Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District– Uganda

  • International Journal for Equity in Health, Volume 19, No. 1, Year 2020

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Study Justification:
– The study aimed to address the maternal health challenges faced by adolescents in Kibuku District, Uganda.
– Approximately 34.8% of the Ugandan population is adolescents, and the national teenage pregnancy rate is 25%.
– In Kibuku District, 17.6% of adolescents aged 12-19 years have begun childbearing.
– Adolescents mothers are vulnerable to many maternal health challenges including stigma, unfriendly services, and early marriages.
– The study aimed to explore these challenges and propose potential solutions.
Study Highlights:
– Qualitative study conducted in August 2018 using in-depth interviews.
– 15 adolescent women who had given birth 2 years prior to the study and had attended Community Score Card (CSC) meetings were interviewed.
– Challenges faced by adolescents during pregnancy, delivery, and postnatal period were identified.
– The CSC addressed general maternal and newborn health issues of the community as a whole, but not specific adolescent health-related maternal health challenges.
– Multi-faceted approach needed to holistically address the challenges faced by adolescents.
Study Recommendations:
– Separate meetings with adolescents should be conducted to address their specific maternal health challenges.
– Targeted mobilization is needed to encourage adolescents to attend CSC meetings.
– Deliberate inclusion of adolescent maternal health challenges into the CSC is necessary.
Key Role Players:
– Sub-county score card coordinators and Village Health Team (VHT) coordinators.
– Research assistants for data collection.
– Kibuku District health office for permission to carry out the research.
Cost Items for Planning Recommendations:
– Payment for CSC coordinators and VHTs for coordination of the project during the intervention.
– Training and payment for research assistants.
– Ethical clearance and approval from relevant committees.
– Costs associated with data collection, transcription, and analysis.
– Costs for mobilization and organization of separate meetings for adolescents.
– Costs for including adolescent maternal health challenges into the CSC.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study conducted in Kibuku district, Uganda. The study utilized in-depth interviews with 15 adolescent women who had given birth 2 years prior to the study and had attended community score card (CSC) meetings. The data was manually analyzed using the framework analysis approach. While the study provides valuable insights into the maternal health challenges faced by adolescents and the extent to which the CSC addressed these challenges, there are a few areas for improvement. Firstly, the sample size is relatively small, which may limit the generalizability of the findings. Secondly, the study does not provide information on the representativeness of the sample and the selection process of the participants. To improve the strength of the evidence, future studies could consider increasing the sample size and ensuring a more rigorous sampling strategy to enhance the generalizability of the findings.

Introduction: Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12–19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges. Methods: This qualitative study utilized in-depth interviews conducted in August 2018 among 15 purposively selected adolescent women who had given birth 2 years prior to the study and had attended CSC meetings. The study was conducted in six sub counties of Kibuku district where the CSC intervention was implemented. Research assistants transcribed the audio-recorded interviews verbatim, and data was analyzed manually using the framework analysis approach. Findings: This study found five major maternal health challenges faced by adolescents during pregnancy namely; psychosocial challenges, physical abuse, denial of basic human rights, unfriendly adolescent services, lack of legal and cultural protection, and lack of birth preparedness. The CSC addressed general maternal and new born health issues of the community as a whole rather than specific adolescent health related maternal health challenges. Conclusion: The maternal health challenges faced by adolescents in Kibuku have a cultural, legal, social and health service dimension. There is therefore need to look at a multi-faceted approach to holistically address them. CSCs that are targeted at the entire community are unlikely to address specific needs of vulnerable groups such as adolescents. To address the maternal health challenges of adolescents, there is need to have separate meetings with adolescents, targeted mobilization for adolescents to attend meetings and deliberate inclusion of their maternal health challenges into the CSC.

