Parent-child sexuality communication has been identified as a protective factor for adolescent sexual and reproductive health, including HIV infection. The available literature on this topic in sub-Saharan Africa is increasing; however a systematic review of studies has not been conducted. This article reviews the literature in the area of parental or caregiver and child communication about sexuality and HIV/AIDS in sub-Saharan Africa. A review of peer reviewed literature published between 1980 and April 2011 was conducted. Communication process studies investigating the frequency, content, style, tone of discussions, preferences, as well as associations with and barriers to sexuality communication are reviewed. In addition, studies which examine behavioral associations with parent-child sexuality communication, and intervention studies to improve parent-child sexuality communication are examined. The findings from process studies suggest wide variation in terms of frequency of discussions, with a range of socio-demographic and other factors associated with sexuality communication. Overall, findings demonstrate that discussions tend to be authoritarian and uni-directional, characterized by vague warnings rather than direct, open discussion. Moreover, parents and young people report a number of barriers to open dialogue, including lack of knowledge and skills, as well as cultural norms and taboos. Findings are less clear when it comes to associations between parental communication and adolescent sexual activity and contraception use. However, nascent indications from intervention research suggest positive findings with increases in frequency and comfort of discussions, among other outcomes. Gaps in the research are identified and discussed with implications for future studies.

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BackgroundEvidence suggests that in spite of some adolescents being sexually active, many parents do not discuss sex-related issues with them due to lack of age-appropriate respectful vocabulary and skills. The likelihood of parent-adolescent communication improving sexual and reproductive health outcomes appears plausible. The desire to understand parent-adolescent communication and how to improve it for promotion of healthy sexual behaviours inspired this research. The paper is meant to describe perceptions of adolescents, parents and school administrators about parent-adolescent communication on sexual issues; describe the content of such communication and identify factors that influence this communication.MethodsThe study was done among two urban and two rural secondary school students in their second year of education. Data were collected from 11 focus group discussions and 10 key Informants Interviews. Data management, analysis and interpretation followed thematic analysis principles. Illuminating verbatim quotations are used to illustrate findings.ResultsParental warmth and acceptability of children was perceived by parents to be foundational for a healthy adolescent- parent communication. Perceptions of adolescents tended to point to more open and frequent communication with mothers than fathers and to cordial relationships with mothers. Fathers were perceived by adolescents to be strict, intimidating, unapproachable and unavailable. While adolescents tended to generally discuss sexual issues with mothers, male adolescents communicated less with anyone on sex, relationships and condoms. Much of the parent-adolescent communication was perceived to focus on sexually transmitted infections and body changes. Discussions of sex and dating with adolescents were perceived to be rare. Common triggers of sexuality discussions with female adolescents were; onset of menstruation and perceived abortion in the neighbourhood. Discussion with male adolescents, if it occurred was perceived to be triggered by parental suspicion of having female ‘friends’ or coming home late. Peers at school and mass media were perceived to the main source of sexuality information.ConclusionsCommunication on sexuality issues between parents and their adolescent children was infrequent and critical elements like sex and specifics of protection against undesirable sexual behaviour consequences were avoided. Peers, schools and mass media should be creatively harnessed to improve parent-adolescent communication about sexuality issues.

In all three sites, a substantial proportion of adolescents reported not communicating with their parents about HIV/AIDS, abstinence, or condoms. The low proportion of explained variation in sexuality communication implies that silence is common across sociodemographic subgroups.

DV is prevalent and widespread in the study sites. Violence control policies and interventions should target young adolescents. Since there was not one clearly defined subgroup identified as being at high risk, such programmes should not be limited to high risk groups only.

