Measuring the medium-term impact of school-based interventions as girls transition into adulthood

世界银行利用跨部门研究来评价继续上学对少女和青年妇女的性健康和生殖健康以及生产力的好处。这表明，大部分成果是由于支持青年女青年协会完成中学教育，中学教育每增加一年，估计童婚和少女怀孕分别减少7.5%和6.5%。他们还指出，与没有受过教育的青年男女相比，完成中学教育的青年男女收入高出5倍，总生育率降低三分之一，避孕药具使用率提高三分之一，儿童发育迟缓率降低约25%。然而，很少有纵向研究证实了这些影响，或检查学校干预措施的影响，作为AGYW达到成年。在马拉维进行的一项向女学生发放现金的研究表明，干预措施对减少艾滋病毒和单纯疱疹病毒（HSV-2）产生了立竿见影的效果，但在干预措施结束两年后，与对照组相比，没有发现任何收益。肯尼亚一项在小学提供现金和艾滋病毒教育的研究跟踪了AGYW直到完成学业，发现生育率没有赶上AGYW没有接受干预措施的比率，这表明生育率在干预期间没有被“压制”，然后被释放。这些相互矛盾的发现需要与其他研究进行验证。我们在4138名肯尼亚中学女生中进行了英国资助的试验，提供现金，月经杯，或两者兼而有之，检查干预措施是否减少辍学，艾滋病毒，HSV-2，以及与AGYW相比的性和生殖危害没有提供干预措施。随着这项试验的结束，我们现在的目标是随访所有参与者，以评估先前的学校干预措施对AGYW的健康和社会公平的中期影响，因为他们过渡到成年，并衡量从先前的试验干预措施的中期成本效益。该研究将对AGYW进行为期33个月的随访，并进行两次单独的调查，通过产前诊所（ANC）和医院记录审查获得额外的数据。我们将使用社会行为调查问卷，并通过挨家挨户的访谈进行艾滋病毒/HSV-2检测。将尽一切努力寻找迁移的女孩，以最大限度地提高先前试验组的代表性。所产生的保健和就业成果将用于审查投资回报和其他成本效益。我们还将进行定性研究，以提供数据来分析结果。关注的关键成果将侧重于：（1）健康-艾滋病毒/HSV-2感染状况、生育率;孕产妇和新生儿的结果;性健康和生殖健康及风险行为、亲密伴侣暴力风险;获得和使用卫生设施的能力;婴儿、儿童和孕产妇死亡率。COVID-19对这些结果的影响也将被评估。(2)财政和社会公平-女童就业类型和收入。我们将与社区接触，以获得他们对试验的看法，其在支持女孩健康，福祉和教育方面的价值，以及衡量的结果是否符合他们的感知需求。我们将继续与卫生部合作伙伴合作，扩大到其他社区合作伙伴，他们将支持研究设计、使用的方法、对结果的解释，并将结果纳入政策和方案指南。该研究将通过研究和社交媒体平台广泛传播。这项研究将通过一对一的指导、开发新技能的讲习班以及利用研究生研究和共同撰写的出版物产生的数据来支持能力建设。

The World Bank has used cross-sectional studies to evaluate the benefits of maintaining schooling on adolescent girls and young women's (AGYW) sexual and reproductive health and productivity. These suggest that most gains are due to supporting AGYW to complete secondary education, with each additional year of secondary education estimated to reduce child marriage and teen pregnancy by 7.5%, and 6.5%, respectively. They also noted that AGYW completing secondary school earn up to 5-fold more, have a one-third reduction in total fertility, increased contraception use by a third, and a ~25% reduction in child stunting compared with AGYW with no education. However, few longitudinal studies have validated these effects, or examined effects of school interventions as AGYW reach adulthood. One study in Malawi, which gave cash to schoolgirls demonstrated an immediate effect of the intervention on reducing HIV and the herpes simplex virus (HSV-2), but detected no gains compared with controls 2 years after the intervention ended. A Kenyan study providing cash and HIV education in primary school followed AGYW to beyond school completion and found fertility rates did not catch up to rates in AGYW not receiving interventions, suggesting fertility was not 'bottled-up' during intervention and then released. These conflicting findings require validation with other studies. Our UK funded trial among 4138 Kenyan secondary schoolgirls, providing cash, a menstrual cup, or both, examined if interventions reduce school dropout, HIV, HSV-2, and sexual and reproductive harms compared with AGYW not provided interventions. As this trial finishes, we now aim to follow-up all participants to evaluate the medium-term impact of prior school interventions on AGYW's health and social equity as they transition to adulthood, and to measure the medium-term cost benefits from the prior trial interventions. The study will follow-up AGYW over 33 months, with two separate surveys with additional data captured through antenatal clinic (ANC) and hospital record reviews. We will use a socio-behavioural survey questionnaire, and HIV/HSV-2 testing, through house-to-house interviews. Every effort will be made to locate girls who have migrated to maximise representativeness across prior trial arms. Health and employment outcomes generated will be used to examine the return on investment and other cost-benefits. We will also conduct qualitative research to provide data to contextualise outcomes. Critical outcomes of interest will focus on: (1) Health - HIV/HSV-2 status, fertility; maternal and neonatal outcomes; sexual and reproductive health and risk behaviours, risk of intimate-partner violence; ability to access and use health facilities; infant, child and maternal mortality. Effects of COVID-19 on these outcomes will also be assessed. (2) Financial and social equity - girls type of employment, and income achieved. We will engage with communities for feedback on their perceptions of the trial, its' value in supporting girls' health, wellbeing, and schooling, and whether outcomes measured align with their perceived needs. We will continue to work with our Ministry of Health partners, expanding to other community-based partners who will support the study design, methods used, interpretation of findings, and inputting of findings into policy and programme guidelines. The research will be disseminated widely through research and social media platforms. The study will support capacity building, through one to one mentoring, workshops to develop new skills, and by utilising data generated for post-graduate studies and co-authored publications.