We carried out a qualitative study in August 2018 using In-depth Interviews (IDIs) to explore the maternal health challenges faced by adolescents during pregnancy, delivery and the post-natal period. We also explored the extent to which the maternal health challenges reported by adolescents had been addressed by the community score card intervention. This study was carried out in Kibuku district, which is located in the eastern region of Uganda with a population of 202,033 people and with 52% of the population being female. People aged 10–17 years are 23% of the total population [38]. The study was carried out in six sub-counties of Kibuku district where the CSC intervention was implemented. The intervention targeted the entire population of the six sub counties. A total of 15 IDIs were conducted among purposively selected adolescent women from six sub-counties. The sub-county score card coordinators and the Village Health Team (VHT) coordinators of the six sub-counties where the CSC was implemented were asked to identify any adolescents who had given birth 2 years prior to the study so as to reduce recall bias and these adolescents should have participated in at least one CSC meeting. Village Health Teams refer to volunteers who are actively involved in coordinating health related issues at community level. They are involved in community mobilization for health activities, promoting hygiene and sanitation, and health education.. The CSC coordinators and VHTs were paid for coordination of the project during the intervention. The IDIs were conducted face to face within the participants’ homes using a guide with open-ended questions that explored the main themes of maternal health challenges faced by adolescents and extent to which CSC addressed those maternal health challenges. Three experienced female research assistants who had a good working knowledge of English and Lugwere (the local language) were recruited and trained in data collection. The IDI guide was translated from English to Lugwere, then back translated and compared to ensure consistency and pre-tested in Kampala district. Written consent was received from each of the interviewees. The interviews, which lasted an average of 2 hours each, were audio recorded, and transcribed verbatim to prepare for analysis. The data was manually analyzed using the framework analysis approach [39, 40]. The transcripts were read and a thematic framework developed on word document based on the major maternal health challenges found to be faced by adolescents during the antenatal, delivery and postnatal period to answer objective one. To answer objective two, we included the major theme of, the extent to which the CSC addressed the adolescent maternal health challenges.. Five sub themes merged from maternal health challenges major theme from the data including; psychosocial challenges, physical abuse and violation of human rights, lack of legal and cultural protection, inadequate adolescent friendly services at health facilities, lack of birth preparedness. For the theme on the extent to who the CSC address the challenges emerged three sub themes including; attendance of CSC meetings by the adolescents, participation of adolescents during the meetings, and selection of indicators to be included in the CSC. We then systematically applied this framework to each of our transcripts and sifted, charted and sorted material according to the themes. We summarized our results using text and quotes from the transcripts that elaborately illustrated meanings or key messages. Ethical clearance was obtained from the Makerere University School of Public Health Higher Degrees Research and Ethics Committee (MakSPH HDREC) and approval from the Uganda National Council of Science and Technology (UNCST), study number SS 4323. Permission to carry out the research was further sought from the Kibuku district health office. The objectives, benefits and risks of the study were explained to the study participants and written informed consent obtained from all the participants. All data obtained were treated as confidential and anonymous identifiers were used. We restricted data access to only the investigators and the three research assistants. Investigators also actively participated in the data collection process through supervision of data collection and daily debrief meetings.

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Adolescent-specific meetings: To address the specific maternal health challenges faced by adolescents, separate meetings could be organized specifically for this age group. This would create a safe and supportive environment where adolescents can openly discuss their concerns and receive targeted information and support.

2. Targeted mobilization: Implement targeted mobilization strategies to ensure that adolescents are aware of and encouraged to attend meetings and participate in maternal health discussions. This could involve working closely with community leaders, schools, and other relevant stakeholders to reach out to adolescents and promote their active involvement.

3. Deliberate inclusion of adolescent maternal health challenges: When implementing community score cards (CSC), it is important to deliberately include the maternal health challenges faced by adolescents. This could involve selecting indicators that specifically address the needs and concerns of adolescent mothers, ensuring that their unique experiences are adequately represented in the CSC process.

These innovations aim to address the multi-faceted challenges faced by adolescents in accessing maternal health services, including stigma, unfriendly services, and lack of legal and cultural protection. By creating targeted interventions and incorporating adolescent-specific perspectives into existing initiatives like the community score card, it is possible to improve access to maternal health for this vulnerable population.
AI Innovations Description
The recommendation to improve access to maternal health for adolescents in Kibuku District, Uganda is to develop separate meetings and targeted mobilization specifically for adolescents. This will ensure that their unique maternal health challenges are addressed and included in the community score card (CSC) intervention.

