Quality Provision of Comprehensive Sexuality Education and Sexual and Reproductive Health in Resource Constrained Higher Education Institutions: A Case of Mukuba University

In an effort to ensure that Institutions of Higher Learning provide quality Comprehensive Sexuality Education (CSE) and Sexual and Reproductive Health (SRH) at the level of Universities and Colleges, indeveloping countries such as Zambia, some universities have engaged in offering programmes and services in CSE and SRH. However, the provision of such programmes has had some limitations in terms of resources to ensure quality delivery. As a result, there was a need to examine the provision of CSE and SRH in a resource constrained Mukuba University. The study has three research objectives: 1) to examine the CSE and SRH programmes and services that are available at Mukuba University;2) to determine the actual resources available for the University to ensure quality provision of CSE and SRH to students;3) to use views and opinions of students and academics to examine the extent to which the CSE and SRH are reflected as standards by UNESCO and universities and colleges. The study took a pragmatic philosophy stance and convergent parallel research design of mixed methods;the primary approach is qualitative which will be analysed using thematic analysis, while the quantitative approach was secondary and the data was analysed using descriptive statistics. The study envisaged some implications that include the rise in communicable diseases such as Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS), gender based violence, general lack of information on matters relating to CSE and SRH among students at Mukuba University. The policy implication is that policy makers will be able to formulate policies that address the needs and challenges of students in providing quality CSE and SRH programmes and services for a university that is constrained with resources. The study found that there was a need to contextualize the quality provision of CSE and SRH at an institutional level, for instance, Mukuba University has created an enabling environment for quality provision of CSE and SRH activities and programmes through training of the stakeholders. Further, it was found that in any successful programme, it is expected to meet certain challenges that might in some cases make it difficult to implement the programme as envisaged. In other words, this study has revealed that there are some drawbacks as well as lessons that Mukuba University could learn from other universities that offer CSE and SRH. The study provides a synergistic conceptual model that could be used in the implementation of CSE and SRH in colleges and universities for sustainability. It is hoped that this study has proved that even with limited resources a university can provide CSE and SHR programmes and services without depending on support from other external funders and cooperating partners.

Evaluation of adolescent/youth-friendly sexual and reproductive health services:A 7-year systematic review from January 2016 to April 2022

Adolescent/youth-friendly sexual and reproductive health services(SRHS)play a vital role in reducing morbidity and mortality associated with adolescent SRH.This review examined studies carried out on adolescent/youth-friendly SRHS with focus on availability,accessibility,utilization as well as perception of health care providers,and adolescents about the services.The study design was systematic review of empirical studies using a well-defined strategy.Online journal was searched comprehensively using Web of Science,Google Scholars databases,PubMed,Medline,and EMBASE.Other sources were identified through the scanning of references of selected sources.The articles selected were between 2016 and 2022 and had qualitative/quantitative and mixed methods.The articles that met the selection criteria were also screened using PRISMA-P guidelines and SPIDER framework for systematic review was further used for inclusion criteria based on the following concepts:sample,phenomenon of interest,design,evaluation and research type.A total number of 32 studies were included in the study and findings were reported based on the five emerging themes.The review showed that majority of the adolescents were not aware of adolescent/youth-friendly SRHS,some health care providers were not also in support of the services which accounted for low utilization of the services among adolescents.The review further showed poor accessibility and nonavailability of AYFSRHS as the only available SRHS were meant for married adults.Therefore,these findings serve as evidence for policy-makers at all the levels of healthcare delivery system to considered all the factors observed in this review and develop strategies that will make adolescent/youth-friendly SRHS available and accessible to adolescents.More so,other stakeholders,especially health care providers must improve their attitude toward provision of adolescent/youth-friendly SRHS.

