Nature of, and responses to key sexual and reproductive health challenges for adolescents in urban slums in sub-Saharan Africa: a scoping review

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Abstract

Background

Addressing adolescents’ sexual and reproductive health and rights (SRHR) requires an understanding of the socio-cultural and spatial settings within which they live. One setting of particular importance is the informal settlements or ‘slums’ that are gradually dominating the urban space. We undertook a scoping review and synthesis of existing evidence on adolescent SRHR in slums in sub-Saharan Africa (SSA) focusing on the characteristics and nature of existing evidence.

Methods

The scoping review was conducted based on Arksey and O’Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and using PRISMA reporting guidelines for scoping reviews. A comprehensive search was undertaken in PubMed, POPLINE, African Journals Online (AJOL), Bioline International and Google Scholar. The search was confined to studies published in peer reviewed journals and reports published online between January 2000 and May 2019. Studies were included in the review if they addressed SRHR issues among adolescents living in urban slums in SSA.

Results

The review included a total of 54 studies. The majority (79.5%) of studies were quantitative. The bulk of studies (85.2%) were observational studies with only eight intervention studies. While half (27) of the studies focused exclusively on adolescents (10–19 years), 12 studies combined adolescents with other young people (10–24 years). The studies were skewed towards sexual behavior (44%) and HIV/AIDS (43%) with very few studies focusing on other SRHR issues such as contraception, abortion, gender-based violence and sexually transmitted infections (STIs) other than HIV. Most of the studies highlighted the significantly higher risks for poor SRHR outcomes among adolescents in slums as compared to their peers in other settlements.

Conclusion

Young people growing up in slums face tremendous challenges in relation to their SRHR needs resulting in poor outcomes such as early and unintended pregnancy, STIs, and sexual violence. The results of this review point to several potential target areas for programming, policy, and research aimed at improved adolescent SRHR in slums in SSA.

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Most cited references 37

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Guidance for conducting systematic scoping reviews.

Micah D.J. Peters, Christina M Godfrey, Hanan Khalil … (2015)

Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.

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Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review

Oluwasola Eniola Banke-Thomas, Aduragbemi Oluwabusayo Banke-Thomas, Charles Ameh (2017)

Background Adolescent mothers aged 15–19 years are known to have greater risks of maternal morbidity and mortality compared with women aged 20–24 years, mostly due to their unique biological, sociological and economic status. Nowhere Is the burden of disease greater than in low-and middle-income countries (LMICs). Understanding factors that influence adolescent utilisation of essential maternal health services (MHS) would be critical in improving their outcomes. Methods We systematically reviewed the literature for articles published until December 2015 to understand how adolescent MHS utilisation has been assessed in LMICs and factors affecting service utilisation by adolescent mothers. Following data extraction, we reported on the geographical distribution and characteristics of the included studies and used thematic summaries to summarise our key findings across three key themes: factors affecting MHS utilisation considered by researcher(s), factors assessed as statistically significant, and other findings on MHS utilisation. Results Our findings show that there has been minimal research in this study area. 14 studies, adjudged as medium to high quality met our inclusion criteria. Studies have been published in many LMICs, with the first published in 2006. Thirteen studies used secondary data for assessment, data which was more than 5 years old at time of analysis. Ten studies included only married adolescent mothers. While factors such as wealth quintile, media exposure and rural/urban residence were commonly adjudged as significant, education of the adolescent mother and her partner were the commonest significant factors that influenced MHS utilisation. Use of antenatal care also predicted use of skilled birth attendance and use of both predicted use of postnatal care. However, there may be some context-specific factors that need to be considered. Conclusions Our findings strengthen the need to lay emphasis on improving girl child education and removing financial barriers to their access to MHS. Opportunities that have adolescents engaging with health providers also need to be seized. These will be critical in improving adolescent MHS utilisation. However, policy and programmatic choices need to be based on recent, relevant and robust datasets. Innovative approaches that leverage new media to generate context-specific dis-aggregated data may provide a way forward. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1246-3) contains supplementary material, which is available to authorized users.

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Stepping Stones and Creating Futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa

Rachel Jewkes, Andrew Gibbs, Nwabisa Jama-Shai … (2014)

Background Gender-based violence and HIV are highly prevalent in the harsh environment of informal settlements and reducing violence here is very challenging. The group intervention Stepping Stones has been shown to reduce men’s perpetration of violence in more rural areas, but violence experienced by women in the study was not affected. Economic empowerment interventions with gender training can protect older women from violence, but microloan interventions have proved challenging with young women. We investigated whether combining a broad economic empowerment intervention and Stepping Stones could impact on violence among young men and women. The intervention, Creating Futures, was developed as a new generation of economic empowerment intervention, which enabled livelihood strengthening though helping participants find work or set up a business, and did not give cash or make loans. Methods We piloted Stepping Stones with Creating Futures in two informal settlements of Durban with 232 out of school youth, mostly aged 18–30 and evaluated with a shortened interrupted time series of two baseline surveys and at 28 and 58 weeks post-baseline. 94/110 men and 111/122 women completed the last assessment, 85.5% and 90.2% respectively of those enrolled. To determine trend, we built random effects regression models with each individual as the cluster for each variable, and measured the slope of the line across the time points. Results Men’s mean earnings in the past month increased by 247% from R411 (~$40) to R1015 (~$102, and women’s by 278% R 174 (~$17) to R 484 (about $48) (trend test, p < 0.0001). There was a significant reduction in women’s experience of the combined measure of physical and/or sexual IPV in the prior three months from 30.3% to 18.9% (p = 0.037). This was not seen for men. However both men and women scored significantly better on gender attitudes and men significantly reduced their controlling practices in their relationship. The prevalence of moderate or severe depression symptomatology among men and suicidal thoughts decreased significantly (p < 0.0001 and p = 0.01). Conclusions These findings are very positive for an exploratory study and indicate that the Creating Futures/Stepping Stones intervention has potential for impact in these difficult areas with young men and women. Further evaluation is needed.

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Author and article information

Contributors

Yohannes Dibaba Wado:

ORCID: http://orcid.org/0000-0002-7200-6116

ywado@aphrc.org

Martin Bangha: mbangha@aphrc.org

Caroline W. Kabiru: ckabiru@aphrc.org

Garumma T. Feyissa: garummatolu@yahoo.com

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 30 September 2020

Publication date PMC-release: 30 September 2020

Publication date Collection: 2020

Volume: 17

Electronic Location Identifier: 149

Affiliations

[1 ]GRID grid.413355.5, ISNI 0000 0001 2221 4219, African Population and Health Research Center, , APHRC Campus, Manga Close, ; P.O. Box 10787-00100, Nairobi, Kenya

[2 ]GRID grid.166341.7, ISNI 0000 0001 2181 3113, Dornsife School of Public Health, , Drexel University, ; Philadelphia, USA

Author information

Yohannes Dibaba Wado http://orcid.org/0000-0002-7200-6116

Article

Publisher ID: 998

DOI: 10.1186/s12978-020-00998-5

PMC ID: 7526107

PubMed ID: 32998741

SO-VID: a2b6bc2f-0686-4c20-a63e-82bb24d0a447

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 22 May 2020

Date accepted : 21 September 2020

Funding

Funded by: David and Lucile Packard Foundation

Award ID: 2016-6250

Funded by: FundRef http://dx.doi.org/10.13039/100004441, Styrelsen för Internationellt Utvecklingssamarbete;

Award ID: 12103

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: slums,srhr,adolescents,scoping review,ssa

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: slums, srhr, adolescents, scoping review, ssa

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