Health-seeking behaviours by gender among adolescents in Soweto, South Africa

Kennedy Otwombe, Janan Dietrich, Fatima Laher, Stefanie Hornschuh, Busisiwe Nkala, Lucy Chimoyi, Angela Kaida, Glenda E Gray, Cari L Miller, Kennedy Otwombe, Janan Dietrich, Fatima Laher, Stefanie Hornschuh, Busisiwe Nkala, Lucy Chimoyi, Angela Kaida, Glenda E Gray, Cari L Miller

Abstract

Background: Adolescents are an important age-group for preventing disease and supporting health yet little is known about their health-seeking behaviours.

Objective: We describe socio-demographic characteristics and health-seeking behaviours of adolescents in Soweto, South Africa, in order to broaden our understanding of their health needs.

Design: The Botsha Bophelo Adolescent Health Study was an interviewer-administered cross-sectional survey of 830 adolescents (14-19 years) conducted in Soweto from 2010 to 2012. Health-seeking behaviours were defined as accessing medical services and/or being hospitalised in the 6 months prior to the survey. Chi-square analysis tested for associations between gender, other socio-demographic and behavioural characteristics, and health-seeking behaviours.

Results: Of 830 adolescents, 57% were female, 50% were aged 17-19 years, 85% were enrolled in school, and 78% reported experiencing medium or high food insecurity. Males were more likely than females to report sexual debut (64% vs. 49%; p<0.0001) and illicit drug use (11% vs. 3%; p<0.0001). Approximately 27% (n=224) and 8% (n=65) reported seeking healthcare or being hospitalised respectively in the previous 6 months, with no significant differences by gender. Services were most commonly sought at medical clinics (75%), predominantly because of flu-like symptoms (32%), followed by concerns about HIV (10%). Compared to females, males were more likely to seek healthcare for condom breakage (8% vs. 2%; p=0.02). Relative to males, a significantly higher proportion of females desired general healthcare services (85% vs. 78%; p=0.0091), counselling (82% vs. 70%; p<0.0001), and reproductive health services (64% vs. 56%; p=0.02).

Conclusions: A quarter of male and female adolescents accessed health services in the 6 months prior to the interview. Adolescents reported a gap between the availability and the need for general, reproductive, and counselling services. Integrated adolescent-friendly, school-based health services are recommended to bridge this gap.

Keywords: South Africa; adolescent health; health promotion; health-seeking; risk behaviours.

Figures

Fig. 1
Fig. 1
Flow chart of health-seeking behaviour and reasons among adolescents in Soweto, South Africa.

