Browsing by Subject "Adolescents"

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    A qualitative study into the advocacy and activism of carers of adolescents with Down Syndrome in Oshana, Namibia
    (2019) Kambowe, Hannah; Duncan, Madeleine; Mckenzie, Judith
    Background: Down Syndrome (DS) is a chromosomal defect known to cause intellectual disability. Adolescents with DS may need to live with their families beyond the transition period into adulthood because they require lifelong care due to the disabling consequences of the genetic condition. Evidence is lacking about the actions that carers in remote rural communities are taking to enhance the rights of their adolescents with DS as enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Aim: To describe the advocacy and activism actions of carers that promote the disability rights of adolescents with DS. Objectives: To describe carers’ understanding of 'activism’ in relation to the needs of adolescents with DS; to explore what actions carers are engaging with in order to promote participation and equal opportunities for social inclusion of adolescents with DS; to describe barriers encountered and strategies used and to describe carers’ advocacy priority list for social inclusion of adolescents with DS. Methodology: A descriptive qualitative approach was used where three carers told their stories of activism and advocacy actions through a semi-structured in-depth interview method. Their stories were audio-recorded, transcribed into textual form and an inductive data analysis followed a framework approach guided by the research aims. Findings: One overriding theme Puuyelele (bringing adolescents with DS into the open) emerged with four categories: namely, “Speaking for and acting on behalf of adolescents with DS”, “Enabling a continuous enlightening process”, “Ensuring ongoing care and services” and “Raising public awareness on human rights of adolescents with DS”. Discussion: Three concepts about DS advocacy and activism for adolescents with DS formed the discussion; first, it is a strategic process requiring togetherness, courage and perseverance; second, it proceeds from vigilant care-giving and service provision and, lastly, it requires rising of human rights awareness. Conclusion: A strategic and contextualised DS advocacy and activism process such as Puuyelele requires human rights awareness and emerges from vigilant care that enhances community participation and social inclusion of adolescents with DS. The process creates a possible and realistic conceptual framework for further strengthening of disability-inclusive development initiatives in Namibia.
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    A research report to meet the requirements of the master of medicine in psychiatry at the University of Cape Town
    (2025) Swartz, Michelle; Dannatt, Lisa
    Background: Cannabis is the most widely used substance worldwide and its use is much higher amongst adolescents. However, adolescents are at higher risk of negative sequelae secondary to this use, including poorer developmental outcomes and the possible development of mental disorders. On 31 March 2017, the South African High Court ruled that cannabis use by an adult in a private dwelling should be decriminalized. Aim: The aim of this study is to determine the clinical profile of adolescents who use cannabis, that present to a tertiary hospital in Cape Town, South Africa, before and after the high court ruling in 2017. Setting The study was conducted reviewing folders of adolescents admitted at Groote Schuur Hospital (GSH) in the Emergency Psychiatric Unit, Ward C23 in Cape Town, South Africa. Methods: This study was a retrospective folder review of adolescents admitted from April 2015 to March 2019. Results:The study included 266 participants and the total number of adolescents using cannabis admitted during the study period was 116. Cannabis use was the most commonly used substance in the study, with increased use seen post-ruling (n = 75; 65%). The most common frequency of cannabis use reported was daily use (n = 43; 57%). When comparing psychiatric diagnoses between cannabis users and non-cannabis users, a significantly higher proportion of patients who used cannabis pre-ruling had psychotic disorder (p < 0.001) and substance use disorder (p = 0.01). Post–ruling, the significance was p < 0.001 for psychotic and substance use disorders. The most common DSM-5 diagnoses in cannabis users pre-ruling were psychotic disorders (n = 27; 65.9%); post-ruling, it was psychotic disorders (n =36; 48%) and trauma and stressor-related disorders (n = 31; 41.3%). Conclusion: The study showed an increasing prevalence of cannabis use in adolescents admitted with mental illness after the high court ruling in 2017. This study also demonstrates that adolescents remain a vulnerable population to the effects of cannabis. This highlights the need for more focused adolescent interventions and services.
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    A wait-list controlled evaluation of the Qhubeka bicycle on an adolescent's physiology, executive function, and school performance
    (2021) Mcdonald, Reece Brian; Swart, Jeroen; Holliday, Wendy
    Learner mobility and active school travel (AST) has been proposed to improve school attendance and academic performance. In South Africa, approximately 86% of learners have been reported as walking to and from school. AST in Africa is becoming less common in urban areas, and this may be a contributing factor to the increased risk and frequency of noncommunicable diseases due to decreased physical activity. The aim of this wait-list controlled evaluation was to assess the physiological and cognitive changes of access to a bicycle versus walking on adolescents. Specifically, changes adolescent's physical activity levels and executive function in a South African low-income community. Two schools were recruited, with the evaluation school receiving bicycles and the control a school who were yet to receive bicycles. Significant differences were observed across the physiological and executive function assessments. Most notably in the executive function tests, the evaluation group showed significant time to completion decreases across all three tests (N-Back, Arrow Flanker, WCST: p< 0.001). The results from this study are significant, as they are the first to assess anthropometric, physiological and executive function in South African adolescents from low-socioeconomic regions. It is evident that there are potential improvements in working memory, inhibition and shifting due to cycling as a mode of AST or during leisuretime. Further research needs to determine the specific mechanisms associated with these improvements.
