Presenter: Mirriam Shawa ( MPH, PGD, University of Limpopo)

1. Utilization of Reproductive Health Services by High School Adolescents in ThabaTseka District Presenter: MirriamShawa (MPH, PGD, University of Limpopo)

2. Overview of Presentation • Background of study • Aim of the study • Objectives of the study • Methodology • Results • Discussion and conclusion • Limitations of the study • Recommendations • References

4. BACKGROUND OF THE STUDY • Adolescence is a transformational human stage during which an individual is neither a child nor an adult (WHO, 2003). • It is characterised by risky behaviours such as unprotected sexual intercourse, alcohol and drug use.

5. Background (contd..) • These activities puts the health of the adolescent at a high risk with consequences such as unwanted pregnancy and unsafe abortion, contracting of sexually transmitted infections (STIs) including HIV and AIDS.

6. Background (contd..) • Youth friendly services were introduced in Lesotho in 1998 through the implementation of the adolescent health clinics (AHC) (Phafoli et al, 2007).

7. Background (contd..) • The strategy was aimed at providing access to reproductive health services (RHS) to the young people.

8. Background (contd..) • Despite this initiative, teenage pregnancy was estimated at 41% and prevalence of HIV infection among the youth at 22% in 2009 (Lesotho Demographic and Health Survey, 2009).

9. Background (contd...) • According to the Paray Mission Hospital records in 2008, 24% of ANC mothers were teenagers aged between 14 and 19 years. • In 2009 the statistic for the same period was 28%

11. Aim of the study • To investigate the utilization of reproductive health services among high school adolescents in Thaba-Tseka district of Lesotho.

12. Objectives of the study • To determine the proportion of high school adolescents that are sexually activein Thaba-Tseka district

13. Objectives (contd..) • To determine the extent of utilization of RHS among the sexually active high school adolescents in Thaba-Tseka district.

14. Objectives (contd..) • To determine the possible factors that influence the utilization of RHS among sexually active high school adolescents in Thaba-Tseka district.

15. Methodology • A quantitative descriptive cross-sectional study design was used. • The study population was all the adolescents aged between 13 -19 years in two high schools in Thaba-Tseka district.

16. Methodology (contd..) • Eight hundred questionnaires were distributed and 780 were completed at the response rate of 97.5% (780/800). • A structured self-administered questionnaire was used to obtain data.

17. Methodology (contd..) • Data capturing and cleaning was done using Microsoft Excel 2003 spreadsheet. • Data analysis was done using StataIC 10 window version. • Binary logistical regression modelling was carried out to identify significant predictors of RHS utilisation.

18. Results Figure 1: Proportion of sexually active respondents (n=723)

19. Figure 3: Proportion of respondents awareness level on AHC services (n= 723)

20. Figure 4: Proportion of sexually active respondents who had ever utilised AHC services (n= 358)

21. Figure 4: Distribution of AHC services utilised by sexually active respondents (n =136)

22. Table 1: Factor influencing utilization of AHC services

24. Discussion and Conclusion • Adolescents engage in sexual activity and most of them do so at a very early age. • More than ¾ of those presently sexually active used some form of contraceptive with majority reporting condom use.

25. Discussion (contd..) • Consistency of condom use is questionable because majority of respondents 95.2% (218/229) indicated buying them from shops. • Some respondents reported using bread wrapping plastic for protection during intercourse • Inconsistent condom use may lead to STIs and unplanned pregnancy.

26. Discussion (contd..) • More than half of the sexually active respondents reported experiencing signs of STIs. • There was under-utilization of RHS with just more than a third 37.9% [136/358]) of the sexually active respondents ever visiting AHC for services. • Only 13.3% (27/203) of respondents who had ever experienced signs of STI sought treatment from the AHC.

27. Discussion (contd..) • Embarrassment, shyness, fear of being seen by people and being uncomfortable to visit the AHC due to lack of privacy were found to be some of the reasons for not utilising the services among adolescents in this study.

28. Discussion (contd..) • The most statistically significant predictors influencing utilization of RHS were; having a friend using the RHS, and having access to RHS.

29. Limitations of the study • The self-reporting of sexual practices may have led to information bias. • The quantitative study design did not allow for probing into certain areas which needed further interrogation.

30. Limitations (contd..) • The study was conducted only in two high schools therefore the findings of the study may not be generalizable.

31. Recommendations • There is a need to embark on increasing awareness and accessibility of RHS among adolescents to promote utilization.

32. Recommendations (contd..) • Need to conduct a similar study on a larger scale or even at a national level. • Evaluate the existing RHS in the country for accessibility or availability especially in disadvantaged areas.

34. References • Phafoli SH, Van Aswegen EJ, Albertus UU. Variables influencing delay in antenatal clinic attendance among teenagers in Lesotho. South African Family Practice 2007;49(9) • Lesotho Demographic and health survey. Ministry of Health and Social Welfare, 2009. • WHO. Adolescent Health and Development in the African Region. WHO, Brazzaville, 2003. • Cartoon source www.CartoonStock.com

35. Thank you!