Alternative Delivery Platforms for Expanding Evidence-based Mental Health Interventions for Youth in Sierra Leone: A Pilot Study.

Given the high rates of mental health problems and poor service access among youth in war-affected countries throughout Sub-Saharan Africa, incorporating evidence-based mental health interventions into alternative delivery platforms could improve service access in these settings. We conducted a randomized controlled pilot study with high-risk Sierra Leonean youth to investigate the feasibility of implementing the Youth Readiness Intervention (YRI), a cognitive behavioral and interpersonal therapy-based group intervention, within an employment promotion program (EPP) and preliminary effects of the YRI on mental health outcomes. Participants were 175 youth (females=62%) ages 18-30 recruited via flyers and radio announcements. Participants were assigned to geographic clusters stratified by gender; clusters were randomized into YRI+EPP (n=58) or EPP-only (n=57). Statistically matched controls were recruited from comparable chiefdoms (n=60). The 12-session YRI was delivered bi-weekly, following EPP completion. Qualitative findings indicated that the YRI was highly feasible and acceptable as integrated into the EPP. Mixed linear effects models showed promising trends. Compared with controls, both YRI+EPP and EPP-only males reported significantly reduced post-traumatic stress symptoms, and YRI+EPP reported marginally significantly reduced emotional regulation difficulties. EPP-only females reported significantly reduced functional impairment compared to controls. Findings suggest that the YRI can be feasibly implemented within an EPP. Integrating the YRI into existing delivery platforms may help increase access to mental health care in Sierra Leone and provide a leverage point for scaling up evidence-based mental health interventions in other low-resource settings globally. [Clinicaltrials.gov; NCT0360361; 5/18/18].

Factors Affecting Continued Use of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC): A Secondary Analysis of a 1-Year Randomized Trial in Malawi.

OBJECTIVE: To assess the supply- and demand-side factors influencing continued use of the injectable contraceptive subcutaneous depot medroxyprogesterone acetate (DMPA-SC). METHODS: We conducted a 12-month randomized controlled trial in Malawi to measure DMPA-SC continuation rates. A total of 731 women presenting to clinic-based providers (CBPs) at 6 Ministry of Health clinics or to community health workers (CHWs) in rural communities were randomized to receive DMPA-SC administered by a provider or be trained to self-inject DMPA-SC. Data collectors contacted women after the reinjection window at 3, 6, and 9 months to collect data on discontinuation and women's experiences. Twelve months after enrollment or at early discontinuation, women had their final interview, including pregnancy testing. We compared continuation, pregnancy, and safety by whether DMPA-SC or self-injection training was provided by CHWs versus CBPs. We also conducted an exploratory analysis assessing the association between women's sociodemographic factors and the risk for discontinuation using stratified Cox proportional hazards models. FINDINGS: The type of provider did not seem to influence continuation, pregnancy, or safety. As reported previously, women in the self-injection group were significantly less likely to discontinue the method compared with women in the provider-administered group (hazard ratio, 0.43; P<.001). The risk for discontinuation was also different among health facility catchment sites (P<.001). No other assessed sociodemographic factors were found to significantly influence the risk for discontinuation. CONCLUSIONS: Public-sector CHWs can safely and effectively provide DMPA-SC and train women to self-inject DMPA-SC in low-resource settings. DMPA-SC continuation did not seem to be influenced by the type of provider, whether CBP or CHW, or women's sociodemographic characteristics.

Correlates of Rapid Repeat Pregnancy Among Adolescents and Young Women in Uganda.

CONTEXT: Short pregnancy intervals can contribute to maternal and child morbidity and mortality. No previous research has explored factors associated with short pregnancy intervals among young women in Uganda, where adolescent pregnancy and short birth intervals are common. METHODS: Data on 626 married or cohabiting women aged 15-22 with one or two previous pregnancies were drawn from the 2011 Uganda Demographic and Health Survey. Bivariate and multivariable logistic regression analyses were used to examine characteristics associated with rapid repeat pregnancy, defined in two ways: a pregnancy occurring within 24 months or 12 months of a prior pregnancy outcome. RESULTS: Among women, 74% and 37% had experienced a rapid repeat pregnancy within 24 months and 12 months, respectively. Rural women were more likely than urban women to have had a rapid repeat pregnancy within 24 months (odds ratio, 2.4). Women aged 15-17 and those 18 or older at first union were more likely than women younger than 15 to have had a rapid repeat pregnancy within 24 months (3.8 and 3.4); those whose partner had at least a secondary education had lower odds than others of the outcome (0.6). The odds of rapid repeat pregnancy increased with the number of months between marriage and first birth (1.05). Variables associated with rapid repeat pregnancy within 12 months included urban-rural residence, region, age at first union and marriage-to-birth interval. CONCLUSIONS: Efforts to reduce rapid repeat pregnancy among young women in Uganda should focus on rural areas. Strategies to reach women during antenatal care and the postpartum period after their first birth should be prioritized.