Young people in sub-Saharan Africa constitute an important group for HIV prevention efforts. Determining their exposure to HIV/AIDS information and communication and their perceived credibility of information sources is imperative to the development of interventions. However, the majority of studies on this topic have been conducted among school-based populations, with few focused on those out of school or on comparing the two groups. A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1 007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/ AIDS information and they communicated more frequently about the topic than did the out-of-school group. Among both groups, exposure to HIV/AIDS information occurred more frequently than discussing the topic. The in-school group gave high credibility ratings to medical doctors, the radio and parents as sources of information, while the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents and doctors as preferred communicators of sexual and reproductive health information. Interventions that address the determinants of educational attainment are needed, as well as ones specifically intended to reach girls or those out of school. The preferences and credibility rankings for sources of HIV/AIDS information suggest the need for evidence-based programmes that utilise peers and promote the involvement of parents or doctors. Particularly needed are interventions that explicitly aim to stimulate discussion among young people about HIV/AIDS and that foster the development of interpersonal skills.

BackgroundDiarrheal disease is a major cause of mortality and morbidity in low and middle income countries with children being disproportionately affected. Project SHINE (Sanitation & Hygiene INnovation in Education) is a grassroots participatory science education and social entrepreneurship model to engage youth and the wider community in the development of sustainable strategies to improve sanitation and hygiene.MethodsBased in rural and remote Tanzania, this pilot study engaged pastoralist high-school students and communities in the development and evaluation of culturally and contextually relevant strategies to improve sanitation and hygiene. Using a train-the-trainer approach, key activities included teacher workshops, school-based lessons, extra-curricular activities, community events and a One Health sanitation science fair which showcased projects related to water, sanitation and hygiene in relation to human and animal health. The process and outcome of the study were evaluated through qualitative interviews and focus group discussions with diverse project participants, as well as pre- and post- questionnaires completed by students on knowledge, attitudes and practices concerning sanitation and hygiene.ResultsThe questionnaire results at baseline and follow-up showed statistically significant improvements on key measures including a decrease in unhygienic behaviors, an increase in the perceived importance of handwashing and intention to use the toilet, and increased communication in the social network about the importance of clean water and improved sanitation and hygiene practices, however there were no significant changes in sanitation related knowledge. Qualitative data highlighted strong leadership emerging from youth and enthusiasm from teachers and students concerning the overall approach in the project, including the use of participatory methods. There was a high degree of community engagement with hundreds of community members participating in school-based events. Sanitation science fair projects addressed a range of pastoralist questions and concerns regarding the relationship between water, sanitation and hygiene. Several projects, such as making soap from local materials, demonstrate potential as a sustainable strategy to improve health and livelihoods in the long-term.ConclusionsThe Project SHINE model shows promise as an innovative capacity building approach and as an engagement and empowerment strategy for youth and communities to develop locally sustainable strategies to improve sanitation and hygiene.

Background: The consumption of industrially processed food, popularly known as junk food, is a growing public health concern worldwide, including in Nepal. Schoolchildren are a vulnerable group and they consume junk food at school. Aim: The aim of this study was to examine multi-level determinants of junk food consumption among basic schoolchildren using the socio-ecological model as a framework. Methods: A cross-sectional study was conducted among students ( n = 404), and a self-reported questionnaire was used to collect the data. The chi-square test and logistic regression were applied to analyse the results using SPSS version 26. Results: Nearly half (47%) of the students reported that they consumed junk foods at snack time. Important variables for explaining junk food consumption were knowledge of food and nutrition—a micro-level determinant; sharing knowledge of food and nutrition with classmates at school—a meso-level determinant; grade of student—an exo-level determinant; and occupation of parents—a macro-level determinant. However, multivariate analysis found that knowledge of food and nutrition ( p < 0.05), and sharing knowledge of food and nutrition with classmates at school ( p < 0.05) were the significant predictors of junk food consumption. Conclusions: Junk food consumption is common among basic-level students in the study schools. Multi-level determinants explain the factors associated with this behaviour, extending from micro to macro as the socio-ecological model asserts. This study points to the need for comprehensive school-based nutrition education that targets multiple levels of influence, focusing on active learning approaches to promote healthy dietary behaviour in students.