Nghiên cứu Kiến thức thái độ Hành vi chăm sóc sức khỏe sinh sản ở nữ thanh niên_exual reproductive knowledge attitudes and behavior among adolescent akha females luangnamtha province lao people’s democratic republic a qualitative and quantitative study Background Gender and ethnicity issues have become important Government expands the reach of basic services to remote areas where many ethnic populations live Traditional norms and practices are also changing as young people migrate from remote areas Reduction in maternal mortality appears to be slow in remote rural areas The rural maternal mortality ratio is more than three times higher than urban ratioEarly marriage and pregnancy in adolescence are the norm in Laos especially in in remote rural areas Rational In the AKha ethnic group, there was some ritual passage of puberty and cultural acceptance of multiple sex partners make adolescents more at risk of STIsLow knowledge of sexual reproductive health among those who are sexually active and barrier of accessibility to adolescent sexual reproductive health services, will likely lead to have an impact on sexual health such as STIs and HIVAIDSGap of understanding SRH knowledge and attitudes towards sexuality among Akha girlsMany complex factors prevent ethnic adolescent girls from seeking sexual reproductive healthcare servicesResearch questionsWhat is the sexual knowledge of Akha girls? How do Akha ethnic girls in Laos utilize health care services?How do Akha ethnic girls seek care for their sexual reproductive healthcare services and the factors that influence their care seeking? MethodologyDesign: Crosssectional study using quantitative and qualitative methodsProject Sites: Long and Sing districts Luangnamta province Study population: Female AKha adolescents aged 14 to 19 years old. Other key informants: head villagers, LYU, LWU, directors’ district and provincial health office and hospitals, and health providers
Sexual Reproductive Knowledge, Attitudes and Behavior among Adolescent Akha Females, LuangNamtha province, Lao People’s Democratic Republic (PDR): A Qualitative and Quantitative Study Faculty of Postgraduate Studies, University of Health Sciences 7th GMS-ICPH, 26-27 September, 2015 Hue University of Medicine and Pharmacy, Vietnam Background • Gender and ethnicity issues have become important • Government expands the reach of basic services to remote areas where many ethnic populations live • Traditional norms and practices are also changing as young people migrate from remote areas • Reduction in maternal mortality appears to be slow in remote rural areas • The rural maternal mortality ratio is more than three times higher than urban ratio • Early marriage and pregnancy in adolescence are the norm in Laos especially in in remote rural areas Rational • In the AKha ethnic group, there was some ritual passage of puberty and cultural acceptance of multiple sex partners make adolescents more at risk of STIs • Low knowledge of sexual reproductive health among those who are sexually active and barrier of accessibility to adolescent sexual reproductive health services, will likely lead to have an impact on sexual health such as STIs and HIV/AIDS • Gap of understanding SRH knowledge and attitudes towards sexuality among Akha girls • Many complex factors prevent ethnic adolescent girls from seeking sexual reproductive healthcare services Research questions • What is the sexual knowledge of Akha girls? • How Akha ethnic girls in Laos utilize health care services? • How Akha ethnic girls seek care for their sexual reproductive healthcare services and the factors that influence their care seeking? Methodology • Design: Cross-sectional study using quantitative and qualitative methods • Project Sites: Long and Sing districts Luangnamta province • Study population: Female AKha adolescents aged 14 to 19 years old Other key informants: head villagers, LYU, LWU, directors’ district and provincial health office and hospitals, and health providers Methodology • Measures: Structured questionnaires were used to determine adolescent’s knowledge and attitudes towards sexual reproductive health • Qualitative methods: FGDs, informal discussion, and in-depth interview to understand the need of comprehensive sexuality education (CSE) and the barriers of accessibility to ARH services Socio-demographic Characteristic • 409 female Akha adolescents were participated in the study • The mean age of participants was 15.6+.52 • One third of adolescents are in the age 14 years and one fourth of them are in the age of 15 years • 49.6% had had primary schooling, • 14.4% had reached middle school, • 2.2% had reached high school and • 1% had continued their education beyond high school; 32.8% had