PREPARE manual for nurses : Building trust, promoting health and changing communities

One in every five people in the world is an adolescent and 85% live in low and middle-income countries. Nearly two thirds of premature death and one third of the total disease burden in adults are associated with conditions or behaviour that begin in youth. Among 15-19 year olds, suicide is the second leading cause of death, followed by violence in the community and family. Promoting nurturing relationships between parents and children early in life, good relationships between young people, training in life skills, and reducing access to alcohol and lethal items such as firearms and knives can help prevent violence. More effective and sensitive care for adolescents experiencing violence is needed. Many adolescent health challenges are closely interrelated and successful interventions in one area can lead to positive outcomes in other areas. The World Health Organization reports that among women aged 15-45 years, gender-based violence accounts for more deaths and disability than cancer, malaria and traffic injuries put together. This has become an important factor, which negatively affects girls and women’s reproductive health and wellbeing. This manual was written for the PREPARE school clinics to promote positive relationships through mentoring, role modelling, education, research and empathic service provision so that young people feel valued, respected and can enjoy positive self and peer relationships free from harm

Child Sexual Exploitation. : An analysis of Serious Case Reviews in England: Poor communication, incorrect assumptions and adolescent neglect

Background Child sexual exploitation (CSE) has evolved from being a largely concealed and unrecognised form of child abuse to being the subject of substantial political and public attention. The purpose of this research was to explore health professionals’ role in detection and prevention. Methods A systematic thematic analysis and synthesis of serious case review (SCR) reports of CSE in England using a socioecological theoretical framework was undertaken. Results Themes identified included health professionals’ lack of understanding of CSE, limited knowledge of the UK law, reluctance to apply relevant policies, and lack of appropriate action. Suboptimal communication with the child, between agencies and with families, lack of understanding of the young person’s context, their vulnerabilities and their continued needs for care and protection were also important. Conclusions This is the first time, to our knowledge, that an analysis and synthesis of all SCRs related to CSE in England has been conducted. The potential to recognise young people vulnerable to CSE is essential for public health prevention and intervention. Acknowledging that the SCRs represent the worst case scenario; nevertheless, this research highlighted the multi-factorial and complex nature of CSE and identified factors that require system-level awareness, training and intervention

Female genital mutilation/cutting: a systematic review and meta-ethnography exploring women’s views of why it exists and persists

Objectives: Despite well-documented negative consequences, female genital mutilation/cutting (FGM/C) continues to be widely practised. In this systematic review, we investigated women's views of why FGM/C exists and persists. Methods: A meta-ethnographic approach was used in this systematic review of qualitative research. Results: Twenty-seven studies were included in this review and they represented the views and experiences of 823 women. FGM/C was considered a ‘rite of passage’ which was enforced to curb the expression of their sexuality and maintain social and gender norms within its communities. Nevertheless, attitudes towards FGM/C were changing among migrant populations. Conclusions: Creating community awareness projects, enforcing strict laws coupled with increasing health professional involvement may reduce the incidence of FGM/C

School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents

Background School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents. Many studies and systematic reviews have concentrated on measuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs). Objectives To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents. Search methods We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Educaton and Global Information System (AEGIS) and National Library of Medicine (NLM) gateway for conference presentations; and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS) centre for Reviews and Dissemination (CRD) websites from 1990 to 7 April 2016. We handsearched the reference lists of all relevant papers. Selection criteria\ud We included randomized controlled trials (RCTs), both individually randomized and cluster-randomized, that evaluated school-based programmes aimed at improving the sexual and reproductive health of adolescents. Data collection and analysis Two review authors independently assessed trials for inclusion, evaluated risk of bias, and extracted data. When appropriate, we obtained summary measures of treatment effect through a random-effects meta-analysis and we reported them using risk ratios (RR) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. Main results We included eight cluster-RCTs that enrolled 55,157 participants. Five trials were conducted in sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland). Sexual and reproductive health educational programmes Six trials evaluated school-based educational interventions. In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants; low certainty evidence), or other STIs (herpes simplex virus prevalence: RR 1.04, 95% CI 0.94 to 1.15; three trials, 17,445 participants; moderate certainty evidence; syphilis prevalence: RR 0.81, 95% CI 0.47 to 1.39; one trial, 6977 participants; low certainty evidence). There was also no apparent effect on the number of young women who were pregnant at the end of the trial (RR 0.99, 95% CI 0.84 to 1.16; three trials, 8280 participants; moderate certainty evidence). Material or monetary incentive-based programmes to promote school attendance Two trials evaluated incentive-based programmes to promote school attendance. In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants; low certainty evidence). Compared to controls, the prevalence of herpes simplex virus infection was lower in young women receiving a monthly cash incentive to stay in school (RR 0.30, 95% CI 0.11 to 0.85), but not in young people given free school uniforms (Data not pooled, two trials, 7229 participants; very low certainty evidence). One trial evaluated the effects on syphilis and the prevalence was too low to detect or exclude effects confidently (RR 0.41, 95% CI 0.05 to 3.27; one trial, 1291 participants; very low certainty evidence). However, the number of young women who were pregnant at the end of the trial was lower among those who received incentives (RR 0.76, 95% CI 0.58 to 0.99; two trials, 4200 participants; low certainty evidence). Combined educational and incentive-based programmes The single trial that evaluated free school uniforms also included a trial arm in which participants received both uniforms and a programme of sexual and reproductive education. In this trial arm herpes simplex virus infection was reduced (RR 0.82, 95% CI 0.68 to 0.99; one trial, 5899 participants; low certainty evidence), predominantly in young women, but no effect was detected for HIV or pregnancy (low certainty evidence). Authors' conclusions There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this

