Disease and health seeking patterns among adolescents in Uganda.
Adolescents in Uganda have a heavy burden of disease mainly from STD's, HIV and effects of unwanted pregnancy. Currently there are initiatives to address this problem. This paper presents results of a project which piloted a package of adolescent health services with the aim of identifying the best approach for providing quality, accessible, and affordable adolescent friendly services.


OBJECTIVE
The main objective of the study was to evaluate the impact of adolescent-friendly health services piloted in the Jinja district Uganda. The specific objectives were to assess adolescents' knowledge, attitudes, and practices related to access and utilization of adolescent friendly services; to assess the perceptions and skills of health workers; and to identify options for scaling up services and sustainability of such services.


METHODS
A KAP (Knowledge, Attitude and Practice) study was conducted among adolescents and service providers at eight health units. Four of the health units had implemented a package of adolescent friendly services, while four other health units had not implemented the package, but were comparable in terms of level of service delivery, catchment size and population characteristics. A structured questionnaire and in-depth interviews were used to collect data.


RESULTS
A total of 128 adolescents and 42 health workers were interviewed, and focus group discussions were used to collect data. More adolescents utilized routine services at four pilot health units as follows: antenatal care (72.8% vs. 53.7%, p = 0.000), maternity care (70.6% vs. 53.1%, p = 0.005), family planning (69.4% vs. 21.1%, p = 0.000), management of STD's (65.5% vs. 31.9%, p = 0.000) and access to laboratory services (49.8% vs. 4.4%, p = 0.000). Adolescents at pilot sites were more knowledgeable on adolescent health problems (74.8% vs. 48.9%, p = 0.000), factors predisposing adolescents to health problems (73.4% vs. 52.5%, p = 0.003), family planning methods (84.5% vs. 68.7%, p = 0.000), HIV as a problem to adolescents (84.5% vs. 68.7%, p = 0.011), and STD's as a problem to adolescents (76.3 vs. 50.2%, p = 0.004). One of the main constraints to the pilot project was an erratic supply of contraceptives and STD drugs mainly from inadequacies in the national health system.


CONCLUSIONS
Implementation of adolescent friendly services improved access and use of services among adolescents; this lead to reduced morbidity from STD's, HIV, and unwanted pregnancies. In order to reach more adolescents, services have to be scaled to lower health units up to the community level. Training of health workers, ensuring a constant supply of contraceptives, STD drugs, and availing voluntary HIV testing and counseling services are key program issues to consider.
Mbonye
Anthony K
AK
Reproductive Health Division, Ministry of Health, Box 7272, Kampala, Uganda. akmbonye@yahoo.com
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D011275:Pregnancy, Unwanted / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology