Complementary and Integrated Nutritional Interventions in Midwifery Care for Adolescent Reproductive and Respiratory Health in Urban Communities: A Systematic Literature Review
DOI:
https://doi.org/10.70716/mohr.v4i3.645Keywords:
adolescent health, midwifery, nutrition therapy, reproductive health, respiratory tract diseasesAbstract
Urban adolescents and women of reproductive age continue to experience interconnected nutritional, reproductive, and respiratory health challenges, particularly in low- and middle-income countries. This systematic review aimed to synthesize recent evidence on complementary and integrated nutritional interventions within midwifery care to improve reproductive and respiratory health outcomes among urban adolescents. Following PRISMA 2020 guidelines, we conducted a systematic search in Scopus and supplemented it with manual reference screening for studies published between 2017 and 2025. Eligible studies included peer-reviewed English-language articles involving adolescents or women of reproductive age in urban settings. A total of 24 studies met the inclusion criteria. Four key themes emerged: anemia and nutritional deficiencies, reproductive health knowledge and access, respiratory health and environmental risks, and systemic barriers to healthcare services. The findings revealed persistent issues related to anemia, malnutrition, menstrual health, and limited reproductive health knowledge, while environmental exposures and unhealthy lifestyles contributed to poor respiratory outcomes. Socioeconomic inequality and restricted healthcare access further exacerbated these challenges. The review highlights the importance of integrated, community-based nutritional interventions within midwifery services to support better health outcomes and reduce urban health disparities.
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Abdul Rahim, K., Padhani, Z. A., & Lassi, Z. S. (2025). Nutrition Intervention During Pregnancy and Lactation BT - Nutrition Across Reproductive, Maternal, Neonatal, Child, and Adolescent Health Care: Focus on Low and Middle Income Countries (Z. S. Lassi & R. A. Salam (eds.); pp. 119–135). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-95721-5_8
Aemro, A., Ali, M. S., Zegeye, A. F., Workneh, B. S., Zeleke, G. A., Mekonen, E. G., Tamir, T. T., Wassie, M., Terefe, B., & Tekeba, B. (2025). Determinants of sexually transmitted infection-related care-seeking behavior among reproductive-age women in sub-Saharan Africa: A multilevel analysis. PLoS One, 20(9), e0331781. https://doi.org/10.1371/journal.pone.0331781
Akwara, E., Pinchoff, J., Abularrage, T., White, C., & Ngo, T. D. (2023). The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: A Scoping Review. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 100(3), 525–561. https://doi.org/10.1007/s11524-023-00724-z
Alsubaie, N., Shah, Z. A., Ilyas, M., Ayaz, S., Habib, I., Binsaleh, A. Y., & Alrossies, A. S. (2026). Iron deficiency in nonpregnant women with normal hemoglobin: a cross-sectional analysis of risk factors and clinical implications. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1700235
Ara, I., Maqbool, M., & Gani, I. (2022). Reproductive Health of Women: Implications and Attributes. International Journal of Current Research in Physiology and Pharmacology, 6(3 SE-Review Articles), 8–18. https://ijcrpp.com/index.php/ijcrpp/article/view/51
Asari, A. A., Birhanu, Z., & Godesso, A. (2025). Adolescents’ health literacy perspectives and implications. BMC Public Health, 25(1), 1233. https://doi.org/10.1186/s12889-025-22341-y
Barrea, L., Verde, L., Annunziata, G., Chedraui, P., Petraglia, F., Cucalón, G., Camajani, E., Caprio, M., Gorini, S., Iorio, G. G., Di Girolamo, R., Carbone, L., Chapela, S., Frias-Toral, E., & Muscogiuri, G. (2025). Effectiveness of Medical Nutrition Therapy in the Management of Patients with Obesity and Endometriosis: From the Mediterranean Diet To the Ketogenic Diet, Through Supplementation. The Role of the Nutritionist in Clinical Management. Current Obesity Reports, 14(1), 68. https://doi.org/10.1007/s13679-025-00662-8
Bibhakar, P., & Sinha, M. (2025). Exploring the motivations and barriers affecting community health workers’ performance in the Noida-Greater Noida Region. Discover Public Health, 22(1), 541. https://doi.org/10.1186/s12982-025-00931-w
