Year-old Girls Research Articles

Clinicopathologic and Molecular Characterization of Four Cases of Pediatric Salivary Secretory Carcinoma (SSC), One with ETV6-RET Fusion.

Salivary gland secretory carcinoma (SSC) is a neoplasm with characteristic histologic features, similar to those of secretory carcinoma of the breast. Only a few pediatric SSC cases have been reported, all with ETV6-NTRK3 fusion. We present four new pediatric SSC examples, one with a novel ETV6-RET fusion. Four cases of SSC were diagnosed between 2010 and 2020: 2 boys, 7 and 9year-old with parotid tumors (1.5 and 1.3cm, respectively); and two 14year-old girls: one with a submandibular tumor (2.1cm), and one with a parotid lesion (1.2cm). Histologically, all tumors were similar: well-circumscribed lesions composed by mid-size, monotonous cells with eosinophilic and sometimes vacuolated cytoplasm. The nuclei are oval to round with open chromatin and a single nucleolus. There are duct-like structures and microcysts with colloid-like material. Immunohistochemically, tumor cells are positive for S100, CK7, mammaglobin and GATA3. A classic ETV6-NTRK3 translocation was confirmed in the three parotid tumors; an ETV6-RET fusion was demonstrated in the submandibular lesion. All patients underwent complete surgical resection and are alive without tumor recurrence after a follow-up time ranging from one to 4years. Pediatric SSC is extremely rare but their characteristic morphology and immunohphenotype facilitate their diagnosis. We describe the first pediatric case with the recently reported ETV6-RET fusion. Similar to adult cases, this tumor is morphologically undistinguishable from those carrying the classic ETV6-NTRK3 translocation. Thus, in pediatric cases with morphology suggestive of SSC and negative ETV6-NTRK3 by RT-PCR, other possible fusions should be investigated.

Wiek menarche dziewcząt z województwa lubuskiego w odniesieniu do środowiska zamieszkania, wykształcenia rodziców, liczby dzieci w rodzinie i standardu życia

The aim of this article is to assess the maturity level of girls in the Lubusz Voivodeship depending on the living environment, parents’ education, the number of children in the family and the standard of living. The material consists of the results of research conducted among 10–18 year-old girls (after menarcheal age) in 2015–2017 in selected primary, middle and upper secondary schools. A total of 3,525 girls were examined. The data were collected by means of a diagnostic survey, using the retrospective method, the research technique was a questionnaire, and the research tool was a questionnaire. Basic statistical characteristics for each variable, one-way analysis of variance, significance level of differences and a test of independence were calculated. The questionnaire was also validated with the reliability coefficient of 0.68, which qualifies it for use in cross-sectional studies. As a result of the analysis of the material, it was found that the following girls matured the earliest those from medium-size and small towns, daughters of fathers with higher or vocational education, daughters of mothers with higher education, girls growing up in families with one child, girls from the richest families.

Secular Trends in Height, Body Mass and Mean Menarche Age in Romanian Children and Adolescents, 1936-2016.

Secular trends in anthropometric parameters have been documented in most European countries, but no data is available regarding Romanian. The aim of the study was to calculate secular trend in height, body mass and mean menarche age for Romanian children and adolescents. Methods: A secondary data analysis was performed using ten data sets for urban and eight data sets for rural boys and girls, age 5–15 years, covering 80 years (1936 to 2016). Secular trend in height (cm/decade), body mass(kg/decade) and mean menarche age (years) were calculated. Results: Overall, there was a positive secular trend for height in both genders, which parallels the gross domestic product (GDP)/capita difference, more pronounced in boys, across all age-groups, with a maximum for 15 years-old boys (~3 cm/decade) and 13 years-old girls (~2 cm/decade). Body mass trend was also positive, more accentuated in the rural population. Mean age at menarche was higher in rural compared to urban girls, had a negative trend with the disappearance of the difference in the latest available data set (2013). Conclusion: In summary, an overall positive and ongoing secular trend in height and body mass was documented in Romanian children and adolescents, especially for the pubertal age-range, in concordance to other western countries, but out of phase by approximately 20 years.

