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Guidance on ethical considerations in planning and reviewing research studies on sexual and reproductive health in adolescents.
Geneva, Switzerland, World Health Organization, 2018. 52 p.This document is intended to address commonly occurring situations and challenges that one faces in carrying out research with adolescents (people aged 10–19 years), the majority of whom are deemed not to have reached the recognized age of majority in their respective settings. To this end, adolescents aged 18 and 19 years are classified as adults in many settings and have the legal capacity to make autonomous decisions regarding their participation in research. In this document, the term “children” refers to people below the age of 18 years, and the term “minor adolescents” refers specifically to people aged 10-18 years.
Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach.
International Journal of Adolescent Medicine and Health. 2016 Nov 10; 30(2)The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-a-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.
Geneva, Switzerland, World Health Organization [WHO], 2017. 86 p.Sexual abuse of children and adolescents is a gross violation of their rights and a global public health problem. It adversely affects the health of children and adolescents. Health care providers are in a unique position to provide an empathetic response to children and adolescents who have been sexually abused. Such a response can go a long way in helping survivors recover from the trauma of sexual abuse. WHO has published new clinical guidelines Responding to children and adolescents who have been sexually abused aimed at helping front-line health workers, primarily from low resource settings, in providing evidence-based, quality, trauma-informed care to survivors. The guidelines emphasize the importance of promoting safety, offering choices and respecting the wishes and autonomy of children and adolescents. They cover recommendations for post-rape care and mental health; and approaches to minimizing distress in the process of taking medical history, conducting examination and documenting findings.
A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study.
BMJ. 2017 Aug 03; 358:j3423.Objectives To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality.Design Growth curve construction and longitudinal cohort study.Setting United States and international growth data, and cohorts in Kenya, Uganda, and Zimbabwe.Participants The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES) US population datasets (age 5-25 years), which were used to construct the 2007 WHO growth reference for body mass index in this age group, were merged with an imputed dataset matching the distribution of the WHO 2006 growth standards age 2-6 years. Validation data were from 685 HIV infected children aged 5-17 years participating in the Antiretroviral Research for Watoto (ARROW) trial in Uganda and Zimbabwe; and 1741 children aged 5-13 years discharged from a rural Kenyan hospital (3.8% HIV infected). Both cohorts were followed-up for survival during one year.Main outcome measures Concordance with WHO 2006 growth standards at age 60 months and survival during one year according to MUAC-for-age and body mass index-for-age z scores.Results The new growth curves transitioned smoothly with WHO growth standards at age 5 years. MUAC-for-age z scores of -2 to -3 and less than-3, compared with -2 or more, was associated with hazard ratios for death within one year of 3.63 (95% confidence interval 0.90 to 14.7; P=0.07) and 11.1 (3.40 to 36.0; P<0.001), respectively, among ARROW trial participants; and 2.22 (1.01 to 4.9; P=0.04) and 5.15 (2.49 to 10.7; P<0.001), respectively, among Kenyan children after discharge from hospital. The AUCs for MUAC-for-age and body mass index-for-age z scores for discriminating subsequent mortality were 0.81 (95% confidence interval 0.70 to 0.92) and 0.75 (0.63 to 0.86) in the ARROW trial (absolute difference 0.06, 95% confidence interval -0.032 to 0.16; P=0.2) and 0.73 (0.65 to 0.80) and 0.58 (0.49 to 0.67), respectively, in Kenya (absolute difference in AUC 0.15, 0.07 to 0.23; P=0.0002).Conclusions The MUAC-for-age z score is at least as effective as the body mass index-for-age z score for assessing mortality risks associated with undernutrition among African school aged children and adolescents. MUAC can provide simplified screening and diagnosis within nutrition and HIV programmes, and in research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Lancet. Psychiatry. 2015 Jun; 2(6):487-8.Add to my documents.
Union of the Comoros. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples aux Comores (EDSC-MICS), 2012.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.20)These facts sheets present information from 58 countries on adolescents’ (ages 15-19) contraceptive use by marital status. In addition, key information, such as reasons for non-use of contraception, as well as where adolescents obtain their contraceptive method, is included. The Demographic Health Surveys (DHS) program www.dhsprogrogram.com conducts nationally representative surveys in low- and middle-income countries. We use the most recently collected data from any country where 1) a survey has been conducted in the past 10 years (2006-2016) and 2) the data are publically available. Analyses of DHS in the fact sheets are weighted according to DHS guidance to be nationally representative. The data provided is aimed to help policymakers and programme planners reduce inequities in service provision and access by understanding adolescents’ current sources of contraception, utilised methods, and reasons why they are not using contraception.