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    Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis
    (2021-11-11) Meinck, Franziska; Orkin, Mark; Cluver, Lucie
    Background Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets (“accelerators”) within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. Methods Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. Results Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. Conclusion Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.
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    Alcohol, binge drinking and associated mental health problems in young urban Chileans
    (Public Library of Science, 2015) Mason-Jones, Amanda J; Cabieses, Báltica
    Objective To explore the link between alcohol use, binge drinking and mental health problems in a representative sample of adolescent and young adult Chileans. METHODS: Age and sex-adjusted Odds Ratios (OR) for four mental wellbeing measures were estimated with separate conditional logistic regression models for adolescents aged 15-20 years, and young adults aged 21-25 years, using population-based estimates of alcohol use prevalence rates from the Chilean National Health Survey 2010. RESULTS: Sixty five per cent of adolescents and 85% of young adults reported drinking alcohol in the last year and of those 83% per cent of adolescents and 86% of young adults reported binge drinking in the previous month. Adolescents who reported binging alcohol were also more likely, compared to young adults, to report being always or almost always depressed (OR 12.97 [95% CI, 1.86-19.54]) or to feel very anxious in the last month (OR 9.37 [1.77-19.54]). Adolescent females were more likely to report poor life satisfaction in the previous year than adolescent males (OR 8.50 [1.61-15.78]), feel always or almost always depressed (OR 3.41 [1.25-9.58]). Being female was also associated with a self-reported diagnosis of depression for both age groups (adolescents, OR 4.74 [1.49-15.08] and young adults, OR 4.08 [1.65-10.05]). CONCLUSION: Young people in Chile self-report a high prevalence of alcohol use, binge drinking and associated mental health problems. The harms associated with alcohol consumption need to be highlighted through evidence-based prevention programs. Health and education systems need to be strengthened to screen and support young people. Focussing on policy initiatives to limit beverage companies targeting alcohol to young people will also be needed.
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    Anthropometric, physiological characteristics and rugby-specific game skills of schoolboy players of different age categories and playing standards
    (2020-02-10) Chiwaridzo, Matthew; Ferguson, Gillian D; Smits-Engelsman, Bouwien C M
    Abstract Background Rugby is increasingly gaining popularity among school-aged male junior players in countries hardly known for dominating international rugby, such as Zimbabwe. Given rugby combativeness, participating adolescents should possess qualities or skills commensurate with the physical demands of the sport for effective participation. This study investigated the independent and interactive effects of age category and playing standard on anthropometric, physiological characteristics and rugby-specific game skills among Zimbabwean athletes. Methods Two hundred and eight elite, sub-elite and non-rugby players competing at Under 16 and Under 19 age categories were assessed using the School Clinical Rugby Measure (SCRuM) test battery. Participants underwent height, sitting height, mass, skinfolds, speed, agility, upper-and-lower muscular strength and power, prolonged high-intensity intermittent running ability, tackling, passing and catching assessments in a cross-sectional experimental design. Results Age categories had significant main effect on all SCRuM test items except sum of seven skinfolds (p = 0.45, η2p = 0.003). Playing standard had significant main effects for all variables except height (p = 0.40, η2p = 0.01) and sum of seven skinfolds (p = 0.11, η2p = 0.02). Specifically, upper-and-lower muscular strength and power, prolonged high-intensity intermittent running ability, tackling, passing and catching improved with increasing playing standards. However, two-way analysis of variance only demonstrated significant interactions between the effects of age category and playing standards for vertical jump height (VJ) test, 2-kg medicine ball chest throw (2-kg MBCT) test, Yo-Yo intermittent recovery test level 1 (Yo-Yo IRT L1), and tackling and catching tests. Yo-Yo IRT L1, VJ, tackling and catching tests demonstrated greater discriminative ability among Under 16 s, whereas the 2-kg MBCT test showed better ability in Under 19 s. Conclusion All SCRuM variables except skinfolds improved with age, highlighting relative sensitivity in differentiating older from younger athletes. However, the discriminative ability by playing standards for VJ, 2-kg MBCT, Yo-Yo IRT L1, tackling and catching ability tests was age-dependent. These findings informs on general attribute development in junior rugby players with age and on specific players attributes in need of monitoring for attainment of elite status at U16 or U19 level.
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    Antiretroviral therapy outcomes among adolescents and youth in rural Zimbabwe
    (Public Library of Science, 2012) Bygrave, Helen; Mtangirwa, Judith; Ncube, Kwenzakwenkosi; Ford, Nathan; Kranzer, Katharina; Munyaradzi, Dhodho
    Around 2 million adolescents and 3 million youth are estimated to be living with HIV worldwide. Antiretroviral outcomes for this group appear to be worse compared to adults. We report antiretroviral therapy outcomes from a rural setting in Zimbabwe among patients aged 10-30 years who were initiated on ART between 2005 and 2008. The cohort was stratified into four age groups: 10-15 (young adolescents) 15.1-19 years (adolescents), 19.1-24 years (young adults) and 24.1-29.9 years (older adults). Survival analysis was used to estimate rates of deaths and loss to follow-up stratified by age group. Endpoints were time from ART initiation to death or loss to follow-up. Follow-up of patients on continuous therapy was censored at date of transfer, or study end (31 December 2008). Sex-adjusted Cox proportional hazards models were used to estimate hazard ratios for different age groups. 898 patients were included in the analysis; median duration on ART was 468 days. The risk of death were highest in adults compared to young adolescents (aHR 2.25, 95%CI 1.17-4.35). Young adults and adolescents had a 2-3 times higher risk of loss to follow-up compared to young adolescents. When estimating the risk of attrition combining loss to follow-up and death, young adults had the highest risk (aHR 2.70, 95%CI 1.62-4.52). This study highlights the need for adapted adherence support and service delivery models for both adolescents and young adults.
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    ART adherence trajectories and correlates of treatment outcomes among adolescents in the Eastern Cape Province of South Africa
    (2025) Zhou, Siyanai; Knight, Lucia; Toska, Elona
    Background: Sustained adherence to antiretroviral treatment (ART) is essential for viral suppression among adolescents living with HIV. In turn, suppressed viral load reduces the risk of onward transmission, HIV-related morbidity, and mortality, optimising overall health and well-being. Yet, adherence to ART among adolescents living with HIV (ALHIV) remains suboptimal compared to children and adults. Adherence measurement varies widely with no gold standard, and composite assessments such as longitudinal self-reported adherence have not been thoroughly evaluated among ALHIV in low-resource settings. In sub-Saharan Africa, evidence on longitudinal sustained ART adherence and its impacts on subsequent HIV treatment outcomes for ALHIV remains scarce. Prior studies on ART adherence—largely cross-sectional—have relied on traditional aggregate methods, dichotomising adolescents as adherent versus non-adherent which is insufficient to capture variations in adherence over time. Longitudinal ART adherence trajectories may aid the assessment of sustained long-term adherence and its impact on HIV treatment outcomes among ALHIV. To address these gaps, this PhD examined the validity of longitudinal self-reported measures of ART adherence among ALHIV in South Africa. It used group-based trajectory models (GBTMs) to identify ART adherence trajectories and examined their association with HIV treatment outcomes—viral suppression and mortality. It further explored factors contributing to distinct adherence trajectories, and the impact of psychosocial and structural provisions on long-term HIV treatment outcomes among ALHIV in South Africa. Methods: This PhD is an analysis of a three-wave longitudinal cohort study of 1046 ALHIV and 473 HIV-negative peers aged 10-19 years at baseline, in the Eastern Cape province of South Africa. From 2014 to 2018, participants completed questionnaires that included their socio-demographic information and self-reported adherence at all three visits. All participants and their caregivers gave informed consent to participate. In parallel, routine viral load data were extracted from physical and electronic patient files in health facilities, and the National Health Laboratory Services (NHLS) of South Africa (2014-2019). Viral load laboratory test results for 75.2% of the participants were obtained. Mortality was ascertained through community tracing and reporting from 2016 to 2022. All analyses in this thesis used the longitudinal cohort data to address the specific objectives. Statistical analyses included mixed effects logistic regression, group-based trajectory modelling, and path analysis. Findings: The first analysis (Chapter 4) explored the validity of five longitudinal self-reported adherence measures to screen for non-adherence and identify ALHIV with elevated viral load (>1000 copies/mL). Self-report measures included any missed dose in the past 3-days, past-week, past-month, days missed in the past-month, and any past-year missed clinic appointment and were all significantly associated with elevated viral load. The individual sensitivity of each measure varied from 79.5% to 91.6%, and positive predictive values were above 75%. Using the five self-reported adherence measures and group-based trajectory modelling, four adolescent adherence trajectories were identified (Chapter 5), namely ‘consistent (49.8%), ‘low start and increasing' (20.8%); ‘gradually decreasing' (23.5%), and ‘low and decreasing (5.9%) adherence. Compared to the consistent adherence trajectory, membership in each of the three inconsistent adherence trajectories was significantly associated with lower adjusted odds of durable viral suppression—having suppressed viral load (<1000 copies/ml) at two or more consecutive study waves. Complementary mortality analysis (Chapter 6) showed that all-cause mortality rates differ across the four adherence trajectories, and sustained adherence to ART was associated with lower rates of mortality among ALHIV. The analysis found that ALHIV experience higher all-cause mortality than their HIV-negative peers, despite ART rollout in South Africa. Guided by the socio-ecological model (Chapter 7), pathways linking barriers contributing to the distinct longitudinal adherence trajectories were established using path analysis. Experiencing mental health