Utilization of youth-friendly health services by the youth in Lusaka Urban District
Mushinda, Elizabeth Tshabangu
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Over the last decade, young peoples' health has become a subject of increasing concern throughout the World (Senderwitz, 1995). The needs of the young people are complex, diverse and demand urgent attention. This is all due to the changing patterns of behavior, combined with changing living conditions that have increased health hazards for the young people (WHO, 1992). Young people often know very little and have incorrect information or have heard rumors about sexuality and contraception. The reproductive health risks faced by young people include STIs, HIV/AIDS and unwanted pregnancies often leading to unsafe abortions and its complications (Quyed, 1998). However, insufficient information and unattractive services at the health centers has resulted in young people being reluctant to seek reproductive health services. Thus, making the "Youth Friendly Health Services"(YFHS) more available, accessible and acceptable to the young is a growing challenge for the policy makers, health providers and youths themselves.Objectives: •To determine the number of health centers providing "youth friendly health services". •To make a detailed analysis of the services offered at the YFHS comers. •To determine the utilization rates of the YFHS by the young people (15-24) in both high and low density areas randomly selected in Lusaka urban district over the past four years (1999, 2000, 2001 and 2002) •To determine the association between availability, accessibility, acceptability and the utilization of YFHS, using the Tanahashi model. •To describe the youths' perception of the quality of services provided at the various clinics. Study design Cross-sectional study was carried out. Study site Lusaka Urban District. Subjects and Sampling A total of 373 youths (15-24) residing in Lusaka urban for at least the past 6 months or more were randomly selected in the residential areas of the randomly selected 4 zones using the multistage sampling method. Main outcome measure Utilization of the "Youth Friendly Health Services" by the youths aged 15-24 years in Lusaka urban district. Results: The results of the study show that the age groups 15-19 years and 20-24 years were about equally presented. The persons who utilized the YFHS more (60%) tended to be older. Age was significantly associated with-the utilization of "the YFHS (p=0.0151)The majority (75.3%) of the youths were knowledgeable about the YFHS and most of those who were knowledgeable (68%) did utilize the services. However, 24.1% were not knowledgeable about the services and denied having ever utilized them. On the source of information on YFHS, those who cited school as their source of information were 56% less likely to utilize the YFHS. However, those who cited Peer educators were two times more likely to utilize these services as compared to those who cited other sources like church, friends, neighbors and cousins. More than three-quarters (78.0%) had reported having had sexual intercourse 6 months prior to the study and most of these (60.5%) utilized the YFHS. There was a significant association between those with the history of having had sexual intercourse and the utilization of the YFHS (p = 0.0006). On multivariate analysis it was revealed that those who gave history of having had sexual intercourse 6 months prior to the survey were 67% more likely to utilize the YFHS as compared to those who had no history of sexual intercourse. As regards to the availability of the YFHS, at the time of the study was at 95.7% while accessibility was at 66.2% due to the fact that some health centers had no offices and flexible working hours. As for acceptability and quality of the services most of the youths (93.2%) who utilized the services described the reception given to them by the provider as welcoming, while 77.2% of them described the time spent at the corner with the provider as having had a good time. The study also revealed that more than three quarters (88.1%) said the discussion took place in the office, showing that privacy was observed. However, it is important to provide the peer educators with an office where they can carry out their duties.Conclusion: The study revealed that youths were sexually active and yet almost one quarter of the respondents had no knowledge of the YFHS resulting in non-utilization of the YFHS.Therefore, there is need to intensify the sensitization of the young people on the YFHS available. This will improve the utilization rate of the YFHS, which in turn will help change the sexual behavior of the youth thus resulting in improved health status of the young people who are the future generation.
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