Adolescent sexual and reproductive health research in sub-Saharan Africa: a scoping review of substantive focus, research volume, geographic distribution and Africa-led inquiry

Abstract

BackgroundPrevious review studies have not systematically mapped the existing body of knowledge on adolescent sexual and reproductive health (ASRH) in sub-Saharan Africa (SSA). Our scoping review addresses this gap by examining how the body of research on ASRH in SSA has evolved over the past decade, and its present profile, in terms of trends in volume, geographic and substantive focus, and Africa-led inquiry.MethodsWe used a three-step search strategy to identify English and French peer-reviewed publications and relevant grey literature on ASRH in SSA published between January 2010 and December 2019. Two reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion.ResultsA total of 1302 articles were published over the period, rising from 91 in 2010 to 183 in 2015. However, the bulk of the studies (63.9%) focused on six (South Africa, Kenya, Nigeria, Tanzania, Uganda and Ethiopia) of the 46 SSA countries. Ten countries had no ASRH papers, while five others each had only one publication. While issues like HIV (17.2%), sexual behaviours (17.4%) and access to sexual and reproductive health services (13.0%) received substantial attention, only a few studies focused on early adolescence (10–14 years), programme interventions, scaling up of interventions and policy evaluation. Just over half of publications had authors with African institutional affiliations as first authors (51.1%) or last author (53.0%). Sixteen per cent of papers did not include any authors from institutions in Africa.ConclusionsOur review demonstrated that research on ASRH is limited in focus and is unevenly distributed across SSA countries. The identified gaps can guide future research and funding to advance ASRH policies and programmes. It is also vital for stakeholders in the research enterprise, including researchers, donors, ethical review boards, and journal editors and reviewers, to implement measures that foster national investigators’ inclusion.

Implementation Strategies to Enhance Youth-Friendly Sexual and Reproductive Health Services in Sub-Saharan Africa: A Systematic Review

“…Further and rigorous implementation research is needed to better understand the effectiveness of out-of-facility approaches for delivering HIV and SRH services among young people in resource limited settings. Lastly, we found that majority of the included studies were conducted between 2015 to 2020, which might reflect the increasing recognition and commitment toward achieving the post-2015 development agenda on addressing adolescent sexual and reproductive health and rights ( 9 , 72 ).…”

“…Furthermore, existing SRH services are configured for adults and often served by adults who are not sensitive to their needs ( 7 , 8 ). The inadequacy in SRH service provision and utilization in this region is congruent with high rates of sexually transmitted infections (STIs), including HIV, unsafe abortion, early and unintended pregnancies among youth ( 8 , 9 ). Of even greater concern is that more than half of new HIV infections in SSA still occur among those aged 15–24 years ( 10 ) and adolescent girls and young women are 14 times more likely to be newly infected with HIV than their male counterparts ( 11 ).…”

Experiences of HIV Positive Serostatus Disclosure to Sexual Partner Among Individuals in Discordant Couples in Mbarara City, Southwestern Uganda

“…The main reasons for not disclosing HIV status to sexual partners were fear of shame, rejection, stigma, being judged, fear of being separated or divorced, and having a violent partners. 9 , 28 , 34 , 40–42 Combined couples counseling is necessary to minimize the challenges that come with serostatus disclosure. Cases of divorce were common among couples that delayed disclosing their status and or when the HIV negative partner found out the status of the HIV positive partner before disclosure.…”

“Such conversations are not had in the families”: a qualitative study of the determinants of young adolescents’ access to sexual and reproductive health and rights information in Rwanda

“…While the global developmental agenda focuses on enabling universal access to SRH information [3,5], extant literature does not have sufficient evidence on this aspect among young adolescents. Generally, research involving young adolescents in low-and middle-income countries, including Rwanda, is scant [11,26]. Studies involving young adolescents have focused on gender norms [9,27,28] and attitudes [14].…”