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

Jan Walter De Neve, Omar Karlsson, Chelsey R. Canavan, Angela Chukwu, Seth Adu-Afarwuah, Justine Bukenya, Anne Marie Darling, Guy Harling, Mosa Moshabela, Japhet Killewo, Günther Fink, Wafaie W. Fawzi, Yemane Berhane

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)70-80
Number of pages11
JournalTropical Medicine and International Health
Volume25
Issue number1
DOIs
Publication statusPublished - 1 Jan 2020

Keywords

  • adolescent health
  • child development
  • education
  • school enrolment
  • sub-Saharan Africa

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