symptoms, medication side effects, internalised HIV stigma, food insecurity, longer clinic travel time (>1 hour), and witnessing domestic violence or conflict were associated with inconsistent adherence trajectories relative to the ‘consistent adherence' trajectory. More importantly, the pathways linking co-occurring barriers, and mental health symptoms to longitudinal adherence were unique for each trajectory or ALHIV sub-group. The final analysis (Chapter 8) revealed that access to government-provided social protection and family psychosocial support was associated with greater improvements in long-term ART adherence and viral load outcomes. Conclusions: This PhD documents multiple ART adherence trajectories, low rates of viral suppression, and high all-cause mortality among ALHIV in South Africa. Self-reported adherence shows promise for low-cost and relatively easy-to-administer alternative measures to ensure timely identification of poor adherence to ART among adolescents, particularly in settings where virologic monitoring is limited. ALHIV displayed distinct adherence behaviour patterns over time, which provides an opportunity to identify and target specific sub-groups of ALHIV in need of adherence support interventions. The multiple barriers identified and their pathways to longitudinal adherence trajectories present another opportunity to tailor care to specific groups of ALHIV, possibly informing differentiated service delivery to different sub-groups of ALHIV. Government-provided social protection and strategies to address psychological well-being can be key add-on support provisions to enhance the effectiveness of ART treatment among ALHIV in low-resource settings. Overall, this PhD demonstrates the need to shift from a one-size-fits-all model of care to customised HIV care and combine biomedical with psychosocial and structural interventions to address the needs of distinct groups of ALHIV.
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    Can social protection improve Sustainable Development Goals for adolescent health?
    (Public Library of Science, 2016) Cluver, Lucie D; Orkin, F Mark; Meinck, Franziska; Boyes, Mark E; Yakubovich, Alexa R; Sherr, Lorraine
    BACKGROUND: The first policy action outlined in the Sustainable Development Goals (SDGs) is the implementation of national social protection systems. This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa. METHODS: We conducted a longitudinal survey of adolescents (10-18 years) between 2009 and 2012. Census areas were randomly selected in two urban and two rural health districts in two South African provinces, including all homes with a resident adolescent. Household receipt of social protection in the form of 'cash' (economic provision) and 'care' (psychosocial support) social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for interactions between social protection and socio-demographic covariates, and marginal effects models. FINDINGS: Social protection was associated with significant adolescent risk reductions in 12 of 17 gender-disaggregated SDG indicators, spanning SDG 2 (hunger); SDG 3 (AIDS, tuberculosis, mental health and substance abuse); SDG 4 (educational access); SDG 5 (sexual exploitation, sexual and reproductive health); and SDG 16 (violence perpetration). For six of 17 indicators, combined cash plus care showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys' hunger and girls' school dropout. For tuberculosis, and for boys' sexual exploitation and girls' mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents on these challenging burdens. Interpretation National social protection systems are not a panacea, but findings suggest that they have multiple and synergistic positive associations with adolescent health outcomes. Such systems may help us rise to the challenges of health and sustainable development.
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    The candidate TB vaccine, MVA85A, induces highly durable Th1 responses
    (Public Library of Science, 2014) Tameris, Michele; Geldenhuys, Hennie; Luabeya, Angelique KanyKany; Smit, Erica; Hughes, Jane E; Vermaak, Samantha; Hanekom, Willem A; Hatherill, Mark; Mahomed, Hassan; McShane, Helen; Scriba,Thomas J
    BACKGROUND: Vaccination against tuberculosis (TB) should provide long-term protective immunity against Mycobacterium tuberculosis ( M.tb ). The current TB vaccine, Bacille Calmette-Guerin (BCG), protects against disseminated childhood TB, but protection against lung TB in adolescents and adults is variable and mostly poor. One potential reason for the limited durability of protection may be waning of immunity through gradual attrition of BCG-induced T cells. We determined if a MVA85A viral-vector boost could enhance the durability of mycobacteria-specific T cell responses above those induced by BCG alone. METHODS: We describe a long-term follow-up study of persons previously vaccinated with MVA85A. We performed a medical history and clinical examination, a tuberculin skin test and measured vaccine-specific T cell responses in persons previously enrolled as adults, adolescents, children or infants into three different Phase II trials, between 2005 and 2011. RESULTS: Of 252 potential participants, 183 (72.6%) consented and completed the study visit. Vaccine-induced Ag85A-specific CD4+ T cell responses were remarkably persistent in healthy, HIV-uninfected adults, adolescents, children and infants, up to 6 years after MVA85A vaccination. Specific CD4+ T cells expressed surface markers consistent with either CD45RA−CCR7+ central memory or CD45RA−CCR7− effector memory T cells. Similarly durable Ag85A-specific CD4+ T cell responses were detected in HIV-infected persons who were on successful antiretroviral therapy when MVA85A was administered. By contrast, Ag85A-specific CD4+ T cell frequencies in untreated MVA85A-vaccinated HIV-infected persons were mostly undetectable 3-5 years after vaccination. CONCLUSION: MVA85A induces remarkably durable T cell responses in immunocompetent persons. However, results from a recent phase IIb trial of MVA85A, conducted in infants from the same geographic area and study population, showed no vaccine efficacy, suggesting that these durable T cell responses do not enhance BCG-induced protection against TB in infants.
