Format

Send to

Choose Destination
Trop Med Int Health. 2020 Jan;25(1):70-80. doi: 10.1111/tmi.13328. Epub 2019 Nov 26.

Are out-of-school adolescents at higher risk of adverse health outcomes? Evidence from 9 diverse settings in sub-Saharan Africa.

Author information

1
Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
2
Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
3
Centre for Economic Demography, Lund University, Lund, Sweden.
4
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
5
University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria.
6
Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
7
Department of Community Health, Makerere University School of Public Health, Kampala, Uganda.
8
Institute for Global Health, University College London, London, UK.
9
Africa Health Research Institute, Kwa-Zulu Natal, South Africa.
10
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
11
Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
12
Swiss Tropical and Public Health Institute, Basel, Switzerland.
13
University of Basel, Basel, Switzerland.
14
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
15
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
16
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.

Abstract

in English, French

OBJECTIVES:

We analysed mutually comparable surveys on adolescent attitudes and behaviours from nine sites in seven sub-Saharan African countries, to determine the relationship between school enrolment and adolescent health outcomes.

METHODS:

Data from the Africa Research, Implementation Science, and Education Network cross-sectional adolescent health surveys were used to examine the associations of current school enrolment, self-reported general health and four major adolescent health domains: (i) sexual and reproductive health; (ii) nutrition and non-communicable diseases; (iii) mental health, violence and injury; and (iv) healthcare utilisation. We used multivariable Poisson regression models to calculate relative risk ratios with 95% confidence intervals (CI), controlling for demographic and socio-economic characteristics. We assessed heterogeneity by gender and study site.

RESULTS:

Across 7829 adolescents aged 10-19, 70.5% were in school at the time of interview. In-school adolescents were 14.3% more likely (95% CI: 6-22) to report that their life is going well; 51.2% less likely (95% CI: 45-67) to report ever having had sexual intercourse; 32.6% more likely (95% CI: 9-61) to report unmet need for health care; and 30.1% less likely (95% CI: 15-43) to report having visited a traditional healer. School enrolment was not significantly associated with malnutrition, low mood, violence or injury. Substantial heterogeneity was identified between genders for sexual and reproductive health, and in-school adolescents were particularly less likely to report adverse health outcomes in settings with high average school enrolment.

CONCLUSIONS:

School enrolment is strongly associated with sexual and reproductive health and healthcare utilisation outcomes across nine sites in sub-Saharan Africa. Keeping adolescents in school may improve key health outcomes, something that can be explored through future longitudinal, mixed-methods, and (quasi-)experimental studies.

KEYWORDS:

Afrique subsaharienne; adolescent health; child development; education; santé des adolescents; school enrolment; scolarisation; sub-Saharan Africa; éducation

PMID:
31692194
DOI:
10.1111/tmi.13328

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center