Centre for Infectious Disease, Lusaka, Zambia.
University of Washington, Seattle, Washington, USA.
Syst Rev. 2022 Aug 9;11(1):161. doi: 10.1186/s13643-022-02035-x.
BACKGROUND: The COVID-19 pandemic could worsen adolescent sexual and reproductive health (ASRH). We sought evidence on the indirect impacts of previous infectious disease epidemics and the current COVID-19 pandemic on the uptake of ASRH in sub-Saharan Africa (SSA) to design relevant digital solutions. METHODS: We undertook a literature scoping review to synthesize evidence on the indirect impacts of COVID-19 on ASRH in SSA per the Arksey and O'Malley framework and PRISMA reporting guidelines. We conducted the search on PubMed, Embase, Google Scholar, and ResearchGate in June and November 2020. We included all peer-reviewed, English-language primary studies on the indirect impacts of infectious disease epidemics on the uptake of sexual and reproductive health (SRH) in SSA. RESULTS: We included 21 of 42 identified studies. Sixteen studies (76.2%) quantitatively assessed utilization and access to SRH during epidemics. Five studies (2 [9.6%] qualitative and 3 [14.3%] mixed methods) explored factors affecting SRH services. All studies focused on adult populations, most often on labor and delivery (n = 13 [61.9%]) and family planning (n = 8 [38.1%]) outcomes. Although we sought out to assess all outbreaks, epidemics, and pandemics, the only relevant studies took place during the West African Ebola pandemic (n = 17 [80.9%]) and COVID-19 pandemic (n = 4 [19.0%]). One study (4.8%) highlighted adolescent-specific outcomes and condom use. Most studies found declined access to and utilization of facility delivery, antenatal care, family planning, and HIV care. One study noted an increase in adolescent pregnancies. However, other studies noted similar, or even increasing trends in access to and utilization of other SRH services (family planning visits; HIV diagnosis; ART initiation) during epidemics. Barriers to SRH uptake included factors such as a reduced ability to pay for care due to lost income, travel restrictions, and fear of infection. Supply-side barriers included lack of open facilities, workers, commodities, and services. Community-based peer delivery systems, telemedicine, and transport services improved SRH uptake. CONCLUSION: Access to SRH services during epidemics among adolescents and young people in SSA is understudied. We found that no studies focused on SRH outcomes of abortion, emergency contraception, sexually transmitted infections, or cervical cancer. To improve access to and utilization of SRH during pandemics, we recommend the following; in terms of research, key standardized SRH indicators should be included in routine data collection, routine data should be disaggregated by age, gender, and geography to understand gaps in ASRH service delivery, and additional rigorous epidemiological and social-behavioral studies should be conducted. On implementation, community-based peer delivery systems and telemedicine, internet-based, and other technological solutions may better reach adolescent and young people in SSA.
背景:COVID-19 大流行可能会恶化青少年的性健康和生殖健康(ASRH)。我们旨在检索和评估以往传染病大流行和当前 COVID-19 大流行对撒哈拉以南非洲(SSA)青少年性健康和生殖健康获取的间接影响的证据,从而设计相关的数字解决方案。
方法:我们根据 Arksey 和 O'Malley 框架以及 PRISMA 报告准则,进行了一次文献范围的综述,以综合评估 COVID-19 对 SSA 青少年 ASRH 的间接影响的证据。我们于 2020 年 6 月和 11 月在 PubMed、Embase、Google Scholar 和 ResearchGate 上进行了检索。我们纳入了所有关于传染病流行对 SSA 性健康和生殖健康(SRH)获取的间接影响的同行评审、英语原始研究。
结果:我们纳入了 42 项研究中的 21 项。16 项研究(76.2%)定量评估了传染病期间 SRH 的利用和获取情况。5 项研究(2 项定性和 3 项混合方法)探讨了影响 SRH 服务的因素。所有研究均聚焦于成年人群,其中大多数(n=13 [61.9%])关注的是分娩和计划生育(n=8 [38.1%])的结果。尽管我们试图评估所有的暴发、流行和大流行,但只有相关研究发生在西非埃博拉大流行(n=17 [80.9%])和 COVID-19 大流行(n=4 [19.0%])期间。一项研究(4.8%)强调了青少年特有的结果和避孕套使用情况。大多数研究发现,获得和利用设施分娩、产前护理、计划生育和艾滋病毒护理的机会减少。一项研究指出青少年怀孕人数增加。然而,其他研究指出,在传染病流行期间,其他 SRH 服务(计划生育就诊;艾滋病毒诊断;ART 启动)的利用和获取情况也存在类似甚至增加的趋势。SRH 获取的障碍包括因收入损失而导致无力支付护理费用、旅行限制和对感染的恐惧等因素。供应方的障碍包括缺乏开放的设施、工作人员、商品和服务。社区为基础的同行提供系统、远程医疗和运输服务改善了 SRH 的获取。
结论:在 SSA 的青少年和年轻人中,传染病期间 SRH 服务的获取情况研究不足。我们发现,没有研究关注堕胎、紧急避孕、性传播感染或宫颈癌的 SRH 结果。为了在大流行期间改善 SRH 的获取和利用,我们建议:在研究方面,应将关键的标准化 SRH 指标纳入常规数据收集,应按年龄、性别和地理位置对常规数据进行细分,以了解 ASRH 服务提供方面的差距,并应开展更多严格的流行病学和社会行为研究。在实施方面,社区为基础的同行提供系统和远程医疗、基于互联网的和其他技术解决方案可能会更好地覆盖 SSA 的青少年和年轻人。
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