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Abstract
Background Adolescent pregnancy is associated with multifaceted challenges that impact countries’ health, education and economic stability. Despite ongoing interventions, in developing countries such as Kenya, adolescent pregnancy rates continue to be high. There is a need for more synthesised evidence on regional-specific risk factors to support tailored prevention strategies.
Objective This scoping review aims to explore what is known about the risk factors and intervention strategies focused on adolescent pregnancy prevention in Kenya.
Methods and analysis Using the Arksey and O’Malley framework combined with a three-step search strategy as recommended by the Joanna Briggs Institute, relevant articles will be identified from the PubMed, Scopus, Web of Science, CINAHL and PsycINFO databases. The focus will be on literature published from 1 January 2008 to 31 December 2023, addressing risk factors and public health strategies aimed at adolescent pregnancy prevention in Kenya. The analysis will involve thematic data extraction and charting to highlight patterns in adolescent pregnancy risk factors, intervention outcomes and existing gaps.
Ethics and dissemination No ethical approval is needed. The dissemination strategy includes peer-review publication and presentation to relevant stakeholders.
Conclusion This review will provide a comprehensive summary of the literature on the risk contributors and interventions for adolescent pregnancy prevention in Kenya. The evidence map may be used by relevant stakeholders to address adolescent pregnancy prevention gaps in strategy as well as inform interventions that are context-specific.
Registration Open Science Framework (https://doi.org/10.17605/OSF.IO/Q5F9G); Pre-results.
- Adolescents
- Pregnancy
- Primary Prevention
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STRENGTHS AND LIMITATIONS OF THIS STUDY
The study will employ multiple database searches, covering data over the past 15 years, increasing the relevance and diversity of its results.
The use of the Arksey and O’Malley framework paired with the Joanna Briggs Institute three-step search strategy ensures a structured and extensive analysis.
This review will be limited to English publications, which will potentially overlook relevant results from non-English articles.
Study quality assessments are omitted, as the review aims to map out relevant literature without critical evaluation.
Introduction
Adolescent pregnancy involves multiple challenges with unique complexities. Pregnancy during these formative years heightens the risk of adverse pregnancy outcomes, including death for both mothers and infants.1 At an economic and educational level, the disruption of schooling as a result of these pregnancies hinders academic advancements and keeps the poverty cycle going. In the Global South, adolescents often face hindered access to vital reproductive health services due to restrictive regulations that impede their ability to make informed decisions.2
According to the data from the World Health Organisation (WHO), an average of 21 million adolescent girls became pregnant worldwide in 2019, with approximately 50% being unplanned.3 The adolescent pregnancy rate in low- and middle-income countries (LMICs) is reported to be 6.48%.4 In Kenya, the national adolescent pregnancy rate decreased to 15% in 2022, although this decrease varied significantly at the county level, with rates as high as 50% in some regions.5 While a variety of adolescent pregnancy prevention interventions are in place in sub-Saharan Africa (SSA), there remains a substantial gap in the comprehensive evaluation of their forms, effectiveness and sustained feasibility.6 In Kenya, there is a need to both inform prevention strategies to better address this issue and identify gaps in the literature for future research.
It is important to ascertain which adolescent pregnancy prevention interventions are successful, under what circumstances they are most effective and in what ways they can be strengthened and their impact increased. This knowledge may directly inform programme interventions and guide policymakers in targeted legislation. Highlighted gaps in current prevention interventions may be used by programme managers to guide resource allocation and may also point to research priority areas. Overall, this review will equip relevant stakeholders (policymakers, advocates and practitioners) with insights that are actionable, and this will allow for context-specific, adaptable solutions.
This scoping review aims to map out the current literature on risk contributors and interventions aimed at adolescent pregnancy prevention in Kenya.
Aims
The following research questions are addressed:
What are the risk factors associated with adolescent pregnancy in Kenya?
Which intervention strategies are presently being applied to reduce adolescent pregnancy rates in Kenya?
What gaps exist in the current adolescent pregnancy prevention intervention strategies in Kenya?
