Gloria Thupayagale-Tshweneagae

Needs of South African adolescents orphaned by AIDS: evidence from photography and photo-elicitation

BACKGROUND Available evidence shows that over half of all orphans under the age of 18 years are adolescents aged between 12 and 17 years. Despite this, the needs of adolescents orphaned by AIDS are seldom recognized or adequately addressed in policy and programmes. Instead, the focus tends to be on the needs of orphans and vulnerable children. However, there are several factors that render adolescent-specific programmes important. PURPOSE Using data from an urban area in South Africa, this paper illuminates the needs of adolescents orphaned by AIDS. METHOD A phenomenological study using photography and photo-elicitation was used with 15 adolescents aged between 14 and 18 years orphaned by AIDS. RESULTS The study participants captured different objects that were grouped under six broad themes: symbols of death, nature, people, past life, children and hope. The photographic component of the study was followed by photo-elicitation. From the meanings the adolescents made of their images, the needs of adolescents orphaned by AIDS were discerned as love, care and acceptance, safety, and security and support. CONCLUSION Overall, the results showed that adolescents orphaned by AIDS want to feel secure, safe, wanted by caregivers and to feel that caregivers support them in their grieving journey.

The Burden of Secrecy Among South African Adolescents Orphaned By HIV And AIDS

HIV thrives in an atmosphere of silence and secrecy. The stigma, real or feared, of HIV/AIDS is often a barrier to support and care that adolescent orphans need. The purpose of this article is to describe the burden of silence borne by adolescents orphaned by HIV and AIDS. A phenomenological study using photography and photo-elicitation was done among orphaned adolescents. Fifteen adolescents orphaned by HIV and AIDS, living in an urban area of South Africa, participated in the study. Participants photographed objects, such as graveyards, hearses, and a room where a parent committed suicide. These photographed objects were grouped as symbols of death. Nature and people also were photographed. Photo-elicitation revealed the psychosocial impact that results from the secrecy about parental cause of death. Implications for mental health practitioners are also discussed.

Discrimination against South African adolescents orphaned by AIDS.

This article describes the discrimination against adolescents orphaned by AIDS. A qualitative phenomenological approach using reflective diaries was used to extract how this population is discriminated on. Fifteen adolescents ages 14 to 18 living in an urban area in South Africa participated in the study. Data were collected as part of a larger study in which a peer-based mental health intervention was designed for use with adolescents orphaned by AIDS. Colaizzis seven stages were used to analyze the data from the reflective diaries. Analysis revealed that adolescents orphaned by AIDS experienced physical, social, and institutional expressions of stigma leading to discrimination. Adolescents were discriminated on by peers, caregivers, and teachers. The results of this study show that adolescents orphaned by AIDS face discrimination; further studies on the topic with a larger sample are needed to verify these findings.

Factors Influencing Women's Preferences for Places to Give Birth in Addis Ababa, Ethiopia.

The main aim of this study was to examine factors determining womens preference for places to give birth in Addis Ababa, Ethiopia. A quantitative and cross-sectional community based study design was employed. Data was collected using structured questionnaire administered to 901 women aged 15–49 years through a stratified two-stage cluster sampling technique. Multinomial logistic regression model was employed to identify predictors of delivery care. More than three-fourth of slum women gave birth at public healthcare facilities compared to slightly more than half of the nonslum residents. Education, wealth quintile, the age of respondent, number of children, pregnancy intention, and cohabitation showed net effect on womens preference for places to give birth. Despite the high number of ANC attendances, still many pregnant women especially among slum residents chose to deliver at home. Most respondents delivered in public healthcare institutions despite the general doubts about the quality of services in these institutions. Future studies should examine motivating factors for continued deliveries at home and whether there is real significant difference between the quality of maternal care service offered at public and private health facilities.

Posttraumatic Stress Disorder among Spouses of Patients Discharged from the Intensive Care Unit after Six Months

The Intensive Care Unit (ICU) can be traumatic, not only for patients, but also their closest relatives, especially spouses. Within Botswana, a developing country with very few ICUs and not so sophisticated machinery or a generalised lack of counselling for relatives, the ICU experience can be more traumatic. This study reports on the proportion of spouses who continued to experience mental distress, including the incidence of posttraumatic stress disorder, at six months after the discharge of their spouse from an intensive care unit. Mixed data collected approaches were used on a convenience sample of 28 spouses of patients who had been hospitalised at the Princess Marina Hospital ICU, Gaborone, Botswana, in the six months prior to the interview sessions. Participants were interviewed six months after the discharge of their spouse from the Intensive Care Unit using the PCL-S (PTSD Checklist). All the patients had been mechanically ventilated and had been hospitalised in the ICU for more than three days. Fifteen spouses reported intrusive memories of ICU and avoided reminders of the experience six months later. Ten spouses reported feeling anxious for a short while after their spouses discharge but that they had come to terms with the experience. In order to mitigate the trauma experienced by spouses the study suggests that pre- and post-counselling for close relatives, especially spouses, should be implemented at the point of hospitalisation, during admission, and after discharge for a period of at least six months.

