Pregnancy and marriage among teenage schoolgirls in rural western Kenya; a secondary analysis of a menstrual solution feasibility COHORT study

Authors

  • Elizabeth Nyothach Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
  • Eleanor Ambrose Health and Life Sciences, Liverpool University, Liverpool, United Kingdom
  • Anna M. van Eijk Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
  • David Obor Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
  • Linda Mason Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
  • Clifford Oduor Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
  • Garazi Zulaika Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
  • Kayla F. Laserson Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
  • Penelope A. Phillips Howard Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom http://orcid.org/0000-0003-1018-116X

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20213440

Keywords:

Pregnancy, Schoolgirls, Adolescence, Sexual and reproductive health, Child marriage, Education

Abstract

Background: Adolescent pregnancy increases the risk of adverse health outcomes, social stigma, loss of education and employment, and early marriage. Research characterising at risk girls will inform targeting of effective interventions.

Methods: Risk characteristics for adolescent pregnancy were evaluated in schoolgirls aged 14-16 years as a secondary analysis in a longitudinal study evaluating menstrual products in 30 primary schools in rural western Kenya. Characteristics of participants were collected at baseline and follow-up.  Descriptive and multivariate analysis were conducted.

Results: Of 766 girls enrolled into the study, aged 14-16 years and followed over a school year, 53 (7%) were or became pregnant, with three (6%) neonatal deaths reported. Girls with the lowest compared with the highest socio-economic status had 2.5-fold higher risk of pregnancy (13.1% vs 5.0%: adjusted risk ratio (aRR) 2.48, confidence limits 1.32-4.64). Girls reporting early menarche (<13 years) had a 2.5-fold higher risk of pregnancy (aRR 2.61, 1.38-4.92), while those happy in school had a reduced risk (aRR 0.60, 0.34-1.04). Age, presence of parents, and being harassed by boys or men were not associated with pregnancy risk. Twenty-two girls (2.9%) married by the study end.  Marriage was significantly associated with pregnancy (aRR 13.44, 5.50-32.83) and a history of sex at baseline (3.15, 1.55-6.38). All but two girls dropped out of school when pregnant with only five girls returning after delivery.

Conclusions:Pregnancy leading to school dropout and child marriage remains an urgent public health concern among teenage girls in rural Kenya. Interventions are needed to enable schoolgirls to reach their educational potential.

 

Author Biography

Penelope A. Phillips Howard, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

Professor of Public Health Epidemiology, Department of Clinical Studies

References

WHO. Adolescent pregnancy- WHO Fact Sheet, 2020. Available at: https://www.who.int/newsroomfactsheets/detail/adolescent-pregnancy. Accessed on 20 April 2021.

Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis. Reprod Health. 2018;15(1):195.

Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review. Reprod Health. 2018;15(1):15.

Wodon Q, Male C, Montenegro C, Nguyen H, Onagoruwa A. The Cost of Not Educating Girls: Educating Girls and Ending Child Marriage: A Priority For Africa. Washington, DC: World Bank; 2018.

United Nations Fund for Population Activities. Girlhood, not motherhood: Preventing adolescent pregnancy. New York, USA: United Nations Populations Fund; 2015.

Karra M, Lee M. Human capital consequences of teenage childbearing in South Africa. Washington, DC: Population Reference Bureau; 2012.

Madeni F, Horiuchi S, Iida M. Evaluation of a reproductive health awareness program for adolescence in urban Tanzania--a quasi-experimental pre-test post-test research. Reprod Health. 2011;8:21.

Ahikire J, Aramanzan M. A survey on re-entry of pregnant girls in primary and secondary schools in Uganda. Uganda: UNICEF; 2011: 1-45.

Morara AN, Chemwei B. Drop out among Pupils in Rural Primary Schools in Kenya: The Case of Nandi North District, Kenya. J Edu Pract. 2013;4(19):1-12.

Kenya National Bureau of Statistics, Ministry of Health Kenya, National AIDS Control Council, Kenya Medical Research Institute, National Council for Population and Development, ICF International. Kenya Demographic and Health Survey 2014. USA: DHS; 2015.

Wodon Q, Male C, Montenegro C, Nguyen H, Onagoruwa A. The cost of not educating girls: Educating girls and ending child marriage: A priority for Africa. Washington, DC: World Bank; 2018.

Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121(1):40-8.

WHO. Global health estimates: deaths by cause, age, sex, by country and by region, 2000–2016, 2020Available at: https://www.who.int/healthinfo/global_burden_disease/en/. Accessed on 20 April 2021.

United Nations. The Sustainable Development Goals Report 2016. New York, USA: United Nations; 2016.

