Sexual and reproductive health of adolescents and young people in Gambia: a systematic review

¹Society for the Study of Women´s Health (SSWH), Old Yundum, Coastal Road, The Gambia, ²Directorate of Health Research, Ministry of Health, Old Yundum, Coastal Road, The Gambia, ³West African Health Organization (WAHO), Bobo-Dioulasso, Burkina Faso

^&Corresponding author
Mat Lowe, Society for the Study of Women´s Health (SSWH), Old Yundum, Coastal Road, The Gambia

Introduction    

Concerns about adolescents and youth sexual and reproductive health (AYSRH) have grown over the past years because of the unprecedented increasing proportions of young people and rates of sexual and reproductive health infections, early sexual debut, teenage and unwanted pregnancies, and gender-based violence, including female genital mutilation/cutting. Teenage pregnancies outside of marriage among adolescent girls, in particular, are a significant cause for concern in The Gambia, where almost one in five (18%) of adolescent girls age 15 to 19 are already mothers or pregnant with their first child [1]. In addition, teen pregnancies constitute a significant cause of unsafe abortions, contributing to 13% of Gambia´s maternal deaths[2]. Even though there is a lack of data on the prevalence of adolescent pregnancies and abortions, in 2011 alone, there were 19 cases of abandoned babies [3]. These figures increased to 20 in 2012 and 25 in 2013 [4].

In addition to the complications which might lead to death, other consequences for an unmarried adolescent and youth with an unplanned pregnancy include expulsion from home, dishonor for her family and herself, and child neglect and abuse [5]. The underlying causes of unplanned pregnancies among adolescents and young people are many. These include lack of timely and appropriate information from parents on sexual and reproductive health; denial of adolescents and young people's access to sexual and reproductive health information and services [6]. Misinformation about sex and the lack of youth-friendly sexual and reproductive health services in the Gambia also pose challenges to young girls' sexual and reproductive health [6]. These issues combined have contributed to the high prevalence of HIV/AIDS in the country. The prevalence of HIV/AIDS was higher among females, 2.1%, compared to males, 1.7% [7]. Knowledge of HIV transmission is also limited in the Gambia, with only 27 percent of women and 36 percent of men age 15-49 having comprehensive knowledge about AIDS.

Although there are policy frameworks regarding sexuality education to empower adolescents and young people with knowledge and practical skills to make safe and informed choices and exercise their rights, there is limited evidence on the effectiveness of these policy frameworks. Close observations indicate that adolescents and young people (aged 10-24) who constitute 32% of the national population lack quality information and services on sexual and reproductive health. This systematic review explores the sexual and reproductive health indicators of adolescents and young people in the Gambia. The review was part of a more extensive baseline study of sexual and reproductive health of adolescents and young people in the Gambia, initiated by the West African Health Organization (WAHO).

Methods     

Reporting: the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline [8] was used to report this study.

Search strategies and information sources: an extensive electronic literature search to identify terms related to sexual and reproductive health of adolescents and young people in the Gambia was conducted. Search terms focused mainly on modern contraceptive and STIs prevalence rates, availability and accessibility of sexual and reproductive health (SRH) services, and satisfaction with SRH services among adolescents and young people (aged 10-24 years). Electronic literature searches were conducted in accessible databases including PubMed, Google Scholar and African Journals Online. These databases were searched without restriction to date. Search terms are described in (Table 1).

Study selection and eligible criteria: the studies included in this review were peer-reviewed published studies in English and national reference documents, including project and programs reports and evaluations, without restriction to date. Published studies and national reference documents that provided no information on sexual and reproductive health of adolescents and young people were excluded. The study population of interest included adolescents and young people. For adolescents and young people, the study applied the official definitions of the UN. The UN defines adolescents as individuals being 10-19 years old and young people as those persons between the ages of 15 and 24 years. A total of 27 published, peer-reviewed articles were identified through the keyword search that was conducted on April 15, 2020. A title and abstract screening to determine final inclusion in the review was then conducted which resulted to 12 articles been excluded due to topic irrelevance and or lack of data reported on sexual and reproductive health of adolescents and young people (Figure 1). Beside the studies that were obtained from the electronic literature search, national reference documents that contained relevant in-country data on sexual and reproductive health of adolescents and young people were also collected from relevant government and non-government agencies (Table 2). A total of 7 national reference documents were collected. Of these, 3 were included in this review.

Data extraction and analysis: the review author (OA) designed a data extraction form. The other authors (ML, PIGS, and YAMM) independently checked the data extraction form for accuracy. The data extraction was then used by (ML and PIGS) to extract data from published studies. The data collection form was employed to extract the following information from each included study; study ID, author, year of publication, data source, study area, study design, population and setting, the age range of study participants, mean age of participants, sample size, and outcome measures including contraceptive and STIs prevalence rates, availability and accessibility of sexual and reproductive health services, level of satisfaction with sexual and reproductive health services. Since this was a rapid systematic review, the authors did not assess the risk of bias for the studies included in the review. In addition, due to the inclusion of qualitative and quantitative studies, conducting a meta-analysis of the data was not appropriate. Instead, the authors chose a descriptive narrative synthesis as the most suitable data synthesis method for this review.

