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Table 3 Characteristics and key findings of studies assessing sexual and reproductive health outcomes for young people in humanitarian settings

From: A forgotten group during humanitarian crises: a systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings

Author (year) & Article typeStudy design and qualityStudy settingTarget populationIntervention (strategy, implementer, donor)Key findings
Prevention of unintended pregnancies
Nehme and Spilotros
2018 [40]
Grey literature
Case Study
Medium quality
DRC
Urban
Armed conflict (Protracted)
Adolescent girls (Age not specified)Provision of family planning services through adolescent SRH training for providers and adolescent participatory workshops
Implementer: International Rescue Committee (IRC)
Donor: David and Lucille Packard Foundation
Number of adolescents accepting new methods of contraception increased from 67 in March 2017 to 156 in December 2017.
89·0% of adolescent clients accepted long-acting methodsUse of sexually transmitted infection (STI) services steadily increased.
Prevention of transmission of and reduction in morbidity and mortality due to HIV and sexually transmitted infections (STIs)
Atwood et al
2012 [33]
Peer-reviewed
Randomised control trial (RCT)
Medium quality
Liberia
Urban
Armed conflict (Post-conflict)
General
In-school 6th grade youth
(Age not specified)
Eight module curriculum delivered in-school over 8 weeks by health educators
Implementer: Not specified
Donor: National Institute of Mental Health
Significantly increased protective peer norms
(p < 0·05) and positive attitudes towards condoms
(p < 0·05).
Increased frequency of condom use at 9 months.
No significant improvement in age of sexual initiation and number of multiple sex partnerships.
Atwood et al
2012 [32]
Peer-reviewed
RCT
Medium quality
Liberia
Urban
Armed conflict (Post-conflict)
General
In-school 6th grade youth engaging in transactional sex
Ages 14–18
Eight module curriculum delivered in-school over 8 weeks by health educators
Implementer: Not specified
Donor: National Institute of Mental Health
No impact on risk factors for adolescents that engaged in transactional sex
For participants comprised of adolescents engaging in transactional sex for a range of rewards, the intervention group was found to have a higher number of sex partners (β = 0·33, p < 0·01) and increased frequency of sex (β = 0·27, p < 0·01) in the previous three months.
Casey et al
2006 [27]
Peer-reviewed
Controlled before-and-after
Medium quality
Sierra Leone
Urban
Armed conflict (Protracted)
General
Ages 15–24
Intensive outreach education by peers, including a focus on improving negotiation skills.
Free condom distribution.
Implementer: American Refugee Committee International
Donor: David and Lucille Packard Foundation
Increase in ability to name 3 HIV prevention methods in male (from 4·0% to 45·0%) and females (from 4·0% to 36·0%), both p < 0·01.
Reported condom use at last sex increased: Males 16·0% to 37·0%, females 16·0% to 46·0%.
Talbot 2013 [30]
Peer-reviewed
One-arm cohort
High quality
Rwanda
Peri-Urban
Armed conflict (Post-conflict)
General
Rwandan orphans
Ages 15–25
Incorporating HIV prevention education activities into an existing mental health intervention.
Implementer: Uyisenga N’Mzanzi
Donor: Gilead Foundation
Reported condom use when engaging in high-risk behaviour increased from 54·0% at baseline to 78·0% at study completion.
Percentage reporting exchanging sex for money, food or favours decreased from 13·0% to 9·0% (p = 0·006).
HIV risk-taking behaviour assessed via the AIDS Clinical Trials Group (ACTG) Sexual Behaviour Index did not change significantly over the 12-month study period (23·0% (0·42) at baseline vs. 24·0% (0·43) at 12 months, p = 0·858).
Prevention of sexual and gender-based violence and response to the needs of survivors
Lilleston et al (2018) [31]
Peer-reviewed
Qualitative
High quality
Lebanon Rural
Armed conflict (Protracted)
Refugees
Adolescent girls
(Age not specified)
GBV mobile service delivery designed to complement static GBV services.Each mobile team included an adolescent girls’ assistant.
Implementer: IRC
Donor: US Department of State, NoVo Foundation, Swedish International Development Corporation
Adolescents developed trusting friendships as a result of the service, received emotional support from the adolescent assistant, improved family relationships, felt safer and more confident, and had increased knowledge and skills to feel safer when leaving the house.
Stark 2018 [28]
Peer-reviewed
RCT
High quality
Ethiopia
Refugee camps
Armed conflict (Protracted)
Refugees
Adolescent girls
Ages 13–19
40 fixed-curriculum, mentor-facilitated sessions once a week for 10 months.Caregivers also participated in monthly discussion sessions.
