title: Identifying youth-friendly service practices associated with adolescents' use of reproductive healthcare services in post-conflict Burundi: a cross-sectional study.
abstract: Very little is known about reproductive health service (RHS) availability and adolescents' use of these services in post-conflict settings. Such information is crucial for targeted community interventions that aim to improve quality delivery of RHS and outcomes in post-conflict settings. The objectives of this study therefore was to examine the density of RHS availability; assess spatial patterns of RHC facilities; and identify youth-friendly practices associated with adolescents' use of services in post-conflict Burundi.
  
  
  
  A cross-sectional survey was conducted from a full census of all facilities (n = 892) and provider interviews in Burundi. Surveyed facilities included all public, private, religious and community association owned-centers and hospitals. At each facility efforts were made to interview the officer-in-charge and a group of his/her staff. We applied both geospatial and non-spatial analyses, to examine the density of RHS availability and density, and to explore the association between youth-friendly practices and adolescents' use of RHS in post-conflict Burundi.
  
  
  
  High spatial patterning of distances of RHC facilities was observed, with facilities clustered predominantly in districts exhibiting persistent violence. But, use of services remained undeterred. We further found a stronger association between use of RHS and facility and programming characteristics. Community outreach, designated check-in/exam rooms, educational materials (posters, print, and pictures) in waiting rooms, privacy and confidentiality were significantly associated with adolescents' use of RHS across all facility types. Cost was associated with use only at religious facilities and youth involvement at private facilities. No significant association was found between provider characteristics and use of RHS at any facility.
  
  
  
  Our findings indicate the need to improve youth-friendly service practices in the provision of RHS to adolescents in Burundi and suggest that current approaches to provider training may not be adequate for improving these vital practices. Our mixed methods approach and results are generalizable to other countries and post-conflict settings. In post-conflict settings, the methods can be used to identify service availability and spatial patterns of RHC facilities to plan for targeted service interventions, to increase demand and uptake of services by youth and young adults.
authors.affiliation: Department of Geography and Regional Studies, University of Miami, 1300 Campo Sano Ave, Coral Gables, FL, 33124, USA. moise@miami.edu.
authors.forename: Imelda K
authors.initials: IK
authors.lastname: Moise
authors.affiliation: Department of Geography and Regional Studies, University of Miami, 1300 Campo Sano Ave, Coral Gables, FL, 33124, USA.
authors.forename: Jaclyn F
authors.initials: JF
authors.lastname: Verity
authors.affiliation: University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kangmennaang
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000068337:Armed Conflicts / Q000639:trends*; D002063:Burundi / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008297:Male; D034121:Reproductive Health Services / Q000706:statistics & numerical data* / Q000639:trends*; D055815:Young Adult