Neal SE, Mouli V, Chou D. Adolescent first births in East Africa: disaggregating characteristics, trends and determinants. Reprod Health. 2015;12:13.

Ministry of Health National Council for Population and Development Kenya, Ministry of Planning and National Development Kenya, USAID, Division of Reproductive Health. Kenya Adolescent Reproductive Health And Development Policy Implementation Assessment Report. Washington, DC: Population Reference Bureau; 2013.

Omoro T, Gray SC, Otieno G. Teen pregnancy in rural western Kenya: a public health issue. Int J Adolesc Youth. 2018;23(4):399-408.

Howard PA, Nyothach E, Kuile FO, Omoto J, Wang D, Zeh C, et al. Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya. BMJ Open. 2016;6(11):13229.

Odhiambo FO, Laserson KF, Sewe M, Hamel MJ, Feikin DR, Adazu K, et al. Profile: the KEMRI/CDC Health and Demographic Surveillance System--Western Kenya. Int J Epidemiol. 2012;41(4):977-87.

Alexander K, Oduor C, Nyothach E. Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls? Water. MDPI. 2014;6:1453-66.

Cummings P. Methods for estimating adjusted risk ratios. Stata J. 2009;9:175-96.

Wado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19(1):59.

Kenya National Bureau of Statistics, ICF Macro. Kenya Demographic and Health Survey 2008-09. USA: Kenya National Bureau of Statistics (KNBS) and ICF Macro; 2010.

Wado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19(1):59.

Garenne M. Trends in age at menarche and adult height in selected African countries (1950-1980). Ann Hum Biol. 2020;47(1):25-31.

Sidze EM, Stillman M, Keogh S. From paper to practice: Sexuality education policies and their implementation in Kenya. Kenya: Gutmacher Institute; 2017.

Sarfo EA, Yendork JS, Naidoo AV. Examining the intersection between marriage, perceived maturity and child marriage: perspectives of community elders in the Northern region of Ghana. Cult Health Sex. 2021;23(7):991-1005.

Ibitoye M, Choi C, Tai H, Lee G, Sommer M. Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries. PLoS One. 201;12(6):78884.

Nash K, Malley G, Geoffroy E, Schell E, Bvumbwe A, Denno DM. "Our girls need to see a path to the future" --perspectives on sexual and reproductive health information among adolescent girls, guardians, and initiation counselors in Mulanje district, Malawi. Reprod Health. 2019;16(1):8.

Mkutu K, Mkutu TR. Public health problems associated with “boda boda” motorcycle taxis in Kenya: The sting of inequality. Aggression and Violent Behavior. 2019;47:245-52.

Stoner MCD, Rucinski KB, Edwards JK, Selin A, Hughes JP, Wang J, et al. The Relationship Between School Dropout and Pregnancy Among Adolescent Girls and Young Women in South Africa: A HPTN 068 Analysis. Health Educ Behav. 2019;46(4):559-68.

Grant MJ, Hallman KK. Pregnancy-related school dropout and prior school performance in KwaZulu-Natal, South Africa. Stud Fam Plann. 2008;39(4):369-82.

Kenya Department of Development Coordination. National Poverty Eradication Plan 1999-2015. Kenya: Government Printers; 1999.

Oruko K, Nyothach E, Gutierrez E, Mason L, Alexander K, Vulule J, et al. 'He is the one who is providing you with everything so whatever he says is what you do': A Qualitative Study on Factors Affecting Secondary Schoolgirls' Dropout in Rural Western Kenya. PLoS One. 2015;10(12):144321.

Parliament of Kenya. Hansard Report of Senate Debates; Wednesday, November 14, 2018, 2018. Available at: arliament.go.ke/sites/default/files/2018-11/Wednesday%2C%2014th%20November%2C%202018. Accessed on 20 April 2021.

African Institute for Development Policy, United Nations Fund for Population Activities. Policy Dialogue: Tackling Teen Pregnancy in Kenya. Kenya: AFIDEP; 2019.

Hindin MJ, Kalamar AM, Thompson TA, Upadhyay UD. Interventions to Prevent Unintended and Repeat Pregnancy Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature. J Adolesc Health. 2016;59(3):8-15.

Dellicour S, Desai M, Mason L, Odidi B, Aol G, Howard PA, Laserson KF, et al. Exploring risk perception and attitudes to miscarriage and congenital anomaly in rural Western Kenya. PLoS One. 2013;8(11):80551.

Zulaika G, Kwaro D, Nyothach E, Wang D, Gutierrez E, Mason L, et al. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya. BMC Public Health. 2019;19(1):1317.

Downloads

Published

2021-08-26

Issue

Section

Original Research Articles