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    Child mental health in Sierra Leone: a survey and exploratory qualitative study
    (2016) Yoder, Hélène N C; Tol, Wietse A; Reis, Ria; de Jong, Joop T V M
    Abstract Background This study complements the growing amount of research on the psychosocial impact of war on children in Sierra Leone by examining local perceptions of child mental health, formal and informal care systems, help-seeking behaviour and stigma. Methods The study combined: (1) a nationwide survey of mental health care providers, with (2) exploratory qualitative research among service users and providers and other stakeholders concerned with child and adolescent mental health, with a particular emphasis on local explanations and stigma. Results Formal mental health care services are extremely limited resulting in an estimated treatment gap of over 99.8 %. Local explanations of child mental health problems in Sierra Leone are commonly spiritual or supernatural in nature, and associated with help-seeking from traditional healers or religious institutions. There is a considerable amount of stigma related to mental disorders, which affects children, their caregivers and service providers, and may lead to discrimination and abuse. Conclusions Child and Adolescent Mental Health (CAMH) care development in Sierra Leone should cater to the long-term structural effects of war-violence and an Ebola epidemic. Priorities for development include: (1) the strengthening of legal structures and the development of relevant policies that strengthen the health system and specifically include children and adolescents, (2) a clearer local distinction between children with psychiatric, neurological, developmental or psychosocial problems and subsequent channelling into appropriate services (3) supplementary CAMH training for a range of professionals working with children across various sectors, (4) specialist training in CAMH, (5) integration of CAMH care into primary health care, education and the social welfare system, (6) further research on local explanations of child mental disorders and the effect they have on the well-being of the child, and (7) a careful consideration of the role of religious healers as care providers.
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    Combined HIV Adolescent Prevention Study (CHAPS): comparison of HIV pre-exposure prophylaxis regimens for adolescents in sub-Saharan Africa—study protocol for a mixed-methods study including a randomised controlled trial
    (2020-10-30) Nash, S; Dietrich, J; Ssemata, A S; Herrera, C; O’Hagan, K; Else, L; Chiodi, F; Kelly, C; Shattock, R; Chirenje, M; Lebina, L; Khoo, S; Bekker, L-G; Weiss, H A; Gray, C; Stranix-Chibanda, L.; Kaleebu, P; Seeley, J; Martinson, N; Fox, J
    Background HIV remains a major public health issue, especially in Eastern and Southern Africa. Pre-exposure prophylaxis is highly effective when adhered to, but its effectiveness is limited by cost, user acceptability and uptake. The cost of a non-inferiority phase III trial is likely to be prohibitive, and thus, it is essential to select the best possible drug, dose and schedule in advance. The aim of this study, the Combined HIV Adolescent PrEP and Prevention Study (CHAPS), is to investigate the drug, dose and schedule of pre-exposure prophylaxis (PrEP) required for the protection against HIV and the acceptability of PrEP amongst young people in sub-Saharan Africa, and hence to inform the choice of intervention for future phase III PrEP studies and to improve strategies for PrEP implementation. Methods We propose a mixed-methods study amongst young people aged 13–24 years. The first component consists of qualitative research to identify the barriers and motivators towards the uptake of PrEP amongst young people in South Africa, Uganda and Zimbabwe. The second component is a randomised clinical trial (ClinicalTrials.gov NCT03986970, June 2019) using a novel ex vivo HIV challenge method to investigate the optimal PrEP treatment (FTC-TDF vs FTC-TAF), dose and schedule. We will recruit 144 amongst HIV-negative uncircumcised men aged 13–24 years from voluntary male medical circumcision clinics in two sites (South Africa and Uganda) and randomise them into one of nine arms. One group will receive no PrEP prior to surgery; the other arms will receive either FTC-TDF or FTC-TAF, over 1 or 2 days, and with the final dose given either 6 or 20 h prior to surgery. We will conduct an ex vivo HIV challenge on their resected foreskin tissue. Discussion This study will provide both qualitative and quantitative results to help decide the optimum drug, dose and schedule for a future phase III trial of PrEP. The study will also provide crucial information on successful strategies for providing PrEP to young people in sub-Saharan Africa. Trial registration ClinicalTrials.gov NCT03986970 . Registered on 14 June 2019
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    Condom use and sexuality communication with adults: a study among high school students in South Africa and Tanzania
    (BioMed Central Ltd, 2013) Namisi, Francis; Aaro, Leif; Kaaya, Sylvia; Onya, Hans; Wubs, Annegreet; Mathews, Catherine
    BACKGROUND: Fostering adolescents' communication on sexuality issues with their parents and other significant adults is often assumed to be an important component of intervention programmes aimed at promoting healthy adolescent sexual practices. However, there are few studies describing the relationship between such communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships between adolescents' communication with significant adults and their condom use in three sites in this region. METHODS: Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison schools were used. The design is therefore a prospective panel study with three waves of data collections. Data were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents' communication with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of variance, as well as prospectively using multiple ordinal logistic regression analysis. RESULTS: Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on communication (across topics and communication partners) than both occasional users and never-users, who had the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for possible confounders, communication scores significantly predicted consistent condom use prospectively in all three ordinal logistic regression models (Model R2 = .23 to .31). CONCLUSION: The findings are consistent with the assertion that communication on sexuality issues between adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school adolescents. The associations between communication variables and condom use might have been stronger if we had measured additional aspects of communication such as whether or not it was initiated by the adolescents themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality.