Republic of Chad. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples au Tchad (EDST-MICS), 2014-15.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.19)These facts sheets present information from 58 countries on adolescents’ (ages 15-19) contraceptive use by marital status. In addition, key information, such as reasons for non-use of contraception, as well as where adolescents obtain their contraceptive method, is included. The Demographic Health Surveys (DHS) program www.dhsprogrogram.com conducts nationally representative surveys in low- and middle-income countries. We use the most recently collected data from any country where 1) a survey has been conducted in the past 10 years (2006-2016) and 2) the data are publically available. Analyses of DHS in the fact sheets are weighted according to DHS guidance to be nationally representative. The data provided is aimed to help policymakers and programme planners reduce inequities in service provision and access by understanding adolescents’ current sources of contraception, utilised methods, and reasons why they are not using contraception.
Republic of Cameroon. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples du Cameroun (EDSC-MICS), 2011.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.18)These facts sheets present information from 58 countries on adolescents’ (ages 15-19) contraceptive use by marital status. In addition, key information, such as reasons for non-use of contraception, as well as where adolescents obtain their contraceptive method, is included. The Demographic Health Surveys (DHS) program www.dhsprogrogram.com conducts nationally representative surveys in low- and middle-income countries. We use the most recently collected data from any country where 1) a survey has been conducted in the past 10 years (2006-2016) and 2) the data are publically available. Analyses of DHS in the fact sheets are weighted according to DHS guidance to be nationally representative. The data provided is aimed to help policymakers and programme planners reduce inequities in service provision and access by understanding adolescents’ current sources of contraception, utilised methods, and reasons why they are not using contraception.
Burkina Faso. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples du Burkina Faso (EDSBF-MICS), 2010.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.16)
Republic of Benin. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante du Benin (EDSB), 2011-2012.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.15)
State of world population 2014. The power of 1.8 billion. Adolescents, youth and the transformation of the future.
New York, New York, United Nations Population Fund [UNFPA], 2014 Jan. 136 p.Young people matter. They matter because they have inherent human rights that must be upheld. They matter because an unprecedented 1.8 billion youth are alive today, and because they are the shapers and leaders of our global future. Yet in a world of adult concerns, young people are often overlooked. This tendency cries out for urgent correction, because it imperils youth as well as economies and societies at large. In some countries, the growth of the youth population is outpacing the growth of the economy and outstripping the capacities of institutions charged with providing them basic services. Will schools and universities be able to meet the demand for education? Some 120 million young people reach working age every year. Will there be enough jobs to accommodate their need for decent work and a good income? Are health services strong enough? Will the young, including adolescents, have the information and services they need to avoid early, unintended and life-changing parenthood? Will the next generation be able to realize its full potential? The State of World Population 2014, released today by UNFPA, the United Nations Population Fund, looks at these and other questions to show how young people are key to economic and social progress in developing countries, and describes what must be done to realize their full potential. The global report, titled "The Power of 1.8 Billion," also provides the latest trends and statistics on adolescent and youth populations worldwide, framing investments in youth not solely as responding to the needs of young people, but also as an imperative for sustainable development.
Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:40-8.OBJECTIVE: To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. DESIGN: Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. SETTING: Twenty-nine countries in Africa, Latin America, Asia and the Middle East. POPULATION: Women admitted for delivery in 359 health facilities during 2-4 months between 2010 and 2011. METHODS: Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. MAIN OUTCOME MEASURES: Risk of adverse pregnancy outcomes among adolescent mothers. RESULTS: A total of 124 446 mothers aged =24 years and their infants were analysed. Compared with mothers aged 20-24 years, adolescent mothers aged 10-19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26-34 weeks was significantly lower among adolescent mothers. CONCLUSIONS: Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Bulletin of the World Health Organization. 2012 Sep 1; 90(9):659-63.OBJECTIVE: To assess the implications of implementing the World Health Organization (WHO) 2010 guidelines for antiretroviral therapy (ART) initiation in adults and adolescents with human immunodeficiency virus (HIV) infection, which recommend initiating ART at a CD4+ T lymphocyte (CD4+) threshold of = 350 cells/mm(3) instead of = 200 cells/mm(3), which was the earlier threshold. METHODS: Between April and May 2010, CD4+ test results were collected for all HIV-infected patients recorded in the pre-ART and ART registers of 19 high-patient-load health centres in Addis Ababa, Ethiopia, and the regions of Amhara, Oromia, SNNPR (Southern Nations, Nationalities and People's Region) and Tigray. At 12 centres patient records were independently reviewed to assess data accuracy. To estimate the total number of patients who would need ART at health centres if Ethiopia adopted the new WHO guidelines, the number of patients needing ART based on current guidelines were added to the number of asymptomatic patients enrolled in pre-ART with a CD4+ count > 200 but = 350 cells/mm(3) FINDINGS: Adoption of the new WHO guidelines would increase the total number of patients on ART in the 19 health centres in Ethiopia by about 30%: from 3583 to 4640. CONCLUSION: The shift in the CD4+ threshold for ART initiation will substantially increase the demand for ART in Ethiopia. Since under the current systems only 60% of Ethiopia's patients in need of ART are receiving the medications, scaling up ART programmes to accommodate the increased demand for drugs will not be possible unless government funding and support increase concurrently.
