Strengthening our knowledge base and research capacity for improved adolescent health in sub-Saharan Africa: a South–South–North collaboration

Globally, adolescent health has gained momentum as a public health priority 1. Adolescence is the period in the life course when important physical, cognitive, behavioural and social developments take place and determine health in later life stages. For instance, behaviours established in adolescence – diet, exercise, substance use, violence and sexual behaviour – will shape behaviours in adulthood and affect long‐term health outcomes 2-4. In Africa, adolescents make up about one‐fifth of the population 5. Despite the fact that many of the most important causes of death and ill health tend to occur in older ages, adolescents bear large burdens of disease, particularly in Africa. An estimated 1.2 million adolescents died globally in 2015, 45% of whom lived in Africa 5, 6. Adolescence is thus critically important for population health, both directly through the development and large disease burdens that occur during this life stage, and indirectly through impacts on later life stages as well as the health and well‐being of adolescents’ future families. Recent global initiatives and movements have recognised this importance 1, 7. For example, the United Nations’ Global Strategy for Women’s, Children’s and Adolescents’ Health 8 outlines areas of focus for investments in adolescents for health improvement over the coming decades 1. Yet, to date there is limited knowledge about many important aspects of adolescence, such as detailed understanding of unmet healthcare needs and effective interventions to reach adolescents for health promotion and disease prevention. The Global Strategy thus calls for ‘global and national research networks, knowledge platforms and data hubs to provide accurate, timely and transparent evidence, knowledge, data analysis and synthesis’, on adolescence and health. With the Adolescent Health Study, the ARISE Network – a network of 21 research institutions from nine countries in sub‐Saharan Africa – followed this call. The overarching goal of this study was to guide local interventions that can address structural, behavioural and biological health risks among adolescents. The study currently includes nine communities, of which six have existing Health and Demographic Surveillance Systems (HDSSs). The HDSSs are ideally positioned to support adolescent health research in sub‐Saharan Africa: they follow geographically defined populations over time and can place adolescents within rich longitudinal contexts of families and communities 1, 9. Traditionally, HDSSs have focused data collection on childhood and adulthood. The ARISE Network Adolescent Health Study demonstrates for the first time the knowledge gains that are possible when HDSSs incorporate detailed surveys of adolescent health risks, behaviours and outcomes. The ARISE Network Adolescent Health Study is distinctive in that it was conducted at the community level, including adolescents both in and out of school. Globally, most surveys on adolescent health are school‐based 10, such as the Global Youth Tobacco Survey (GYTS) 11, Health Behaviour in School‐Aged Children Study (HBSC) 12 and Global Student Health Survey (GSHS) 13. In many communities in Africa, large proportions of adolescents are out of school, warranting population‐based research platforms to identify the specific needs of out‐of‐school youth and to establish the effects of school enrolment on health behaviours and outcomes. In addition to advancing translational research with a focus on adolescents at this stage, the ARISE Network aims to build and sustain public health research capacity in partnership with academic and policy institutions, serving as a platform to promote robust implementation research and address critical questions of public health for sub‐Saharan Africa. This issue of Tropical Medicine & International Health contains 12 research papers using data from the ARISE Network Adolescent Health Study. The first two papers describe the methods used for the study and the prevalence of key risk factors across communities and domains 14, 15. Three papers explore adolescent risk behaviours across communities in detail: nutrition 16, sexual and reproductive health knowledge 17, and depressive symptoms and suicidal ideation 18. One paper describes correlations between school enrolment and health risks 19. Six papers focus on particular adolescent health domains in single communities or countries, including sexual behaviour in Uganda 20; malnutrition in Tanzania 21; adolescent stunting 22 and HIV‐related practices 23 in Ethiopia; and female genital cutting 24 and eating disorders 25 in Burkina Faso. Findings from these papers describe diverse, complex and context‐specific health needs among adolescent populations. Taken together, these papers paint a picture of the adolescent health landscape in these sub‐Saharan African communities and highlight the need for future research. In particular, intervention studies are needed to improve health promotion and disease prevention among adolescents and to influence health outcomes across the life course. Our community‐based approach allows us to recontextualise schools as a setting for interventions, pointing towards (i) the potential to intervene through schools (e.g. curriculum changes to improve sexual and reproductive health), (ii) the need for interventions to increase school attendance for adolescent health (e.g. through improved school nutrition programs) and (iii) the need to specifically address the healthcare needs of out‐of‐school youth (e.g. programs to reduce substance use and mental health morbidities). The ARISE Network Adolescent Health Study became possible through a South–South–North collaboration that paired global methods and domain experts in Africa, Europe and the United States with experts on local communities and cultures. Building on the findings reported in this issue, and coupled with continued dialogue with policy and decision makers, we believe that this collaboration has the potential to propel local research into grounded actions for adolescent health and well‐being 26, 27.

Tropical Medicine \& International Health

2-4

Editorial

https://doi.org/10.1111/tmi.13342