The recommendation is based on a qualitative study conducted in August 2018, which explored the maternal health challenges faced by adolescents during pregnancy, delivery, and the postnatal period. The study found that adolescents face challenges such as psychosocial issues, physical abuse, denial of basic human rights, lack of legal and cultural protection, unfriendly adolescent services, and lack of birth preparedness.

The CSC is a social accountability tool that aims to identify and address challenges faced by the community in service delivery and utilization. However, the study found that the CSC addressed general maternal and newborn health issues of the community as a whole, rather than specific adolescent health-related maternal health challenges.

To address the maternal health challenges of adolescents, the recommendation is to have separate meetings with adolescents, targeted mobilization to encourage their attendance, and deliberate inclusion of their maternal health challenges into the CSC. This approach will ensure that the specific needs of vulnerable groups, such as adolescents, are addressed and that they have a voice in the decision-making process regarding their maternal health.

Ethical clearance was obtained for the study, and written informed consent was obtained from all participants. The data collected was treated as confidential and anonymous identifiers were used to protect the participants’ privacy. The study was conducted in collaboration with the Kibuku District health office and had approval from the Makerere University School of Public Health Higher Degrees Research and Ethics Committee and the Uganda National Council of Science and Technology.
AI Innovations Methodology
Based on the provided information, the study aimed to explore the maternal health challenges faced by adolescents in Kibuku District, Uganda, and assess the extent to which the community score card (CSC) intervention addressed these challenges. The methodology used in the study involved qualitative research methods, specifically in-depth interviews (IDIs) with 15 adolescent women who had given birth two years prior to the study and had attended CSC meetings.

Here is a brief description of the methodology used in the study:

1. Study Design: The study utilized a qualitative approach to gain an in-depth understanding of the maternal health challenges faced by adolescents and the effectiveness of the CSC intervention in addressing these challenges.

2. Sampling: Purposive sampling was used to select 15 adolescent women who had given birth two years prior to the study and had participated in CSC meetings. The sub-county score card coordinators and Village Health Team (VHT) coordinators identified these participants.

3. Data Collection: In-depth interviews were conducted face-to-face within the participants’ homes. The interviews were audio recorded and lasted an average of 2 hours each. A guide with open-ended questions was used to explore the main themes of maternal health challenges faced by adolescents and the extent to which the CSC addressed these challenges.

4. Data Analysis: The audio-recorded interviews were transcribed verbatim and analyzed manually using the framework analysis approach. A thematic framework was developed based on the major maternal health challenges identified and the extent to which the CSC addressed these challenges. The transcripts were read, and the data was sifted, charted, and sorted according to the themes.

5. Ethical Considerations: Ethical clearance was obtained from the Makerere University School of Public Health Higher Degrees Research and Ethics Committee and approval from the Uganda National Council of Science and Technology. Informed consent was obtained from all participants, and confidentiality and anonymity were ensured.

The study found five major maternal health challenges faced by adolescents during pregnancy: psychosocial challenges, physical abuse, denial of basic human rights, unfriendly adolescent services, lack of legal and cultural protection, and lack of birth preparedness. The CSC intervention addressed general maternal and newborn health issues of the community as a whole, but not specific adolescent health-related maternal health challenges.

In conclusion, the study suggests the need for a multi-faceted approach to holistically address the maternal health challenges faced by adolescents. To address these challenges, separate meetings with adolescents, targeted mobilization for adolescents to attend meetings, and deliberate inclusion of their maternal health challenges into the CSC are recommended.

Statistics:
Citations: 10
Authors: 9
Identifiers:
DOI: 10.1186/s12939-020-01267-4
Research Areas:
Community Interventions, Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Technology and Innovations, Violence and Injury
Study Countries:
Uganda
Study Design:
Case Study, Cross Sectional Study, Grounded Theory, randomised-control-trial
Study Approach:
Qualitative
Participants Gender:
Female
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