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  • 1.
    chilambe, Kunda
    et al.
    Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Mulubwa, Chama
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Zulu, Joseph Mumba
    Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Malizgani, Chavula Paul
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Experiences of teachers and community-based health workers in addressing adolescents’ sexual reproductive health and rights problems in rural health systems: a case of the RISE project in Zambia2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 335Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)’ experiences in addressing ASRHR problems in in rural health systems in Zambia.

    Methodology: The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services.

    Results: The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution.

    Conclusion: This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.

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  • 2.
    Jonsson, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Pat, Puthy
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Mulubwa, Chama
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Jegannathan, Bhoomikumar
    Mathias, Kaaren
    Conducting research with young people at the margins: lessons learnt and shared through case studies in Cambodia, India, Sweden and Zambia2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikel-id 2185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Building on the value of engaging with and enabling the participation of marginalised young people in research, theaim of this article was to profle practical and procedural issues faced when conducting studies with young peoplewho experience some form of marginalisation. Drawing on observations and research experiences from four diversecase studies involving young people who were either imprisoned in Cambodia, living in informal urban communitiesin North India, residing in rural northern Sweden or attending school in rural Zambia, learnings were identifed underthree thematic areas. Firstly, a need exists to develop trusting relationships with stakeholders, and especially the participating young people, through multiple interactions. Secondly, the value of research methods that are creative andcontext sensitive are required to make the process equitable and meaningful for young people. Thirdly, it is importantto fatten power relations between adults and young people, researchers and the researched, to maximise participation. These fndings can inform future youth research in the feld of global public health by detailing opportunitiesand challenges of engaging in research with young people on the margins to promote their participation.

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  • 3.
    Mulubwa, Chama
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health, University of Zambia, Lusaka, Zambia; Zambart Project, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Zulu, Joseph Mumba
    Michelo, Charles
    Sandøy, Ingvild Fossgard
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Can sexual health interventions make community-based health systems more responsive to adolescents?: A realist informed study in rural Zambia2020Ingår i: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 17, nr 1, artikel-id 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights' needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) 'ordinary' community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents.

    METHODS: This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention-Context-Actors-Mechanism-Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories.

    RESULTS: We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification', which was also expected would lead to individuals developing a 'supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages.

    CONCLUSION: The two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform 'ordinary' community-based health systems into systems that are responsive to adolescents.

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  • 4.
    Mulubwa, Chama
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health, University of Zambia, Lusaka, Zambia; Centre of Infectious Diseases and Research in Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Zulu, Joseph Mumba
    School of Public Health, University of Zambia, Lusaka, Zambia..
    Michelo, Charles
    School of Public Health, University of Zambia, Lusaka, Zambia..
    Sandøy, Ingvild Fossgard
    Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway..
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Combining photo-elicitation and discourse analysis to examine adolescents' sexuality in rural Zambia2022Ingår i: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 21, nr 1, artikel-id 60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: This article aimed to analyse constructions of adolescents' sexualities and sexual health and the consequences of these discourses for adolescents' exercise of their sexual reproductive health and rights (SRHR) in rural Zambia.

    METHODS: Interpretative repertoires, which is rooted in discursive psychology was used to analyse data from photo-elicitations interviews and focus group discussions. Our participants included 25 adolescents who participated in a SRHR intervention that aimed to reduce adolescents' pregnancies and early marriages.

    RESULTS: We identified three interpretative repertories: 1) sex is for mature people in which adolescents positioned themselves as 'immature, and young to engage in sex; 2) gendered respectful behaviours in which what was considered disrespectful (and respectful) behaviour in relation to sexuality were strongly influenced by gender, and more clearly defined for girls than it was for boys. Sexuality was not only about individual choices but about being respectful to parents; and 3) acquiring and using knowledge about sexuality in which adolescents conflicted between having and applying SRHR knowledge.

    CONCLUSION: These repertories offer an important context that shape how adolescents negotiate, adopt and resist SRHR interventions. Future interventions that target adolescents' SRHR must aim to address the sexual scripts that serve to erect barriers against positive sexual behaviours, including access to SRHR services that promote safer sex.

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  • 5.
    Mulubwa, Chama
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Munakampe, Margarate Nzala
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Namakula, Hilda
    Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Hernandez, Alison
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn M.
    Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences New Mulago Hospital Complex, Kampala, Uganda.
    Birabwa, Catherine
    Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Chemonges, Denis
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Namatovu, Fredinah
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Makumbi, Fredrick
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
    Framing contraceptive use motivations among adolescents and young adults living in informal settlements in Kira municipality, Wakiso district, Uganda2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 658515Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The use of contraceptives among adolescents and young adults is one of the most cost-effective strategies to address many sexual and reproductive health (SRH) challenges, including unintended pregnancies, early marriages, and sexually transmitted infections. Despite a high burden of SRH challenges, uptake and unmet needs of modern contraceptives remain low in Uganda, especially among adolescents and young adults in informal settlement settings. This study aimed to explore the motivations of adolescents and young people to use modern contraceptives (or not).

    Methods: We analysed qualitative data from eight focus group discussions with 88 adolescents and young people aged 18-24 years residing in informal settlements of urban communities in Kira Municipality of Wakiso district, Uganda.

    Results: Motivations for use (or not) of modern contraceptives were framed by two interrelated constructs, sources of information on contraception and the unacceptable use of contraceptives among adolescents widespread in the community. These two, in turn, formed the scope of knowledge upon which adolescents and young people based their decision on whether or not to access and use modern contraceptives.

    Conclusion: To be more effective, sexual and reproductive health programs and interventions that aim to motivate the use of modern contraceptives among adolescents and young people in informal settings should be more comprehensive and focused on alleviating individual, health systems, social, religious factors that reinforce negative health-seeking behaviours towards contraceptive use. In addition, there is a need to support adolescents and young people with socio-economic empowering strategies that equip them with sufficient resources to choose contraceptives of their choice.

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  • 6.
    Mulubwa, Chama
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health, University of Zambia, Lusaka, Zambia; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
    Zulu, Joseph Mumba
    School of Public Health, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents’ sexual and reproductive health needs in rural Zambia2024Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 24, nr 1, artikel-id 1228Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents’ access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents’ SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents’ SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents.

    Methods: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz’s grounded theory approach was used for the analysis.

    Results: We present the core category “being both a grandmother and a CBHW”, which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents’ SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges.

    Conclusion: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people’s sexual and reproductive health.

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