Busso, D., Echeverría, G., Passi-Solar, A., Morales, F., Farías, M., & Margozzini, P. (2021). Folate status in women of childbearing age in the Urban Metropolitan Region of Chile: results from the National Health Survey 2016-2017. Public Health Nutrition, 24(3), 385–392. https://doi.org/10.1017/S1368980020002608
Buszkiewicz, J. H., Tseng, A. S., Dai, J., Ismach, A., Beese, S., Collier, S. M., Spiker, M. L., & Otten, J. J. (2025). Association between early-pandemic food assistance use and subsequent food security trajectories among households in Washington State during the first three years of the COVID-19 pandemic. PLoS One, 20(5), e0321585. https://doi.org/10.1371/journal.pone.0321585
Chowdhury, R., Taneja, S., Dhabhai, N., Mazumder, S., Upadhyay, R. P., Sharma, S., Tupaki-Sreepurna, A., Dewan, R., Mittal, P., Chellani, H., Bahl, R., Bhan, M. K., & Bhandari, N. (2020). Burden of preconception morbidity in women of reproductive age from an urban setting in North India. PLoS One, 15(6), e0234768. https://doi.org/10.1371/journal.pone.0234768
Cliffer, I. R., Yelverton, C., Dong, J., Dwumah-Agyen, M., Ferrero, E., Partap, U., Shah, I., & Fawzi, W. (2025). Family planning and nutrition: systematic review of the effects of family planning on nutritional status of adolescent girls and women of reproductive age. BMJ Global Health, 10(Suppl 1), e015734. https://doi.org/10.1136/bmjgh-2024-015734
Dagnaw, M., Belay, D. G., Degu, T., Angaw, D. A., & Tsheten, T. (2025). Prevalence of Anemia Among Adolescent Girls in Sub-Saharan Africa: Systematic Review and Meta-Analysis. Public Health Reviews, 46, 1608303. https://doi.org/10.3389/phrs.2025.1608303
Das, P., Saha, S., Das, T., Das, P., & Roy, T. B. (2025). Spatial association of biosocial and economic factors with reproductive women's obesity in urban India. PLoS One, 20(3), e0319580. https://doi.org/10.1371/journal.pone.0319580
Dondi, A., Carbone, C., Manieri, E., Zama, D., Del Bono, C., Betti, L., Biagi, C., & Lanari, M. (2023). Outdoor Air Pollution and Childhood Respiratory Disease: The Role of Oxidative Stress. In International Journal of Molecular Sciences (Vol. 24, Issue 5, p. 4345). https://doi.org/10.3390/ijms24054345
Endale, Fitsum, Woldeyohannes, Demelash, Belayneh, Fanuel, Tamene, Aiggan, Habte, Aklilu, Gizachew, Addisalem, Sulamo, Dawit, Yirga Demessie, Yohannes, Yohannes, Janet, Mekonen, Tadesse, & Akiso, Denebo. (2022). Menstrual abnormality, maternal illiteracy, and household factors as main predictors of anemia among adolescent girls in Ethiopia: Systematic review and meta-analysis. Women’s Health, 18, 17455057221129398. https://doi.org/10.1177/17455057221129398
Fledderjohann, J., Patterson, S., & Owino, M. (2023). Food Insecurity: A Barrier to Reproductive Justice Globally. International Journal of Sexual Health, 35(2), 296–311. https://doi.org/10.1080/19317611.2023.2201841
Gashi, V., Ahmetaj, Y., Ahmetaj, L., Selmonaj Rama, M., & Shahini, M. (2025). Current lifestyle and risk for asthma: Sedentary lifestyle, obesity, and ETS. Allergologia Et Immunopathologia, 53(4), 169–177. https://doi.org/10.15586/aei.v53i4.1364
Glatzel, K., Ameye, H., Hülsen, V., & Qaim, M. (2024). Changing food environments in Africa’s urban and peri-urban areas: Implications for diets, nutrition, and policy (Issue 235). University of Bonn, Center for Development Research (ZEF). https://hdl.handle.net/10419/304435
Govers, C., Calder, P. C., Savelkoul, H. F. J., Albers, R., & van Neerven, R. J. J. (2022). Ingestion, Immunity, and Infection: Nutrition and Viral Respiratory Tract Infections. Frontiers in Immunology, Volume 13, 2022. https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.841532
Habiburrahman, M., & Putra, A. B. (2024). Evaluating primary care programs: a problem-solving cycle with a literature review on program evaluation for cervical cancer screening at a community health center, Jakarta, Indonesia. Family Medicine & Primary Care Review, 26(1), 26–38. https://doi.org/10.5114/fmpcr.2024.134700
