is a serious health problem in Indian school children. A high prevalence of anaemia has been reported in non-pregnant adolescent girls. Adolescent girls are most vulnerable to the influences of cultural & gen- der norms, which often discriminate against them. Dietary patterns and physical activity in addition to schooling & countervailing social norms for early marriage influence the health and nutritional well-being of adolescents. At this age girls having menses and menarche age (10-13 years). In this age nutrients, requirements of iron further increase. This review article purposes the effect of various ayurvedic drugs on anaemia from the existing literature. Keywords: Ayurveda, nutritional anaemia, Pandu Roga, Adolescent girls.

Undernutrition among Pregnant Adolescent, A scoping Review

Background In pregnant adolescents, it is hypothesized that there is ‘nutrient partitioning’, a competition for nutrients between the still growing adolescent mother and her rapidly developing fetus resulting in a compromised nutrition status of both. This scoping review examined the prevalence of undernutrition, associated factors and outcomes of adolescent pregnancy. Methods We used a five stages framework suggested by Arksey & O`Male (2005) to carry out this scoping review. Published articles, reviews and reports were identified through a complete search. We included articles published in English language from 2000 to 2020. We summarized prevalence, associated factors and health outcomes of pregnancy during adolescence. Results 25 studies met the inclusion criteria. 32% of the studies are on dietary intake, 20% of them reported nutritional status and associated factors and 48% studies discussed effect of poor nutrition on outcome of Pregnancy during adolescence. Only 4 of the studies are community based and 21 are facility based. Magnitude of undernutrition among pregnant adolescent girls ranged from 23.5–34%; Social determinants of health such as poor access to antenatal care visits, low educational status of partners, poor dietary intake, early marriage, rural residency, young age and having multiple pregnancies are associated with poor nutritional status. Pregnant adolescents have also more risks of poor pregnancy outcomes compared with pregnant adults’ women. These include fetal complications like prematurity, low or very low birth weight, and perinatal mortality, major congenital defects; hypertensive pregnancy disorders, abortion, urinary infections, and premature rupture of the fetal membranes,. Conclusion A higher magnitude of undernutrition, less dietary intake and more risks of poor pregnancy outcomes were observed from reviewed studies. This review demonstrated absence of comprehensive literature which might be explored through a population-based prospective study.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003–2014 Ghana demographic and health survey (GDHS) data

Objective: We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Design: Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Setting: Countrywide, covering rural and urban areas in Ghana. Participants: Non-pregnant adolescent girls aged 15–19 years. Results: Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. Conclusions: The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Psychological Health and Life Experiences of Pregnant Adolescent Mothers in Jamaica

A recent Jamaican school-based survey revealed that 23.1% of 13–15 year-olds, had attempted suicide one or more times during the last 12 months. Research that links adolescent pregnancy and suicidal behaviour is lacking in Jamaica. Psychological distress and suicidal behaviours amongst pregnant adolescents elsewhere in the Americas has been documented at prevalence of between 13.3%–20%. The purpose of the study was to explore the experiences and the impact of pregnancy on pregnant adolescent psychological health. Individual interviews and focus groups were conducted with adolescents in two Jamaican antenatal clinics. One clinic was designed as a ‘Teen Pregnancy Clinic’ and the other used the standard antenatal clinic design. The following themes were identified: decision-making, resilience, social support, community support system, distress, and perceptions of service. Participants reported positively on the specific interventions tailored to their needs at the Teen Clinic. Although motherhood is valued, none of the pregnancies in this study were planned by the mother. Of the 30 adolescents interviewed, seven cases were referred for counseling due to their need for emotional and psychological support. One of the adolescents reported recent sexual violence and another reported having experienced childhood sexual abuse. Historically, Jamaican adolescent mothers faced barriers to education, self determination, and family planning. Empowering, adolescent-centred healthcare and comprehensive reproductive health education may mitigate psychosocial distress.

