Sub-Saharan African youth are growing up in very challenging contexts. Yet, the ramifications of major influences on youth development in SSA have yet to be fully understood. Research evidence is needed to fully understand the issues that confront young people in contemporary SSA and develop programs and policies to mitigate the difficult circumstances facing them. However, the literature on youth in the region is quite limited and focuses largely on sexual and reproductive health, primarily in light of high fertility rates and the HIV pandemic. Yet, recent studies demonstrate that young people in SSA are at risk for other factors that impact negatively on their health and wellbeing including, poor dietary habits and physical inactivity , poor mental health [22, 49], and injuries [50, 51], among others. For example, Jenkins and colleagues  observed a 5.8% prevalence of common mental disorders among 16–29 year olds in a population-based study in Kenya.
Although there is substantial literature on multiple drivers of adolescent health and wellbeing in the global north , the unique context in which many African youth are experiencing the transition of adulthood means that this literature may only provide a partial picture of what is needed to inform policies and programs geared towards African youth. High-quality research capacity within the continent is vital if SSA is to develop effective evidence-based policies and programs to ensure the wellbeing of her youth. Unfortunately, SSA’s capacity to produce scientific knowledge is greatly impeded by multiple factors including reduced scientific output in many of her universities due to heavy teaching loads , significant emphasis on consultancies to supplement incomes , inability of governments to fund research, and loss of academics and researchers to institutions in the global north or non-research sectors [55, 56]. The consequences of this situation are quite telling – a recent review of the region’s contribution to scientific knowledge as measured by papers published in various international databases shows that the region contributes to less than 1% of the world science production . The low research outputs therefore undermine the capacity of African countries to draw on locally-owned and relevant research evidence to inform policy and practice.
To illustrate the dearth of region-specific research on youth, we conducted a Medline search in January 2013 using the following key words “adolescent*” OR “youth*” with the following limits activated: Humans, Journal Article, English, published in the last 5 years, and Field: Title/Abstract. This search yielded 38415 hits. Adding the medical subject heading (MESH) term “Africa South of the Sahara" reduced the number of hits to 867 (2.3% of the original hits). Although the search is likely biased in terms of focus (medical or public health fields) and the database likely omits a substantial proportion of peer-reviewed journals published by SSA-based institutions, these findings serve as a useful illustration of the limited pool of literature on youth health in SSA.
At country level, nationally-representative data on youth in SSA are primarily gathered through Demographic and Health Surveys (DHSs), which focus on youth and adults aged 15–49 (for women) and 15–54 (for men). This means that early adolescents aged 10–14 are systematically excluded from these surveys . Moreover, DHSs often focus on reproductive and sexual health and are cross-sectional in nature and thus offer limited opportunities for following up youth development in a long-term perspective that could help disentangle causal pathways. Some countries have also implemented the Global School-based Student Health Survey (GSHS) conducted in partnership with the WHO. The GSHS provides useful data on 13–15 year olds but unfortunately is restricted to school-going children in a limited number of countries.
Overall, there are few SSA-based long-term studies on youth development that can clarify linkages between health and the social, political, and economic contexts that define the lives of African youth. However, there are several longitudinal studies in the region that have examined diverse aspects of young people’s health and wellbeing: the Transitions to Adulthood project (TTA), conducted in two informal settlements in Nairobi (Kenya) [37, 59, 60]; and, in South Africa, the Cape Area Panel Study (CAPS) [61–63] and the Birth-to-Twenty Study (BT20) [64, 65], among others. These studies provide a good example of the types of large-scale, longitudinal studies that are needed to better understand the drivers and determinants of young people’s health in SSA. For example, the TTA study made important contributions in areas often neglected in research including youth resilience , problem behaviors including substance use , and the timing and sequencing of key markers of transitions to adulthood . Likewise, the BT20 study has generated evidence on ethnic differences in bone mass and physical activity; and the impacts of exposure to violence on emotional and social adjustment in children, among others .
Remedying limited research capacity on young people’s health and wellbeing
Developing high-quality research capacity on young people’s health is critical if countries in the region are to develop evidence-based policies and programs to address their needs. However, SSA suffers from limited investments in research and scientific output. Unlike other regions in the world which have several centers of research excellence focusing on young people’s health, the region generally lacks strong research programs that draw together the diverse disciplines needed for a comprehensive understanding of the drivers of young people’s health. Possible ways to address this gap include strengthening inter- and multi-disciplinary research training programs on young people’s health in African universities and the development of south-south and south–north collaborations with institutions having longstanding research experience on young people’s health. While space will not permit us to systematically review current research training opportunities and the lessons they present, Bates and colleagues  highlight a variety of approaches to address the shortcomings of research training in African universities, particularly at the doctoral level. These approaches include investments to improve access to electronic resources, improvements in internet connectivity, improvements in the quality of supervision, expansion of the pool of supervisors through collaborations with institutions, and formal skills training on various aspects of research including scientific writing. Several programs to enhance research capacity at African universities in a diverse range of fields [53, 68] provide a good framework for addressing the shortcomings of research training.
With regard to the development of research collaborations to build a critical mass of researchers on youth health, the INDEPTH Network serves as an illustration of how like-minded institutions can come together to build a critical mass of researchers able to address youth health. The Network is currently leading discussions on the development of multi-site, multi-country longitudinal research on adolescent transition into adulthood in SSA, with emphasis on young people’s sexual and reproductive health that will be nested on participating health and demographic surveillance sites. This collaborative research undertaking is also expected to provide a platform for researchers to engage with global experts on young people’s health in the region. Some funding organizations are also making important investments in research in adolescent health globally. While few of these research grants are received and led by African researchers based in Africa, they present potential for building local capacity to conduct research on youth health. The creation of a regional association with special focus on young people’s health may be another avenue to bring together researchers, policy makers and program staff working on youth health and development in the region. Creation of such an organization would foster greater attention on young people’s health in the region and provide an opportunity to advocate for services, policies, and research on youth health. One possible approach to developing such an organization would be to initially seek charter membership in organizations such as the International Association for Adolescent Health, or the Society for Adolescent Health and Medicine.
Although a substantial pool of literature on youth health issues published by African scholars may exist in local African and international journals, this literature may be largely unavailable to other researchers, particularly those in Africa. For example, the Journal of Child & Adolescent Mental Health, which is published in association with the South African Association for Child and Adolescent Psychiatry and Allied Professionals, requires a subscription fee. The cost of accessing articles with subscription fees is likely prohibitive for many Africa-based researchers. The creation of an open-access journal focusing on adolescent and youth health in Africa that is supported by an international team of scholars may be one approach to ensure the visibility of this work. Local African journals must also raise their international visibility by ensuring that they are indexed in major databases such as Medline and EBSCO, among others.