Early Menarche and the Reproductive Health of Ghanaian Girls and Young Women

项目摘要/摘要 15至24岁的青春期女孩和年轻女性背负着不成比例的负面负担 全球性健康和生殖健康(SRH)成果。在撒哈拉以南非洲地区尤其如此 (SSA)，其中15-19岁女孩的主要死亡原因是与怀孕和 分娩。在南非所有新的艾滋病毒感染中，每年约有三分之一发生在15-24岁的年轻女性中。 来自不同高收入国家(HIC)的研究表明，容易受到SRH负面结果的影响， 包括早孕和分娩以及性传播感染(STI)，女孩的发病率可能会上升 年轻女性在很小的时候就达到了月经初潮(这是性成熟较早的征兆)。确实有 有迹象表明，这也适用于SSA的女孩，但几乎没有可用的证据是不确定的。为数不多的 来自SSA的月经初潮数据也表明了整个SSA月经初潮年龄下降的长期趋势。有一个 迫切需要更好地了解月经初潮早期对SSA患者SRH的影响，以及通过 考虑到SSA女孩经历的负SRH结局的高负担，哪个月经初潮会影响SRH 和年轻女性。使用的数据来自“加纳青少年艾滋病毒风险行为的性别社会背景” (R01HD06101；PI：Bingenheimer，PhD)，一项对两个城市周边地区青少年进行的为期三年的纵向研究 在加纳的社区中，目前的提案旨在开始解决这一知识差距。纵向的 在拟议的研究中使用的数据的性质将使我能够检查女孩向不同 随着时间的推移，结果与他们的月经初潮年龄相关，从而促进了因果推断--这比 来自SSA的少数其他可用的研究都使用了横断面数据。目前的提案将 研究月经初潮早期如何影响SSA中青春期女孩和年轻女性的各种SRH结局 确定在HIC中看到的模式是否也适用于SSA，或者是否在SSA中找到独特的模式。 在我通过培训活动获得的方法技能和实质性知识的基础上，我将 通过以下方法探讨月经初潮早期对SSA患者SRH结局的影响 具体目标：1)测试月经初潮早期是否与性暴力、危险的性行为和 加纳少女和年轻妇女的早孕；2)探讨早期怀孕的过程 通过评估强迫的冥想作用，月经初潮导致SSA女孩的负SRH结果 第一次性行为、早期性启动和早婚；以及3)确定哪些因素是已知的保护因素 防止或增加对包括教育和饮酒在内的负面SRH结果的易感性，与 月经初潮早期影响SSA的SRH结局。这项研究项目将为更大的 了解SSA青年月经初潮早期的SRH后果，并帮助确定干预因素 On以减轻月经初潮早期导致的负面SRH结局。该项目将提供培训和 作为一名独立研究人员的发展所必需的研究经验。

PROJECT ABSTRACT/SUMMARY Adolescent girls and young women between the ages of 15 and 24 bear a disproportionate burden of negative sexual and reproductive health (SRH) outcomes worldwide. This is particularly so in Sub-Saharan Africa (SSA), where the leading causes of death among girls aged 15-19 are complications related to pregnancy and childbirth. About a third of all new HIV infections in SSA also occur in young women aged 15-24 annually. Research from various high-income countries (HICs) suggests that vulnerability to negative SRH outcomes, including early pregnancy and childbirth and sexually transmitted infections (STIs), may be elevated in girls and young women who reach menarche at an early age (an indication of early sexual maturation). There are indications that this also applies to girls in SSA, but the little available evidence is inconclusive. The few menarcheal data from SSA also suggest secular trends of declining age of menarche across SSA. There is an urgent need to better understand the effect of early menarche on SRH in SSA, and the underlying process by which early menarche affects SRH given the high burden of negative SRH outcomes experienced by SSA girls and young women. Using data from “Gendered Social Context of Adolescent HIV Risk Behavior in Ghana” (R01HD06101; PI: Bingenheimer, PhD), a three-year longitudinal study of adolescents from two peri-urban communities in Ghana, the current proposal aims to begin to address this gap in knowledge. The longitudinal nature of the data being used in the proposed study will allow me to examine girls’ transitions to various outcomes over time relative to their age at menarche thus facilitating causal inferences – an advantage over the few other available studies from SSA that have all used cross-sectional data. The current proposal will examine how early menarche affects various SRH outcomes in adolescent girls and young women in SSA to determine whether patterns seen in HICs also apply to SSA or whether unique patterns are found in SSA. Building on the methodological skills and substantive knowledge I gain through my training activities, I will explore the process by which early menarche contributes to negative SRH outcomes in SSA with the following specific aims: 1) to test whether early menarche is associated with sexual violence, risky sexual behavior and early pregnancy in Ghanaian adolescent girls and young women; 2) to explore the process through which early menarche leads to negative SRH outcomes among girls in SSA by assessing the meditational role of forced first sex, early sexual initiation and early marriage; and 3) to identify which factors that are known to protect against or increase vulnerability to negative SRH outcomes, including education and alcohol use, interact with early age at menarche to affect SRH outcomes in SSA. The research project will contribute to a greater understanding of the SRH consequences of early menarche in SSA youth and help identify factors to intervene on to mitigate negative SRH outcomes resulting from early menarche. The project will provide training and research experiences necessary for my development as an independent researcher.