Implementer: IRC
Donor: Department for International Development (DFID)
Intervention group no more or less likely to engage in transactional sexual exploitation compared to control group after receiving the interventionOR = 0·62 (95% CI 0·3–1·26) p = 0·082
Tanner et al
2017 [39]
Grey literature
DRC: two-arm waitlisted RCTEthiopia: two-group waitlisted cluster RCTPakistan: single group pre- and post-test survey evaluationAll contained qualitative component
High quality
DRC
Ethiopia
Pakistan
Refugee camps
Armed conflict (Protracted)
General/refugees
Adolescent girls
DRC: age 10–14
Ethiopia: age 13–19
Pakistan: age 10–19
40 fixed-curriculum, mentor-facilitated sessions once a week for 10 months.Caregivers also participated in monthly discussion sessions.
Implementer: IRC, Colombia University
Donor: DFID
Girls participating in the programme reported having greater support networks and a safe place to interact with other adolescent girls.
Girls in Ethiopia were nearly twice as likely to report having friends and the girls in DRC who reported having four or more friends increased from 54% at baseline to 96% at endline
Girls participating in the intervention were also found to have greater hope for the future.
Girls in the intervention had twice the odds of reporting girls should be 18 or older when they have their first child and almost twice the odds of reporting girls should be 18 or older when they get married.
Improved knowledge of SGBV services among girls and the intervention made services more adolescent friendly.
Caregivers reported greater warmth and affection and lower overall rejection of their daughters.
No significant changes in exposure to SGBV or the attitudes of girls towards gender and SGBV.
No effect on levels of violence experienced.
The intervention was found to be feasible and acceptable
Intervention targeting outcomes across multiple SRH domains
Barnett et al (2018) [34]
Peer-reviewed
Case Study
Medium quality
Sierra Leone
Rural
Disease outbreak (Acute and stabilised)
General
Ages 12–18
Radio educational programmes aimed at increasing awareness of teen pregnancy, sexual violence, HIV and hygiene practices.
Implementer: Child-to-Child, Pikin-to-Pikin
Donor: The Circle
Reached an audience of 136,678 listeners.
Children showed good recall of key messages such as how to prevent teenage pregnancy.
Children talked to their peers about what they had learnt, thus spreading the message.
Teachers had increased knowledge about sensitive topics such as teenage pregnancy and confidently talked to children about these.
Bosmans et al
2012 [29]
Peer-reviewed
Qualitative
Low quality
Colombia
Internally displaced persons’ (IDPs) settlements
Armed conflict (Protracted)
Adolescent IDPs
(Age not specified)
Use of different forms of interactive theatre and arts in workshops to address taboos surrounding SRH issues and approach topics such as disease, domestic violence, sexual abuse, unwanted pregnancy, friendship, joy and love.Used to transmit and procure SRH information at schools attended by IDP adolescents.Training for public health staff in medical aspects of adolescent sexual and reproductive health (ASRH) and adolescent-friendly services.
Implementer: Colombian authorities, United Nations (UN) agencies, various Non-governmental organisation (NGOs) (not specified) and local universities
Donor: United Nations Population Fund (UNFPA) and Government of Belgium
Intervention restored dignity and increased awareness of rights. One participant noted that the use of theatre and dance “created trust and opened a space in which these matters could be discussed” [29].
Improved awareness of and attitudes to SRH among adolescents, caregivers and health workers.
Availability of and access to services remained a problem.
Chaudhary et al (2017)
Peer-reviewed [35]
Case study
High quality
Nepal
Rural
Natural disaster (Acute)
Adolescent girls and boys
(Age not specified)
Establishment of an ASRH working group.
Adolescent-friendly service corners set up in reproductive health camps, run by trained adolescent facilitators and volunteers.
Establishment of linkages between adolescent-friendly corners and adolescent-friendly services in health facilities.
Implementer: Nepal Ministry of Health, UNFPA, World Health Organization (WHO)
Donor: Not specified
Adolescent-friendly corners served over 4231 young people. More than 14,666 adolescents received ASRH services overall.
Tanabe et al
2012 [38]
Grey literature
Case study
High quality
Thailand
Peri-urban
Armed conflict (Protracted)
Migrant adolescents
Ages 15–24
Youth centre- based workshops covering: reproductive anatomy, physical and emotional changes during adolescence, FP, sex and gender, HIV/STI transmission and prevention, consequences of unsafe abortion.
