Embleton Lonnie, Braitstein Paula, Di Ruggiero Erica, Oduor Clement, Wado Yohannes Dibaba
Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, Toronto, Ontario, Canada.
Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
PLOS Glob Public Health. 2023 Feb 22;3(2):e0001508. doi: 10.1371/journal.pgph.0001508. eCollection 2023.
We examined the association between adolescents' sexual and reproductive health (SRH) service utilization in the past 12 months and structural, health facility, community, interpersonal, and individual level factors in Kenya. This cross-sectional analysis used baseline data collected in Homa Bay and Narok counties as part of the In Their Hands intervention evaluation from September to October 2018. In total, 1840 adolescent girls aged 15 to 19 years were recruited to complete a baseline survey. We used unadjusted and adjusted logistic regression to model factors associated with SRH utilization across the social-ecological framework levels. Overall, 36% of participants reported visiting a health facility for SRH services in the past 12 months. At the structural level being out-of-school (AOR: 2.12 95% CI: 1.60-2.82) and not needing to get permission to go (AOR: 1.37 95%CI: 1.04-1.82) were associated with SRH service utilization. At the interpersonal level, participants who reported being able to ask adults for help when they needed it were more likely to report using SRH services in the past 12 months (AOR: 1.98, 95% CI: 1.09-3.78). At the individual level, having knowledge about where to obtain family planning (AOR = 2.48 95% CI: 1.74-3.57) and receiving information on SRH services in the past year (AOR: 1.44 95% CI:1.15-1.80) were associated with SRH service utilization. Our findings demonstrate the need for interventions, policies, and practices to be implemented across structural, health facility, community, interpersonal, and individual levels to comprehensively support adolescent girls to access and use SRH services.
我们研究了肯尼亚青少年在过去12个月内性与生殖健康（SRH）服务利用情况与结构、卫生设施、社区、人际及个体层面因素之间的关联。这项横断面分析使用了2018年9月至10月在霍马湾县和纳罗克县收集的基线数据，作为“掌握在她们手中”干预评估的一部分。总共招募了1840名15至19岁的少女来完成一项基线调查。我们使用未调整和调整后的逻辑回归模型，对社会生态框架各层面与SRH服务利用相关的因素进行分析。总体而言，36%的参与者报告在过去12个月内曾前往卫生设施寻求SRH服务。在结构层面，失学（调整后比值比[AOR]：2.12，95%置信区间[CI]：1.60 - 2.82）以及外出无需获得许可（AOR：1.37，95%CI：1.04 - 1.82）与SRH服务利用相关。在人际层面，报告在需要时能够向成年人求助的参与者，在过去12个月内更有可能报告使用过SRH服务（AOR：1.98，95%CI：1.09 - 3.78）。在个体层面，了解获取计划生育服务的地点（AOR = 2.48，95%CI：1.74 - 3.57）以及在过去一年中收到过SRH服务信息（AOR：1.44，95%CI：1.15 - 1.80）与SRH服务利用相关。我们的研究结果表明，需要在结构、卫生设施、社区、人际及个体层面实施干预措施、政策和实践，以全面支持少女获取和利用SRH服务。