Influencia del estreñimiento en la enuresis monosintomática y en el síndrome enurético

Constipation has classically been considered as a risk factor of enuresis, although there are increasingly more publications that report a similar prevalence of constipation in both enuretics and non-enuretics. To determine the influence of constipation in monosymptomatic and non-monosymptomatic enuresis, and to find out the prevalence of the three disorders, as well the lower urinary tract dysfunction and bladder-bowel dysfunction in the population. A cross-sectional observational prevalence study on a representative population sample of 5 to 9 year-old school boys and girls of Galicia, Spain. A questionnaire was completed in the schools on urinary and bowel habits, which included questions from the Paediatric Lower Urinary Tract Scoring System (PLUTSS) diagnostic questionnaire and grading of the lower urinary tract dysfunctions. The enuresis was diagnosed using the International Children's Continence Society (ICSS), and if it was also associated with diurnal symptoms, it was also classified as non-monosymptomatic enuresis. The constipation was evaluated using the Rome III criteria and the adapted Bristol stool scale. A total of 772 questionnaires were included in the study. The prevalence of constipation was 20% and that of enuresis was 9.1% (62.9% monosymptomatic enuresis and 37.1% non-monosymptomatic), with the prevalence of bladder-bowel dysfunction being 5.2%. It was observed that constipation had no influence on the presence of monosymptomatic enuresis, but it did have an influence on non-monosymptomatic enuresis and lower urinary tract dysfunctions, where it was a significant risk factor. The differential diagnosis between monosymptomatic and non-monosymptomatic enuresis is essential in the initial evaluation of the patient with enuresis, since the therapeutic management and the characteristics of both disorders are different, with constipation only being a risk factor in cases of non-monosymptomatic enuresis.

Current burden of cervical cancer in Bulgaria - epidemiological study

Abstract Background The risk factors of cervical cancer are well established and the disease is preventable through vaccination and early detection by screening. The disease ranks as leading cause of female cancer in Bulgaria. The objective of the research was to describe the current burden of cervical cancer in Bulgaria and medical decisions to improve women's health. Methods The information were summarized at the national level on the basis of official on-line database from the annual reports of the of the immunoprophylaxis activities of the National Center of Infectious and Parasitic Diseases (NCIPD), National Center for Public Health and Analyzes (NCPHA). Data for morbidity and mortality rate and vaccine coverage were analyzed and presented in tables and figures. Results Cancer registration has been compulsory in Bulgaria since 1952. National program for the primary prevention of cervical cancer was applied in 2012 (2012-2016, 2017-2020). From the same year was uses immunization against HPVs for 12 -year-old girls. Through these measures, the state guarantees the right of citizens to affordable primary prevention without imposing obligations. Despite the preventive strategy, the expected results are not observed. In 2018, the total number of registered malignancies of the cervix was 15759. The incidence of 100,000 population was 435.8. Of these, the number of newly diagnosed cases were 850, the incidence was 23.5 per 100,000 population. HPV vaccination coverage in girls by birth cohort was 15.1% - 1st dose and 14.3% - 2nd dose for 12-year-old girls and 7% - 1st dose for 13-year-old girls. Conclusions Bulgaria has a leading position in the incidence and mortality of cervical cancer among European countries, requiring mandatory screening and immunization against the Human Papilloma viruses. Key messages Cervical cancer, incidence rate, mortality rate. Vaccination coverage, HPVs, Bulgaria.

Burden of Children of Patients with Mental Illness - A High Risk Population that Needs Selective and Indicated Prevention?

