MultipleImpacts of Ethiopia’s Health Extension Programme on Adolescent Health and Wellbeing: a Quasi-Experimental Study 2002-2013

Abstract

Background. Scalable interventions are needed to support adolescents thrive. Since 2003, the Ethiopian Government’s Health Extension Programme (HEP) has reached millions of households. We evaluated the relationship between household support from HEP and eleven indicators of adolescent health and wellbeing. Methods. We used Young Lives Ethiopia cohort data between 2002 and 2013. Outcomes were: not underweight, self-reported very good health, education enrolment, domestic tasks, paid work, fertility knowledge, sexually transmitted infection knowledge, no child marriage, no early pregnancy, literacy, and numeracy. We evaluated associations between household support from HEP at age 15 and study outcomes at age 19 using propensity score weighted regression, stratifying by sex, and adjusting for receipt of the Productive Safety Net Programme, and economic shocks. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP vs. no exposure. Findings. Of 775 adolescents with complete follow-up, 46% were female, with baseline mean age 7.87 years (SD: 0.29). Sixty-six percent of adolescents reported household support from HEP. Baseline predictors of support included lower household wealth, lower caregiver education, rural location, and residence in Tigray. Propensity score weighting yielded good balance. In boys, HEP was positively associated with education enrolment (APD: +17ppts, 95% CIs: +6ppts; +27ppts), and negatively associated with paid work (APD: -16ppts, 95% CIs: -27ppts; -4ppts). In girls, HEP was positively associated with fertility knowledge (APD: +14ppts, 95% CIs: 2ppts; 25ppts), no child marriage (APD: +19ppts, 95% CIs: +9ppts; +29ppts), no early pregnancy (APD: +18ppts, 95% CIs: +9ppts; +28ppts), education enrolment (APD: +23ppts, 95% CIs: +11ppts; +34ppts), literacy (AMD: +7ppts, 95% CIs: +2; +11), and numeracy (AMD: +10ppts, 95% CIs: +5; +14). Interpretation. Policies promoting HEP will substantially support multiple areas of adolescent health and wellbeing, and help their transition to adulthood.