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    Content validity and test-retest reliability of a low back pain questionnaire in Zimbabwean adolescents
    (BioMed Central, 2017-02-28) Chiwaridzo, Matthew; Chikasha, Tafadzwa Nicole; Naidoo, Nirmala; Dambi, Jermaine Matewu; Tadyanemhandu, Cathrine; Munambah, Nyaradzai; Chizanga, Precious Trish
    Background: In Zimbabwe, a recent increase in the volume of research on recurrent non-specific low back pain (NSLBP) has revealed that adolescents are commonly affected. This is alarming to health professionals and parents and calls for serious primary preventative strategies to be developed and implemented forthwith. Early identification initiatives should be prioritised in order to curtail the condition and its progression. In an attempt to be proactive in minimising the prevalence of recurrent NSLBP, this study was conducted to evaluate the content validity and test-retest reliability of a survey questionnaire with the aim of proffering a valid and reliable questionnaire which can be used in non-clinical settings to identify adolescents with recurrent NSLBP in Harare, Zimbabwe and determine the possible factors associated with the condition. Methods: The study was conducted in two parts. The first part assessed content validity of the questionnaire using four experts derived from academia and clinical practice. The second part evaluated the reliability of the questionnaire among 125 high school-children aged between 13 and 19 years in a test-retest study. Results: Twenty-six (26) out of thirty questions in the questionnaire had an Item Content Validity index of 1.00, demonstrating complete agreement among content experts. Overall, the Scale Content Validity Index for the questionnaire was 0.97. Item completion for the reliability study was satisfactory. The questionnaire items had kappa values ranging from 0.17 (slight agreement) to 1 (perfect agreement). High levels of reliability were found for the questions on school bag use (k=0.94), sports participation (k=0.97), and lifetime prevalence (k=0.89). Conclusion: Excellent content validity and slight to perfect test-retest reliability was found for the Low Back Pain (LBP) questionnaire. These results are comparable to findings of other studies evaluating the psychometric properties of LBP questionnaires. Cognisant of the limitations of the study, the results of this study suggest that the LBP questionnaire could be used in local studies investigating LBP among adolescents although questions enquiring on functional limitations and sciatica may need further consideration.
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    Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township
    (BioMed Central Ltd, 2014) Middelkoop, Keren; Bekker, Linda-Gail; Morrow, Carl; Lee, Namee; Wood, Robin
    BACKGROUND: Tuberculosis (TB) transmission rates are exceptionally high in endemic TB settings. Adolescence represents a period of increasing TB infection and disease but little is known as to where adolescents acquire TB infection. We explored the relationship between residential exposure to adult TB cases and infection in children and adolescents in a South African community with high burdens of TB and HIV. METHODS: TB infection data were obtained from community, school-based tuberculin skin test (TST) surveys performed in 2006, 2007 and 2009. A subset of 2007 participants received a repeat TST in 2009, among which incident TB infections were identified. Using residential address, all adult TB cases notified by the community clinic between 1996 and 2009 were cross-referenced with childhood and adolescent TST results. Demographic and clinic data including HIV status were abstracted for TB cases. Multivariate logistic regression models examined the association of adult TB exposure with childhood and adolescent prevalent and incident TB infection. RESULTS: Of 1,100 children and adolescents included in the prevalent TB infection analysis, 480 (44%) were TST positive and 651 (59%) were exposed to an adult TB case on their residential plot. Prevalent TB infection in children aged 5-9 and 10-14 years was positively associated with residential exposure to an adult TB case (odds ratio [OR]:2.0; 95% confidence interval [CI]: 1.1-3.6 and OR:1.5; 95% CI: 1.0-2.3 respectively), but no association was found in adolescents [greater than or equal to]15years (OR:1.4; 95% CI: 0.9-2.0). HIV status of adult TB cases was not associated with TB infection (p=0.62). Of 67 previously TST negative children, 16 (24%) converted to a positive TST in 2009. These incident infections were not associated with residential exposure to an adult TB case (OR: 1.9; 95% CI: 0.5-7.3). CONCLUSIONS: TB infection among young children was strongly associated with residential exposure to an adult TB case, but prevalent and incident TB infection in adolescents was not associated with residential exposure. The HIV-status of adult TB cases was not a risk factor for transmission. The high rates of TB infection and disease among adolescents underscore the importance of identifying where infection occurs in this age group.