Experiences from the field: HIV prevention among most at risk adolescents in Central and Eastern Europe and the Commonwealth of Independent States.
Geneva, Switzerland, UNICEF, Regional Office for Central and Eastern Europe and the Commonwealth of Independent States, .  p.This document shares experiences in an effort to support programmers, policymakers, and donors to carry out and strengthen further programming among most-at-risk-adolescents (MARA) and other vulnerable adolescents in the Central and Eastern Europe and the Commonwealth of Independent States Region and beyond. It presents programming experiences from Albania, Bosnia and Herzegovina, Moldova, Montenegro, Romania, Serbia, and Ukraine. The overarching goal of these programs has been to promote HIV prevention among MARA and to ensure their integration into national HIV / AIDS program strategies and monitoring and evaluation frameworks.
New York, New York, UNICEF, 2012 Apr.  p.Adolescents experience intense physical, psychological, emotional and economic changes as they make the transition from childhood to adulthood. This edition of Progress for Children sets out who adolescents are, where they live, what they do, what their problems are and how their needs are -- or are not -- being met. Understanding adolescents in all their diversity is fundamental to improving their lives.
[Ethic evaluation of sexual health programs on adolescence]. Valoracion Etica de los Programas de Salud Sexual en la Adolescencia.
Cuadernos De Bioetica. 2011 Jan-Apr; 22(74):77-91.In public health services, the interest in sexuality seems to turning from traditional topics such as potential treatments for male erectile dysfunction, psychosomatic disorders, the control of premature ejaculation and contraception. Instead, an increasingly prominent role is being given to prevention strategies carried out by means of campaigns or through sexual health programme sin schools. The different teaching strategies that underlie these programmes, which in many cases lack social consensus but are often promoted by international organizations such as WHO or UNESCO, reveal not only divergent ethical conceptions and worldviews on the meaning of sexuality, but also conflicting starting points, means and goals, focusing either on barrier-contraceptive methods or on sexual abstinence and personal responsibility. There is therefore a pressing need to understand the scientific evidence underlying each educational approach and the ethical postulates of each pedagogical proposal. This paper presents an outline of a six-point adolescent sexuality education program, which is respectful of individuals' ethical convictions. Given that few works on preventive medicine issues include an ethical evaluation of the steps followed in their development, this article also proposes a systematic evaluation of strategies for sexual health in the community that is developed through four steps verifying the following aspects: 1) the accuracy of information, 2) the level of evidence, 3) efficiency and 4) non-maleficence about the target population of each health program. The methodology used in these sexual health programs is another aspect that will verify their ethical consistence or, conversely, their absence of ethical values. We emphasize the duty of designers of programme for children not to carry then out against the will of their parents or tutors, and not conceal sensitive and relevant information.
From paper to practice. Implementing the World Health Organization’s 2010 Antiretroviral Therapy Recommendations for Adults and Adolescents in Zambia.
Arlington, Virginia, John Snow [JSI], AIDS Support and Technical Assistance Resources [AIDSTAR-One], 2011 May.  p. (USAID Contract No. GHH-I-00-07-00059-00; AIDSTAR-One Case Study Series)After the 2009 release of WHO’s Rapid Advice for HIV treatment in adults and adolescents, Zambia launched a broad-based effort to update its national treatment protocols. The Ministry of Health succeeded in creating an efficient and inclusive review and revision process for the guidelines, which they began implementing in 2011.
Consultation on strategic information and HIV prevention among most-at-risk adolescents. 2-4 September 2009, Geneva. Consultation report.
New York, New York, UNICEF, 2010. 65 p.The Consultation on Strategic Information and HIV Prevention among Most-at-Risk Adolescents (MARA) focused on experiences in countries where HIV infection is concentrated among men who have sex with men (MSM), injecting drug users (IDUs), and those who sell sex. The meeting facilitated the exchange of information across regions on country-level data collection regarding MARA; identified ways to use strategic information to improve HIV prevention among MARA; and suggested ways to build support for MARA programming among decision-makers.
