Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi.
Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi.
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DOI：
10.1371/journal.pone.0196041
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Crampin AC
中科院分区：
文献类型：
--
作者：
Glynn JR;Sunny BS;DeStavola B;Dube A;Chihana M;Price AJ;Crampin AC
辍学与早孕和早婚有关，但对学习成绩的影响知之甚少。我们的目的是评估学校表现是否会影响初次性行为、怀孕和结婚的年龄，以及从什么年龄开始辍学和表现与这些后来的生活事件有关。对马拉维北部人口监测站2007-2016年的数据进行了分析，这些数据每年更新一次学校教育状况和年级，并进行了相关的性行为调查，以评估特定年龄的学校表现（以年级年龄衡量）和状态（在校或校外）与随后的初次性行为年龄、怀孕年龄和婚姻年龄之间的关系。在控制社会经济因素的情况下，使用Cox回归的里程碑分析来估计在选定（里程碑）年龄上学的初次性行为、怀孕和婚姻的风险比。在10-18岁的16000名儿童中，至少有一个结果的信息是可用的。到2011年，在年龄≥15岁的人群中可获得性处子行为。对于女孩来说，失学与更早的性行为、怀孕和结婚密切相关。例如，使用14岁时的教育状况，与小学女生相比，那些辍学的女生随后的初次性行为、怀孕和结婚的调整风险比分别为5.39 （95% CI 3.27-8.86）、2.39 （95% CI 1.82-3.12）和2.76（2.08-3.67）。对于男孩来说，与初次性行为的同等相关性较弱，为1.92(0.81-4.55)，但与婚姻的同等相关性很强，为3.74(2.28-6.11)，尽管男孩结婚较晚。对于女孩或男孩来说，年龄超过年级与初次性行为无关。对于女孩来说，从10岁开始就超龄与早孕和早婚相关(例如，与10岁时的正常年龄相比，超龄≥3岁的女孩怀孕的调整风险比为2.84（1.32-6.17)，结婚的调整风险比为3.19(1.47-6.94)）。对于男孩来说，年龄超过年级与12岁起早婚相关，年龄越大相关性越强（例如，年龄超过3岁的男孩与14岁步入婚姻道路的男孩相比，调整后的风险比为2.41(1.56-3.70)）。在14岁时年龄超过3岁的女孩中，39%在18岁之前怀孕，而在正常情况下怀孕的女孩中，这一比例为18%。主要的限制是使用报告的初次性行为年龄、怀孕年龄和结婚年龄。即使在对社会经济因素进行调整后，10岁儿童的学业进展情况也能预测青少年怀孕和结婚。早期教育干预可以减少少女怀孕和结婚，并改善学习。
School dropout has been linked to early pregnancy and marriage but less is known about the effect of school performance. We aimed to assess whether school performance influenced age at sexual debut, pregnancy and marriage, and from what age school drop-out and performance were associated with these later life events. Data from 2007–2016 from a demographic surveillance site in northern Malawi with annual updating of schooling status and grades, and linked sexual behaviour surveys, were analysed to assess the associations of age-specific school performance (measured as age-for-grade) and status (in or out of school) on subsequent age at sexual debut, pregnancy and marriage. Landmark analysis with Cox regression was used to estimate hazard ratios of sexual debut, pregnancy and marriage by schooling at selected (landmark) ages, controlling for socio-economic factors. Information on at least one outcome was available for >16,000 children seen at ages 10–18. Sexual debut was available on a subset aged ≥15 by 2011. For girls, being out of school was strongly associated with earlier sexual debut, pregnancy and marriage. For example, using schooling status at age 14, compared to girls in primary, those who had dropped out had adjusted hazard ratios of subsequent sexual debut, pregnancy and marriage of 5.39 (95% CI 3.27–8.86), 2.39 (1.82–3.12), and 2.76 (2.08–3.67) respectively. For boys, the equivalent association with sexual debut was weak, 1.92 (0.81–4.55), but that with marriage was strong, 3.74 (2.28–6.11), although boys married later. Being overage-for-grade was not associated with sexual debut for girls or boys. For girls, being overage-for-grade from age 10 was associated with earlier pregnancy and marriage (e.g. adjusted hazard ratio 2.84 (1.32–6.17) for pregnancy and 3.19 (1.47–6.94) for marriage, for those ≥3 years overage compared to those on track at age 10). For boys, overage-for-grade was associated with earlier marriage from age 12, with stronger associations at older ages (e.g. adjusted hazard ratio 2.41 (1.56–3.70) for those ≥3 years overage compared to those on track at age 14). For girls ≥3 years overage at age 14, 39% were pregnant before they were 18, compared to 18% of those who were on track. The main limitation was the use of reported ages of sexual debut, pregnancy and marriage. School progression at ages as young as 10 can predict teenage pregnancy and marriage, even after adjusting for socio-economic factors. Early education interventions may reduce teenage pregnancy and marriage as well as improving learning.
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