Implementer: Adolescent Reproductive Health Network
Donor: Not specified
Numbers of new and repeat FP clients decreased form May–June 2011 to May–June 2012. NB as the intervention was been operational since 2008, it is not clear whether these data are representative of contraceptive uptake since initiation of the intervention.
Colombia
Semi-rural
Armed conflict (Protracted)
IDPs
Ages 10–24
Clinics, mobile health brigades and community education on SRH (content not specified).
Training of youth peer educators.
Adolescent participation in development of training materials.
Implementer: Profamilia, The Regional Human Rights Commission (RHRC)
Donor: Not specified
Percentage of young women in a relationship using a modern contraceptive method increased from 47·0% to 54·8% (ages 15–19) and 61·7 to 71·7% (ages 20–24) from 2008 to 2010.
Percentage of young women not in a relationship using a method increased for injection and IUD (except for IUD in ages 20–24). Large increase in implant use for ages 20–24. No implant uptake in younger age groups.
Uganda
Peri-urban
Armed conflict (Stabilised)
Previous IDPs, now returnees
Ages 10–24
Consultations at youth centre, community outreach, school visits, home visits, support groups, clubs, edutainment, radio and newspaper.
Services include: STI diagnosis and treatment, HIV counselling and testing, FP, male circumcision, post-rape care.
Implementer: Straight Talk Foundation
Donor: Not specified
From 2007 to 2012: Initial increase in number of clients accepting pill, injection and condoms but all returned to baseline by 2010.
Initial increase in total FP clients and total clients accepting a method but also returned to baseline
Tanabe et al
2013 [37]
Grey literature
Case study
High quality
DRC
Setting not specified
Armed conflict (Protracted)
Adolescents
Age 10–19
Training of medical staff on ASRH toolkit.
Support groups for pregnant adolescents.
Peer-educator led activities for in-school adolescents including HIV/STI prevention, pregnancy prevention, and gender norms.
Implementer: Save the Children, Women’s Refugee Commission (WRC), The UN Refugee Agency (UNHCR)
Donor:
Improvement in adolescent friendly services checklists.
Increased use of SRH services (mainly ages 15–19).
Increased knowledge among pregnant adolescents (not significant).
Improvements seen in attitudes of in-school adolescents (p < 0·05).
A four-fold increase in the number of adolescents aged 15–19 years attending the adolescent counselling room at the health centre from 14 adolescents in August 2013 to 56 adolescents in October 2013. There was a drop-off in November 2013 with only 22 adolescents attending the counselling room. However, as this is the final data point, it is not known if this was a new downward trend. Facility staff attributed this finding to adolescents feeling comfortable directly accessing health services without first attending the adolescent counselling room.
UNFPA
2016 [36]
Grey literature
Case study
Medium quality
Malawi
Camps
Natural disaster (Acute)
IDP adolescents
(Age not specified)
Youth clubs in displacement camps providing integrated STI/ HIV, SGBV, and young people’s welfare within MISP interventions
Implementer: UNFPA, Youth Net and Counseling (YONECO), Centre for Victimised Women and Children (CAYWOC)
Donor:
Established 32 youth clubs, reached more than 2000 adolescents and young people
The adolescent involvement was reported to increase the sustainability of the clubs as well as the buy-in from the community.
It was also reported that in Nepal following an earthquake the involvement of adolescents in the emergency response allowed the interventions to impact previously difficult to reach groups of adolescents.
Case study
Medium quality
Nepal
Rural
Natural disaster (Acute)
IDP adolescents
(Age not specified)
Reproductive health camps included a separate tent set up specifically for adolescents.
Young volunteers trained on a wide range of SRH issues including menstrual hygiene, STI/HIV prevention, child marriage and adolescent pregnancy, delivery and childbirth, and SGBV.
Implementation of the MISP.
Implementer: UNFPA, Manmohan Memorial Community Hospital (MMMCH), Pharping, ADRA Nepal
Donor: Not specified
Established 132 mobile reproductive health camps, reached 16,977 adolescents
Case study
Medium quality
Philippines
Camps
Natural disaster (Acute)
General/IDP adolescents
(Age not specified)
Young people recruited as volunteers and active partners.
Volunteers trained to conduct awareness-raising sessions on safe motherhood, FP, STIs, and SGBV. Implementation of the MISP.
Implementer: UNFPA, Family Planning Organisation of the Philippines (FPOP), Y-PEER, Pilipinas, Department of Health
Donor: Not specified
Trained 30 youth volunteers. Distributed hygiene kits and provided services for 3967 young people