Health providers' perceptions of adolescent sexual and reproductive health care in Swaziland.

AIM: To explore health providers' perceptions of adolescent sexual and reproductive healthcare services in Swaziland. METHODS: Fifty-six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes. FINDINGS: Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents' situation. Forty-four wanted to be trained on post-abortion care while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly services and to train heathcare providers in adolescent sexual and reproductive health services. CONCLUSION: The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in Swaziland and appropriate youth-friendly services at all levels. There is need for nurse/midwifery participation, advocacy and leadership in policy development.

Adolescents' views on decision-making regarding risky sexual behaviour.

PURPOSE: To explore adolescents' views regarding risky sexual behaviour who were aged between 13 and 19 years. METHODS: A purposive sample was drawn from adolescents who were participating in workshops, organized by the Ministry of Health and Social Welfare. The sample consisted of a mix of in-school and out-of-school adolescents aged between 13 and 19 years. The overall aim of the workshops was to explore adolescents' views on decision-making regarding risky sexual behaviour. The educational status of participants lay between grades 0 and 12. A total of 24 focus group discussions were conducted, six in each of the four regions of Swaziland (Manzini, Hhohho, Lubombo and Shiselweni). Each group consisted of 6-12 participants. All focus group discussions were audiotaped and later transcribed. FINDINGS: The following four major themes emerged from content analysis: sexual behaviour, age at first intercourse, peer pressure and trust in the relationship. These were all found to be important factors in decision-making for risky sexual behaviours. CONCLUSIONS: Obtaining a sexual history, motivation to use condoms, guidance and counselling on ways to reduce adolescents' risk of sexual exploitation, and peer education programmes, are all of importance when aiming to reduce risky sexual behaviour. RECOMMENDATION: Adolescents should receive positive reinforcement for responsible sexual behaviour including abstinence and, where appropriate, use of active birth control.

Quality of maternity care for adolescent mothers in Mbabane, Swaziland.

Early pregnancy and unplanned childbirth may have far-reaching physical, psychological and social consequences for the adolescent girl and her offspring and are therefore public health issues of concern. A number of evidence-based maternity practices might, if properly applied, prevent unnecessary health-related problems in mothers and newborns, postnatally. In order to identify the areas of maternity practice that require improvement in Swaziland, the overall aim of this study was to generate systematic data on the maternity care and social support provided by health professionals (for adolescent mothers and their children) on admission, in the labour ward, and during and after delivery. The study was carried out during a 3-month period from April to June 1998. All pregnant adolescents with an uneventful term pregnancy, admitted to the Mbabane Government Hospital maternity ward in the morning of the study days, were informed about the purpose of the study and asked if they would like to participate. A total of 33 pregnant adolescents agreed and in-depth interviews were conducted with those participants. Observations and checklists were used to assess the maternity care given to the study participants. Results revealed that on admission to the labour ward, verbal communication and interaction between the midwife and the adolescent were minimal, and none of the adolescents was encouraged to bring a social support person to remain with them during labour. During the progress of labour, nearly 50% of the adolescent mothers developed complications and approximately 27% had a lower-segment Caesarean section. Special attention should therefore be paid to adolescent sexual and reproductive health service needs. These should include contraceptive counselling in order to prevent pregnancy at a young age and also to improve their sexual and reproductive health statuses.

Targeted intervention research studies on sexually transmitted diseases (STD): methodology, selected findings and implications for STD service delivery and communications.

OBJECTIVE: To report the findings of qualitative studies designed for use in improving sexually transmitted disease (STD) programs. The studies explore illness conceptions and treatment behaviors for STD in five African countries. These targeted intervention research (TIR) studies were performed on clinic-based and community-based samples in representative communities and utilized a variety of qualitative research methods (e.g. in-depth and key informant interviews, focus group discussions). FINDINGS: Study findings revealed that community members' explanations of symptoms, classification of illnesses, and perceptions of whether symptoms are pathological or serious influence individual health-care-seeking behaviors. Data also showed that local terms for STD are often disparaging and do not fit into biomedical designations. STD patient care-seeking frequently reflects an ordered, albeit loosely constructed, process of elimination in pursuit of symptom relief, wherein alternative treatments are tried and proven effective or abandoned. CONCLUSIONS: The TIR studies highlight the importance of community-specific strategies aimed at increasing prompt care seeking at qualified biomedical facilities. Information from study data should lead programs to sensitize health professionals to community understanding about STD and to design services and communication programs that are meaningful and appropriate to local contexts.

PIP: Targeted intervention research (TIR) studies were performed in five African countries (Senegal, Ethiopia, Benin, Morocco, and Swaziland) to improve the utilization of a community perspective in sexually transmitted disease (STD) programs. TIR, conducted by program managers with the aid of a multidisciplinary technical advisory group, examines factors at five levels of analysis (individual, social network, organization, community, and policy) through a variety of qualitative methods. The TIR studies indicated that patients' conceptions of normal versus abnormal health are fundamental to the process of interpreting symptoms and subsequently seeking care. The interpretation of STD symptoms varied across settings (e.g., vaginal lesions and discharge were considered signs of healing in Morocco and Benin), but increasing pain and discomfort were key triggers to seeking treatment. The concept of sexual transmission was blended with other causes such as violation of religious or moral codes, consumption of certain foods, and supernatural forces. Care-seeking tended to reflect an ordered yet loosely constructed process of elimination in pursuit of symptom relief, beginning with alternative regimens. Barriers to biomedical STD care included the need for husband's permission, costs, confidentiality concerns, long waits in public clinics, and fear of judgmental health provider attitudes. Overall, the findings highlight the importance of location-specific strategies aimed at increasing prompt care-seeking at qualified biomedical facilities.