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    Examining the extent to which mobile bully-victim behaviour is a consequence of social integration or aggressive behaviour
    (2018) Jokazi, Nombulelo; Kyobe, Michael
    The absence of a framework or policy to address bullying in South Africa compels the country to rely on pieces of legislation that are closely related to anti-bullying laws such as the Child Justice Act 75 of 2008 and Protection from Harassment Act 71 of 2011. Over-reliance on pieces of legislation creates challenges for victims of these bullying crimes because most of the relational aggression exerted towards victims goes unpunished. Some of the adolescents take the law into their own hands, thus, exacerbate and increases the complexity of bullying crimes. Due to advancements in Information and Communications Technology, bully-victim behaviour does not only take place in physical environments such as schools, but it takes place anywhere, anytime (24/7) on Mobile Social Networks. In 2011, a cyberbullying study by the Centre of Justice and Crime Prevention reported that 69.7% of the youth in South Africa falls in the category of bully-victims. This is alarming given that few studies focus on the role of bullyvictims in South Africa. The exact cause for mobile bully-victim behaviour is unclear, and previous studies have highlighted it is between aggressive behaviour and social integration. Therefore, this study examined aggressive behaviour and social integration to determine which of these two factors contribute the most to mobile bully-victim behaviour. Additionally, mobile social network features that enable this behaviour were investigated. The factors that lead to aggressive behaviour and social integration, resulting in mobile bully-victims, were identified through a literature review. Paper-based surveys were issued to Johannesburg high school adolescents. Johannesburg was mainly selected based on finding by previous studies, which highlighted that most of the online bullying and victimisation happens amongst adolescents in Johannesburg. After data was collected, the results were analysed using Statistica version 13.5. The analysis revealed that, indeed, both aggressive behaviour and social integration cause mobile bully-victim behaviour, however, social integration contributed more than aggressive behaviour. The findings also revealed that WhatsApp and Instagram were the most utilized social networks by mobile bullyvictims. There were no differences between males and females when it comes to mobile bullyvictim behaviour. The causes of mobile bully-victim behaviour that have been identified in this study can be used as a starting point to develop legislation/framework aimed at combating mobile bully-victim behaviour. Given that mobile bully-victims are more suicidal and suffer from depression, psychologists and therapists can use the knowledge obtained from this study to develop psychological treatments specifically for mobile bully-victims.
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    Executive function in adolescents with fetal alcohol spectrum disorders: a developmental perspective
    (2025) Pomario, Tania; Gouse, Hetta-Mari; Thomas, Kevin
    Objective: Children with fetal alcohol spectrum disorders (FASD) have well-documented deficits in executive function. However, few previous studies have examined executive deficits displayed by children with FASD within a developmental framework. This longitudinal study explored the manifestation of executive function in both alcohol-exposed and typically developing adolescents from a low socioeconomic community in a low-and middle-income country. Method: 110 participants (48 with FASD, mean age 14.65 years, SD = 0.65 and 62 controls, mean age 14.49 years, SD = 0.44) were assessed at two time points, 18 months apart. Participants completed a battery of neuropsychological tests to measure executive function. Parents and teachers provided ratings of participants' everyday executive function on the Behavior Inventory of Executive Function (BRIEF). Principal component analysis examined the underlying components of the neuropsychological measures of executive function in the control group. Composite executive function test scores were computed for both groups, and ANCOVA was used to examine whether a) cognitive performance of the FASD group differed from that of the control group, and b) whether there was a change in scores across the two time points. Chi-square and ANCOVA analyses assessed group differences on the BRIEF. Finally, correlations and regressions investigated whether composite cognitive scores were significant predictors of behaviour, as measured by the BRIEF. Results: Neuropsychological measures of executive function clustered into four distinct factors reflecting the domains of Generativity, Attentional Control, Working Memory, and Processing Speed. The FASD group performed significantly worse than the control group on the Working Memory domain (p < .01). On the BRIEF, a significantly higher proportion of the FASD group was rated as having scores in the clinically impaired range by both parents (p < .001) and teachers (p < .01) compared to controls. Significant differences were found between the FASD and control groups on the Emotional Control and Organization of Materials scales of the BRIEF Teacher. Significant differences were found for the Global Executive Composite and the Plan/Organize and Monitor scales on the BRIEF Parent. The cognitive composites Attentional Control and Generativity were significantly negatively correlated with scores on several of the BRIEF Teacher clinical scales for the FASD group. Conclusion: Performance on working memory tasks emerged as the only domain of executive function that distinguished the FASD group from the control group. There was no notable developmental change in executive abilities over the course of the 18- month period in either group. Both parents and teachers reported that the FASD group displayed significantly more executive deficits, but only teacher ratings were correlated with neuropsychological test results. This suggests that children with FASD have more difficulties with executive functioning in their everyday lives than what is being detected on neuropsychological measures alone.