To determinate behavioral problems of children of parents with mental illness. Conclusions for prevention. Inpatients from a psychiatric hospital (N = 399) with children (4-18 yrs.) evaluated their children's behavior with the Child Behavior Checklist (CBCL). Children of mentally ill parents showed significantly more behavioral problems than children of healthy parents. They had overall fewer behavioral problems compared to children with mental illness, however, behavioral problems were similar with respect to "social problems" (4-11 year-old boys, 12-18 year-old girls) and "somatic complaints" (12-18 year-old boys and girls). Results indicate a selective, partly indicated, need for prevention. The data point towards certain areas of behavioral problems that should be particularly targeted when planning such programs.

Dynamics of sickness rate in 15–17- year-old girls in the Russian Federation

The children’s health condition in the Russian Federation, including adolescents, has been characterized by negative trends in the past thirty years.Objective. To identify the main trends in sickness rate (both total and registered for the first time) in 15–17-year-old girls in the Russian Federation, as well as to track the quantity and dynamics of chronicity of diseases by classes and types.Material and methods. The authors analyzed the data of form №12 of the federal statistics in 2000–2017 using the descriptive statistics method.Results. The researchers revealed a significant increase both in the total sickness rate from 1613,8 to 2532,5 per 1,000 girls (by 56,9%) and in the sickness rate registered for the first time from 967,5 to 1577,3 per 1,000 girls (by 63,0%). The increase in total incidence is observed in the most classes of diseases: neoplasms (2,4 times), injuries, poisoning and some other consequences of external causes (2,4 times), congenital anomalies (malformations; 2,3 times), cardiovascular diseases (2 times), diseases of the musculoskeletal system and connective tissue (2 times). Also there was revealed the increase in the incidence registered for the first time in the overwhelming majority of classes of diseases, for example: injuries, poisoning and some other consequences of external causes (2,5 times), diseases of the nervous system (2,2 times), cardiovascular diseases (2 times), neoplasms (2 times), diseases of the ear and mastoid process (2 times), diseases of the musculoskeletal system and connective tissue (1,9 times). High index of the chronicity for all classes of diseases reflect the initially high level of chronic pathology in 15–17-year-old girls, which is an unfavorable characteristic of their health condition. Having analyzed the chronization index the authors revealed its maximum growth for congenital anomalies (malformations; by 31,1%) and neoplasms (by 23,0%), and for certain nosologies: menstrual disorders (5,8 times) and renal failure (4,2 times).Conclusion. The health of children, and especially adolescents, determines the national health in the nearest future; therefore, its preservation and improvement require thorough attention.

El método arqueológico simulado para desarrollar competencias históricas en educación infantil

En las primeras etapas educativas el empleo del patrimonio, la imagen y los objetos en el aula, desde una estrategia dialógica, estimula la curiosidad y facilita abordar cuestiones relacionadas con la identidad, la diversidad cultural, la percepción de los cambios o las continuidades y la argumentación de las causas y consecuencias. Estas nociones son indispensables para que la infancia interprete sus experiencias, comprenda la vida cotidiana y desarrolle habilidades de pensamiento y explicación histórica, ya que el presente es fruto del pasado y se proyecta en el futuro. Presentamos una experiencia implementada en un aula de educación infantil de Pamplona con niños y niñas de 5 años, que utiliza la didáctica del objeto y la simulación del método arqueológico para desarrollar competencias históricas. Los resultados demuestran que el alumnado desarrolla habilidades de pensamiento para observar, describir, hacer preguntas relevantes, realizar hipótesis, comparar semejanzas y diferencias entre pasado y presente o deducir a partir de las pruebas. Además, se acerca al patrimonio de forma crítica, desde lo próximo e individual hacia lo lejano y social y desarrolla la capacidad narrativa y la empatía histórica para construir relatos y explicaciones multicausales, críticas, creativas y contextualizadas, que le permiten adquirir la conciencia histórica.

