The effect of youth-friendly health services on risk of pregnancy among adolescent girls and young women in Lilongwe, Malawi: a secondary analysis of the girl power-Malawi study.

Autor:	Graybill LA; Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, USA., Westreich D; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA., Maseko B; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Phanga T; UNC Project-Malawi, Lilongwe, Malawi., Nthani T; UNC Project-Malawi, Lilongwe, Malawi., Vansia D; UNC Project-Malawi, Lilongwe, Malawi., Chi BH; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA., Daniels JL; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA., Tang JH; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA., Bekker LG; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa., Pettifor AE; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA., Rosenberg NE; Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Jazyk:	angličtina
Zdroj:	American journal of epidemiology [Am J Epidemiol] 2024 Jul 11. Date of Electronic Publication: 2024 Jul 11.
DOI:	10.1093/aje/kwae193
Abstrakt:	In sub-Saharan Africa, adolescent girls and young women aged 15-24 (AGYW) experience high risk of early and unintended pregnancy. We assessed the impact of youth-friendly health services (YFHS) on pregnancy risk among AGYW who participated in the Girl Power study. In 2016, Girl Power randomly assigned four government-run health centers in Lilongwe, Malawi, to provide a standard (n=1) or youth-friendly (n=3) model of service delivery. At six and 12 months, study participants (n=250 at each health center) self-reported their current pregnancy status and received a urine pregnancy test. Because of missing pregnancy test results, we used multiple imputation to correct for outcome misclassification in self-reported pregnancy status, and applied the parametric g-formula on the corrected data to estimate the effect of YFHS on the 12-month risk of pregnancy. After correcting for outcome misclassification, the risk of pregnancy under the scenario where all health centers offered YFHS was 15.8% compared to 23.2% under the scenario where all health centers offered standard of care (risk difference: -7.3%, 95% CI: -15.5%, 0.8%). Access to a model of YFHS that integrates provider training with youth-friendly clinic modifications and community outreach activities may decrease risk of pregnancy among AGYW relative to standard of care. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)
Databáze:	MEDLINE
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