La Comprensión lectora una competencia básica

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behaviours. Their efforts have typically proceeded independently, however, and each professional community's work has not routinely informed that of the other. This lack of communication is understandable, given the differences in professional backgrounds and training, work settings and day-to-day activities. It is believed, however, that this lack of communication inevitably compromises the quality of both research and programs related to teenage sexual health and behaviours. The interdisciplinary group of public health researchers and service providers who were committed to bridging the chasm between research and programs suggested ways in which work to reduce levels of teenage pregnancy and risk-taking can proceed in a more integrated and collaborative fashion. It is believed that research on prevention should be designed and conducted to inform the development of programs and policy. The issues that emerge as these programs and policies are implemented, in turn, will raise questions that promote further research, which ultimately will inform the next generation of programs and policies. The structure of this comment models this process. We begin on the research side and give a brief overview of findings on the antecedents of adolescent sexual risk behaviours and pregnancy, and discuss their implications for program and policy development. This effort is grounded in a comprehensive literature review that was conducted for the Centre for Disease Control and Prevention (CDC, 2001).It was then move to the program side. On the basis of our own clinical observations and discussions with other providers in a variety of settings, we identify a set of critical programmatic issues that hinder success in reducing adolescents' sexual risk-taking. Finally, the specific research questions raised by these service-related issues were outlined. The answers to these questions were believed to have potentially enhanced program efficacy.

Sub Saharan Africa has experienced very high rates of unemployment and poverty among young people aged 15 to 24 (United Nations, 2011). Poverty and reproductive health are intricately related. Poverty is associated with high risk behaviours, such as rape and unsafe sex in exchange for monetary incentives (Kalembo, 2013). These behaviours put young women at risk of unintended pregnancy and sexually transmitted infections such as HIV, which in turn affect their reproductive health (USAID, 2009). Poverty and inadequate healthcare systems compound the vulnerability of young women to sickness and early death.

Young teen mothers are at high risk of experiencing serious complications during pregnancy and childbirth because their bodies often have not yet fully matured (Bernstein & Hansen, 2006). The proportion of births that take place during adolescence is about 2% in China, 18%

in Latin America and the Caribbean and more than 50% in sub-Saharan Africa (WHO, 2011).

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In sub-Saharan Africa, 3.2 million young people are living with HIV and three young women are infected for every young man (UNAIDS, 2008). Moreover 75 percent of all new cases of HIV in this region were found among young women and girls between ages 15–24 years (Global Health Council, 2007).Young people have special sexual and reproductive health needs because of their relatively higher risk of being exposed to inaccurate or incomplete information, which leads them to acquiring HIV and other sexually transmitted infections (STIs), and experiencing unintended pregnancies and maternal complications (Rani &Lule, 2004). At the 1994 International Conference on Population and Development (ICPD), the program of action signed by 179 countries called for the protection and promotion of the rights of adolescents to reproductive health education, information and care, and a reduction in sexually transmitted infections and pregnancy. The United Nation Population Fund (UNFPA) adopted Millennium Development Goals (MDGs) to complement the ICPD program of action in an effort to improve the reproductive health of young people. The MDGs are a framework for progress consisting of eight MDGs which were derived at the Millennium Summit in 2000 by leaders of 189 member states. The MDGs serve as a time-bound, achievable blueprint for reducing poverty and improving lives (UNFPA, 2010).

The ICPD program of action is aligned with the MDGs’ focus on education. Education is not only a goal in itself as stated by the millennium development goal number two (MDG2), but fundamental to eradicating poverty and hunger (MDG1). Education and health care for young people are essential to reducing child and infant mortality and HIV infection (MDG4, MDG5, and MDG6) as well as the promotion of gender equality and empowerment of women (MDG3). Young people should be provided with access to comprehensive and culturally appropriate sexual and reproductive health education in schools (UNFPA 2011). The purpose of this review therefore, was to explore and identify feasible, socially acceptable and effective ASRHE programs in sub-Saharan Africa. The review was conducted as a follow up on goals set forth at the 1994 ICPD to promote ASRH. It was aimed at measuring the progress made so far in sub- Saharan Africa in meeting the ICP goals.

Worldwide, societal shifts and behavioural patterns exacerbated by unique developmental vulnerabilities create a confluence of factors that place today's adolescents at heightened risks for poor health outcomes (Bearinger, 2007). Country-level data show that continued investment in effective prevention and treatment strategies is essential to protect adolescents' sexual and reproductive health. Whereas strategies must be tailored to the developmental

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needs of this age group and their social contexts, effective approaches are multifaceted. All adolescents need access to quality youth-friendly services provided by clinicians trained to work with this population. Sex education programmes should offer accurate, comprehensive information while building skills for negotiating sexual behaviours. Girls and boys also need equal access to youth development programmes that will make them wear the right attitude towards sexual reproductive health.

Adolescent with disability are found most vulnerable and at extremely high risk of sexual abuse, molestation and coercion with various outcomes such as: teenage pregnancy, abortion, low self-confidence, sexually transmitted infections, particularly HIV/AIDS (Taiwo, 2012). It was speculated that this risky sexual practices has significant negative effects on the development of their sexual identity, self-regulation of impulses and desires. A Cross sectional study conducted among 140 adolescents with physical disabilities in four handicapped schools in Osun State South West, Nigeria indicated a significant poor knowledge of sexuality issues such as: unprotected sex, teenage pregnancy, STIs/HIV/AIDS and contraceptive awareness. The study targeted adolescents with physical disability, The Joint National Association of Persons with Disabilities in Nigeria (JONAPWD) in 2010 put the population of people with disability at 11.2 million and segregation show that children constitute about 37.5% of this population. This translates to a little above 4 million children who are physically incapacitated and will become the adolescents requiring reproductive health services in the nearest future without sufficient preparation by the society to meet these needs.

The few studies conducted in sub- Sahara Africa particularly in Nigeria to gain understanding of the perspective of persons with disability issues of sexuality and reproductive health collected data from all categories of young people with disability. The study did not also generated sufficient argument for promoting a healthy sexual behaviour and meeting sexual needs of adolescents with disability. Societal norms, the culture of silence on discussions around sexual issues and believe that adolescents with disability are sexual, informed the existing attitudes of negligence in providing sexuality education to these adolescents.

Consequently, they are left to discover sexual related information on their own by relying on their equally uninformed peers and the media.

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