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

Jan-Walter De Neve, Omar Karlsson, Chelsey R. Canavan, Angela Chukwu , Seth Adu-Afarwuah, Justine Bukenya, Anne Marie Darling, Guy Harling, Mosa Moshabela, Japhet Killewo, Günther Fink, Wafaie W. Fawzi, Yemane Berhane

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review

8 Citeringar (SciVal)


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 cross‐sectional 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 socio‐economic 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. In‐school 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, mixed‐methods, and (quasi‐)experimental studies.
Sidor (från-till)70-80
Antal sidor11
TidskriftTropical Medicine & International Health
Tidigt onlinedatum2019 nov. 6
StatusPublished - 2020 jan.

Ämnesklassifikation (UKÄ)

  • Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi


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