Evaluation of the Functionality of the Networking of Sexual and Reproductive Health Rights Services in the Event of Gender-Based Violence in the Commune of Kpomasse in 2022

Introduction: In developing countries, gender-based violence (GBV) is a real public health problem. In Benin, GBV affects the majority of women and girls (69%). Benin has implemented strategies and set up integrated centers for the management of violence in order to reduce cases of violence and ensure the holistic management of victims. The objective of our study was to assess the functionality of the network of sexual and reproductive health rights (SRHR) in case of GBV in the commune of Kpomasse in 2022. Method: This descriptive and evaluative study was conducted from March 21 to April 11, 2022. The sampling method used was non-probabilistic. Reasoned choice and convenience were the techniques used for the different targets of the study. The functionality of the SRHR service network was assessed first by calculating scores at the structure, process and outcome levels, and then by analysis using the human rights-based approach. Results: Out of the 34 GBV victims identified, only one had received a full response and 54% of the victims had no knowledge of SRHR. The lack of knowledge about health care facilities was 41% for victims and 80% for non-victims in the community who participated in the study. In the case of gender-based violence, the community preferred to settle out of court rather than report it. The functionality of the networking of sexual and reproductive health rights services in the event of the occurrence of gender-based violence in the commune of Kpomassè is insufficient. Lack of knowledge of the roles of rights holders (DD) and duty bearers (DO) explains the insufficient functionality of networking. Conclusion: Training of SRHR service agents and community sensitization are essential to improve the functionality of SRHR service networking in the commune of Kpomasse.

Evaluation of Training Course Effects on Integrated Sexual and Reproductive Health Counseling

Objective To evaluate the training course effects on integrated sexual and reproductive health （SRH） counseling, so as to improve family planning providers＇ capacities of SRH counseling. Methods The SRH training course was conducted by using new curriculum and participatory training methods. The purpose was meeting the SRH needs of clients. Evaluations were done by pre- and post-training questionnaires to trainees. Results The average total scores of trainees were 54.9 before trained and 83.4 after trained respectively. As to trainees＇ self evaluation of the capacities, the capacity for comfortably discussing sexuality and related issues with clients increased from 9.9% to 90.7%, the capacity for helping clients to understand their sexual risk factors increased from 12.5% to 92.2%, the capacity for helping clients assessing their own needs for SRH services, information and emotional support increased from 16.0% to 87.8%, and the capacity for helping clients to develop negotiation and communication skills increased from 12.0% to 86. 0%. Conclusion The training course of integrated SRH counseling changed the traditional training types and services concept o f family planning service providers, and the trainees＇ capacities of implementing integrated SRH counseling also improved very much.

Youth’s Perspectives on a Sustainable Model for the Provision of Youth Friendly Sexual and Reproductive Health Services in Kenya: A Quantitative Approach

Nearly half of the world’s population comprise youths. However, addressing their Sexual and Reproductive Health (SRH) remains a challenge. Globally countries are mandated to continually provide Youth Friendly Sexual and Reproductive Health services (YFSRHs) to the youth. The objective of this study was to assess and describe youth’s perspectives on a sustainable model for the provision of YFSRHs in Kenya. Data was collected among 400 youths aged 18 - 24 years in Embu and Kirinyaga counties, Kenya. A structured questionnaire was utilized as the data collection tool. Collected data was analyzed using SAS statistical software version 9.4. Statistical threshold of P ≤ 0.05 was used. Overall the mean age of the study participants was ±standard deviation (SD) 21.2 ± 1.86 years. Majority of the participants’ perspective on the health care system sustainability was that the waiting time at the facility should be less than an hour, accessible geographically (less than a kilometre), affordable (≤20 Ksh.), and convenient working hours (weekday and weekends ratio 1:1). Advocacy was on health care provider’s attributes of politeness, welcoming, confidential and non-judgmental. The most preferred locations for the youth friendly centres by the participants were community and school based locations. Similarly, parental and community support was reported to highly contribute to sustained utilization and provision of the YFSRHs (P < 0.001). Unlike popular belief, 99.8% did not see the need for recreational facilities at the youth centres to ensure sustainability of the model. To ensure a sustainable model for the provision of YFSRHs, there is need for a multi-sectoral and stakeholder involvement that is;youth, health care system structure, health care service providers, parents and community. Further research is needed on parents and health care service provider’s perspectives on how to sustain the provision of YFSRH services.

