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

De Neve, J-W; Karlsson, O; Canavan, CR; Chukwu, A; Adu-Afarwuah, S; Bukenya, J; Marie Darling, A; ... Berhane, Y; + view all (2020) Are out-of-school adolescents at higher risk of adverse health outcomes? Evidence from 9 diverse settings in sub-Saharan Africa. Tropical Medicine & International Health , 25 (1) pp. 70-80. 10.1111/tmi.13328. Green open access

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Abstract

OBJECTIVES: We analyzed mutually comparable surveys on adolescent attitudes and behaviors from nine sites in seven sub-Saharan African countries, to determine the relationship between school enrollment 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 enrollment, 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 utilization. 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 7,829 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: 39-91) to report unmet need for healthcare; and 30.1% less likely (95% CI: 15-43) to report having visited a traditional healer. School enrollment 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 enrollment. CONCLUSIONS: School enrollment is strongly associated with sexual and reproductive health and healthcare utilization 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 studies.

Type: Article
Title: Are out-of-school adolescents at higher risk of adverse health outcomes? Evidence from 9 diverse settings in sub-Saharan Africa
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/tmi.13328
Publisher version: https://doi.org/10.1111/tmi.13328
Language: English
Additional information: © 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Adolescent Health, Education, School Enrollment, sub-Saharan Africa
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10085755
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