Abstract
BackgroundEarly adolescence is a critical window for intervention when it is possible to lay a foundation for a safe transition to adulthood, before negative outcomes occur. The Adolescent Girls Initiative–Kenya randomized trial tested the effects of combinations of interventions for young adolescent girls in two sites – the Kibera informal settlement in Nairobi and rural Wajir County in the Northeastern region.MethodsThe interventions included community dialogues on the role and value of girls (violence prevention), a conditional cash transfer (education), weekly group meetings for girls with health and life skills training (health), and training and incentives for financial literacy and savings activities (wealth creation). Participants were randomized to one of four study arms: 1) violence prevention only, 2) violence prevention and education, 3) violence prevention, education and health or 4) violence prevention, education, health and wealth creation. An intent-to-treat (ITT) analysis was conducted using longitudinal data to estimate the impact of each combination of interventions and various sensitivity analyses conducted addressing potential attrition bias and multiple hypothesis testing concerns.ResultsIn Kibera, the education conditional cash transfer had small effects on grade attainment but larger impacts on completion of primary school and the transition to secondary school in the most comprehensive arm; the health intervention improved sexual and reproductive health knowledge and condom self-efficacy; and the wealth intervention improved financial literacy and savings behavior. In Wajir, the education conditional cash transfer increased school enrollment and grade attainment, and the wealth intervention improved savings behavior.ConclusionsThe results indicate that when trying to improve a range of outcomes related to adolescent wellbeing for young girls, a multisectoral intervention with components addressing household economic constraints is a promising approach.Trial registrationTrial Registry: ISRCTN, ISRCTN77455458. Registered 24/12/2015 - Retrospectively registered.
Highlights
Over the past decade there has been increased focus on investments and programming for adolescents, in particular girls [1,2,3,4]
Prior to presenting the impact estimates, we assessed balance on baseline characteristics across the experimental arms for the non-attriting sample after 2 years to explore potential bias from non-random attrition. In addition to this consideration of baseline balance, we examined the extent and correlates of attrition in the study using ordinary least squares (OLS) to estimate the probability of successful interview in the two-year follow-up for each site and examined whether the correlates of attrition differed by study arm
In Kibera this included following girls to 27 different counties throughout Kenya; about one-fifth of girls re-interviewed in the two-year followup were located outside of Nairobi City County
Summary
Over the past decade there has been increased focus on investments and programming for adolescents, in particular girls [1,2,3,4]. Mean (sd) Cognitive score (0–16), mean (sd) [n = 1874] Lives with both parents, % [n = 1892] Mother ever attended school, % [n = 1892] Father ever attended school, % [n = 1888] Violence Prevention Experienced violence by a male in the past year, % [n = 1883] Positive gender attitudes score (0–4), mean (sd) [1883] Education Grade attainment, mean (sd) Primary school complete, % Enrolled in school, % Literate in Swahili and English, % [n = 1874] Health Knows most fertile period during menstrual cycle,% [n = 1883] General self-efficacy score (0–6), mean (sd) [n = 1883] Wealth Creation Financial literacy score (0–10), mean (sd) [n = 1883] Saved money in the past 6 months, % [n = 1883] Household-level Household expects girl to complete secondary, % [n = 2008] Household wealth quintile (1–5), mean (sd) [n = 2011] Sample by arm when n = 1909. On average girls scored nearly 6 out of 10 on financial literacy and about one-quarter had saved any money in the past 6 months
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