New York, New York, UNICEF, 2011.  p.This report catalogues, in heart-wrenching detail, the array of dangers adolescents face: the injuries that kill 400,000 of them each year; early pregnancy and childbirth, a primary cause of death for teenage girls; the pressures that keep 70 million adolescents out of school; exploitation, violent conflict and the worst kind of abuse at the hands of adults. It also examines the dangers posed by emerging trends like climate change, whose intensifying effects in many developing countries already undermine so many adolescents' well-being, and by labour trends, which reveal a profound lack of employment opportunities for young people, especially those in poor countries. Adolescence is not only a time of vulnerability, it is also an age of opportunity. This is especially true when it comes to adolescent girls. We know that the more education a girl receives, the more likely she is to postpone marriage and motherhood -- and the more likely it is that her children will be healthier and better educated. By giving all young people the tools they need to improve their own lives, and by engaging them in efforts to improve their communities, we are investing in the strength of their societies. Through a wealth of concrete examples, The State of the World's Children 2011 makes clear that sustainable progress is possible. It also draws on recent research to show that we can achieve that progress more quickly and cost-effectively by focusing first on the poorest children in the hardest-to-reach places. Such a focus on equity will help all children, including adolescents. (Excerpt)
Geneva, Switzerland, WHO, 2009 Nov. 25 p.Based on the latest scientific evidence, the World Health Organization (WHO) has released new recommendations on HIV treatment and prevention and infant feeding in the context of HIV. WHO now recommends earlier initiation of antiretroviral therapy for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.
New York, New York, Center for Reproductive Rights, 2008. 7 p.This document discusses governments’ obligation under international human rights law to provide school-based sexuality education that is scientifically accurate and objective and free of prejudice and discrimination.
New York, New York, United Nations Population Fund, HIV/AIDS Branch, . 8 p. (Guidance Brief)This Brief has been developed by the Inter-Agency Task Team (IATT) on HIV and Young People1 to assist United Nations Country Teams (UNCT) and UN Theme Groups on HIV/AIDS in providing guidance to their staffs, governments, development partners, civil society and other implementing partners on HIV interventions for young people in the education sector. It is part of a series of seven global Guidance Briefs that focus on HIV prevention, treatment, care and support interventions for young people that can be delivered through different settings and for a range of target groups.
Use of Q methodology to analyze divergent perspectives on participatory action research as a strategy for HIV / AIDS prevention among Caribbean youth.
AIDS Education and Prevention. 2008 Aug; 20(4):301-311.This study used Q methodology to examine perspectives regarding participatory action research (PAR) among participants in a UNICEF initiative aimed at enhancing HIV/AIDS prevention among youth in the Caribbean. We interviewed 20 youth PAR researchers and 12 project managers from youth organizations about their attitudes and experiences. Statements from the interviews were used in a structured ranking task. Q factor analysis of the rankings identified three clusters of respondents with differing viewpoints on PAR. The clusters respectively saw PAR as an effective peer education tool, an empowering process for youth, and a tool for gathering information on the gap between knowledge and behavior. We identified divergent perspectives on the purpose and utility of PAR among participants who received the same orientation, training, and support and who worked in the context of a single initiative. These multiple perspectives present both challenges and resources for health projects. (author's)
Journal of School Health. 2008 Jul; 78(7):368-373.India made 2 important policy statements regarding tobacco control in the past decade. First, the India Tobacco Control Act (ITCA) was signed into law in 2003 with the goal to reduce tobacco consumption and protect citizens from exposure to secondhand smoke (SHS). Second, in 2005, India ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). During this same period, India conducted the Global Youth Tobacco Survey (GYTS) in 2003 and 2006 in an effort to track tobacco use among adolescents. The GYTS is a school-based survey of students aged 13-15 years. Representative national estimates for India in 2003 and 2006 were used in this study. In 2006, 3.8% of students currently smoked cigarettes and 11.9% currently used other tobacco products. These rates were not significantly different than those observed in 2003. Over the same period, exposure to SHS at home and in public places significantly decreased, whereas exposure to pro-tobacco ads on billboards and the ability to purchase cigarettes in a store did not change significantly. The ITCA and the WHO FCTC have had mixed impacts on the tobacco control effort for adolescents in India. The positive impacts have been the reduction in exposure to SHS, both at home and in public places. The negative impacts are seen with the lack of change in pro-tobacco advertising and ability to purchase cigarettes in stores. The Government of India needs to consider new and stronger provisions of the ITCA and include strong enforcement measures. (author's)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2008. 20 p.The first few days and weeks of life are among the most critical for child survival. Every year, an estimated 4 million children die during the first month of life. Almost all of these deaths (98%) occur in developing countries. Most neonatal deaths are due to ore-term birth, asphyxia and infections such as sepsis, tetanus and pneumonia. In 2006-2007, to support efforts by countries and regions to reduce newborn deaths, we worked to build capacity for the planning and delivery of improved newborn care services in health facilities and communities, to provide tools and guidance for extending population coverage, and to evaluate the impact of all those actions. (excerpt)