Results     

Results of the search and characteristics of the studies included: the literature searches from all sources yielded a total of twelve (12) published studies and three national reference documents that met the inclusion criteria in this review. The published studies consisted of two (2) qualitative and ten (10) quantitative study designs and the three national reference documents were reports of a Multiple Indicator Cluster Survey (MICS), Demographic and Health Survey (DHS) and a rapid assessment study (Table 3, Table 3 (suite)).

Contraceptive prevalence: three studies reported information about contraceptive prevalence. The reported contraceptive prevalence rates among married and unmarried adolescents and young people aged 10-24 years ranged from 7%-8% in the three studies [9-11] and 9% in a national survey [12].

Availability and accessibility of contraceptives: lack of access and limited knowledge of reproduction and reproductive health were reported in two studies as main reasons for non-use of modern contraceptives among adolescents and young people aged 10-24 years [13,14]. Another study reported the disapproving attitude of health workers as another reason for not seeking contraception and other needed reproductive health services among adolescents and young people [15]. Stigma, shame and lack of money were also reported in one study as major barriers to accessing contraceptive commodities among young people [16]. The low uptake of contraception by young women and girls was also attributed to cultural and religious barriers [17] and common misconception which associate contraception with promiscuity in a study [18].

Prevalence of sexually transmitted infection: there is limited information on the prevalence of STI among adolescents and young people, with only a single study reporting a prevalence rate of 8.4% among married adolescent and young girls aged 15-24 [19].

Satisfaction with sexual and reproductive health services: inadequate counselling and complaints relating to physical environment and process of providing sexual and reproductive health services and information were reported as major factors associated with level of adolescent and young women´s satisfaction with the quality of sexual and reproductive health services they received [20].

Discussion     

This study was a systematic literature review of published studies and national reference documents on sexual and reproductive health of adolescents and young people in the Gambia. The studies and national reference documents included in the review show limited access to sexual and reproductive health among adolescents and young people. As a result of these uptake of modern contraceptive methods is low and contributes to the high pregnancy rates among adolescent girls. The studies also revealed that the low uptake of contraception by adolescents and young people can attributed to cultural and religious barriers including misconceptions which associates contraception with promiscuity; shame and the disapproving attitude of health workers all contributing to the reasons why young people did not access health services, even if they had STI symptoms. Overall, there is limited information on the prevalence of STI among adolescents and young people, with only published study reporting an STI prevalence of 8.4% [19]. This suggests the need to conduct more research to assess the prevalence of STIs among adolescents and young people. The review also explored levels of satisfaction with the quality of sexual and reproductive health services among adolescents and young people and found that inadequate counselling and complaints relating to physical environment and technical process and of providing sexual and reproductive health services and information were major reasons for discontinuation and non-use of sexual and reproductive health commodities and services [21].

Study limitations: some major limitations of this review include the age limit of adolescents in the studies that have been reviewed and the fact that the studies included in the review were limited to studies written in English. Including studies written in other languages would have provided valuable information on sexual and reproductive health of adolescents and young people. In addition, although PubMed, Google Scholar and African Journals Online are among the most used search databases, the review might have missed some relevant studies included in other databases [22]. Some peer-reviewed studies which could not be accessed were also not included. The quality of the included studies was also not described in this review since the risk of bias assessment for included studies was not done. Despite these limitations, the review has important implications for policy and research.

Conclusion     

The findings of this systematic review provide essential baseline data on sexual and reproductive health indicators of adolescents and young people in the Gambia. The study has demonstrated the gaps in evidence on adolescents and young people's sexual and reproductive health indicators in the Gambia. It stressed the need to conduct more studies targeting adolescents and young people because majority of studies conducted on SRH in the Gambia are related to women of reproductive age, which may conceal the real situation and needs of the adolescents with those of the women of higher reproductive age [22].

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Mat Lowe and Phebian Ina Grant Sagnia designed the review, led the searching, screening, and analysis of records and drafted the first and final article. Olusegun Awolaran and Yves Armand Mèdessi Mongbo contributed to the article writing process and provided conceptual insight and feedback on revisions. All authors read and approved the final version of the manuscript.

Acknowledgments     

The authors are grateful to the governmental and non-governmental agencies that provided relevant in-country data for this review, as well as the Netherlands for funding this study.

Tables and figure     

Table 1: search terms

Table 2: list of government and non-government agencies for in-country data

Table 3: characteristics of studies included in the review

Table 3 (suite): characteristics of studies included in the review

Figure 1: PRISMA 2009 Flow diagram

References