School of Nursing & Public Health

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Browsing School of Nursing & Public Health by Subject "Adolescents"

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    The effect of HIV status disclosure and non-disclosure on the psychosocial wellbeing, adherence levels and treatment outcomes of adolescents on Highly Active Anti-Retroviral Therapy (HAART) at Katututra State Hospital, Namibia
    (University of Namibia, 2018) Tjituka, Francina
    Background: With the advent and wide availability of highly active antiretroviral therapy (HAART), HIV- infected children are currently living health lives and growing into adulthood. There has been mounting evidence on the benefits of appropriate HIV disclosure to adolescents. However, various researches reported contradicting results as disclosure having both negative and positive social and psychological impacts on children. This study aimed to determine the effect of HIV status disclosure on the psychosocial wellbeing, adherence to treatment and HIV treatment outcome of adolescents who are taking ART at Katutura State Hospital, pediatric HIV Clinic. The study also aimed to determine the risk of Psycho social “deviations” in HIV status disclosed adolescents as compared to undisclosed adolescent on HAART and to compare the adherence level, CD4 count, and viral load of disclosed and non-disclosed adolescent children also on HAART at the same clinic. The newly implemented Pediatric HIV disclosure program in Namibia prompted this study. The program is guided by the World Health Organization which reported mixed effects after HIV status disclosure on the adolescents and it was deemed necessary to assess whether HIV status disclosure results in a better psychosocial wellbeing, higher CD4 count and lower viral load among adolescent children put on HAART. Methods: A Cross-sectional Analytic research design was employed where the prevalence of being psychosocially unwell and the level of HIV treatment adherence, CD4 count and viral load was compared in two groups of HIV positive adolescents enrolled in HIV care and put on HAART at Katutura Hospital for at least 12 months. Results: Two-hundred HIV-infected adolescents took part in the study, data was analyzed, 99 (49.5%) were disclosed and 101(50.5%) were undisclosed. The mean age of the study participants was 12 years. The findings revealed no association between disclosure status and psychosocial well-being; as 97 (98%) and 98 (97%) of the participants from the disclosed and undisclosed groups were assessed to have been psychosocially well. It was also noted that both groups scored high on adherence to anti-retroviral therapy with an adherence level of above 98%. The results show no difference in viral load suppression between the disclosed and undisclosed group. In addition, the result did not show significant difference in CD4 count between the two groups of adolescents which concludes that disclosure of HIV status is not associated with decreased CD4 count for adolescent living with HIV. The results suggest that disclosure doesn’t affect the psychosocial wellbeing of adolescents, neither does it affect the treatment outcomes of HIV positive adolescents on HAART.
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    Knowledge and experiences of nurses regarding the preparation of adolescents with congenital heart disease for adulthood at Windhoek central hospital, Windhoek, Namibia
    (University of Namibia, 2022) Njembo, Charmine
    The purpose of the study was to determine the nurse’s knowledge and explore the experience of nurses regarding the preparation of adolescents with Congenital Heart Disease (CHD) for adulthood. A convergent mixed method design was used. A descriptive design was applied to describe the nurses’ knowledge on preparation of the adolescents with CHD for adulthood according to the following domains: a) prevention of complications, b) physical activities, c) sexuality and heredity, d) contraception and pregnancy planning for the quantitative data. For qualitative data, a phenomenological descriptive approach was followed to explore and describe the experience of the nurses with regards to the educating, and counselling of adolescents with CHD in preparation for adulthood at Windhoek Central Hospital’s In- and Out-patient cardiac departments. Out of 26 nurses who provide care at Windhoek Central Hospital’s cardiac departments, only 17 nurses who met the inclusive criteria were interviewed. Due to the low numbers, all participants were eligible for both methods. The quantitative data was analyzed and synthesized using the Statistical Package of Social Science (SPSS-version 27) software, which is designed for quantitative data analysis. Descriptive factor analyses were produced using statistical methods using SPSS version 27. The qualitative raw data for this study were analysed through Atlas.ti using the coding system, then the most descriptive words were converted into themes. To achieve the aim of the study, two objectives were set: (a) to determine the nurses’ knowledge on preparation of adolescents with congenital heart disease for adulthood with regard to the prevention of complications, physical activities, sexuality and heredity, contraception and pregnancy planning; and (b) to Explore the nurses’ experience with regards to education, counselling, and preparation of adolescents with CHD for adulthood. ii Objective (a): The study comprised mostly of registered nurses (76.5%), with 17.6% enrolled nurses and only 5.9% of nurses are cardiac specialist nurses. The findings revealed that most nurses (52.9%) who provide direct nursing care to the adolescents with congenital heart disease in a transition period qualified for a long time as nurses and they have appropriate experience for preparing the adolescents with CHD for adulthood. The findings from the quantitative data indicated that although nurse demonstrate good knowledge that adolescent with CHD should consult health facilities