Purpose

Ethiopia has registered remarkable achievements in reaching global development goals, including reducing child marriage. Policymakers are keen to understand which investments have contributed to this. We evaluated the association between Ethiopia’s Health Extension Program (HEP) and 12 adolescent health and wellbeing outcomes.

Methods

We used Young Lives Ethiopia cohort data between 2002 and 2013. We evaluated associations between household support from HEP at age 15 and 12 adolescent outcomes spread across health, gender-based violence, education, and employment at age 19 using the inverse probability of treatment weighting propensity score approach, stratifying by sex. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP versus no exposure.

Results

Of 775 adolescents with complete follow-up, 46% were female. Sixty-six percent of adolescents reported support from HEP, with higher rates of support in poorer, less educated, and rural households, particularly in Tigray Province. In boys, HEP was positively associated with education enrolment (APD: +20 percentage points [ppts], 95% confidence interval [CI]: +9 ppts, +31 ppts) and literacy (AMD: +6 ppts, 95% CI: +0.2, +11), and negatively associated with >4 hours in income-generating activities per day (APD: −19 ppts, 95% CI: −30 ppts, −9 ppts). In girls, HEP was positively associated with no child marriage (APD: +16 ppts, 95% CI: +4 ppts, +27 ppts), no adolescent pregnancy (APD: +17 ppts, 95% CI: +6 ppts, +28 ppts), education enrolment (APD: +27 ppts, 95% CI: +15 ppts, +39 ppts), literacy (AMD: +5 ppts, 95% CI: +0.2, +11), and numeracy (AMD: +8 ppts, 95% CI: +3; +13).

Discussion

Policies promoting HEP are likely to have supported improvements in multiple areas of adolescents’ lives in Ethiopia.

中文翻译：

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埃塞俄比亚健康推广计划对青少年健康和福祉的多重影响：2002-2013 年准实验研究

目的

埃塞俄比亚在实现全球发展目标方面取得了显著成就，包括减少童婚。政策制定者渴望了解哪些投资对此做出了贡献。我们评估了埃塞俄比亚的健康推广计划 (HEP) 与 12 项青少年健康和福祉结果之间的关联。

方法

我们使用了 2002 年至 2013 年之间的年轻生活埃塞俄比亚队列数据。我们使用治疗权重的反概率评估了 15 岁时 HEP 的家庭支持与 12 岁青少年在健康、基于性别的暴力、教育和就业方面的关联。倾向评分法，按性别分层。调整后的概率差异 (APDs) 和调整后的平均差异 (AMDs) 用于对比暴露于 HEP 与未暴露。

结果

在接受完整随访的 775 名青少年中，46% 为女性。66% 的青少年报告了 HEP 的支持，在较贫穷、受教育程度较低的农村家庭，特别是在提格雷省，支持率更高。在男孩中，HEP 与教育入学率（APD：+20 个百分点 [ppts]，95% 置信区间 [CI]：+9 ppts，+31 ppts）和识字率（AMD：+6 ppts，95% CI： +0.2, +11)，并且与每天超过 4 小时的创收活动负相关（APD：-19 ppts，95% CI：-30 ppts，-9 ppts）。在女孩中，HEP 与无童婚（APD：+16 ppts，95% CI：+4 ppts，+27 ppts）、未怀孕（APD：+17 ppts，95% CI：+6 ppts，+ 28 ppts)、教育入学率 (APD: +27 ppts, 95% CI: +15 ppts, +39 ppts)、读写能力 (AMD: +5 ppts, 95% CI: +0.2, +11) 和算术 (AMD: +8 个百分点，95% CI：+3；+13）。

讨论

促进 HEP 的政策可能有助于改善埃塞俄比亚青少年生活的多个领域。