Eco-epidemiological factors' of Head Lice in 10-12 year-old girls in Birjand City in 2017

Introduction: Lice are external parasites found in all socioeconomic classes around the world, which infect millions of people, especially children aged 5-14 years. Considering the growing and epidemiological trend of head lice in recent years, despite careful health care, more prognosis is needed. Therefore, this study aimed to study eco-epidemiological factors of head lice in 10-12 year-old girls in Birjand City in 2017.
 Methods: This cross-sectional study with descriptive-analytic approach was conducted in Birjand City in the 2017. The participants were selected using cluster sampling method from girl primary schools in Birjand City and its suburb areas. Data were entered into SPSS version 22 and analyzed by logistic regression test at significant level of 0.0.5
 Results: Head lice was evaluated in 2417 elementary school girls. The prevalence of head lice infection was 13.6% (n=329) in the population. The prevalence of contamination in urban areas was two times higher than the suburb areas. Significant correlations were observed between head lice infestation and father's education, mother's education, parent's job, family income, nationality, presence of foreigners in a class, habitat, history of previous student infections, presence of an infected person in the family, use of common Chador (piece of cloth worn by Muslim women to cover their body and hair) for praying at school. (p<0.05)
 Conclusion: The prevalence of head lice infection in the present study was higher than other studies. The prevalence of head lice infection was also higher in the suburbs. So, preventive measures, especially in the suburbs are required with regard to factors associated with infection by the health system.

Using Facebook to increase coverage of HPV vaccination among Danish girls: An assessment of a Danish social media campaign

ObjectivesIn this study we assess how different Facebook (FB) posts resonate with parents hesitant about HPV vaccination and how to engage parents in positive dialogues on FB. BackgroundVaccination against human papillomavirus (HPV) was successfully introduced in the Danish childhood vaccination program in 2009 for 12 year-old girls, with coverage reaching approximately 90%. However, negative public debate questioning the safety of the vaccine coincided with a rapid decline in vaccination coverage from 2015. In May 2017, we launched the national campaign Stop HPV – stop cervical cancer with the aim to rebuild trust in the HPV vaccine and increase vaccination coverage. We used a FB page and a social media strategy to engage the campaign’s primary target group: mothers hesitant about HPV vaccination of their daughters. MethodsWe analyzed a variety of posts on the FB page Stop HPV – stop cervical cancer posted from May 2017 to December 2017. We performed analysis documenting post reach, engagement in the posts and sentiment (positive, neutral or negative) of the comments. Focus groups were recruited to provide data about attitudes to the posts and the responses from the FB management team. Results84 unique posts were published on the FB page from May 2017 to December 2017 reaching 3,476,023 individual FB profiles. In focus groups, parents requested more in-depth information. However, analyses of FB posts and sentiment of comments showed that personal stories generated higher engagement rates and more positive dialogues compared to factual posts. ConclusionThe FB page Stop HPV – stop cervical cancer has successfully reached and engaged FB users in dialogue about HPV vaccination. Personal stories are effective in creating positive dialogues on FB. However, it remains important to provide factual information to parents to enable informed decision making about HPV vaccination.

Effect on Crystallinity of Rice After Iron Fortification

Background: Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in India particularly in under-five- year-old children, adolescent girls and pregnant women. Objective: The present study pioneered an investigation, into one of the varieties of paddy (IR-64) and their fortification with sodium iron EDTA salt, its physical properties, cooking characteristics, color, texture and characterization studies. Methods: Fortification was done at two concentrations 1.88g/kg and 3.39g/kg (250 & 450 mg/kg corresponding iron content), it was found that the iron content increased three to four-fold after fortification when compared to their corresponding controls. Results: The results revealed that, there was significant difference in the physical properties of rice in the control, fortified brown and milled rice. Cooking characteristics revealed, that water uptake and volume expansion were higher for fortified milled rice as compared to brown rice. The texture of fortified brown rice was hard as compared to fortified milled rice, although the taste was found satisfactory. The colour was significantly different in brown and milled rice. Conclusion: X-ray diffraction results revealed the polycrystalline nature of the fortified sample, was somewhat less crystalline as compared to control sample.

