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Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review.

ABSTRACT: INTRODUCTION:Adolescent pregnancy causes serious problems not only for girls, but also for their family, and society. This study aimed to understand factors related to adolescent pregnancy in low- and middle-income countries using a multilevel approach adopted by Bronfenbrenner's ecological model. METHODS:A total of 11,933 studies published in between 2000 and 2015 were identified in 4 databases. Based on inclusion criteria and risk of bias assessment, a total of 67 articles were retrieved for analysis. RESULTS:Thematic analysis revealed that early marriage, sexual risk behaviors, substance use, family experience of adolescent birth, peer pressure, and lack of sex education and health service increased the hazards of adolescent pregnancy. Communication with parents, school activities, community meetings, laws, and government policies protected adolescents from pregnancy. CONCLUSIONS:Results of this study suggests that the background of adolescents and complex interactions among various factors should be considered for pregnancy. In future research, mixed-method that supplements the methodological weaknesses of previous studies is also recommended.

SUBMITTER: Chung HW

PROVIDER: S-EPMC6284104 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review.

Chung Hye Won HW Kim Eun Mee EM Lee Ji-Eun JE

Journal of adolescence 20181026

<h4>Introduction</h4>Adolescent pregnancy causes serious problems not only for girls, but also for their family, and society. This study aimed to understand factors related to adolescent pregnancy in low- and middle-income countries using a multilevel approach adopted by Bronfenbrenner's ecological model.<h4>Methods</h4>A total of 11,933 studies published in between 2000 and 2015 were identified in 4 databases. Based on inclusion criteria and risk of bias assessment, a total of 67 articles were ...[more]

PMID: 30390598

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Project description:BackgroundFertility rates among adolescents have fallen globally, yet the greatest incidence remains in low-and middle-income countries (LMICs). Gaining insight into adolescents needs and experiences of pregnancy will help identify if context specific services meet their needs and how to optimise pregnancy experiences. A meta-synthesis of qualitative studies considering adolescent experiences of pregnancy in LMICs has not yet been published.AimTo synthesise available qualitative evidence to provide greater understanding of the needs and experiences of adolescents who become pregnant in low-and middle-income countries.MethodsAn extensive search utilised six databases and citations searching. Studies were included if they were of a qualitative or mixed methods design. Participants lived in LMICs and were adolescents who were pregnant, had experienced pregnancy during adolescence or were an adolescent male partner. Relevant studies were assessed for quality to determine suitability for inclusion. A meta-ethnography approach was used to generate themes and a final line of argument.ResultsAfter screening and quality assessment 21 studies were included. The meta-ethnography generated four themes, A wealth of emotions, I am not ready, Impactful relationships and Respectful and disrespectful care. Unplanned, unwanted and unacceptable pregnancies were a source of shame, with subsequent challenging personal relationships and frequently a lack of needed support. Even when pregnancy was wanted, adolescents faced the internal conflict of their desires not always aligning with socio-cultural, religious and family expectations. Access, utilisation and experiences of care were significantly impacted by adolescents' relationships with others, the level of respectful care experienced, and engagement with adolescent friendly services.ConclusionsAdolescents who experience pregnancy in LMICs deserve support to meet their personal and pregnancy needs; efforts are needed to tailor the support provided. A lack of a health care provider knowledge and skills is an obstacle to optimal support, with more and better training integral to increasing the availability of adolescent friendly and respectful care. Adolescents should be involved in the planning of health care services and supported to make decisions about their care. The diversity across countries mean policy makers and other stakeholders need to consider how these implications can be realised in each context.

Project description:IntroductionAdolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15-19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries.Method and analysisWe employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances.Ethics and disseminationEthics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293).

