Abstract
BackgroundAdolescents aged 10–19 represent one sixth of the world’s population and have a high burden of morbidity, particularly in low-resource settings. We know little about the potential of community-based peer facilitators to improve adolescent health in such contexts.MethodsWe did a systematic review of peer-facilitated community-based interventions for adolescent health in low- and middle-income countries (LMICs). We searched databases for randomised controlled trials of interventions featuring peer education, counselling, activism, and/or outreach facilitated by young people aged 10–24. We included trials with outcomes across key areas of adolescent health: infectious and vaccine preventable diseases, undernutrition, HIV/AIDS, sexual and reproductive health, unintentional injuries, violence, physical disorders, mental disorders and substance use. We summarised evidence from these trials narratively. PROSPERO registration: CRD42016039190.ResultsWe found 20 studies (61,014 adolescents). Fourteen studies tested interventions linked to schools or colleges, and 12 had non-peer-facilitated components, e.g. health worker training. Four studies had HIV-related outcomes, but none reported reductions in HIV prevalence or incidence. Nine studies had clinical sexual and reproductive health outcomes, but only one reported a positive effect: a reduction in Herpes Simplex Virus-2 incidence. Three studies had violence-related outcomes, two of which reported reductions in physical violence by school staff and perpetration of physical violence by adolescents. Seven studies had mental health outcomes, four of which reported reductions in depressive symptoms. Finally, we found eight studies on substance use, four of which reported reductions in alcohol consumption and smoking or tobacco use. There were no studies on infectious and vaccine preventable diseases, undernutrition, or injuries.ConclusionsThere are few trials on the effects of peer-facilitated community-based interventions for adolescent health in LMICs. Existing trials have mixed results, with the most promising evidence supporting work with peer facilitators to improve adolescent mental health and reduce substance use and violence.
Highlights
Adolescents constitute one sixth of the world’s population [1, 2]
We did a systematic review of peer-facilitated community-based interventions for adolescent health in low- and middle-income countries (LMICs)
In several Low- and Middle-Income Countries (LMICs), peer facilitators, defined as adolescents or young adults selected from the group or community they serve, are employed to work in communities and schools as part of national and non-governmental adolescent health programmes. [11,12,13,14]
Summary
Adolescents (persons aged 10–19 years) constitute one sixth of the world’s population [1, 2]. Global systematic reviews have found moderate- to high-quality evidence that interventions in communities and schools have positive effects on adolescent sexual and reproductive health, mental health, substance use, and intimate partner violence [6,7,8,9,10]. In several Low- and Middle-Income Countries (LMICs), peer facilitators, defined as adolescents or young adults selected from the group or community they serve, are employed to work in communities and schools as part of national and non-governmental adolescent health programmes. Empowering young people to inform and implement adolescent health programmes should make these more relevant and effective [2]. Adolescents aged 10–19 represent one sixth of the world’s population and have a high burden of morbidity, in low-resource settings. We know little about the potential of community-based peer facilitators to improve adolescent health in such contexts
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