had no schooling • At the time of the survey, 64.8% are out-of-school Socio-demographic Characteristic • 61.4% of the females indicated that they experienced of ‘Breakthrough Vagina’ and • 19.3% experienced of welcome guest • The age of initiating ‘Breakthrough Vagina’ ranged from 11 to 17 years with a mean of 13.5+1.08; • The mean age of experience welcome guest was 14.8+1.34 and ranged from 11 to 18 years Knowledge Knowledge Mean SD Min Max Reproductive health knowledge 1.7 0.512 Contraceptive knowledge 4.4 0.795 51.7 STIs knowledge 7.2 1.620 13 HIV knowledge 7.0 2.104 12 • Participants had high levels of knowledge of contraception, low levels of knowledge of STIs/HIV/AIDS, and moderate levels of knowledge on reproductive health Source of SRH Information Factor associated with premarital sexual behaviors Having experience of welcome guest (OR ; 95% CI (5.7; 3.1 – 10 Drinking alcohol (OR ; 95% CI (4.2; 2.1 – 8.4)) Older age (OR ; 95% CI (1.2; 1.0 – 1.5)) Knowledge of HIV/AIDS (OR ; 95% CI(0.8; 0.7 – 0.9) Knowledge of STIs (OR ; 95% CI(0.8; 0.67 – 0.9) High education (OR ; 95% CI (0.3; 0.1 – 0.8)) Factor associated with multiple sex partners Having experience of welcome guest (OR ; 95% CI (3.8; 2.0 – 7.0)) 0.25 0.33 0.5 Protective effect α 10 11 Risk effect Contributing factors to the sexual risk behaviors • Attitudes towards sexuality - premarital sex appears to be more acceptable to both males and females in the Akha sexual culture • Multiple sex partners are perceived as acceptable • Traditional practices such as Break Through Vagina’ (BV) for girls – not usually contraceptives (perceived as not having sex) • Many girls participated in the welcome guest which entails visiting men to any Akha village who are entertained and served sexually by young women of the host village - makes them more vulnerable to STIs/HIV/AIDS • Low condoms even though they know about condoms – perceived as not natural Barriers young people’s facing in accessing SRH services • Lack of money • “Adolescents did not go to hospitals if their parents did not have money Some have relatives, so they could borrow from relatives as there were direct and indirect expenses for using health services” (Girl, 17 years old) • Distance to Facilities • Poor road conditions were mentioned by adolescents as the barriers to seeking care or use health services. • “We stayed far from the health center and we have to walk from our village to the health center about hours There was no public transportation from our village to the city; however, there was only one truck in our village.“ (Girl, 17 years old) Shyness, embarrassment and communication • Shyness - adolescent girls dared to discuss with health care providers • Embarrassment – “They are afraid to be seen by others, so they did not use health services at the public health facilities” (Male health care provider, 52 years old) • Difficulty in communication with the health care providers - most did not speak Lao loum language Conclusion • This is the first study that examines SRH knowledge of, attitudes and accessibility to ASRH information & services among female Akha adolescents in the Luangnamtha province, Lao PDR • The study revealed high knowledge of contraception, low STIs/HIV/AIDS, however, they had moderate knowledge on reproductive health • The findings also found a significant proportion of Akha girls engaged in premarital sex, early age at first sex, multiple sex partners, and low condom use Recommendation • Akha girls should be targeted with preventive interventions so as to discourage their sexual initiation • A policy introducing sexuality education to out-of-school Akha girls should be considered Sex education must include material that will increase sex-related knowledge, conception, sexual development and contraception Recommendation • Keep adolescents in the schools or reduce the number of out of school youth, and promote enrollment adolescents in secondary schools and higher education (long term perspective) • Increase adolescent’s accessibility to ASRH information and services by providing the youth friendly services at the district level ຂອບໃຈຫລາຍໆ ... higher than urban ratio • Early marriage and pregnancy in adolescence are the norm in Laos especially in in remote rural areas Rational • In the AKha ethnic group, there was some ritual passage of... to adolescent sexual reproductive health services, will likely lead to have an impact on sexual health such as STIs and HIV/AIDS • Gap of understanding SRH knowledge and attitudes towards sexuality... behaviors • Attitudes towards sexuality - premarital sex appears to be more acceptable to both males and females in the Akha sexual culture • Multiple sex partners are perceived as acceptable