Background The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15–19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15–19 years old) leaving out the young adolescents (10–14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10–14 years. Methods This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10–14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis. Results Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents’ perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies. Conclusion The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.

BackgroundMalawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi’s disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers.MethodsA qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres’ providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software.ResultsPoor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers’ lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post.ConclusionsPositive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers’ job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1694-x) contains supplementary material, which is available to authorized users.

BackgroundEarly adolescence is an important period to lay the foundation for positive sexual health development that can overcome sexual and reproductive health challenges faced by very young adolescents (VYAs) as they reach puberty and sexual debut. We report on first-hand accounts of experiences of VYA girls who participated in girl-only clubs, and explore the club participation influence on their SRH knowledge to reduce the risk for HIV and negative sexual health outcomes. MethodsThis was a qualitative study in which twenty-three in-depth interviews were conducted with VYA girls aged 12-14 years. These girls were enrolled in girl-only clubs in two rural southern districts in Malawi. The clubs were a part of larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. Interventions included improved access to key health services, education support, social skills, asset building, and economic strengthening. Narrative inquiry was used to generate first-hand accounts of the girls’ experiences with club participation. A thematic analysis was used to generate themes from the transcribed stories. ResultsSix main themes were generated: 1) reasons for joining the clubs with desire to learn about SRH issues serving as the main motivation; 2) influence on gender norms and roles whereby participants described a change of gender roles and norms at home; 3) influence on child abuse practices whereby participants reported a decline in child abusive practices at home ;4) influence on life skills and social networks whereby participants described learning about networking; 5) influence of clubs on school attendance whereby out-of-school girls described how economic empowerment of their guardians facilitated their return to school; and 6) influence of clubs on SRH knowledge acquisition and behaviours whereby participants described acquiring knowledge on sexual health issues.Conclusion Girls-only HIV and SRH programs coupled with economic empowerment for their families can be effective in keeping VYA girls in school and improving SRH knowledge and health seeking behavior.

Early sexual relationships are associated with an increased risk of acquiring sexually transmitted diseases including HIV/AIDs, teenage pregnancies, and unsafe abortions among other negative health outcomes. Understanding sexual relationships among very young adolescents (VYAs) is important to equip them to protect themselves from negative sexual health (SH) outcomes. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is an HIV prevention initiative that provided an evidence-based core package of interventions to VYAs to prevent HIV acquisition in 15 countries in sub-Saharan Africa. The Girl Only Club (GOC) was the primary context for the interventions. Our objective in this study was to explore if there was any difference in social support (SS) received concerning sexual relationships between the VYA girls who attended GOCs and those who did not. In-depth interviews were conducted with 43 VYA girls, aged 10–14 years, in two rural southern districts, Zomba and Machinga, in Malawi. Twenty-three VYA girls were participants in GOCs and 20 VYA girls did not participate. A thematic, descriptive approach that involved a constant comparative analysis guided the data analysis, and Nvivo 12 software was used. In both study sites available SS concerning sexual relationships is informational support including information from parents, older relatives, and friends. However, club participants differed from non-club participants in sexual and reproductive health (SRH) knowledge and use. Club participants reported consulting others on decision-making and information on sexual relationships; receiving detailed SH information from clubs; condom use due to education received from the clubs; quitting sexual relationships; and correcting misinformation with club information. GOC participants received more SS which made them more knowledgeable and better at handling sexual relationship issues than those not in clubs. Interventions that integrate SS including social asset building and safe spaces are critical for VYA SRH programming.

Background: The prevalence of teenage pregnancies in Malawi is 29% and about 25% of married and 30% of unmarried adolescents (15-19) use contraceptives. Data on contraceptive use has focused on older adolescents (15-19) leaving out the young adolescents (10-14). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10-14 years.Methods: This was a qualitative study which used Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision making among young adolescents (10-14) in urban Lilongwe. The study was conducted in 6 youth health friendly service centers and in 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually-active in and out of school young adolescents and key informants. The results are organized into themes identified during analysis.Results: Results showed that contraceptive decision making is influenced by social factors (individual, interpersonal, society) and adolescents` perceptions regarding hormonal contraceptives. There is also disconnect between Education and adolescent Sexual and Reproductive Health policies.Conclusion: The findings suggest the need for empowering girls in decision making, addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country.

