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      A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings

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          Abstract

          Background

          Accessibility of sexual and reproductive health (SRH) services in many lower-and-middle-income countries (LMICs) and humanitarian settings remains limited, particularly for young people. Young people facing humanitarian crises are also at higher risk for mental health problems, which can further exacerbate poor SRH outcomes. This review aimed to explore, describe and evaluate SRH interventions for young people in LMIC and humanitarian settings to better understand both SRH and psychosocial components of interventions that demonstrate effectiveness for improving SRH outcomes.

          Methods

          We conducted a systematic review of studies examining interventions to improve SRH in young people in LMIC and humanitarian settings following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Peer-reviewed journals and grey literature from January 1, 2000 to December 31, 2018 were included. Two authors performed title, abstract and full-text screening independently. Data was extracted and analyzed using a narrative synthesis approach and the practice-wise clinical coding system.

          Results

          The search yielded 813 results, of which 55 met inclusion criteria for full-text screening and thematic analysis. Primary SRH outcomes of effective interventions included: contraception and condom use skills, HIV/STI prevention/education, SRH knowledge/education, gender-based violence education and sexual self-efficacy. Common psychosocial intervention components included: assertiveness training, communication skills, and problem-solving.

          Conclusions

          Findings suggest that several evidence-based SRH interventions may be effective for young people in humanitarian and LMIC settings. Studies that use double blind designs, include fidelity monitoring, and focus on implementation and sustainability are needed to further contribute to this evidence-base.

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          Most cited references76

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            Our future: a Lancet commission on adolescent health and wellbeing

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              Epidemiology of women and depression.

              R Kessler (2003)
              Depression is the leading cause of disease-related disability among women in the world today. Depression is much more common among women than men, with female/male risk ratios roughly 2:1. Recent epidemiological research is reviewed. Implications are suggested for needed future research. The higher prevalence of depression among women than men is due to higher risk of first onset, not to differential persistence or recurrence. Although the gender difference first emerges in puberty, other experiences related to changes in sex hormones (pregnancy, menopause, use of oral contraceptives, and use of hormone replacement therapy) do not significantly influence major depression. These observations suggest that the key to understanding the higher rates of depression among women than men lies in an investigation of the joint effects of biological vulnerabilities and environmental provoking experiences. Advancing understanding of female depression will require future epidemiologic research to focus on first onsets and to follow incident cohorts of young people through the pubertal transition into young adulthood with fine-grained measures of both sex hormones and gender-related environmental experiences. Experimental interventions aimed at primary prevention by jointly manipulating putative biological and environmental risk factors will likely be needed to adjudicate between contending causal hypotheses regarding the separate and joint effects of interrelated risk factors.
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                Author and article information

                Contributors
                alethea.desrosiers@gmail.com
                Theresa.betancourt@bc.edu
                kergoatyasmine@gmail.com
                Servillic@who.int
                sayl@who.int
                kobeissil@who.int
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                12 May 2020
                12 May 2020
                2020
                : 20
                : 666
                Affiliations
                [1 ]GRID grid.208226.c, ISNI 0000 0004 0444 7053, Boston College School of Social Work, ; 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA
                [2 ]GRID grid.3575.4, ISNI 0000000121633745, Department of Sexual and Reproductive Health Research, World Health Organization, ; 20 Avenue Appia, 1211 Geneva 27, Switzerland
                Author information
                http://orcid.org/0000-0002-7975-7529
                Article
                8818
                10.1186/s12889-020-08818-y
                7216726
                32398129
                a869e86e-1846-4e64-992b-37fa2938808e
                © The Author(s) 2020

                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
                : 28 March 2019
                : 30 April 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004423, World Health Organization;
                Award ID: NA
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                sexual health,reproductive health,young people,humanitarian settings
                Public health
                sexual health, reproductive health, young people, humanitarian settings

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