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BACKGROUND: Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia. METHODS: This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies. RESULTS: Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment. CONCLUSION: From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.
Pregnancy increases risk of adverse short- and long-term outcomes for adolescent mothers and their babies. Adolescent pregnancy is significantly high in Zambia. However, the risk factors are varied and in need of further review and research. Using a systematic review process, we identify the trends and factors that influence adolescent pregnancy in Zambia from research articles published since 2000. We found that prevalence of adolescent pregnancy in Zambia was between 29%-48% and that nationally, 29.1% of the country's adolescents had given birth as of 2018. Factors identified as influencing adolescent pregnancy in Zambia were analysed at four levels: 1) individual factors such as early or child marriage, exposure to media, knowledge about sexual and reproductive health and contraception, contraceptive use, as well as risky sexual behaviours; 2) interpersonal level factors such as peer pressure, educational attainment, household wealth, influence of male or female headed households, and family members; 3) community/environmental factors such as socio-cultural, gender and sexual norms; and 4) an enabling policy/legal environment covering mostly access to SRH information and services. It was emphasized that various stakeholders should deliberately collaborate to address these issues at all four levels using interventions that are socio-culturally suitable and should be supported by strong political will at policy and implementation levels to facilitate better access to education, improve economic empowerment of girls, review of gender and dysfunctional cultural norms and practices, amongst other considerations.
RESUMO
OBJECTIVE: We examined the national prevalence as well as the individual and contextual factors associated with maternal healthcare utilisation in Mali. SETTING: The study was conducted in Mali. PARTICIPANTS: We analysed data on 6335 women aged 15-49 years from Mali's 2018 Demographic and Health Survey. OUTCOME VARIABLE: Maternal healthcare utilisation comprising antenatal care (ANC) attendant, skilled birth attendant (SBA), and postnatal care (PNC) attendant, was our outcome variable. RESULTS: Prevalence of maternal healthcare utilisation was 45.6% for ANC4+, 74.7% for SBA and 25.5% for PNC. At the individual level, ANC4 + and SBA utilisation increased with increasing maternal age, level of formal education and wealth status. Higher odds of ANC4 + was found among women who are cohabiting (adjusted OR (aOR)=2.25, 95% CI 1.16 to 4.37) and delivered by caesarean section (aOR=2.53, 95% CI 1.72 to 3.73), while women who considered getting money for treatment (aOR=0.72, 95% CI 0.60 to 0.88) and distance to health facility (aOR=0.73, 95% CI 0.59 to 0.90) as a big problem had lower odds. Odds to use PNC was higher for those who were working (aOR=1.22, 95% CI 1.01 to 1.48) and those covered by health insurance (aOR=1.87, 95% CI 1.36 to 2.57). Lower odds of SBA use were associated with having two (aOR=0.48, 95% CI 0.33 to 0.71), three (aOR=0.37, 95% CI 0.24 to 0.58), and four or more (aOR=0.38, 95% CI 0.24 to 0.59) children, and residing in a rural area (aOR=0.35, 95% CI 0.17 to 1.69). Listening to the radio and watching TV were associated with increased maternal healthcare utilisation. CONCLUSION: The government should increase availability, affordability and accessibility to healthcare facilities by investing in health infrastructure and workforce to achieve Sustainable Development Goal 3.4 of reducing maternal morality to less than 70 deaths per 100 000 live births by 2030. It is important to ascertain empirically why PNC levels are astonishingly lower relative to ANC and SBA.