Methods
Protocol design
This review protocol is prospectively registered to the Open Science Framework to guarantee good scientific practice and study transparency (https://doi.org/10.17605/OSF.IO/Q5F9G). Arksey and O’Malley’s methodological framework will be used in conducting the review. It involves defining the research question, identifying relevant studies, selecting studies that meet the predefined inclusion criteria, extracting and charting data and summarising, interpreting, and reporting results.7 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) will be used for reporting the review results. As the study applies a scoping review methodology, no ethical approval will be needed or sought.
Defining the research question (stage 1)
‘What are the known risk contributors and public health interventions targeting adolescent pregnancy prevention among females aged 10-19 years in Kenya?’
Gaps in the current research literature on adolescent pregnancy prevention intervention strategies will also be identified.
Identifying relevant studies (stage 2)
The three-step search strategy as outlined by the Joanna Briggs Institute (JBI) will guide this review.8 The initial strategy will involve limited database searches on PubMed to identify Medical Subject Heading (MeSH) terms for adolescent, pregnancy and Kenya. The titles, abstracts and index terms of these searches will be subsequently reviewed to identify suitable search terms. The final search included all identified keywords and index terms, which will be refined and finalised before the primary search to ensure comprehensive coverage of the literature.
A detailed search of all specified databases (PubMed, Scopus, CINAHL and PsycINFO) will be conducted via previously determined keywords and index terms. Hand searches will also be conducted on the Google Scholar website to ensure appropriate resources. Date limits will be set from 1 January 2008 to 31 December 2023. A duration of 15 years for this evaluation will be used, as recent data can be used to adapt and contextualise the WHO guidelines for reducing adolescent pregnancy. Search strategies will be tailored to each database’s syntax and controlled vocabulary. MeSH terms will be applied for PubMed, Emtree for Embase and keyword adaptations for Scopus/Web of Science. Keywords will be separated or combined via Boolean operators, such as ‘OR’ and ‘AND’, as appropriate. Field codes (eg, TI/DP/AB) will also be adjusted to optimise retrieval across the relevant platforms (online supplemental appendix 1).
Supplemental material
The JBI-recommended Population, Concept, Context (PCC) framework (table 1) will be used to ensure matching of the study selection with the research question.8
Population, Concept, Context (PCC) framework
Search strategies will be customised to specific database’s syntax and indexing systems (eg, MeSH terms for PubMed, Emtree for Embase and keyword adaptations for Scopus/Web of Science). Boolean operators and field codes (eg,TI/AB/KW) will be adjusted to optimise retrieval across platforms.
Table 2 shows an illustrative search strategy for PubMed and the results from a trial search performed on 1 July 2024.
Trial search strategy for PubMed
Inclusion and exclusion criteria (stage 2)
Inclusion
Publications involving adolescent females between the ages of 10 and 19 years focused on either the determinants of adolescent pregnancy or preventative public health strategies designed to mitigate or prevent it. Eligible studies may include qualitative, quantitative or mixed-methods approaches involving primary studies, secondary analysis or in-depth reviews. Articles must be in English and focus on a Kenyan setting or provide data pertinent to it. Relevant articles examining the social, cultural, economic or healthcare system factors influencing adolescent pregnancy will also be included.
Non-English publications were not included due to constraints in translation resources; however, the majority of health research articles in Kenya are published in English (an official language in Kenya).
Exclusion
Research articles without age-specific data for adolescents, including those focused only on broader groups like women of reproductive age (15–49 years) or youths aged 15–35 years were excluded. Non-peer-reviewed materials such as opinion pieces, commentaries, conference abstracts, editorials and studies without rigorous methodology or detailed findings will also not be considered.
Studies meeting the inclusion criteria will be loaded into Rayyan and EndNote software. These software programmes also handle record management, article tracking and the preparation of a final reference list.
Study selection (stage 3)
A systematic three-step process will be used in the study selection.
Step 1: Each study identified will be stored in Rayyan. Two independent reviewers will review their titles and abstracts by using a predefined checklist. Inter-rater reliability will be assessed via Cohen’s kappa (κ≥0.7) to objectively measure reviewer agreement.9 Discrepancies will be resolved through interactive team discussions.