Hargreaves, D., Mates, E., Menon, P., Alderman, H., Devakumar, D., Fawzi, W., Greenfield, G., Hammoudeh, W., He, S., Lahiri, A., Liu, Z., Nguyen, P. H., Sethi, V., Wang, H., Neufeld, L. M., & Patton, G. C. (2022). Strategies and interventions for healthy adolescent growth, nutrition, and development. The Lancet, 399(10320), 198–210. https://doi.org/10.1016/S0140-6736(21)01593-2
Hasan, M. M., Soares Magalhaes, R. J., Garnett, S. P., Fatima, Y., Tariqujjaman, M., Pervin, S., Ahmed, S., & Mamun, A. A. (2022). Anemia in women of reproductive age in low- and middle-income countries: progress towards the 2025 global nutrition target. Bulletin of the World Health Organization, 100(3), 196–204. https://doi.org/10.2471/BLT.20.280180
Hasan, M., Tasfina, S., Haque, S. M. R., Saif-Ur-Rahman, K. M., Khalequzzaman, M., Bari, W., & Islam, S. S. (2019). Association of biomass fuel smoke with respiratory symptoms among children under 5 years of age in urban areas: results from Bangladesh Urban Health Survey, 2013. Environmental Health and Preventive Medicine, 24(1), 65. https://doi.org/10.1186/s12199-019-0827-3
Jones, N., Pincock, K., Baird, S., Yadete, W., & Hamory Hicks, J. (2020). Intersecting inequalities, gender and adolescent health in Ethiopia. International Journal for Equity in Health, 19(1), 97. https://doi.org/10.1186/s12939-020-01214-3
Khizar, M., Ruel-Bergeron, J., Zavala, E., Chang, K., Kang, Y., de Pee, S., Black, R. E., & Christian, P. (2024). Delivery platforms for reaching adolescents with nutrition interventions in low- and middle-income countries. Annals of the New York Academy of Sciences, 1538(1), 71–84. https://doi.org/https://doi.org/10.1111/nyas.15196
Mare, K. U., Aychiluhm, S. B., Sabo, K. G., Tadesse, A. W., Kase, B. F., Ebrahim, O. A., Tebeje, T. M., Mulaw, G. F., & Seifu, B. L. (2023). Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modeling with ordered logistic regression analysis. PLoS One, 18(11), e0294992. https://doi.org/10.1371/journal.pone.0294992
Menezes, R., Lelijveld, N., Wrottesley, S. V, Brennan, E., Mates, E., & James, P. T. (2022). Integrating Women and Girls’ Nutrition Services into Health Systems in Low- and Middle-Income Countries: A Systematic Review. In Nutrients (Vol. 14, Issue 21, p. 4488). https://doi.org/10.3390/nu14214488
Morales, F., Montserrat-de la Paz, S., Leon, M. J., & Rivero-Pino, F. (2024). Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children’s Health Status: A Literature Review. In Nutrients (Vol. 16, Issue 1, p. 1). https://doi.org/10.3390/nu16010001
Naz, L., Ali, A., Yasmin, S., & Trueha, K. (2025). Geospatial inequalities in women’s malnutrition in Pakistan. BMC Women’s Health, 25(1), 225. https://doi.org/10.1186/s12905-025-03752-w
Phongluxa, K., Langeslag, G., Jat, T. R., Kounnavong, S., Khan, M. A., & Essink, D. R. (2020). Factors influencing sexual and reproductive health among adolescents in Lao PDR. Global Health Action, 13(sup2), 1791426. https://doi.org/10.1080/16549716.2020.1791426
Prithishkumar, I. J., Sappani, M., Ranjan, V., Garg, C., Mani, T., Babu, M., Joy, M., Rao, B., & Edwin Sam Asirvatham, J. L. (2024). Double burden of malnutrition among women of reproductive age: Trends and determinants over the last 15 years in India. PLoS One, 19(6), e0304776. https://doi.org/10.1371/journal.pone.0304776
Regasa, R. T., & Haidar, J. A. (2019). Anemia and its determinant of in-school adolescent girls from rural Ethiopia: a school-based cross-sectional study. BMC Women’s Health, 19(98). https://doi.org/10.1186/s12905-019-0791-5
Rodgers, M., South, E., Harden, M., Whitehead, M., & Sowden, A. (2025). Contextual factors in systematic reviews: understanding public health interventions in low socioeconomic status and disadvantaged populations. Archives of Public Health, 83(1), 153. https://doi.org/10.1186/s13690-025-01644-x
Sabet, F., Prost, A., Rahmanian, S., Al Qudah, H., Cardoso, M. N., Carlin, J. B., Sawyer, S. M., & Patton, G. C. (2023). The forgotten girls: the state of evidence for health interventions for pregnant adolescents and their newborns in low-income and middle-income countries. The Lancet, 402(10412), 1580–1596. https://doi.org/10.1016/S0140-6736(23)01682-3
Santisouk, P., Hansana, V., & Thanh Huong, N. (2020). Pregnancy health literacy among teenagers in Kaysone district, Savannakhet Province, Lao PDR. Global Health Action, 13(sup2), 1791412. https://doi.org/10.1080/16549716.2020.1791412
Sari, P., Judistiani, R. T. D., Herawati, D. M. D., Dhamayanti, M., & Hilmanto, D. (2022). Iron Deficiency Anemia and Associated Factors Among Adolescent Girls and Women in a Rural Area of Jatinangor, Indonesia. International Journal of Women’s Health, 14(null), 1137–1147. https://doi.org/10.2147/IJWH.S376023
Sarwer, M. N., Reza, M. R. U., Mohammad Ahamed, F., Rabby, M. F., & Begum, L. (2025). Knowledge on iron-rich food intake and responses toward nutritional health among urban poor women of reproductive age. BMC Women’s Health, 25(1), 604. https://doi.org/10.1186/s12905-025-04008-3
Sharif, N., Das, B., & Alam, A. (2023). Prevalence of anemia among reproductive women in different social group in India: Cross-sectional study using nationally representative data. PLoS One, 18(2), e0281015. https://doi.org/10.1371/journal.pone.0281015
Shi, X. (2022). Environmental health perspectives for low- and middle-income countries. Global Health Journal, 6(1), 35–37. https://doi.org/https://doi.org/10.1016/j.glohj.2022.01.003
Spence, E. H., Niles, M. T., Bertmann, F., & Belarmino, E. H. (2024). Experiences participating in federal nutrition assistance programs during the early months of the COVID-19 pandemic: an investigation in Vermont. Nutrition Journal, 23(1), 74. https://doi.org/10.1186/s12937-024-00963-z
Suarez, C., & Adibi, S. (2025). Integrating Traditional Nutritional Wisdom into Digital Nutrition Platforms: Toward Culturally Adaptive and Inclusive Health Technologies. In Nutrients (Vol. 17, Issue 12, p. 1978). https://doi.org/10.3390/nu17121978
Sunuwar, D. R., Singh, D. R., Chaudhary, N. K., Pradhan, P. M. S., Rai, P., & Tiwari, K. (2020). Prevalence and factors associated with anemia among women of reproductive age in seven South and Southeast Asian countries: Evidence from nationally representative surveys. PLoS One, 15(8), e0236449. https://doi.org/10.1371/journal.pone.0236449
Talukder, A., Kelly, M., Sayeed, M. A., Gray, D., & Sarma, H. (2026). Defining double burden of malnutrition across individual, household, and population levels: A narrative review. Nutrition & Dietetics, 83(1), 8–22. https://doi.org/https://doi.org/10.1111/1747-0080.70037
Tharumakunarajah, R., Lee, A., Hawcutt, D. B., Harman, N. L., & Sinha, I. P. (2024). The Impact of Malnutrition on the Developing Lung and Long-Term Lung Health: A Narrative Review of Global Literature. Pulmonary Therapy, 10(2), 155–170. https://doi.org/10.1007/s41030-024-00257-z
Vasava, D., Patel, F., Tyagi, A., Gavaniya, G., Dadhaniya, D., & Thaker, R. (2022). Menstrual problems of adolescent girls attending urban tertiary care hospital: One-year study. Indian Journal of Obstetrics and Gynecology Research, 9(1), 1–5. https://doi.org/10.18231/j.ijogr.2022.001
Vongsavanh, V., Lan, V. T. H., & Sychareun, V. (2020). Sexual and reproductive health communication between parents and high school adolescents in Vientiane Prefecture, Lao PDR. Global Health Action, 13(sup2), 1785145. https://doi.org/10.1080/16549716.2020.1785145
Wang, D., Nguyen, C. H., Asghari-Kamrani, A., Partap, U., Shah, I., & Fawzi, W. W. (2025). Nutrition and reproductive potential of women in low- and middle-income countries: a systematic review and meta-analysis. BMJ Global Health, 10(Suppl 1), e015713. https://doi.org/10.1136/bmjgh-2024-015713
Wantini, N. A., & Hidayati, T. (2025). Strengthening the role of midwives in adolescent reproductive health education. BIDANA: Jurnal Ilmu Dan Praktik Kebidanan, 1(1), 8–14. https://doi.org/10.65307/bidana.v1i1.35
Wrottesley, S. V, Mates, E., Brennan, E., Bijalwan, V., Menezes, R., Ray, S., Ali, Z., Yarparvar, A., Sharma, D., & Lelijveld, N. (2023). Nutritional status of school-age children and adolescents in low- and middle-income countries across seven global regions: a synthesis of scoping reviews. Public Health Nutrition, 26(1), 63–95. https://doi.org/DOI: 10.1017/S1368980022000350
Wu, B., Luo, S., Xu, C., Yang, T., & Chen, Y. (2022). Influence factors for upper respiratory tract infection in Chinese rural children: A cross-sectional study. Frontiers in Pediatrics, 10, 954363. https://doi.org/10.3389/fped.2022.954363
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