Exploring Communication Challenges Between Nurses and Mechanically Ventilated Patients in the Intensive Care Unit: A Structured Review

BACKGROUND Mechanical ventilation is a necessary procedure for patients with a range of illnesses and conditions. Mechanical ventilation affects voice production, leaving patients unable to communicate their needs with nurses and family. The communication difficulty causes distress, frustration, and anger if not attended to. AIMS This structured review sought to identify communication challenges which exist between nurses and mechanically ventilated patients in intensive care units (ICU) and hence explore possible solutions to improve these communication challenges. METHODS A electronic search of MEDLINE, CINAHL, and PsycINFO was conducted to identify relevant literature on nurse-patient communication challenges in the ICU published between January 2005 and December 2014. Studies meeting the inclusion criteria were retrieved in full, reviewed, and study quality assessed. RESULTS Six studies were identified for inclusion in the review. Analysis identified five core influences on communication in the ICU: patients consciousness level, nature of nurse-patient interactions, communication methods, staff skills and perceptions, and the intensive care physical environment. LINKING EVIDENCE TO ACTION An evidence-based and multifactorial communication intervention encompassing staff skills development and training, development of relevant patient materials or devices and collaborations with relevant health professionals like speech and language therapists has the potential to improve nurse-patient communication in the ICU and hence improve patient outcomes.

Patterns of caesarean-section delivery in Addis Ababa, Ethiopia

Setting The study was conducted in Addis Ababa, the capital city of Ethiopia. Specifically, it was conducted in all healthcare facilities offering maternity and obstetric services. Objective The objective of the study was to explore the patterns of caesarean-section (CS) delivery in Addis Ababa. Methods A cross-sectional survey was carried out between December 2013 and January 2014. The population for the study were women aged between 15 and 19 years of age who had given birth in the last 1–3 years before the date of data collection. The Census and Survey Processing System software was used for data capturing and analysing both descriptive and inferential statistics using Statistical Package for Social Sciences version 20.0. Results Amongst the 835 women who delivered at health facilities, 19.2% had given birth by CS. The prevalence of CS based on medical indication was 91.3%. However, 6.9% of CS performed had no medical indication. Private health facilities performed more CSs than public health facilities, 41.1% and 11.7% respectfully. CS was high amongst women of higher socio-economic standing. Conclusion Overall, CS deliveries rate in Ethiopia is above the rate recommended by the World Health Organisation. Because socio-economic factors influence CS delivery, governments should play a key role in regulating performance of CSs in private institutions.

Development and implementation of a peer-based mental health support programme for adolescents orphaned by HIV/AIDS in South Africa.

Aim: The article describes a framework and the process for the development of the peer-based mental health support programme and its implementation. The development of a peer-based mental health support programme is based on Eriksons theory on the adolescent phase of development, the psycho-educational processes; the peer approach and the orphaned adolescents lived experiences as conceptual framework. Methods: A triangulation of five qualitative methods of photography, reflective diaries, focus groups, event history calendar and field notes were used to capture the lived experiences of adolescents orphaned to HIV and AIDS. Analysis of data followed Colaizzis method of data analysis. Results: The combination of psycho-education, Eriksons stages of development and peer support assisted the participants to gain knowledge and skills to overcome adversity and to assist them to become to more resilient. Conclusion: The peer based mental health support programme if used would enhance the mental health of adolescent orphans.

Perceptions of adolescents and teachers on school-based sexuality education in rural primary schools in Uganda

BACKGROUND Evidence-based sexuality education programmes are a cornerstone in reducing adolescent sexual risk behaviours and promoting sexual health. Several initiatives aimed at reducing sexual and reproductive problems among adolescents have been done. These initiatives include life skill education and abstinence program. Despite these initiatives teen pregnancy, sexually transmitted diseases and abortion are still common among school going adolescents. OBJECTIVES The purpose of this study was to explore the experiences and perceptions of adolescents and teachers regarding school-based sexuality education in rural primary schools. METHODS A purposive sample was drawn from primary school-going adolescents aged 12-16 years and teachers aged 28-52 in four rural schools. Eleven audio taped individual interviews and eight focus group discussions were used to collect data. A constant comparison method of data analysis was applied by following the Strauss and Corbin (1998) analysis process of open, axial and selective coding to analyse textual qualitative data until themes, categories and sub-categories were identified and developed. RESULTS Data analysis revealed that adolescents benefitted from School Based Sexuality Education but the implementation of programmes was undermined by physical and contextual factors such as challenges at national, institutional, community, family and individual levels. CONCLUSION It is vital to review the teaching and learning resources and to fully integrate sexuality education into the formal school curriculum. A combined effort of major stakeholders including teachers, community leaders, adolescents, healthcare professionals and parents is needed for sexuality education among adolescents to succeed.

The TEAM model for mental health promotion among school-going adolescents

Objective: This paper reports on the process followed in developing the “TEAM” (an acronym for the proposed intervention) model for the promotion of mental health among school-going adolescents. Methods: A sequential explanatory mixed method combining both quantitative and qualitative approaches was used to gain in-depth understanding of the experiences of adolescents, school health nurses and teachers in dealing with emotional and social problems in high schools. Data collection was conducted in 4 phases from 2012 to 2015 and included a desk review of literature, qualitative interviews with 12 school teachers; qualitative interviews with 10 school health nurses and quantitative interviews with 347 adolescents. The quantitative tool that was used for the study was based on the Social and Emotional Learning Model. Results: Key findings from the study revealed inappropriate handling of emotions by adolescents, leading them to form destructive groups (gangs); involvement in alcohol and substance abuse; disrespect; and adolescent pregnancy. Conclusion: A universal team-oriented collaborative model that will assist adolescents to shift negative energy and attitudes to positive and productive lifestyles is required. The TEAM model centres all the activities of a collaborative and focused team on the facilitation of a sense of belonging, ownership and complete engagement of pupils in schools that will contribute positively to social and emotional well-being.