A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health

BACKGROUND: Accessible sexual, reproductive, and mental healthcare services are crucial for adolescent health and wellbeing. It has been reported that school-based healthcare (SBHC) has the potential to improve the availability of services particularly for young people who are normally underserved. Locating health services in schools has the potential to reduce transport costs, increase accessibility and provide links between schools and communities. METHODS: A systematic review of the literature was undertaken. Pubmed, Psychinfo, Psychnet, Cochrane CENTRAL, and Web of Science were searched for English language papers published between January 1990 and March 2012RESULTS:Twenty-seven studies were found which fitted the criteria, of which, all but one were from North America. Only three measured adolescent sexual, reproductive, or mental health outcomes related to SBHC and none of the studies were randomized controlled trials. The remaining studies explored accessibility of services and clinic utilization or described pertinent contextual factors. CONCLUSIONS: There is a paucity of high quality research which evaluates SBHC and its effects on adolescent sexual, reproductive, and mental health. However, there is evidence that SBHC is popular with young people, and provides important mental and reproductive health services. Services also appear to have cost benefits in terms of adolescent health and society as a whole by reducing health disparities and attendance at secondary care facilities. However, clearer definitions of what constitutes SBHC and more high quality research is urgently needed

Sexual, reproductive and mental health among young men (10–24) in low-and-middle income countries: a scoping review

BackgroundThe relationship between SRH and mental health among men is not well documented, especially in the 10–24 age group. This scoping review aimed to investigate what is known about the association between SRH and mental health among young men (10–24) in LMICs.MethodsEmbase, APA PsycInfo, MEDLINE(R) ALL, ASSIA and the Cochrane Library of Database of Systematic Reviews were searched from the year of establishment up to August 2022. The review was reported using the PRISMA-ScR checklist.ResultsA total of (n = 2636) studies were identified from the five databases. After the completion of screening, only ten studies (n = 8 cross-sectional, n = 1 mixed methods and n = 1 qualitative) met the eligibility criteria and were included in the review. The findings suggest that there is a reciprocal relationship between mental health and SRH. Sperm concentration and total sperm count were found to be lower in depressed men. Poor mental health was associated with early sexual debut, higher rates of sexual activity and an increased number of sexual partners. Poor mental health was also found among men who had sex with men (MSM). In addition, we found a relationship between sexual abuse, sexual coercion and poor mental health.ConclusionThe findings of this unique study indicate that poor mental health is associated with poor SRH outcomes and vice versa among young men (10–24) living in LMICs. However, further research will be needed to establish the temporal relationship between SRH and mental health outcomes

Changes to parental consent procedures in South Africa - implications for school-based adolescent sexual health research

N/

The impact of COVID-19 on intimate partner violence in Europe

The family and intimate relationships should be a place of safety, but for many, violence and trauma occur even within this context. Intimate partner violence (IPV) can take many forms and can include physical, sexual, and emotional abuse and a range of controlling behaviours. It affects younger and older, cis and transgender women and men. What we do know is that across the European region, more than a quarter of ever-partnered women, aged 15 and older, have experienced IPV. This has contributed to interpersonal violence being the fourth leading cause of death among people aged 15-29 years in the WHO European Region. Over the past year and a half, in a world in a constant state of emergency during the COVID-19 pandemic, increases in sexual assault and violence, particularly against women, have been reported. The WHO Europe member states have reported a 60% increase on average in emergency calls from women subjected to IPV, alongside a 23-32% increase in IPV and domestic violence (DV) cases since the lockdown began. This may not reflect the true scale of the problem as less than 40% of women seek help of any kind and men and boys may be less likely to report it. In most countries with available data on the issue, most women rely on family and friends, and rarely ask formal institutions for assistance. Even as pandemic lockdown measures are lifted, there are long-term health, wellbeing, and socioeconomic consequences that will prevail. The European Union (EU) has incorporated new measures in response to intimate partner violence. Examples are the Gender Equality Strategy 2020-2025 and the Victims’ Right Directive and EU Strategy on victims’ rights. These strategies outline a set of key actions including preventing gender-based violence, supporting and protecting victims (i.e., empowering victims to report a crime, claim compensation, and recover from consequences of crime), and holding perpetrators accountable during crises such as the COVID-19 pandemic. Both strategies are specifically focused on vulnerable victims (e.g., children, victims of gender-based violence, and/or domestic violence) as one of their key priorities