Usage of the Method of Child Training for Improving Lessons of Physical Education for Children of 9–10 Years

While exercising, there is a purposeful impact on the complex of body natural properties, which belongs to physical qualities of a person. Affecting physical qualities, under certain conditions, achieve a significant change of the level and direction of their development. In this regard, the aim of the research paper is to analyse the developed and scientifically grounded methods of circuit training for optimization of Physical Education lessons for primary school children. The Purpose of the Study – to elaborate and scientifically substantiate the training methods optimization of Physical Education lessons for primary school children. Research Organization, based on the fact, that 107 pupils of 9th–10th forms took part at the experiment. They were divided into experimental and control groups (experimental groups include 27 boys and 26 girls; control groups –28 boys and 26 girls). The experiment was attended by 9–10 year-old boys and girls that were included to the main medical group. Results.The chosen tests were informative in order to the dynamics detection of the developed methods and gave a positive growth for both groups (p <0,05; p <0,01). But the best result was shown by the experimental group. Due to the fact that during the methodology construction, not only the sensitive development, but also those aspects that would motivate the children before classes, were taken into consideration. Conclusions. Data, obtained during the methodology implementation of the circuit training, proved the effectiveness of our methods, that used during the school year as a modernized tool for increasing the level of physical preparedness of primary school children.

INDICATORS OF ADIPOSITY ASSOCIATED WITH LOW BODY ESTEEM IN ADOLESCENTS.

ABSTRACTObjective: To investigate the association between weight status and anthropometric indicators of adiposity with body esteem.Methods: Cross-sectional study including 305 adolescents from a public school in Rio de Janeiro, Brazil. Data were collected by a self-administered questionnaire and anthropometric measurements. The Body-Esteem Scale for Adolescents and Adults was used to evaluate total body esteem and the “appearance”, “weight”, and “attribution” domains. Body mass index (weight/stature2) was applied to assess weight status and waist circumference, the central body adiposity. The association between indicators of adiposity and body esteem was assessed using Student’s t-test or Mann-Whitney’s test and linear regression models, stratified by sex and age group.Results: Overweight/obesity was observed in 46% of younger adolescents (10 to 13 year-old girls, 10 to 14 year-old boys), 38% of older boys (15 to 18 year old), and 16% of older girls (14 to 18 year old). For both boys and girls in the younger age group, body mass index and waist circumference (as continuous variables) were inversely associated with total body esteem and weight domain. Overweight/obesity was associated with the appearance body esteem domain only among younger male adolescents; no association was found between either the body mass index or waist circumference and the attribution domain.Conclusions: Indicators of adiposity were associated with low body esteem. These findings underscore the fact that considering adolescents’ feelings concerning their body and appearance is important to promote a healthy control of weight.

The immune response to a two-dose schedule of quadrivalent HPV vaccine in 9–13 year-old girls: Is it influenced by age, menarche status or body mass index?

HPV vaccines are highly immunogenic. A two-dose schedule for 9–14 year-old is recommended. However, no data exist regarding the impact of age, menarche status and body mass index (BMI) on the immune response to a two-dose schedule. In this post-hoc analysis, we present antibody titers to HPV6/11/16/18 in 9–13 year-old girls participating in a randomized clinical trial and assigned to receive two doses of quadrivalent HPV vaccine at 6 months interval (NCT00501137). Antibody titers were measured at month 7 and 24 of the study by using a competitive Luminex immunoassay (cLIA).Both, at Month 7 and 24 the GMTs for four HPV genotypes were similar across the age bands, and did not vary significantly by menarche status. Overweight and obese girls had lower GMTs. More than 99% of girls remained seropositive for HPV 6/11/16 and 89% for HPV18 at month 24. Comprehensive data in overweight and obese vaccines are warranted.

