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

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 crosssectional 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 socioeconomic 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. Inschool 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, mixedmethods, and (quasi-)experimental studies.

Adolescent health in sub‐Saharan Africa: results from the ARISE Network

“…Some of the most interesting findings from this set of surveys, among many, relate to the comparison that was made between in‐school and out‐of‐school adolescents7. As well as showing, as expected, that in‐school adolescents reported that their life was ‘going well’, the study showed that out‐of‐school adolescents were at highest risk of reporting poor general health in settings with high average levels of school enrolment.…”

Challenges Faced by Female Out-of-School Adolescents in Accessing and Utilizing Sexual and Reproductive Health Service: A Qualitative Exploratory Study in Southwest, Ethiopia

“…Decreasing school dropout rate improves the sexual and reproductive health outcomes of the adolescents. 12 The study done in Uganda also revealed that out-of-school adolescents were less likely to practice safe sex and to use modern family planning methods than in-school adolescents. 13,14 Unlike the current study, previous studies conducted in different part of the country have mainly focused on inschool-adolescents who relatively have a better access to SRH service and information when compared to out-ofschool adolescents.…”

“Because at school, you can become somebody” – The perceived health and economic returns on secondary schooling in rural Burkina Faso

“…Secondary schooling has been linked with sustained benefits for health, economic and social outcomes [1], including reductions in mortality [2], and reductions in the risk of cardiovascular [3, 4] and sexually transmitted diseases [5, 6]. Investment in secondary schooling may not only yield large dividends for individuals themselves–but also for other household members [7, 8].…”