in case of side effects of medication (94.1%), avoidance of physical demanding occupation (100%) however only 76.5% of nurses agreed that adolescents with CHD in transition should not partake in any competitive sport. While nurses acknowledged that adolescents with CHD may engage in sexual activities that they are capable of performing (70.6%) and that adolescents with CHD are at risk of pregnancy related complications (100%). However, the respondents nevertheless had average knowledge about action adolescents with CHD should take in event of medication side effect (52.9%), poor knowledge about risks incurred by engagement in sexual activities (11.8%), subsequent poor knowledge about risk of hereditary of CHD to the offspring (11.8%) and average knowledge about the choices of contraceptive for adolescents with CHD, most respondents 82.4% correctly recommended the Implanon as the suitable method of contraceptive for adolescents with CHD, however this method of contraceptive is standard for all adolescents with CHD at Windhoek central hospital cardiac department, without considering the specific cardiac lesion, type of cardiac surgical intervention and treatment regimen for an individual adolescent with congenital heart disease, as proposed by Sable et., (2011) and World Health organization (2009). Additionally, the findings indicated that nurses use a holistic approach when preparing the adolescent with CHD for adulthood by focusing on key aspects of preparation such as: iii prevention of complications, physical activities, sexuality, heredity, contraception and pregnancy. Objective (b): Nurses felt that, they encouraged disease acceptance during counselling as this might result in better physical and mental well-being of the adolescents with congenital heart disease. It is worthy to note that most of the participants in the interviews spoke highly on the importance of treatment adherence. Moreover, nurses had the impression that sufficient knowledge is provided to adolescents with adolescents with CHD with regard to International Normalized Ratio training. Although a holistic approach on other matters that affect the adolescents with CHD is used by nurses to ensure a smooth transition, the nurses’ perceive that there is still a need for psychological support to help the adolescents to cope with the disease as CHD requires ongoing medical attention as CHD causes limitations to the patient’s daily activities. Nurses felt that although activities intolerance was mostly discussed with the transitioning adolescents with CHD, nurses’ did not discuss the benefits of exercise. Therefore, adolescents with CHD could risk developing perceived physical activity restrictions. From the qualitative section, the main themes which emerged were Inform patients on the nature of CHD, Extreme physical activities, The future of adolescents living with CHD, Educate on sexual activities, Educate on career choice, Nurses knowledge, Care and empathy psychological support and Policy/guideline. The researcher recommended the implementation of a checklist to guide the nurses in assessing the needs of adolescents with CHD in the transition period as well as in-service training for nurses to initiate an effective and efficient education and counselling to the adolescent with CHD in a transition period.
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    The association between disclosure and adherence to Antiretroviral Therapy among adolescents living with HIV in Windhoek, Khomas region, Namibia
    (University of Namibia, 2024) Manvwali, Martha Kachana; Alfeus, Anna
    The study was conducted in Windhoek, Khomas region, Namibia, focusing on adolescents living with HIV aged 10-19 who had been receiving antiretroviral therapy (ART) care for at least six months between 2010 and 2021. It also included healthcare workers who had worked in the ART department for at least six months during the data collection period. The primary objective was to assess the association between disclosure (the process of revealing one's HIV-positive status) and adherence to ART among adolescents living with HIV. A mixed method approach with an explanatory sequential design was employed. The quantitative component used an unmatched case-control design with a 1:1 ratio, while the qualitative component utilized an exploratory design to complement the quantitative analysis. The study participants included 20 healthcare workers and 37 adolescents living with HIV who were on ART care. Findings revealed that among adolescents with good adherence (≥90%), 76% had been fully disclosed about their HIV-positive status, while 20% were partially disclosed. In contrast, among adolescents with poor adherence (<90%), 92% had not been disclosed about their HIV-positive status. Some adolescents who were fully disclosed learned about their status accidentally. Caregivers of the adolescents and healthcare workers were the key informants in disclosure and adherence aspect. The study recommends strengthening disclosure programs through enhanced efforts by the Ministry of Health and Social Services. This includes training healthcare providers involved in the disclosure process, educating parents/caregivers or guardians about the disclosure process and the skills required to conduct it at home, ensuring equitable distribution of disclosure tools and equipment among health facilities, and implementing standardized disclosure processes through Standard Operating Procedures (SOPs) and guidelines consistently across all health facilities nationwide. Future research should explore factors that enable adolescents to accept their HIV-positive status with reduced distress and examine their experiences during and after disclosure sessions, including their psychosocial support needs. In summary, this study aimed to understand the relationship between disclosure and adherence to ART among adolescents living with HIV in Namibia and provided recommendations to improve the disclosure process and support for these adolescents