Sexually transmitted infection (STI): A malady with skewed marital unfaithfulness, the Nigerian experience

Marital unfaithfulness is a major contributor to sexually transmitted infections in both sexes; however, societal view of the menace seems to use various lenses for the different sexes. Globally, evidence suggests that marital infidelity has existed in history. In Africa, as well as in Western society, infidelity is a problem facing many families and accounts for high incidence of divorce. This narrative review described and synthesized literature on marital infidelity and its association with sexually transmitted infections. We conducted informal interviews with married women on their experiences with marital infidelity in Nigeria. Associated physical, social and psychological cultured imposed consequences were experienced by women in Nigeria. The recurrent themes felt helplessness, enduring physical, emotional and psychological torture, accepting fate with reservation and being strangers in marital union. This narrative review could initiate critical thoughts and discussions on the factors in skewed marital unfaithful and the contribution to reproductive health and family life.

Autodétermination des femmes dans la santé sexuelle et reproductive à Lubumbashi, République Démocratique du Congo / NA

ntroduction.La santé reproductive est caractérisée par une vie sexuelle satisfaisante, sûre et la capacité de se reproduire et de prendre des décisions. La vie de beaucoup de femmes estmarquée par les capacités d'action réduites quant aux décisions portant sur leur propre vie. L'objectif était d'évaluer l'autodétermination des femmes en matière de la santésexuelle et reproductive.Matérieletméthodes.Il s'agit d'une étude descriptive transversale effectuée dans 5 maternités de la ville de Lubumbashi au mois de juillet 2021 au près des 46 accouchées ayant accepté librement de participer à cette étude basée sur le questionnaire préétabli. Résultats.L'analyse des données montre que la moyenne d'âge était de 27,8 ± 3,6 ans avec les extrêmes entre 17 et 41 ans, dont 58,7% d'entre elles avaient le niveau de secondaire et paucipares dans 52,17%. La décision des rapports sexuels revenait au couple dans 58,70%. La décision d'avoir les enfantsrevenait au couple alors que celle de nommer les enfants revenait au mari dans 45,65% et 45,65%. Le nombre d'enfants était déterminé par le couple dans 45,65%. L'espacement des naissances était déterminé par la femme dans 45,65%. Le début de la CPN était décidé par la femme dans 86,6% et le choix du lieu des consultation prénatales(CPN) étaient décidés par la femme dans 89,13%. Le moment de se rendre à la maternité était décidé par la femme dans 73,91%. Le retour à domicile était décidé par le couple dans 39,13% et la décision des rapports sexuels après l'accouchement revenait à l'homme dans 52,17%.Conclusion.La femme congolaise n'a pas toujours une autodétermination maximale dans la santé reproductive. Ainsi des efforts supplémentaires sont nécessairespour laisser la liberté aux femmes de prendre des décisions qui conviennent mieux pour leur santé

Reproductive health education: a qualitative study of health seeking behaviour of in-school female adolescents

Introduction: adolescents in developing countries are often vulnerable to sexually transmitted diseases (STDs) and unplanned pregnancies. It is estimated that about 13 million adolescent girls have unplanned births each year in developing countries. This study examined the scope of the School Health Education Programme (SHEP) and health-seeking behaviours of female adolescents in Junior High School (JHS). Methods: this qualitative research used the narrative approach. Group discussions were conducted among 100 female adolescents aged 12-19 years. Interviews were conducted among five community health workers in five health centres that provide reproductive health services. The in-depth interviews and group discussions were documented, transcribed and analyzed using NVivo 11, whilst thematic analysis was used in analyzing data. Results: the mean age of adolescents was 15.5 years, with 74% reporting having knowledge of STDs. It was observed that the SHEP offers various information on health issues such as menstrual hygiene, STDs, personal hygiene, contraceptives, personal development and unsafe abortion practices. Adolescent reproductive health services were also available in the health centres but patronage was low as a result of perceived negative attitude of health workers and trust. Knowledge on issues of reproductive health is insufficient among JHS female adolescents, with many of them relying on the media and peers for reproductive health support. Conclusion: in this study, female adolescents are generally involved in risky sexual behaviour due to their low level of knowledge on reproductive issues and their unwillingness to patronize available reproductive health services because of the health system and cultural barriers.

Exploring the effects of programmatic intervention on family planning health literacy and contraceptive utilization in eastern Uganda

Uganda Village Project (UVP) implemented the Healthy Village Initiative (HVI) and conducted household surveys to assess the effects of the initiative. This data adds to the limited body of knowledge regarding the efficacy of community health interventions for reproductive health in rural east Africa. As part of the HVI, UVP surveys rural Ugandan households before and after a 3-year programmatic intervention to assess changes in family planning health literacy, and contraception utilization. Results showed that there was an increase in contraceptive utilization, an increase in family planning health literacy, and a decrease in unmet need for contraception. Community-based outreaches led by community members and health workers can contribute to improving access to contraception, utilization of contraception, and health literacy surrounding contraception. (Afr J Reprod Health 2022; 26[4]: 15- 21).

"When America Sneezes, the World Catches a Cold" What does overturning Roe v. Wade mean for women's reproductive health in Africa?

Communities and countries and ultimately the world are only as strong as the health of their women." - Michelle Obama, 2016 On 24 June 2022, the Supreme Court of the United States (SCOTUS) decided on Dobbs v Jackson Women's Health Center, overturning the historic Roe v. Wade decision that has, since 1973, confirmed and enshrined the constitutional right of a woman to seek an abortion1 . Restrictions to legal, safe abortions are known to have serious repercussions for maternal and infant health. Evidence shows that restricting access to abortion does not reduce the number of abortions; it only makes abortion less safe and more likely to lead to preventable complications, including maternal death. Conversely, expanding access to safe, legal abortion­a common medical procedure that carries very little risk when performed by a trained provider in an appropriate environment­is associated with improved maternal health outcomes. Further, illegal abortion results in negative societal outcomes, including chronic morbidity for the individual woman; economic burdens to women and their communities when they cannot work or finish school; and added stress to families, communities, and already over-stretched public health systems.

Challenges to ethical integration of reproductive health education in schools of Tshwane District, South Africa

The Integrated School Health Policy was set to ensure the incorporation of a multi-disciplinary approach to health care in South African schools. However, the implementation of sexuality and reproductive health teaching and learning has not been without problems. Central to sexuality and reproductive health education is the common ethical application of the subject in teaching. School sexuality and reproductive health education have proved to be a sensitive issue across a socio-cultural environment. Compliance with ISHP programs in sexuality and gender orientation is related to the inclusion of a more comprehensive education for learners to cover human rights and sexual diversity. This paper aims to reflect on the ethical challenges related to the integration of reproductive health education and teaching in schools in the City of Tshwane. This study applied a descriptive exploratoryquantitative research design. Data was collected using a survey questionnaire and a checklist, and applied stratified random sampling to select schools that participated in the study. Data were analysed using descriptive statistics which included frequencies and percentages (%). The results show that the absence of health care values in organisational strategies will challenge the ethical dimension relating to sexuality and reproductive health education. The ethical dilemma of teaching sexual and reproductive health in schools can prove to be a challenging exercise since its a sensitive issue in most societies. Sexuality and reproductive health education is compounded by a lack of clear guidelines in the ISHP programs and the diversity of stakeholders that do not hold a common or standardised ethical framework. Furthermore, lack of sufficient teacher preparation adds to the ethical dilemma in managing school ethical issues in general. (Afr J Reprod Health 2022; 26[4]: 75-81).

The social and cultural consequences of infertility in rural and periurban

Relatively little is known about infertility experiences among women in rural Malawi and the impact of infertility on women's marital and family relations. This article examines the perspectives of women and health care providers regarding women's concepts of reproductive health and attitudes toward infertility. The paper explores the supports and barriers to managing infertility at the individual, household, and community levels. The data presented was drawn from semi-structured interviews with health care providers and patients within a prevention of mother to child transmission program and focus group discussions with community men and women in four communities in Southern Malawi. Seventy-eight patients, 12 health care providers, and 32 community leaders participated in the study. The findings suggest that gender inequities and kinship relations intersect to produce infertility related stigma which exacerbates the social and cultural consequences of being infertile in these study communities. Social support from other women experiencing infertility is one strategy to help women manage the social and cultural burden of infertility in these study communities. These results shed light on the meaning of motherhood to women living in rural and periurban Sub-Saharan African communities and call for an expansion of infertility services, social services, and mental health services for both women and men who experience infertility. (Afr J Reprod Health 2022; 26[7]: 112-126).

"It is just a lot to deal with": A qualitative study exploring the sexual and reproductive health needs of a sample of female sex workers in six locations in Southern Africa

The sexual and reproductive health of female sex workers in Southern Africa is particularly important, given the high prevalence of HIV among this population. This paper presents the results of a rapid assessment study conducted prior to the implementation of the "SRHR-HIV Knows No Borders" project in six Southern African countries. Trained interviewers interviewed 20 sex workers across 10 high migration communities. Data were analysed thematically. Participants were well informed about and were able toaccess preventive methods for STIs and pregnancy, although reports of condom failures were common. While sex workers found SRH services easily accessible, many reported experiences of stigma and discrimination when accessing them. Physical and sexual violence were common occurrences among participants, both from their clients and the police. In addition to addressing stigma within the healthcare and broader community, interventions could provide opportunities for those looking to exit the industry by providing skills training and microfinance support. (Afr J Reprod Health 2022; 26[5]: 72-80).

Experiences of adolescent pregnancy among Maasai in Kenya: Implications for prevention

Adolescent fertility rates are high in Kenya and increase the likelihood of maternal and infant morbidity and mortality. The objectives were to (1) explore the prevalence of unintended pregnancy among Maasai adolescent mothers, (2) understand the context in which pregnancy is occurring, and (3) suggest community-based strategies to prevent adolescent pregnancy. In in-depth, individual, qualitative interviews with Maasai females that gave birth during adolescence, pregnancy was unintended in 100% of cases. Our results suggest a desire among this population to prevent pregnancy and the need for contraception. Our recommendations include comprehensive sex education that targets very young adolescents, implementation of mechanisms to strive toward universal primary education, and the provision of resources and skills to adolescents that they need to practice safer sex. (Afr J Reprod Health 2022;26[6]:36-44).

Establishing communities of practice to improve health policy, systems and reproductive, maternal, newborn, child and adolescent health in West Africa

Objectives: To explore and analyse factors that facilitate and inhibit the initiation and functioning of a national and transnational Community of Practice (CoP) for health policy and systems (HPS) and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) in West Africa and to identify lessons for CoP interventions in similar multilingual low and middle-income contexts. Design: A case study, with the case defined as processes, enablers and barriers to the initiation and functioning of a national and transnational CoP for HSP and RMNCAH in West Africa and drawing on a review and analysis of secondary data from the program, workshop, country team and project reports, and training sessions. Setting: The Economic Community of West African States (ECOWAS). Participants: Professionals from two Anglophone (Ghana and Sierra Leone) and four Francophone (Burkina Faso, Cote d'Ivoire, Niger e Senegal) ECOWAS countries. Interventions: Training and mentoring of multi-disciplinary country teams supported by small research grants to undertake formative evaluation and advocacy of priority HPS and RMNCAH issues; support for CoP development within and across country teams. Results: The desire to learn from peers and mentors was a major enabler of the process. Human and financial resource availability, competing demands for time, communication in the context of a Francophone-Anglophone official language divide and the arrival of COVID-19 were all constraints. Conclusions: This study highlights the processes, achievements, and challenges of establishing country-level and transnational CoPs in West Africa. CoPs require sustained human and financial resource investments, communication and medium-to-long-term implementation support for sustainability and impact.

Street youths: reproductive health risk status, reproductive health challenges and barriers to health services utilization in a southwestern City, Nigeria

Background Information: According to the United Nations, about 150 million youth spent most of their time on the street, or better still, homeless. This is becoming a global phenomenon and majority of this vulnerable people live in large cities and urban areas of developing countries. Street youths are among the high risk, insecure and vulnerable groups who are often exposed to various forms of abuses and diseases, including reproductive health issues. Methodology: A descriptive cross-sectional study carried out among street youths in Ikorodu Local Government, Lagos State using a multi staged sampling technique. Frequency tables were drawn at the univariate level, chi squared was used to test for association between socio-demographic characteristics and sexual risk level. Data was analyzed using SPPSS version 22, p value was set at 0.05 Results: Almost half 48(48.5%) of the respondents were between the age range 20-24years and two third 61(61.6%) of them were female and 27(27.3%) had up to senior secondary education attainments. Majority 73(73.7%) of them have been on the street for more than 3months and 32 (32.3%) professed that the reason they were on the street was to search for job while 25 (25.3%) because of family disharmony among parents. Eighty-six (86.9%) of the respondents were sexually active, 31 (36.0%) of which have more than four sexual partners. Duration of stay on the street and their educational status were determinants of risky sexual behavior and polygamous setting was found to be statistically significant (p value =0.035) with reproductive health challenges. Conclusion: There is high risk sexual practice among street youths in Ikorodu Local Government. Strategic interventions aimed at minimizing sexual risky behaviors among street youths should focus on reducing the duration of stay on the street as well as increasing access to contraception

Barriers to utilization of sexual and reproductive health services among young deaf persons in Ghana

Despite significant progress made to improve access to sexual and reproductive health (SRH) services to the general populace in Ghana, information on the accessibility of such services to deaf persons is limited. This study investigated access to and utilization of SRH services among young female deaf persons in Ghana. Sixty deaf persons were interviewed from six metropolis/municipalities/districts in three regions of Ghana. The data were collected using focus group discussion and one-on-one interviews. The data were subjected to content analysis, leading to the identification of two broad themes. The study identified barriers at two levels: point of service delivery and barriers at the individual level. For instance, at the point of service delivery, they were claims that deaf women were victims of negative attitudes from health workers. The study concludes on the need for health policymakers to consider collaborating with the Ghana National Association of the Deaf in an effort towards designing inclusive SRH programmes.

Perceptions, knowledge and exercises of sexual and reproductive health rights and associated factors among adolescents in East Arsi Zone, Ethiopia: A sequential explanatory mixed method study

Sexual and reproductive health rights (SRHRs) are the rights of all people regardless of their age, sex and other characteristics to make choices about their own reproductive issues. This study aimed to explore and describe adolescents' perceptions, knowledge and exercises of SRHR and associated factors among going adolescents in Arsi zone, Ethiopia. This study was guided by;explanatory sequential mixed-method study design. Thus, a two-phase data collection approach was adopted. In Phase I, the quantitative data were collected from 800 adolescent (15-19 years) using pre tested and self-administrated questionnaires. In Phase II, a semi-structured interview guide was used to collect data from 12 key informant interviews with teachers and health care providers and 4 focus group discussions with adolescents who were not participated in quantitative phase. The findings from the phases I and II approaches were merged through a comparison of findings side by side. Quantitative data was cleaned and analysed using SPSS 25 while thematic analysis was used for qualitative data. In phase I of 827 total adolescents invited to the study, 800 (96.7%) respondents participated in the study. Overall, less than half (26.1%) had ability to exercises and (45.3%) knowledgeable about SRHRs. In this study, adolescents with 17-19 years (AOR=3.30, 95% CI: 2.17-5. 23), grades 11 to 12 (AOR=1.69, 95% CI: 1. 23-2.35) and knowledge (AOR=1.47, 95%CI: 1.05-2.05) were significantly associated with SRHRs exercises. The research found misperception, limited knowledge and exercises amongst adolescents about SRHRs in secondary schools emphasising the rights-based approach. It is urged to promote educational campaigns to reduce misconceptions and increase knowledge of SRH rights among adolescents

Traditional birth attendants and reproductive health services in the context of covid-19: a scoping review

Background: In developing countries, the lack of accessible, affordable and acceptable orthodox care makes a significant proportion of the populace patronize the nearby available and cheap traditional birth attendants (TBAs) that share similar local custom and tradition. Although there are widely diverging shreds of evidence regarding their effectiveness as health care providers, they may have a limited role as a workforce during the ongoing COVID-19 pandemic where the more community-based distribution of commodities is increasingly considered due to movement restrictions. However, it is still doubtful if their integration into the formal health system may substantially contribute to basic health care delivery especially in the rural often hard to reach areas. Objectives: To explore the various roles of TBAs in reproductive health service delivery with implication for redefining their roles especially with the advent of the COVID-19 pandemic. Methodology: We searched and reviewed relevant literature on TBAs in PubMed, Africa Journals Online (AJOL) and Google scholar and relevant institutional websites for the role of TBAs pre and during the pandemic. The databases searched yielded 92 articles of potential significance to this review. After title/abstract review, 65 articles were moved to full document review. Nineteen articles explicitly and strictly focusing on TBAs concerning reproductive health were included in this review. Results: TBAs are providers of a wide range of reproductive health services and training to expand their roles and makes them safer is necessary for any consideration of their engagement; this implies the fight against COVID-19. TBAs should only be engaged if the gap in the resources for health must be filled by leveraging on their existing traditional roles and acceptance in the community. Conclusion: TBAs are widely utilised providers of care to their communities especially in the area of maternal care. With increasing emphasis on community-based services in healthcare delivery and the emergence of COVID-19, their roles must be reviewed and updated regularly to redefine their role in the health care delivery system especially because of the myriad personal and technical limitations associated with them. Any engagement with them should be with caution and as a stop-gap measur.

Comparative assessment of young people's psychosocial, economic state and reproductive health needs between total and partial lockdown states of Nigeria

Introduction: In Nigeria, adolescents and young adults, age 10-24 years constitute 32% of the entire population. They are particularly vulnerable when disasters occur, such as in the current pandemic. Existing events and circumstances including the various pandemic-related movement restrictions (lock-down) influences behavioural attitudes and predisposes to risky sexual behaviours.Methodology: This is a comparative cross-sectional study conducted between a total lockdown (Osun) state and partial lockdown (Oyo) state in South-Western Nigeria. A convenience sampling technique was adopted using a self-administered closed-ended questionnaire designed using Google form and data were then analysed using SPSS version 22. Bivariate analysis and Logistic regression were performed with the level of significance set at p < 0.05. Results: A higher proportion of those in Osun (total lockdown) state have their needs extremely difficult to meet during the pandemic period compared to Oyo (partial lockdown) had their needs only a little difficult to meet. Different factors were found to influence the social, economic effect and reproductive health needs but age and educational level attained were found to be common factors that affected young people needs during the lockdown period. Conclusion: Access to contraceptive drastically reduced during this pandemic, especially among those under total lockdown, this may consequently lead to the increase incidence of unwanted pregnancies among the youths, which if not well managed could lead to unsafe abortion and invariably, death. As new COVID-19 cases continue to emerge, staying at home for prolonged periods of time can pose a significant challenge on the health of young people.

Adolescent­parent communication on sexual and reproductive health issues amongst secondary school students in Western Region 1 of The Gambia

Background: Adolescent­parent communication about sexual issues is a challenging issue worldwide. In The Gambia, many traditional communities limit such communication and this can have an adverse influence on sexual and reproductive health (SRH) outcomes and behaviours in adolescents. Aim: The study assessed adolescent­parent communication on selected SRH issues amongst secondary school students. Setting: The study was conducted in selected secondary schools in Western Region 1 of The Gambia. Methods: This descriptive cross-sectional study utilised mixed methods. For the questionnaire survey, secondary school students were selected using a multistage sampling technique whilst parents for focus group discussions were purposively selected. Results: A total of 600 adolescents and 48 parents were studied. Only 360 (60.0%) of the students had heard of SRH. One-third (67.3%) knew about sexually transmitted infection (STIs) such as human immunodeficiency virus and acquired immunodeficiency syndrome (56.5%), gonorrhoea (40.5%) and syphilis (2.5%). Social media (31.0%) were the predominant source of information regarding SRH issues, followed by television (22.0%), school (14.0%) and parents (9.0%). Half (50.8%) of the adolescents discussed sexual intercourse with their parents ­ mostly with their mothers. Parental and cultural factors, fear, shyness and ignorance were the main reasons why adolescents did not discuss specific SRH issues with their parents. Conclusion: This study showed that adolescent­parent communication on SRH issues was poor. Programmes supporting parents to effectively communicate SRH matters with their children should be designed and implemented

Engaging students to improve sexual and reproductive health: a report of the university leadership for change initiative in Niger

Few development projects have addressed the sexual and reproductive health (SRH) needs of university students in West Africa or sought to promote student leadership to extend SRH benefits to others. This report presents results from the Evidence-to-Action Project's University Leadership for Change Initiative in Niger which had the goal to begin filling this gap. The Initiative used an innovative behavior change methodology with students at Abdou Moumouni University in Niamey, Niger and subsequently expanded it to three additional universities by applying ExpandNet scale-up approaches. 200 students trained as peer leaders reached almost 8,000 youths with SRH information and counseling, student leaders and university clinic staff distributed nearly 80,000 condoms and the project achieved national policy change through its collaboration with the Ministry of Public Health and the Ministry of Higher Education, Research and Innovations. The report concludes with key lessons about the benefits of student engagement and creativity in this effort

Sexual and reproductive health among high school adolescents in West Shoa zone, Oromia Region in Ethiopia

Adolescent's sexual and reproductive health is a challenge in many low and middle-income countries. We assessed the knowledge and attitude towards sexual and reproductive health among adolescents in West Shoa zone, Oromia region, Ethiopia. The study was cross-sectional using simple multi-stage random sampling and a structured questionnaire was used to collect data among adolescents aged 15 ­ 19 years. Frequency distribution of dependent and independent variables were computed and Odds ratios were calculated to determine association between variables. Most participants were from poor and illiterate families. Slightly over half of them had heard about sexual and reproductive health and the knowledge of emergency contraceptive was limited. About 80% of the girls who had become pregnant ended the pregnancy with an abortion and discussion between parents and adolescents on sexuality issues were poor. Effort to empower adolescents and communities with correct sexual and reproductive health is required; academic curricula should be reviewed and health facilities should be engaged to provide sexuality education