Setting Regional Research Priorities for Sexual and Reproductive Health and Rights Services in Humanitarian Settings

Background: Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health services such as maternal, neonatal mortality, human immunodeficiency virus transmission and unsafe abortion still remains inadequate. The ability to understand the magnitude of the needs and highlight existing gaps is supported by improved data which is critical to informing effective policies, programming and funding decisions. The purpose of this report is to present the results of a research prioritization exercise on sexual and reproductive health and rights services in humanitarian settings for the WHO Africa region for the next three years. Methods: We adapted the Child Health and Nutrition Research Initiative method in three phases. Experts from the region participated in an online survey to identify key areas for research in sexual and reproductive health and rights. To identify potential areas for research, the experts ensured answerability, effectiveness, deliverability, equity and potential impact of the questions. The research areas they identified were reviewed by World Health Organization technical team from headquarters. In a meeting of 67 participants, the questions were subjected to further review and analysis. Using a modified for scoring criteria, the questions were scored and ranked to provide the top ten priority questions to address sexual and reproductive health and rights services in humanitarian settings. Results: A list of 21 priority research questions on sexual and reproductive health and rights services in humanitarian settings were scored and ranked. Top ten priorities research questions were identified. Those that scored highly by scoring 30 points out of the possible maximum of 30 include: “determining the prevalence and associated factors of unwanted pregnancies and abortions performed in emergency and humanitarian settings”, “evidence on gender-based violence in humanitarian situations and its associated factors” and “defining an optimal model for coordinating sexual and reproductive health and rights interventions and responses in crisis situations”. Conclusions: Top ten research priorities in sexual and reproductive health and rights services in humanitarian settings were identified. The priority research areas have the potential to identify the best areas for programming of services in humanitarian settings. It is our hope that the identified research areas will be prioritized to support programming of services in humanitarian settings based on scientific evidence.

Research Priorities for mHealth and Innovative Strategies in Sexual and Reproductive Health and Rights in the WHO Africa Region

Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.

The WHO African Region: Research Priorities on Sexual and Reproductive Health and Rights

Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. Methods: We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. Results: A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe abortion. 5% of the participants prioritized cervical cancer prevalence, prevention and treatment as a thematic area out of the questions in the top 20 research priority questions. Conclusions: Key priority research questions in sexual and reproductive health and rights were identified around five themes. The priority list will be of significance to World Health Organization regional Office for Africa and her stakeholders for the next three years.

Perceptions of Nurses at Ndola Teaching Hospital towards Sexual Health Needs of People with Mental Health Problems

Sexual and reproductive health (SRH) is among the fundamental packages of health care, which all clients seeking health care should receive. However, it is unclear how healthcare providers, in particular, nurses perceive the issue of people with mental problems having sexual health needs. The aim of this study was to explore perceptions of nurses at Ndola Teaching Hospital towards sexual health needs of people with mental health problems. A general descriptive qualitative study design was utilized and data were collected using three focus group discussions (FGDs) that were recorded and later transcribed verbatim. Purposive sampling was used to select 21 nurses who participated in the study. Nine were male, while 12 were female. Each FGD comprised seven participants. Thematic analysis was used to analyze the data, and six major themes: 1) physiological interplay among different body systems, 2) disease process and effects of psychotropic, 3) participant differences in age, gender, educational level, and cultural backgrounds, 4) staff shortages in mental health units, 5) deficient record keeping, and 6) Social stereotypes and labelling theories emerged. Despite acknowledging the existence of sexual activity among people with mental health problems;participants had both positive and negative perceptions. It is, therefore, recommended that interventions aimed at strengthening implementation of SRH guidelines among nurses caring for people with mental health problems should be put in place.

Sexual and Reproductive Service Interventions for Menstrual Regulation,Safe Abortion,and Post-abortion Care and Their Effectiveness During Disaster Response:A Global Systematic Review

Sexual and reproductive health(SRH)services are crucial for women especially during disasters,to reduce maternal mortality and morbidity from miscarriages,unsafe abortions,and post-abortion complications.This study explored the SRH interventions provided during disaster response.A systematic review was conducted to identify what menstrual regulation(MR),safe abortion(SA),and post-abortion care(PAC)approaches/interventions exist to promote resilience in the health system in disaster settings;what intervention components were most eff ective;and challenges and opportunities to meeting SRH rights.Five electronic databases were searched,resulting in 4194 records.Following the screening process,seven publications were included.The intervention-related information in each publication was assessed based on availability,accessibility,acceptability,and quality.Two SRH approaches/interventions were found.The eff ectiveness of intervention components could not be conducted due to the limited number of relevant studies.Challenges were found at facility and community levels,and opportunities included overcoming them,making MR,SA,and PAC integral to the mitigation phase,and policy change to overcome barriers related to unaff ordability and inaccessibility.Recommendations are provided to encourage research and policy towards improving neglected SRH in disaster settings to realize Sustainable Development Goal 3 and the Global Strategy and Sendai Framework's priority to promote disaster-resilient health systems.