Project description:In 2021, an estimated 18 million children did not receive a single dose of routine vaccinations and constitute the population known as zero dose children. There is growing momentum and investment in reaching zero dose children and addressing the gross inequity in the reach of immunization services. To effectively do so, there is an urgent need to characterize more deeply the population of zero dose children and the barriers they face in accessing routine immunization services. We utilized the most recent DHS and MICS data spanning 2011 to 2020 from low, lower-middle, and upper-middle income countries. Zero dose status was defined as children aged 12-23 months who had not received any doses of BCG, DTP-containing, polio, and measles-containing vaccines. We estimated the prevalence of zero-dose children in the entire study sample, by country income level, and by region, and characterized the zero dose population by household-level factors. Multivariate logistic regressions were used to determine the household-level sociodemographic and health care access factors associated with zero dose immunization status. To pool multicountry data, we adjusted the original survey weights according to the country's population of children 12-23 months of age. To contextualize our findings, we utilized United Nations Population Division birth cohort data to estimate the study population as a proportion of the global and country income group populations. We included a total of 82 countries in our univariate analyses and 68 countries in our multivariate model. Overall, 7.5% of the study population were zero dose children. More than half (51.9%) of this population was concentrated in African countries. Zero dose children were predominantly situated in rural areas (75.8%) and in households in the lowest two wealth quintiles (62.7%) and were born to mothers who completed fewer than four antenatal care (ANC) visits (66.5%) and had home births (58.5%). Yet, surprisingly, a considerable proportion of zero dose children's mothers did receive appropriate care during pregnancy (33.5% of zero dose children have mothers who received at least 4 ANC visits). When controlled for other factors, children had three times the odds (OR = 3.00, 95% CI: 2.72, 3.30) of being zero dose if their mother had not received any tetanus injections, 2.46 times the odds (95% CI: 2.21, 2.74) of being zero dose if their mother had not received any ANC visits, and had nearly twice the odds (OR = 1.87, 95% CI: 1.70, 2.05) of being zero dose if their mother had a home delivery, compared to children of mothers who received at least 2 tetanus injections, received at least 4 ANC visits, and had a facility delivery, respectively. A lack of access to maternal health care was a strong risk factor of zero dose status and highlights important opportunities to improve the quality and integration of maternal and child health programs. Additionally, because a substantial proportion of zero dose children and their mothers do receive appropriate care, approaches to reach zero dose children should incorporate mitigating missed opportunities for vaccination.

Project description:Introduction Fertility levels among adolescents remain high in many settings. The objective of this paper was to review the available literature about postpartum and lactational amenorrhoea among adolescents in low-income and middle-income countries (LMICs). Methods We searched Medline, Embase, Global Health and CINAHL Plus databases using terms capturing adolescence and lactational or postpartum amenorrhoea. Inclusion criteria included publication date since 1990, data from LMICs, and topic related to lactational amenorrhoea as a postpartum family planning method or as an effect of (exclusive) breast feeding among adolescents. Thematic analysis and narrative synthesis were applied to summarise and interpret the findings. Results We screened 982 titles and abstracts, reviewed 75 full-text articles and included nine. Eight studies assessed data from a single country (three from India, two from Bangladesh, two from Turkey, one from Nigeria). One study using Demographic and Health Survey data included 37 different LMICs. The five studies measuring duration of postpartum or lactational amenorrhoea reported a wide range of durations across the contexts examined. Four studies (from Bangladesh, Nigeria and Turkey) examined outcomes related to the use of lactational amenorrhoea as a family planning method among adolescents. We did not find any studies assessing adolescents’ knowledge of lactational amenorrhoea as a postpartum family planning method. Likewise, little is known about the effectiveness of lactational amenorrhoea method among adolescents using sufficiently large samples and follow-up time. Conclusion The available evidence on lactational amenorrhoea among adolescents in LMICs is scarce. Given the potential contribution of lactational amenorrhoea to prevention of short interpregnancy intervals among adolescents and young women, there is a need for a better understanding of the duration of lactational amenorrhoea, and the knowledge and effective use of lactational amenorrhoea method for family planning among adolescents in a wider range of LMIC settings.

Dataset Information

Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review.

Publications

Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review.

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