Study on Consumer Exposure to Sun Spray and Sun Cream in South Korea

When conducting risk assessments of cosmetic ingredients, it is important that reliable exposure information is obtained for cosmetic products. As cosmetics are becoming more diverse, continuous effort must be made to obtain exposure data that reflect their growth and usage trends. The usage pattern of cosmetics, such as the application area and amount used, may differ by product type and also by country. We conducted a survey to compare the amount of sun spray and sun cream used in a usage environment in South Korea. The study was conducted on Haeundae Beach, one of the most popular beaches in South Korea. A total of 1,255 beachgoers participated in this study; 604 and 651 participants used the sun spray and sun cream, respectively, while sunbathing and enjoying water activities on the beach for one day. Exposure was analyzed following a probabilistic method. On comparing all subjects, it was found that the group that used sun spray (mean: 44.52 g/day) used significantly more product (p = 0.000) than those who used sun cream (mean: 20.51 g/day). By analyzing the daily exposure of sun spray and sun cream per unit body weight according to age and gender, the exposure amount of sun spray and sun cream was found to be highest among 2~9 year-old girls (mean for sun spray: 2.51 g/kg/day, p95: 5.50 g/kg/day, mean for sun cream: 0.79 g/kg/day, p95: 1.79 g/kg/day). The amount of sun spray used is approximately twice that of sun cream. Among both the sun spray and sun cream groups, the exposure amount per unit body weight was highest in girls younger than 10. These factors should be considered when conducting risk assessments of sun spray and sun cream.

Cost-benefit analysis of a projected national human papilloma virus vaccination programme in Lebanon.

The adoption of a population-based human papilloma virus (HPV) vaccination programme is debated in Lebanon on epidemiological, sociocultural, logistical and economic grounds. This cost-benefit analysis contributes to generating quantitative evidence necessary for a decision regarding costs through locally available data. The 2 sides of the cost-benefit analysis equation are: estimation of the cost of HPV vaccination campaigns targeting 11 year-old girls, using the cheapest vaccine in 2016 and estimation of the management cost for treatment of a yearly average case-load for cervical cancer. A Cervarix® only campaign would cost US$ 5 407 790 to vaccinate 38 083 11-year-old girls. The estimated cost of managing a mean annual mixed case-load of 100 incident cervical cancer cases would cost US$ 1 591 336. The nearest break-even point may occur 5 years after this current analysis. This cost-benefit analysis using limited available data indicates that massive HPV vaccination would not be cost-beneficial under the circumstances existing in 2016. Nevertheless, some indications point to the need for a re-assessment around 2020. This finding will inform public health decision-makers in Lebanon and similar neighbouring countries.

Usual intake and dietary sources of Selenium in adolescents: A cross-sectional school-based study

Selenium is a mineral that constitutes selenoproteins and, therefore, has been studied, especially in cardiovascular diseases. Some risk factors for the development of these diseases, such as obesity, hypertension and dyslipidemia, have been observed early in life, including in childhood and adolescence, and food and nutrient intake is an important associated factor for their development. The aim of this study was to assess usual intake of selenium (Se) and dietary inadequacies regarding the consumption of this mineral, and to identify the main dietary sources of Se among 12-17 year-old Brazilian adolescents. Data from the Study of Cardiovascular Risk in Adolescents, performed countrywide in the years 2013 and 2014, were used to estimate inadequate Se dietary intake. The National Cancer Institute's method was used, considering two days of 24h dietary recall (24hR). The contribution of each food group to the total intake of Se was determined using a single 24hR, and was defined as a ratio between the total intake of Se and the percentage of Se in each food group, until reaching 95%. Food mentioned by adolescents were categorized into 39 food groups, according to macronutrient similarities. Data from 76,957 adolescents aged from 12-17 years (49.7% girls) from public and private schools were assessed. Selenium intake was according to recommendation levels. Mean Se intake ranged from 84.3 to 105.9μg among sex and age groups. Considering the whole sample, meat, pasta, poultry, and fish were the food groups that contributed with the greatest amount of Se (representing 57.9% of total Se). Brazil nuts are consumed in bigger quantity only by 14-17 year-old girls, contributing to 1.6% of the Se in their diets. Brazilian adolescents have an adequate Se intake because of the high consumption of meat, pasta, and poultry. Although Brazil nuts are the most important dietary source of Se, adolescents consume them in very small amounts, leading to a small contribution in the total intake.