Setting Research Priorities for Cervical Cancer Prevalence, Prevention and Treatment in WHO Africa Region

Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. Methods: We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. Results: “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. Conclusion: The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.

Utilization of online systems to promote youth participation in research:A methodological study

BACKGROUND Online surveys can align with youth’s increased use of the internet and can be a mechanism for expanding youth participation in research.This is particularly important during the coronavirus disease 2019(COVID-19)pandemic,when inperson interactions are limited.However,the advantages and drawbacks of online systems used for research need to be carefully considered before utilizing such methodologies.AIM To describe and discuss the strengths and limitations of an online system developed to recruit adolescent girls for a sexual health research study and conduct a three-month follow up survey.METHODS This methodology paper examines the use of an online system to recruit and follow participants three months after their medical visit to evaluate a mobile sexual and reproductive health application,Health-E You/Salud iTuTM,for adolescent girls attending school-based health centers(SBHCs)across the United States.SBHC staff gave adolescent girls a web link to an online eligibility and consent survey.Participants were then asked to complete two online surveys(baseline and 3-month follow-up).Surveys,reminders,and incentives to complete them were distributed through short message service(SMS)text messages.Upon completing each survey,participants were also sent an email with a link to an electronic gift card as a thank-you for their participation.Barriers to implementing this system were discussed with clinicians and staff at each participating SBHC.RESULTS This online recruitment and retention system enabled participant recruitment at 26 different SBHCs in seven states across the United States.Between September 2021 and June 2022,415 adolescent girls were screened using the Qualtrics online survey platform,and 182 were eligible to participate.Of those eligible,78.0%(n=142)completed the baseline survey.Participants were racially,geographically,and linguistically diverse.Most of the participants(89.4%)were non-White,and 40.8%spoke Spanish.A total of 62.0%(n=88)completed the 3-month follow-up survey.Limitations of this system included reliance on internet access(via Wi-Fi or cell service),which was not universally available or reliable.In addition,an individual unrelated to the study obtained the survey link,filled out multiple surveys,and received multiple gift cards before the research team discovered and stopped this activity.As a result,additional security protocols were instituted.CONCLUSION Online systems for health research can increase the reach and diversity of study participants,reduce costs for research personnel time and travel,allow for continued study operation when in-person visits are limited(such as during the COVID-19 pandemic),and connect youth with research using technology.However,there are challenges and limitations to online systems,which include limited internet access,intermittent internet connection,data security concerns,and the potential for fraudulent users.These challenges should be considered prior to using online systems for research.

Developing a model for reducing maternal mortality in South Africa

Objective:High maternal mortality ratios(MMRs)remain a concern in many parts of the world,especially in developing countries like South Africa.Different models have been developed,tried,and tested worldwide,in the hope that they will reduce maternal mor tality,but without much success.Methods:A qualitative approach was used to conveniently select a sample of 10 women attending an antenatal clinic in a rural area,in one of the districts of Kwa Zulu-Natal(KZN)Province.Data were collected by means of interviews with the women.Data were analyzed employing Burnard’s content analysis approach.Results:Four themes emerged:(1)age at first pregnancy;(2)birth intervals,risks in pregnancy and hospitalization;(3)the use of contraception;and(4)HIV status.All themes that emerged revealed inattention to reproductive health(RH)needs,resulting in poor RH outcomes as an area of concern.Conclusions:Greater emphasis needs to be placed on meeting the sexual and reproductive health(SRH)needs of South African women,if maternal mor tality rates are to be reduced.An alternative model for reducing maternal mor tality in South Africa is proposed.

Research Priorities for Preventing Unsafe Abortions in the WHO Africa Region

Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.

Research Priorities for Addressing Gender Based Violence in the WHO Africa Region

Background: There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. Methods: We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. Results: A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing gender-based violence against women”. The second most highly ranked question was on the assessment of the extent and strategies to prevent gender-based violence in the context of humanitarian crises. Conclusions: Priority research questions for addressing gender based violence were identified. This exercise provides a three year investment case for research with high potential of effectively identifying interventions with high impact on addressing gender based violence.