Step 2: After the initial screening, two reviewers will examine the full-text studies against the inclusion and exclusion criteria, with the checklist previously used in step 1. To ensure consistency and complete consensus, the selected articles will be re-evaluated by a third reviewer.
Step 3: Articles with unresolved uncertainties, in terms of inclusion, will be forwarded for further review by a fourth supervising reviewer. The results from all stages will be mapped out in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart, as shown in figure 1.10 There will be no evaluation of the methodological quality of the articles.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart draft illustrating the flow of records through the process of the scoping review.
Charting data (stage 4)
An Excel data charting form will be used to answer the review’s scope. Relevant details will be extracted from the full texts of the selected articles. This includes bibliographic details (journal, author, title and year of publication), along with the study objectives, setting, research methodology and findings. Table 3 presents a draft version of the data chart.
Data chart
A pilot test of 20% of the selected articles will be performed to ensure the validity and applicability of the coding framework. From this test, if the need for additional categories is prompted, appropriate modifications will be made to the framework and corresponding data extraction protocol. Any challenges identified during the pilot study will be reviewed by the research team for resolution.
Data gaps will be identified as either critical (ie, study design/participant characteristic/intervention detail/outcome measures) or supplementary (ie, sample size/region of study/sample size). Corresponding authors will be contacted via email twice within 14 days for a response. In instances where the authors fail to respond within 14 days, studies lacking critical data will be excluded post hoc, with rationale documented in the PRISMA-ScR flow diagram. Studies missing supplementary information will be flagged as ‘incomplete’ and analysed for potential bias via sensitivity testing. A supplementary log will detail all exclusions and follow-up attempts.
Collating, summarising and reporting the results (stage 5)
As described in this protocol, this scoping review is intended to synthesise existing information on risk factors and adolescent pregnancy prevention interventions in Kenya.
This review will adopt the socioecological model to describe findings from the relevant studies. As adopted from a similar study, this model provides a structured framework that outlines the influences of health behaviours and outcomes at the individual, interpersonal, organisational, community and policy levels.11–13
The results will be presented as summaries. The key findings and results will be systematically tabulated in line with the previously established data extraction framework. This analysis will detail both the well-known dimensions and existing gaps in adolescent pregnancy prevention research, providing a comprehensive overview.
Ethics and dissemination
Given that this review synthesises publicly available literature and does not involve new data collection, ethical approval was not required.
The study results will be made accessible through a peer-reviewed open-access journal publication for broad dissemination. In order to enhance the meaningful application, findings will also be shared with the relevant stakeholders in Kenya, including community health educators, adolescent health-focused non-governmental organisations and the Ministry of Health, Kenya. An additional dissemination strategy will involve regional public health conference presentations.
Patient and public involvement
The study aims to synthesise existing data. It does not involve any direct participant engagement or data collection; therefore, patient and public involvement was not sought.
Discussion
This scoping review protocol outlines the steps in compiling literature looking at the risk contributors to adolescent pregnancy in Kenya, as well as the prevention interventions in place. Mapping the current knowledge and highlighting gaps in this area could help in the development of future adolescent pregnancy prevention strategies and policies.
A limitation of this study is the exclusive use of English-language articles. This may result in gaps in understanding community-specific insights and grassroots interventions, under-representing indigenous knowledge, thereby limiting the generalisability of the results. It is important to note, however, that Kenya’s official language is English, and the majority of peer-reviewed research is in English.
The absence of quality assessment for the included studies will prioritise mapping the breadth and nature of the evidence. Including diverse study designs is important for identifying gaps in the adolescent pregnancy prevention landscape in Kenya.
Ethics statements
Patient consent for publication
Footnotes
X @AsasoKim
Contributors AM conceived the study. KAO developed the protocol and drafted the manuscript. DD, AM and AG contributed to the manuscript content according to their fields of expertise. KAO is responsible for the overall content of the manuscript as the guarantor. All the authors read and approved the final manuscript. Curie academic writing AI by AJE was used to optimise the output language.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.