The Effect of Education-Based Health Action Process Approach on Parenting Skills of Mothers with Girl Students in Mashhad

Introduction: Parenting is a complex activity, which includes special procedures and behaviors that affect the child's growth. The aim of this study was to determine the effect of educational intervention based on the health action process approach on the parenting skills of girl students’ mothers in Mashhad. Methods: This was a quasi-experimental study conducted on 100 mothers (50test and 50control), who had 10-13 year-old girls. Mothers were selected using cluster sampling method. Data were collected by a questionnaire designed based on the health action process approach. The questionnaire also contained the demographic questions and its validity and reliable were completed before and 2months after the intervention. After completing the questionnaires, data were analyzed by SPSS 16 and descriptive (frequency, percentage, mean, and SD) and analytical tests (Mann-Whitney and Wilcoxon) at the significance level of 0.05. Results: The Chi-square test showed no statistically significant difference between the experimental and control groups in terms of family size, mothers' age category, level of education, and job. The Mann-Whitney test showed that significant difference existed between the experimental and control groups before intervention) P=0.01Z=2.57( only with regard to action planning. Moreover, two months after the intervention, significant differences were observed between the two groups in all constructs. Conclusion: According to the results, the educational intervention based on the structures of the health action process approach can have a positive impact on mother's parenting skills.

Facilitators and barriers in the utilization of World Health Organization's Preventing Early Pregnancy Guidelines in formulating laws, policies and strategies: what do stakeholders in Ethiopia say?

Each year, approximately 16 million 15-19 year-old girls give birth. In 2011 the World Health Organization (WHO) published the evidence-based "Preventing Early Pregnancy and Poor Reproductive Outcomes among Adolescents in Low and Middle Income Countries" guidelines to inform policies and programs. However, little is known about their country-level use to influence supportive environments to reduce early childbearing. We sought to identify alignment of Ethiopian laws, polices and strategies with these guidelines, whether these guidelines contributed to them, and identify facilitators and barriers to their utilization. First, we analyzed Ethiopian legal, policy, and strategy documents relating to adolescent pregnancy to determine their alignment with the WHO early pregnancy guidelines. We then conducted and thematically analyzed 11 interviews with key informants (KIs) working in adolescent and/or reproductive health at the national level. Laws, policies, and strategies to address early childbearing are in place in Ethiopia and address the six domains of the WHO adolescent pregnancy guidelines. KIs reported that they were aware of the WHO adolescent pregnancy guidelines, but none mentioned it without prompting. Six barrier/facilitator themes emerged: knowledge, national agenda, laws, resources, culture, and cooperation. Ethiopia has a policy framework consistent with WHO's adolescent pregnancy guidelines which may have contributed to their development. The lack of spontaneous identification of the guidelines by the KIs we interviewed, raises questions of their knowledge and use of the guidelines. Targeted dissemination of guidelines by WHO to relevant stakeholders may facilitate their use.

Adolescent Pregnancy: A Health Challenge

Every year, some 3.9 million girls aged 15 to 19 years undergo unsafe abortions (1). Approximately 16 million girls aged 15 to 19 years and 2.5 million girls under 16 years give birth each year in developing regions (2, 3). Complications during and childbirth are the leading cause of death for 15 to 19 year-old girls globally (4). Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years (5, 6).The term is often used synonymously with teenager. In this sense adolescent pregnancy means in a woman aged 10–19 years (2, 7). Pregnant teenagers face many of the same related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy or to give birth (8). For girls aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age (9). Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc.) (5, 6).