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

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

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

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

Intimate partner violence in early adolescence : the role of gender, socio-economic factors and the school

Background: Intimate partner violence (IPV) among adolescents is common worldwide, but our understanding of perpetration, gender differences and the role of social-ecological factors remains limited. Objectives: To explore the prevalence of physical and sexual IPV perpetration and victimisation by gender, and associated risk and protective factors. Methods: Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA), participating in the PREPARE study, completed a self-administered questionnaire. Results: The participants’ mean age was 13.65 years (standard deviation 1.01), with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) reporting perpetrating IPV. Girls were less likely to report being a victim/survivor of physical IPV (odds ratio (OR) 0.72; 95% confidence interval (CI) 0.57 - 0.92) and less likely to be a perpetrator of sexual IPV than boys (OR 0.33; 95% CI 0.21 - 0.52). Factors associated with perpetration of physical and sexual IPV were similar and included being a victim/survivor (physical IPV: OR 12.42; 95% CI 8.89 - 17.36, sexual IPV: OR 20.76; 95% CI 11.67 - 36.93), being older (physical IPV: OR 1.26; 95% CI 1.08 - 1.47, sexual IPV: OR 1.36; 95% CI 1.14 - 1.62 ), having lower scores on school connectedness (physical IPV: OR 0.59; 95% CI 0.46 - 0.75, sexual IPV: OR 0.56; 95% CI 0.42 - 0.76) and scoring lower on feelings of school safety (physical IPV: OR 0.66; 95% CI 0.57 - 0.77, sexual IPV: OR 0.50; 95% CI 0.40 - 0.62). Conclusions: Physical and sexual IPV was commonly reported among young adolescents in SA. Further qualitative exploration of the role of reciprocal violence by gender is needed, and the role of ‘school climate’-related factors should be taken into account when developing preventive interventions

Trauma, resilience and mental health in migrant and non-migrant youth: : An international cross-sectional study across six countries

Resilience is a dynamic process of positive adaptation to significant adversity. While there has been substantial focus on risks and negative outcomes associated with youth migrancy, there is limited evidence of the relationship between the adversity of migration, and resilience, wellbeing, and positive mental health in adolescents. This international study aimed to explore the differences in resilience, wellbeing, and mental health behaviors in migrant and non-migrant adolescents tested across six countries (Australia, New Zealand, UK, China, South Africa, and Canada) with varying levels of trauma exposure. The study was a cross-sectional survey design with a convenience sample of 194 10-17 year old migrants and non-migrants. The migrant sample included both "internal" migrants (change of residence within a country) and "external" migrants (change of residence across national borders) for comparison. Across the sites, migrants reported a higher mean number of traumatic events for the past year than non-migrants, with internal migrants reporting more events than external migrants overall. South African adolescents reported a higher mean number of traumatic events for the past year than all other sites. External migrants reported higher resilience scores yet reduced prosocial behaviors relative to internal migrants and non-migrants, whereas both internal and external migrants reported higher peer problems than non-migrants. When considering the interacting effects of trauma, the presence or absence of trauma did not appear to impact migrant scores in terms of resilience, wellbeing, or conduct problems. In comparison, trauma-exposed non-migrants showed detriments relative to trauma-exposed migrant peers for all of these measures. In conclusion, the survey tool was found to be reliable and acceptable for use in international studies of different samples of adolescent migrants. Overall, migrant adolescents showed greater resilience resources than non-migrants and, although the migrants experienced more traumatic events, the impact of trauma on mental health outcomes was greater in the non-migrants. There is a need for further research with larger prospective sample sizes to investigate how levels of resilience and wellbeing vary over time and across countries, and the ways resilience can be promoted in adolescents exposed to trauma, regardless of migrancy status

Engagement of health workers and peer educators from the National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram during the COVID-19 pandemic : Findings from a situational analysis

BACKGROUND: To understand the impact of COVID-19 on implementation of the peer education programme of the National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram (RKSK); repurposing of the RKSK health workers and Peer Educators (PEs) in COVID-19 response activities and effect on adolescents´ health and development issues. METHODS: Virtual in-depth interviews were conducted with stakeholders (n = 31) (aged 15 to 54 years) engaged in the implementation of the RKSK and peer education programme at state, district, block, and village levels in Madhya Pradesh and Maharashtra (India). These interviews were thematically coded and analysed to address the research objectives. RESULTS: Despite most peer education programme activities being stopped, delayed, or disrupted during the pandemic and subsequent lockdown, some communication networks previously established, helped facilitate public health communication regarding COVID-19 and RKSK, between health workers, PEs, and adolescents. There was repurposing of RKSK health workers and PEs’ role towards COVID-19 response-related activities. PEs, with support from health workers, were involved in disseminating COVID-19 information, maintaining migrant and quarantine records, conducting household surveys for recording COVID-19 active cases and providing essential items (grocery, sanitary napkins, etc.) to communities and adolescents. CONCLUSION: PEs with support from community health workers are able to play a crucial role in meeting the needs of the communities during a pandemic. There is a need to further engage, involve and build the skills of PEs to support the health system. PEs can be encouraged by granting more visibility and incorporating their role more formally by paying them within the public health system in India