Abstract
BackgroundMany adolescent girls in Kenya and elsewhere face considerable risks and vulnerabilities that affect their well-being and hinder a safe, healthy, and productive transition into early adulthood. Early adolescence provides a critical window of opportunity to intervene at a time when girls are experiencing many challenges, but before those challenges have resulted in deleterious outcomes that may be irreversible. The Adolescent Girls Initiative-Kenya (AGI-K) is built on these insights and designed to address these risks for young adolescent girls. The long-term goal of AGI-K is to delay childbearing for adolescent girls by improving their well-being.InterventionAGI-K comprises nested combinations of different single-sector interventions (violence prevention, education, health, and wealth creation). It will deliver interventions to over 6000 girls between the ages of 11 and 14 years in two marginalized areas of Kenya: 1) Kibera in Nairobi and 2) Wajir County in Northeastern Kenya. The program will use a combination of girl-, household- and community-level interventions. The violence prevention intervention will use community conversations and planning focused on enhancing the value of girls in the community. The educational intervention includes a cash transfer to the household conditioned on school enrollment and attendance. The health intervention is culturally relevant, age-appropriate sexual and reproductive health education delivered in a group setting once a week over the course of 2 years. Lastly, the wealth creation intervention provides savings and financial education, as well as start-up savings.Methods/DesignA randomized trial will be used to compare the impact of four different packages of interventions, in order to assess if and how intervening in early adolescence improves girls’ lives after four years. The project will be evaluated using data from behavioural surveys conducted before the start of the program (baseline in 2015), at the end of the 2-year intervention (endline in 2017), and 2 years post-intervention (follow-up in 2019). Monitoring data will also be collected to track program attendance and participation. Primary analyses will be on an intent-to-treat basis. Qualitative research including semi-structured interviews of beneficiaries and key adult stakeholders in 2016 and 2018 will supplement and complement the quantitative survey results. In addition, the cost-effectiveness of the interventions will be assessed.DiscussionAGI-K will provide critical evidence for policy-makers, donors and other stakeholders on the most effective ways to combine interventions for marginalized adolescent girls across sectors, and which packages of interventions are most cost-effective.Trial registrationISRCTN77455458, December 24, 2015Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2888-1) contains supplementary material, which is available to authorized users.
Highlights
Many adolescent girls in Kenya and elsewhere face considerable risks and vulnerabilities that affect their well-being and hinder a safe, healthy, and productive transition into early adulthood
The Adolescent Girls Initiative-Kenya (AGI-K) is a randomized trial designed to test whether different combinations of 2-year long multi-sectoral interventions, targeted to young adolescent girls (11–14 years) can improve their well-being after 4 years, and in doing so enable safe, healthy and productive transitions into young adulthood
While there is growing evidence that combined health and wealth creation are important [10, 13, 38], this study examines the impact of layering this combination onto violence prevention and education
Summary
The existing literature points to the potential value of investing in very young adolescents before critical negative life events – school dropout, unintended pregnancy, early marriage, and experience of sexual and gender based violence – have occurred. In order to provide policy-relevant evidence that governments, donors, and other stakeholders can use to scale up successful interventions for girls, it is critical to understand the costs associated with each intervention and how much impact can be expected for the additional financial inputs. While the intervention packages are substantively the same across the two sub-studies (Nairobi and Wajir), the specifics of the interventions were designed to be culturally appropriate for each study area. Findings from both studies can be compared and conclusions made about whether the same packages of interventions had impacts on the same types of outcomes in both areas, and if not, why there were differences.
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