Impact of the DREAMS interventions on educational attainment among adolescent girls and young women: Causal analysis of a prospective cohort in urban Kenya.

Schadrac Agbla,Jane Osindo,Abdhalah Ziraba,Lucy Chimoyi,Isolde Birdthistle,Sian Floyd,Annabelle Gourlay,Elvis O Wambiya,Sarah Mulwa,José Antonio Ortega

doi:10.1371/journal.pone.0255165

Abstract

DREAMS promotes a comprehensive HIV prevention approach to reduce HIV incidence among adolescent girls and young women (AGYW). One pathway that DREAMS seeks to impact is to support AGYW to stay in school and achieve secondary education. We assessed the impact of DREAMS on educational outcomes among AGYW in Nairobi, Kenya. In two informal settlements in Nairobi, 1081 AGYW aged 15-22 years were randomly selected in 2017 and followed-up to 2019. AGYW reporting invitation to participate in DREAMS during 2017-18 were classified as "DREAMS beneficiaries". Our main outcome was being in school and/or completed lower secondary school in 2019. We used multivariable logistic regression to quantify the association between being a DREAMS beneficiary and the outcome; and a causal inference framework to estimate proportions achieving the outcome if all, versus no, AGYW were DREAMS beneficiaries, adjusting for the propensity to be a DREAMS beneficiary. Of AGYW enrolled in 2017, 79% (852/1081) were followed-up to 2019. In unadjusted analysis, DREAMS beneficiaries had higher attainment than non-beneficiaries (85% vs 75% in school or completed lower secondary school, Odds Ratio (OR) = 1.9; 95%CI: 1.3,2.8). The effect weakened with adjustment for age and other confounders, (adjusted OR = 1.4; 95%CI: 0.9,2.4). From the causal analysis, evidence was weak for an impact of DREAMS (estimated 83% vs 79% in school or completed lower secondary school, if all vs no AGYW were beneficiaries, difference = 4%; 95%CI: -2,11%). Among AGYW out of school at baseline, the estimated differences were 21% (95%CI: -3,43%) among 15-17 year olds; and 4% (95%CI: -8,17%) among 18-22 year olds. DREAMS had a modest impact on educational attainment among AGYW in informal settlements in Kenya, by supporting both retention and re-enrolment in school. Larger impact might be achieved if more AGYW were reached with educational subsidies, alongside other DREAMS interventions.

Highlights

Education, as a Sustainable Development Goal (SDG) is closely linked to other SDGs including good health and wellbeing (SDG 3), gender equality (SDG 5), and decent work and economic growth (SDG 8) [1,2,3]
DREAMS had a modest impact on educational attainment among AGYW in informal settlements in Kenya, by supporting both retention and re-enrolment in school
Larger impact might be achieved if more AGYW were reached with educational subsidies, alongside other DREAMS interventions

Summary

Introduction

As a Sustainable Development Goal (SDG) is closely linked to other SDGs including good health and wellbeing (SDG 3), gender equality (SDG 5), and decent work and economic growth (SDG 8) [1,2,3]. Spending more time in school might increase contact with health-promotion messages delivered within schools [8], and among girls limits opportunities to interact with male partners who are often older, and with a higher HIV risk profile compared to the girls [9, 11,12,13] Even with these well-documented benefits of education, challenges that hinder access to primary education and transition to secondary school in sub-Saharan Africa (SSA) still exist. These constraints act at various levels such as within the families (e.g., inability to pay school fees, or pay for uniforms and supplies, or limited support from guardians), limited resources within schools and inequitable social norms at the community level where girls’ education may be viewed as less important compared to boys’ education [3, 14,15,16]. We assessed the impact of DREAMS on educational outcomes among AGYW in Nairobi, Kenya

Objectives

Methods

Results

Conclusion