Mutea Lilian, Maluni Justinah, Kabue Mark, Were Vincent, Ontiri Susan, Michielsen Kristien, Gichangi Peter
PhD Candidate, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Deputy Office Director, Health Population and Nutrition Office, USAID Kenya & East Africa, Nairobi, Kenya.
Research Associate, KEMRI-Wellcome Trust, Nairobi, Kenya.
Sex Reprod Health Matters. 2023 Dec;31(1):2257073. doi: 10.1080/26410397.2023.2257073. Epub 2023 Oct 4.
Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15-19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents' discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42-0.79, = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08-0.82, = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.
青少年性与生殖健康（ASRH）服务是改善青少年健康状况的关键。本研究旨在确定一项将肯尼亚医疗机构和社区活动相结合的干预措施在提高ASRH服务利用率方面的有效性。采用准实验评估设计来评估该干预措施的有效性。通过分层整群抽样方法，在基线期（2019年9月）和终期（2020年12月）针对15至19岁女孩在干预组和对照组进行了两项横断面家庭调查。我们采用差分法分析研究中干预组和对照组在基线期和终期结果的净变化，并对显著不同的变量进行精确匹配以解决不平衡问题。干预组共有1011名参与者，对照组有880名。描述性结果显示，干预组对性、怀孕和避孕误解的知晓率净增12.7%，而对照组为10.4%。在多变量回归分析中，有两个结果仍然显著：青少年因害怕父母（调整后风险比[aPR]=0.58，95%置信区间[CI]=0.42 - 0.79，P=0.001）或缺乏伴侣支持（aPR=0.25，95%CI=0.08 - 0.82，P=0.023）而在寻求ASRH服务时的不适感降低。将医疗机构和社区方法相结合的干预措施在增加ASRH信息和服务的使用方面并不有效。对此探讨了可能的原因。