Psychological Health and Life Experiences of Pregnant Adolescent Mothers in Jamaica

A recent Jamaican school-based survey revealed that 23.1% of 13–15 year-olds, had attempted suicide one or more times during the last 12 months. Research that links adolescent pregnancy and suicidal behaviour is lacking in Jamaica. Psychological distress and suicidal behaviours amongst pregnant adolescents elsewhere in the Americas has been documented at prevalence of between 13.3%–20%. The purpose of the study was to explore the experiences and the impact of pregnancy on pregnant adolescent psychological health. Individual interviews and focus groups were conducted with adolescents in two Jamaican antenatal clinics. One clinic was designed as a ‘Teen Pregnancy Clinic’ and the other used the standard antenatal clinic design. The following themes were identified: decision-making, resilience, social support, community support system, distress, and perceptions of service. Participants reported positively on the specific interventions tailored to their needs at the Teen Clinic. Although motherhood is valued, none of the pregnancies in this study were planned by the mother. Of the 30 adolescents interviewed, seven cases were referred for counseling due to their need for emotional and psychological support. One of the adolescents reported recent sexual violence and another reported having experienced childhood sexual abuse. Historically, Jamaican adolescent mothers faced barriers to education, self determination, and family planning. Empowering, adolescent-centred healthcare and comprehensive reproductive health education may mitigate psychosocial distress.

Prevalencia y factores relacionados con el consumo de alcohol en adolescentes embarazadas: una revisión sistemática

Introduction: alcohol consumption during pregnancy causes physical, cognitive and behavioral problems in the mother and the unborn baby. The literature recommends abstinence from this substance during pregnancy. However, the presence of factors in adolescents could be related to the initiation or continuation of alcohol consumption while pregnant. Objective: twas to identify the prevalence and factors that are related to alcohol consumption in pregnant adolescents (AE). Method: a systematic review of articles in English and Spanish published between 2009 and 2019 in the adolescent population was carried out. The databases were PubMed, Web of Science: Social Sciences Citation Index, Science Citation Index, and Scopus. The search terms included the words “pregnancy,” “pregnant,” “adolescent,” “adolescence,” and “alcohol.” Data extraction was performed independently by one author using the study quality indicators. Results: CADE prevalence’s in AE were determined. Also, personal, psychological and spiritual factors related to CADE. Alcohol consumption prior to pregnancy and exposure to the presence of previous pregnancies were the most mentioned as personal factors. Likewise, relationships of psychological factors such as depression and anxiety were identified. In addition, social factors were identified such as having a single parent, having friends who smoke or drink, as well as not having a partner. Finally, some spiritual factors were found, among which the importance given to religion stands out. Conclusions: alcohol consumption during pregnancy is multifactorial, however, there are personal, psychological, social and spiritual factors that increase the risk of consuming alcohol up to four times more.

Dietary diversity and its correlates among pregnant adolescent girls in Ghana

Background Dietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients, and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana. Methods As part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO minimum dietary diversity for women index was used to determine the dietary diversity score (DDS) of the participants from a previous days’ 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires. Results The mean age of the participants was 17.5 (±1.4) years with an MDD-W of 4.4 and 56% recording inadequate MDD score. More rural (63.6%) than urban dwellers (50.6%) had inadequate DDS (p = 0.008). Among all the multiple variables tests of associations on dietary diversity, only hunger status (p = 0.028) and both food aversion and poverty status (p = 0.003) had a significant effect on the adolescents’ dietary diversity. Rural dwelling adolescents (AOR = 1.7, p = 0.035, 95% CI = 1.0–2.6) recorded higher odds for inadequate DD compared with the urban respondents. Pregnant adolescents with severe hunger had higher odds (Unadjusted OR = 1.9, p = 0.053, 95% CI 1.1–3.8) for inadequate dietary diversity compared with those with no hunger. Conclusions Inadequate DD is common among pregnant adolescents in this study and is associated with rural living, food insecurity, poverty, and food craving. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity.