Obstetric outcomes and antenatal access among adolescent pregnancies in Kwazulu-Natal, South Africa

Background: Pregnancy among adolescents in South Africa is a growing concern as it may be associated with adverse socioeconomic and health impacts. Timeous initiation and optimal utilisation of antenatal care (ANC) services is imperative to ensure positive pregnancy outcomes. However, this is not always possible owing to various challenges. Methods: A multi-method study design using both retrospective record review and qualitative interviews was undertaken at a district hospital on the North Coast of KwaZulu-Natal, South Africa. Data on ANC attendance trends and obstetric/perinatal outcomes for all recorded adolescent pregnancies (13­16 years) at the district hospital under study was collected over 3 years (2011­2013) (n = 314). Qualitative interviews with randomly selected pregnant adolescents were conducted to assess experiences of ANC access and utilisation.Results: Late ANC booking and reduced ANC visits were common for adolescent pregnancies. Under-utilisation of ANC (i.e. less than 4 visits) was significantly associated with lower gestational age (< 37 weeks) (OR = 2.64; 95% CI = 1.04; 6.74; p < 0.05). Low birthweight, low Apgar scores as well as the incidence of maternal anaemia and pregnancy-induced hypertension (PIH) were found to be related to late ANC booking. In-depth interviews suggested that teenagers suffered emotional vulnerability linked to family, partner and financial support. They discussed various barriers linked with accessing ANC while acknowledging perceived benefits.Conclusion: Adolescent pregnancy was associated with late booking and reduced ANC visits, which was a risk for adverse maternal health outcomes. In-depth interviews suggested numerous challenges associated with ANC access including; financial barriers, attitude of healthcare workers (HCWs), long queues, distance travelled to access ANC services, human immunodeficiency virus (HIV) status and a lack of knowledge

HIV/AIDS Knowledge; Behaviour and Beliefs Among South African University Students

Globally; South Africa has the highest prevalence of HIV/AIDS. In the absence of cure; prevention is the only available method to reduce HIV prevalence rates. This can only be obtained through behavioural change; which is associated with a good knowledge about HIV. The study aims to determine the knowledge; beliefs; behaviours and sources of HIV and AIDS information among university students at two tertiary institutions in South Africa. The study was a quantitative; cross-sectional; descriptive and comparative survey. Students from the Western Cape Province and the KwaZulu-Natal Province participated in the study. The main findings of the study were that althoughstudents had an adequate general knowledge on HIV/AIDS; both groups scored the lowest in the transmission modes of HIV. The media was the main source of HIV/AIDS information for students and university health care facilities need to be more proactive in informing students about the transmission of HIV/AIDS

SISTA South Africa: The Adaptation of an Efficacious HIV Prevention Trial Conducted with African-American Women for isiXhosa-speaking South African Women

Although new HIV treatments continue to offer hope for individuals living with HIV; behavioural interventions shown to reduce HIV risk behaviour remain one of the most powerful tools in curbing the HIV epidemic. Unfortu- nately; the development of evidencebased HIV interventions is a resource-intensive process that has not progressed as quickly as the epidemiology of the disease. As the epidemic continues to evolve; there is a need to expedite the development of evidence-based HIV interventions for populations that are often disproportionately impacted by HIV/AIDS. One mechanism of accelerating the development process is to adapt evidence-based HIV interventions for vulnerable populations. The aim of this paper was to describe the adaptation process of a HIV intervention for African-American women for black South African Xhosa women. For African-American women the intervention was effective in increasing consistent condom use; sexual self-control; sexual communication; sexual assertiveness and partner adoption of norms supporting consistent condom use

Determinants of communication between partners about STD symptoms: implications for partner referral in South Africa

"Background: STDs as preventable diseases are a major public health problem in South Africa; both in terms of their effect on quality of life; their economic costs and the fact that STDs as co-factors drive the HIV epidemic. Their widespread occurrence and high prevalence rates are cause for concern. It is argued that the duration of infection increases the probability of harmful sequelae and STD transmission; including HIV; to others. The promotion of seeking health care for STD symptoms at an early stage and partner referral for STD treatment are important strategies in preventing STD transmission to others and re-infection of partners. The cost implications of contact tracing by healthcare workers has resulted in patients being encouraged to refer their partners for STD treatment. This has not always been effective; despite efforts to improve partner referral rates by improved ""contact cards"" (i.e. a card with a code representing the STD that the patient has been treated for to be given to sexual partners as a way to speed up treatment) and more accessible healthcare services. Other studies have found that the proportion of clients who present with contact cards at STD services ranged from about 2 to 39 ; while the proportion of partners who were referred for treatment range from 16 to 30 . Mathews et al. argue that returning contact cards might not be a sensitive enough proxy indicator for partner referral rates.Partner referrals have been found to be seriously compromised by patients' causal explanations for STDs; as well as by the unequal power of the genders in sexual relationships; which impacts on the patients' ability to communicate about sexual matters. Patients often lack an understanding of the importance of referring their asymptomatic partners for treatment. Women's inability to discuss sexual issues due to their unequal status in sexual relationships might impact on partner referral behaviour. Men have been found to blame the STD on the ""outside women"" (sexual partners outside the primary relationship) and are therefore less likely to refer these partners. The conflict that could arise from informing a partner about an STD was viewed by men as a reason not to communicate about having a STD.While the ability to communicate about STDs with sexual partners is an essential prerequisite for referring them for medical treatment; little attention has been paid to understanding this process. This study is aimed at gaining some understanding of the determinants of communication between partners about STD symptoms. In this study; ""talking with a partner about STD symptoms"" before seeking medical treatment was viewed as an indication of the likelihood of future partner referral behaviour. Methods A randomly selected sample of 1 477 patients with STD symptoms was interviewed using a structured questionnaire. Logistic regression analysis was used to identify the determinants of talking to a partner about the present STD.ResultsIt was found that patients who had talked with their partner about their current STD symptoms were more likely to be female; be employed; have a tertiary level of education; have had only one sexual partner in the preceding six months; have used condoms; albeit inconsistently during the last six months; and to have thought about abstaining from sex while infected. Those who talked were also more likely to have good knowledge about the effects of STDs and the transmission of STDs in the absence of symptoms; had positive attitudes towards condoms and perceived social support for partner referral. Conclusion: Improved partner referral through health education interventions needs to focus specifically on a subgroup of patients; e.g. men and the unemployed; and on the improvement of knowledge regarding the consequences of STDs and asymptomatic transmission. Social and partner support for partner referral and perceived self-efficacy in this regard should be encouraged and maintained. In the absence of skills and counselling services to manage the consequences of STD partner referral; this prevention strategy will remain vulnerable."