经济支持、全面性教育及社区对话对赞比亚农村地区少女早孕及九年级考试入学率的影响：一项整群随机试验

Effectiveness of economic support, comprehensive sexuality education and community dialogue on early childbearing and sitting for grade nine exams among adolescent girls in rural Zambia: a cluster randomised trial.

作者信息

Sandøy Ingvild Fossgard, Mudenda Mweetwa, Hegdahl Hanne Keyser, Zulu Joseph Mumba, Grønvik Taran, Munsaka Ecloss, Jacobs Choolwe, Svanemyr Joar, Tungodden Bertil, Blystad Astrid, Olowski Linda Kampata, Makasa Mpundu Chikoya, Moland Karen Marie, Mæstad Ottar, Mori Amani Thomas, Fylkesnes Knut Martin, Musonda Patrick

机构信息

Centre for Intervention Science in Maternal and Child Health (CISMAC), Norway.

Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Postbox 7804, N-5020, Bergen, Norway.

出版信息

EClinicalMedicine. 2024 Nov 15;78:102934. doi: 10.1016/j.eclinm.2024.102934. eCollection 2024 Dec.

DOI:10.1016/j.eclinm.2024.102934

PMID:39624460

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11609475/

Abstract

BACKGROUND

Adolescent pregnancies pose a risk to young mothers and their babies. In Zambia, one third of 18-year-old girls have given birth. Poverty, low secondary school enrolment, misinformation, and community norms contribute to early childbearing. We assessed the effectiveness of economic support alone and combined with comprehensive sexuality education (CSE) and community dialogue on childbearing and sitting for grade nine exams among girls.

METHODS

This cluster randomised trial had one control and two intervention arms. In 2016, 157 rural schools (units of randomisation) were included, and girls in grade seven were eligible. After recruitment, schools were stratified by district and randomised (ratio 31:63:63). In one arm, girls and their guardians were offered economic support. Another arm combined CSE and community dialogues with the economic support. The interventions were implemented for 27 months, and the participants were followed for another 2 years. The primary outcomes were and . The trial is registered with ISRCTN (ISRCTN12727868).

FINDINGS

Between 3rd March and 15th July 2016, 4922 girls were recruited, with 999 randomised to the control, 2004 to the economic and 1919 to the combined arm. The combined support gave a moderate reduction in the incidence of birth within eight months of the intervention period's end (risk difference (RD) -0.042 (95% CI -0.084, -0.0003), possibly a minimal reduction in birth before the 18th birthday (RD -0.010 (95% CI -0.053, 0.032), and a substantial increase in sitting for grade nine exams (RD 0.17 (95% CI 0.11, 0.22). The economic support alone tended to give slightly smaller effects.

INTERPRETATION

Our findings suggest that a combination of economic support, CSE and community dialogue may give small reductions in adolescent childbearing. The same interventions can increase completion of basic education.

FUNDING

The Research Council of Norway, the University of Bergen and the Swedish International Development Cooperation Agency (SIDA).

摘要

背景

青少年怀孕对年轻母亲及其婴儿构成风险。在赞比亚，三分之一的18岁女孩生育过。贫困、中学入学率低、错误信息以及社区规范导致了早育现象。我们评估了单纯经济支持以及经济支持与全面性教育（CSE）和社区关于生育及九年级考试的对话相结合的方式对女孩的有效性。

方法

这项整群随机试验有一个对照组和两个干预组。2016年，纳入了157所农村学校（随机分组单位），七年级女孩符合条件。招募后，学校按地区分层并随机分组（比例为31:63:63）。在一个组中，为女孩及其监护人提供经济支持。另一个组将全面性教育和社区对话与经济支持相结合。干预措施实施27个月，对参与者再随访2年。主要结局是和。该试验已在国际标准随机对照试验编号注册库（ISRCTN12727868）注册。

研究结果

在2016年3月3日至7月15日期间，招募了4922名女孩，其中999名随机分配到对照组，2004名分配到经济支持组，1919名分配到综合组。综合支持在干预期结束后的八个月内使生育发生率适度降低（风险差（RD）-0.042（95%置信区间-0.084，-0.0003），可能在18岁生日前生育略有减少（RD -0.010（95%置信区间-0.053，0.032），并且九年级考试参考率大幅提高（RD 0.17（95%置信区间0.11，0.22）。单纯经济支持的效果往往略小。