Background Early adolescence is an important period to lay the foundation for positive sexual health development that can overcome sexual and reproductive health (SRH) challenges faced by very young adolescents (VYAs) as they reach puberty and sexual debut. In this study, we explored the following questions: first, what are the experiences of VYA girls on DREAMS’ Go Girl club participation? Second, how does club participation influence the VYAs SRH knowledge to reduce their risk for HIV and negative sexual health outcomes? Methods This was a qualitative study in which twenty-three in-depth interviews were conducted with VYA girls aged 12–14 years. These girls were enrolled in girl-only clubs in two rural southern districts in Malawi. The clubs were a part of larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. Interventions included improved access to key health services, education support, social skills, asset building, and economic strengthening. Narrative inquiry was used to generate first-hand accounts of the girls’ experiences with club participation. Thematic analysis was used to generate themes from the transcribed stories. Results Six main themes were generated: 1) reasons for joining the clubs with desire to learn about SRH as a motivation for joining the clubs.; 2) influence on gender norms and roles whereby participants described a change of gender roles and norms at home; 3) influence on child abuse practices whereby participants reported a decline in child abusive practices at home;4) influence on life skills and social networks whereby participants described learning about networking; 5) support to go back to school whereby out-of-school girls described how economic empowerment of their guardians facilitated their return to school; and 6) influence of clubs on SRH knowledge acquisition and behaviours whereby participants described acquiring knowledge on sexual health issues. Conclusion Girls-only HIV and SRH programs coupled with economic empowerment for their families can be effective in keeping VYA girls in school and improving SRH knowledge and health seeking behavior.

IntroductionTargeting very young adolescents (VYAs) with sexual health (SH) interventions is increasingly being recognised as one of the strategies for addressing SH challenges in late adolescence. However, there is a dearth of literature regarding SH interventions implemented specifically for VYAs in sub-Saharan Africa (SSA). This scoping review aims to provide a summary of documented evidence on SH interventions that include VYAs in SSA, identify gaps in existing interventions and provide recommendations for further programmatic work on SH for VYAs.Methods and analysisThe methods for this scoping review will be guided by the framework proposed by Arksey and O’Malley and further enhanced by Levacet aland the Joanna Briggs Institute. We will search electronic databases: Popline, EMBASE, PubMed, CINAHL, Dimensions, African Journals Online (AJOL) and specific summon country-specific search. We will include published studies from SSA and only adolescent SH interventions published from the year 2003–2022. Furthermore, we will include programmatic and intervention literature that has not been published in peer-reviewed articles. The data will be charted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review. The data will then be collated and summarised.Ethics and disseminationThe scoping review methodology involves putting together information from articles or grey literature that is either publicly available or shared by the authors, this study does not require ethical approval. Findings of this scoping review will be published in a scientific journal and presented at relevant scientific fora and conferences. This scoping review will provide a comprehensive overview of the evidence base of adolescent SH interventions for VYAs in SSA and will highlight critical gaps in the existing interventions and areas where further programmatic work is needed for VYAs in SSA.Registrationhttps://archive.org/details/osf-registrations-gn538-v1.

Background: The prevalence of teenage pregnancies in Malawi is 29% and about 25% of married and 30% of unmarried adolescents (15-19 years old) use contraceptives. Data on contraceptive use has focused on older adolescents (15-19 years old) leaving out the young adolescents (10-14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10-14 years.Methods: This was a qualitative study which used Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision making among young adolescents (10-14 years old) in urban Lilongwe. The study was conducted in 6 youth health friendly service centers and in 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually-active in and out of school young adolescents and key informants. The results are organized into themes identified during analysis.Results: Results showed that contraceptive decision making is influenced by social factors (individual, interpersonal, society) and adolescents` perceptions regarding hormonal contraceptives. There is also disconnect between Education and adolescent Sexual and Reproductive Health policies.Conclusion: The findings suggest that interventions to scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.