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    Healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study
    (BioMed Central, 2018-02-13) Jonas, Kim; Crutzen, Rik; Krumeich, Anja; Roman, Nicolette; van den Borne, Bart; Reddy, Priscilla
    Background: Adolescents’ sexual and reproductive healthcare (SRH) needs have been prioritized globally, and they have the rights to access and utilize SRH services for their needs. However, adolescents under-utilize SRH services, especially in sub-Saharan Africa. Many factors play a role in the under-utilization of SRH services by adolescents, such as the attitude and behaviour of healthcare workers. The aim of this study therefore, was to explore and gain an in-depth understanding of healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of these services to adolescents in South Africa. Methods: Twenty-four healthcare workers in public SRH services in Cape Town, South Africa participated in this qualitative study through focus group discussions. To fulfill the aims of this study, nine focus group discussions were conducted among the SRH nurses. Results: SRH nurses indicated that they are experiencing challenges with the concept and practice of termination of pregnancy. They explained that this practice contradicted their opposing beliefs and values. Some nurses felt that they had insufficient SRH skills, which hinder their provision of adequate SRH services to adolescents, while others described constraints within the health system such as not enough time to provide the necessary care. They also explained having limited access to schools where they can provide SRH education and pregnancy prevention services in the surrounding area. Conclusions: Nurses are faced with numerous challenges when providing SRH services to adolescents. Providing the nurses with training programmes that emphasize value clarification may help them to separate their personal beliefs and norms from the workplace practice. This may help them to focus on the needs of the adolescent in a way that is beneficial to them. At the health systems level, issues such as clinic operating hours need to be structured such that the time pressure and constraints upon the nurse is relieved.
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    High-school adolescents’ motivation to rugby participation and selection criteria for inclusion in school rugby teams: coaches’ perspective (the SCRuM project)
    (BioMed Central, 2019-02-26) Chiwaridzo, M; Ferguson, G; Smits-Engelsman, B C M
    Objective: Despite increasing rugby popularity among schoolboys’ worldwide, specific factors influencing their motivation to participate in rugby remain unclear. Therefore, this study was conducted in two parts with a dual purpose of exploring perceptions of rugby coaches on (i) factors motivating schoolboys to engage in competitive rugby, and (ii) criteria for selecting schoolboy rugby players for possible inclusion in school rugby teams. Results A qualitative study targeting Zimbabwean high school-based rugby coaches purposively-recruited during the 2017 Dairiboard Zimbabwe Rugby School Festival was conducted. Using the conventional approach to content analysis, the 22 recruited male coaches (median age = 45.5 years) felt that playing rugby is a choice largely influenced by either intrinsic or extrinsic motives for schoolboys. Additionally, coaches considered players’ characteristics (performance during training, attitude, physical qualities and skills) and match-related factors when selecting schoolboys for possible inclusion in school rugby teams. To effectively promote competitive rugby participation among schoolboys and promote sustainable and effective talent identification programmes in Zimbabwe, more recognition should be paid to factors motivating schoolboys to participate in rugby and also on the factors coaches consider when assembling school rugby teams which indirectly informs on what coaches think should be trained among schoolboy rugby players.
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    HIV status disclosure to perinatally-infected adolescents in Zimbabwe: a qualitative study of adolescent and healthcare worker perspectives
    (Public Library of Science, 2014) Kidia, Khameer K; Mupambireyi, Zivai; Cluver, Lucie; Ndhlovu, Chiratidzo E; Borok, Margaret; Ferrand, Rashida A
    Introduction & Objectives: Due to the scale up of antiretroviral therapy, increasing numbers of HIV-infected children are living into adolescence. As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises. This study aimed to understand how perinatally-infected adolescents learn about their HIV-status as well as to examine their preferences for the disclosure process. METHODS: In-depth interviews were conducted with 31 (14 male, 17 female) perinatally-infected adolescents aged 16-20 at an HIV clinic in Harare, Zimbabwe, and focused on adolescents' experiences of disclosure. In addition, 15 (1 male, 14 female) healthcare workers participated in two focus groups that were centred on healthcare workers' practices surrounding disclosure in the clinic. Purposive sampling was used to recruit participants. A coding frame was developed and major themes were extracted using grounded theory methods. RESULTS: Healthcare workers encouraged caregivers to initiate disclosure in the home environment. However, many adolescents preferred disclosure to take place in the presence of healthcare workers at the clinic because it gave them access to accurate information as well as an environment that made test results seem more credible. Adolescents learned more specific information about living with an HIV-positive status and the meaning of that status from shared experiences among peers at the clinic. CONCLUSIONS: HIV-status disclosure to adolescents is distinct from disclosure to younger children and requires tailored, age-appropriate guidelines. Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent. The study also highlights the value of peer support among adolescents, which could help reduce the burden of psychosocial care on caregivers and healthcare workers.