References

    1. Statistics South Africa. Mid year population estimates. 2011. Available from: [cited 9 July 2014].
    1. Barker G. Adolescents, social support and help seeking behaviour. 2007. Available from: [cited 9 July 2014].
    1. National Youth Commission. Pretoria: Office of the Deputy President; 2009. National youth policy 2009–2014.
    1. WHO. Adolescent health epidemiology. 2014. Available from: [cited 9 July 2014].
    1. Cooper D, Dickson K, Blanchard K, Cullingworth L, Mavimbela N, von Mollendorf C, et al. Medical abortion: the possibilities for introduction in the public sector in South Africa. Reprod Health Matters. 2005;13:35–43.
    1. Richter LM, Norris SA, Ginsburg C. The silent truth of teenage pregnancies–Birth to Twenty cohort’s next generation. S Afr Med J. 2006;96:122–124.
    1. Dunkle KL, Jewkes RK, Brown HC, Yoshihama M, Gray GE, McIntyre JA, et al. Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. Am J Epidemiol. 2004;160:230–9.
    1. van Rooyen H, McGrath N, Chirowodza A, Joseph P, Fiamma A, Gray G, et al. Mobile VCT: reaching men and young people in urban and rural South African pilot studies (NIMH Project Accept, HPTN 043) AIDS Behav. 2013;17:2946–53.
    1. Katz IT, Nkala B, Dietrich J, Wallace M, Bekker LG, Pollenz K, et al. A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers. PLoS One. 2013;8:e72094.
    1. Seedat M, Van Niekerk A, Jewkes R, Suffla S, Ratele K. Violence and injuries in South Africa: prioritising an agenda for prevention. Lancet. 2009;374:1011–22.
    1. Dickson-Tetteh K, Pettifor A, Moleko W. Working with public sector clinics to provide adolescent-friendly services in South Africa. Reprod Health Matters. 2001;9:160–9.
    1. LoveLife. Youth-friendly HCT. Available from: [cited 24 November 2014].
    1. City of Johannesburg. Census 2011 – main place “Soweto”. 2011. Available from: [cited 14 July 2014].
    1. Statistics South Africa. Census 2011 municipal report Gauteng. 2012. Available from: [cited 14 July 2014].
    1. Coates J, Swindale S, Bilinsky P. Washington, DC: Academy for Educational Development; 2007. Household Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide.
    1. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
    1. Chabrol H, Montovany A, Chouicha K, Duconge E. [Study of the CES-D on a sample of 1,953 adolescent students] Encephale. 2002;28:429–32.
    1. SAS Institute Inc. 2nd ed. Cary, NC: SAS Institute; 2009. SAS/STAT® 9.2 user’s guide; pp. 170–1.
    1. Kisker EE, Brown RS. Do school-based health centers improve adolescents’ access to health care, health status, and risk-taking behavior? J Adolesc Health. 1996;18:335–43.
    1. Richter MS, Mfolo V. The perception of South African adolescents regarding primary health care services. Sci World J. 2006;6:737–44.
    1. Health Systems Trust. National health care facilities baseline audit. 2012. Available from: [cited 14 July 2013].
    1. Hampanda K, Ybarra M, Bull S. Perceptions of health care services and HIV-related health-seeking behavior among Uganda adolescents. AIDS Care. 2014;26:1209–17.
    1. Mmari KN, Oseni O, Fatusi AO. STI treatment-seeking behaviors among youth in Nigeria: are there gender differences? Int Perspect Sex Reprod Health. 2010;36:72–9.
    1. Mmari K, Blum R, Sonenstein F, Marshall B, Brahmbhatt H, Venables E, et al. Adolescents’ perceptions of health from disadvantaged urban communities: findings from the WAVE study. Soc Sci Med. 2014;104:124–32.
    1. Plüddemann A, Flisher AJ, McKetin R, Parry C, Lombard C. Methamphetamine use, aggressive behavior and other mental health issues among high-school students in Cape Town, South Africa. Drug Alcohol Depend. 2010;109:14–19.
    1. Ramirez-Avila L, Regan S, Giddy J, Chetty S, Ross D, Katz JN, et al. Depressive symptoms and their impact on health-seeking behaviors in newly-diagnosed HIV-infected patients in Durban, South Africa. AIDS Behav. 2012;16:2226–35.
    1. Rosen EU. Adolescent health problems–can paediatricians in SA cope? S Afr Med J. 1988;73:337.
    1. Mayosi BM, Lawn JE, van Niekerk A, Bradshaw D, Abdool Karim SS, Coovadia HM, et al. Health in South Africa: changes and challenges since 2009. Lancet. 2012;380:2029–43.
    1. Madu SN, Matla MP. Illicit drug use, cigarette smoking and alcohol drinking behaviour among a sample of high school adolescents in the Pietersburg area of the Northern Province, South Africa. J Adolesc. 2003;26:121–36.
    1. Campbell C, Scott K, Nhamo M, Nyamukapa C, Madanhire C, Skovdal M, et al. Social capital and HIV competent communities: the role of community groups in managing HIV/AIDS in rural Zimbabwe. AIDS Care. 2013;25:S114–22.
    1. Handa S, Pettifor A, Thirumurthy H, Halpern C. Effect of a national social cash transfer program on HIV risk behavior in Kenya. Nineteenth International AIDS Conference, Abstract FRLBD01; Washington DC. 2012. Available from: [cited 10 April 2014].
    1. Skovdal M, Robertson L, Mushati P, Nyamukapa C, Sherr L, Gregson S. Community-led cash transfers in Zimbabwe: pathways for buy-in and improved child health and development. Nineteenth International AIDS Conference, Abstract TUPDE0104; Washington DC. 2012. Available from: [cited 10 April 2014].
    1. Budlender D, Woolard I. Geneva: International Labour Office; 2006. The impact of the South African child support and old age grants on children’s schooling.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever