Adolescents represent about one-fourth of the world’s population, with almost 90% living in low- and middleincome countries (LMIC), however, most research on programs to improve health and well-being during adolescence has taken place in high-income countries and with older adolescents (ages 15–19). Comparatively little attention has been paid to young adolescents (10–14 years) living in low-resource and humanitarian settings, although this is beginning to change with global efforts to build knowledge and evidence for interventions in diverse LMICs specific to the needs of younger adolescents with the recognition that this is a time of significant and rapid physical, emotional, social, and cognitive changes in their lives.
In eastern Democratic Republic of Congo (DRC), the setting for the study, rural populations of South Kivu province have experienced more than two decades of conflict, political instability, and extreme poverty. Despite its vast physical size and abundant natural resources, the DRC is one of the poorest countries in the world, ranking 176th out of 189 countries and territories in the 2018 Human Development Index. The situation in Eastern DRC remains volatile, with over 70 armed groups active in North and South Kivu provinces. In 2016 alone, the United Nations Children’s Fund (UNICEF)-coordinated Rapid Response to Movements of Populations (RRMP) program provided multi-sectoral (e.g., health, education, protection, housing) assistance to 2.3 million conflict-affected people. Child poverty is widespread and particularly concentrated in conflict affected and hard-to-reach rural areas in Eastern DRC. According to UNICEF, 80% of DRC children under 15 years old have experienced at least two major deprivations (e.g., absences of food, housing, water, and medical care) during their childhood.