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

世界银行利用横断面研究评估了维持青春期女孩和年轻妇女上学的益处，包括性健康和生殖健康以及生产力。这些建议表明，大部分收益归因于支持AGYW完成中学教育，据估计，每多上一年中学教育，童婚和青少年怀孕分别减少7.5%和6.5%。他们还指出，与没有受过教育的AGYW相比，完成中学学业的AGYW的收入增加了5倍，总生育率降低了三分之一，避孕用具的使用量增加了三分之一，儿童发育迟缓的发生率减少了约25%。然而，很少有纵向研究证实这些影响，或者检查学校干预在AGYW成年后的影响。马拉维的一项研究向女学生发放现金，证明了干预对减少艾滋病毒和单纯疱疹病毒(HSV-2)的立竿见影的效果，但在干预结束两年后，与对照组相比没有发现任何进展。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完成学业后的情况，发现AGYW的生育率没有赶上没有接受干预的AGYW的生育率，这表明生育率在干预期间并没有被“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。我们的英国资助的试验在4138名肯尼亚中学女生中进行，提供现金、月经杯或两者都提供，检查与未提供干预措施的AGYW相比，干预措施是否减少了辍学、艾滋病毒、HSV-2以及性和生殖伤害。随着这项试验的结束，我们现在的目标是跟踪所有参与者，以评估先前学校干预对AGYW成年后健康和社会公平的中期影响，并衡量先前试验干预的中期成本收益。这项研究将对AGYW进行33个月的跟踪调查，并进行两项独立的调查，并通过产前诊所(ANC)和医院记录审查获得更多数据。我们将通过挨家挨户的访谈，使用社会行为调查问卷和艾滋病毒/单纯疱疹病毒2型检测。将尽一切努力找到已移徙的女孩，以最大限度地扩大先前审判各武装的代表性。产生的健康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，以便将结果与具体情况联系起来。关注的关键结果将集中在：(1)健康--艾滋病毒/单纯疱疹病毒2型状况、生育率；孕产妇和新生儿结局；性健康和生殖健康及危险行为、亲密伴侣暴力风险；获得和使用卫生设施的能力；婴儿、儿童和产妇死亡率。还将评估新冠肺炎对这些结果的影响。(2)金融和社会公平--女孩的就业类型和实现的收入。我们将与社区接触，以了解他们对这项试验的看法，它在支持女孩健康、福祉和学校教育方面的价值，以及衡量的结果是否与她们感知的需求一致。我们将继续与卫生部合作伙伴合作，扩大到其他以社区为基础的合作伙伴，他们将支持研究设计、使用的方法、研究结果的解释以及将研究结果纳入政策和方案指南。这项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辅导、开发新技能的讲习班以及利用为研究生研究和合著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.