Young Adolescent Girls Research Articles

Value of Adding Bioelectrical Impedance Analysis to Anthropometric Indices in the Diagnosis of Metabolic Syndrome in 10-16 Years Old Schoolgirls.

The use of bioelectrical impedance analysis (BIA) in clinical settings is common. However, the value of BIA-based parameters in diagnosing metabolic syndrome (MetS) in children is under-investigated. Herein, we aimed to study the usefulness of BIA-indices in the diagnoses of MetS in 6–10-year-old girls. Therefore, a diagnostic accuracy case-control study was conducted, which included 75 girls aged 10–16 years, divided into three age-matched groups (normal, None-MetS, and MetS). Anthropometric indices, BIA parameters (including fat-free mass (FFM), body fat percent (BFP), and total body water (TBW)), blood pressure (BP), and blood samples were collected. Our main findings show that for girls in None-MetS and MetS groups, the waist circumference (WC) correlated positively with waist-hip ratio and mid-arm circumference (r = 0.58, 0.47, respectively), but not with BFP based on skinfold thickness (SFT), or mid-arm muscle area. WC was positively correlated with FFM and TBW, while high-density lipoprotein was inversely correlated with FFM. However, fasting blood glucose, triglycerides and BP showed no association with anthropometric measurements and BIA components. WC was the best indicator of MetS (AUC = 0.88, cut-off = 81.5 cm), followed by BMI (AUC = 0.84, cut-off = 26.9 kg/m2), while BFP based on SFT was the least sensitive (62.5%). In conclusion, apart from the FM index, anthropometric parameters such as WC are more valuable in diagnosing MetS in young adolescent girls.

Clinical Study of Prevalence of Polycystic Ovarian Syndrome in Adolescent Girls with Irregular Menstruation

Background: Polycystic Ovarian Syndrome (PCOS) accounts for significant healthcare costs, emotional distress and significant impact on quality of life of women. Even though a fairly common problem it is a complex trait with unclear etiology. The present study was conducted to study various clinical presentations in the adolescent girls with polycystic ovarian syndrome having menstrual irregularities. Aims and Objectives: To study the anthropometric measurements among PCOS patients and to find the association of various risk factors. Material and Methods: It was an observational, cross-sectional study conducted in Out-patient department of Obstetrics and Gynecology at a tertiary healthcare center in Maharashtra. This study was conducted amongst the adolescent girls coming to the OPD of Obstetrics and Gynecology with irregular menses. Results: We evaluated the study subjects according to the Rotterdam’s criteria. We observed that 51.96% cases fulfilled two of the three criteria, while 29.13% cases fulfilled all the three criteria from Rotterdam’s criteria for PCOS. Oligomenorrhea was noted among 46.45% subjects, followed by hypomenorrhea among 32.28% cases. Primary amenorrhea was observed among 21.25% cases. Secondary amenorrhea was seen as the presenting symptom in 4.72% cases. Conclusions: Adolescents who had irregular menses and signs of increased androgen secretion should undergo investigations and must be treated. Prompt treatment following early diagnosis of PCOS helps improve quality of life in young adolescent girls.

Recollections of How the Child Marriage Field Has Evolved

Recollections of How the Child Marriage Field Has Evolved

Associations between Home- and School-Based Violent Experiences and the Development of Sexual Behavior in Young Adolescent Girls in the Rural Southern Region of Malawi

Associations between Home- and School-Based Violent Experiences and the Development of Sexual Behavior in Young Adolescent Girls in the Rural Southern Region of Malawi

Oxytocin genetic pathway (CD38) and SDQ psychosocial characteristics in adolescent schoolchildren

To determine an effect of CD38 on the regulation of oxytocin (OT) production and to identify psychosocial characteristics according to the Strength and Difficulties Questionnaire (SDQ) in adolescent schoolchildren. The study included 308 adolescents, aged 11-18 years, of an unbiased school sample from three large cities of Central Siberia (Krasnoyarsk, n=194; Abakan, n=76; Kyzyl, n=38). All participants were Russian. The ethnicity was determined by mother's descent. Psychological study using SDQ and analysis of gene polymorphisms in DNA from saliva samples were carried out. Genotyping was performed using TaqMan allele discrimination technology with TaqMan probes (DNA synthesis, Russia) using real-time polymerase chain reaction and Rotor-Gene 6000 (Corbett Life Science, Australia). Data were analyzed using Statistica v.10 software. In adolescence, the high activity of the OT pathway can cause a number of negative effects, such as emotional instability («Emotional problems» (p=0.048), «Goodman total score» (p=0.057), «Hyperactivity» (p=0.075). The differences are statistically significant (p≤0.05)) in young (11-14 years old) adolescent girls who carry the A allele for rs3796863 polymorphism. Similar gender differences are characteristic and have been described for other populations. The distribution of the CD38 rs3796863 genotypes was similar to that in Caucasians. In adolescence, OT production decreases in comparison with the prepubertal period, and there are gender differences in its concentration in biological liquids towards an increase in girls compared to boys. In addition, the medians of individual SDQ scales differed significantly between boys and girls in our sample. Our results support the hypothesis of excessive social sensitivity mediated by OT, which may lead to some gender- and age-dependent psychosocial problems.

A case study on the assessment of perception towards body image and nutritional status among girl students studying in a district college in West Bengal

Students, mainly girl students, are the future of our society. Hence, it's most important to look into the critical aspects like health, education, self-respect, and earning opportunity. Women and children are the vulnerable sections worldwide. Data shows that young adolescent girls, including college students, usually suffer from anemia, hair and skin issues, obesity or underweight issues, and more. Additionally, urban girls are also psychologically affected due to their perception of body image and overall improper nutritional status. Our study is a survey-oriented study where a simple random sampling method has been used. The survey was conducted in a district girls' college in West Bengal for two days in October 2018. Two dietitians, two nutrition subject experts, and one homeopathic doctor were present with the pre-tested semi-structured questionnaires format duly filled by each respondent. 110 interested girl students studying graduation participated in the primary health cum nutrition screening. BMI calculation through height and weight measurements, screening of nails, hair, skin, tongue, dietary habits, and basic nutrition knowledge assessments were made on the spot. Altogether, data was collected through the dichotomous questionnaires based on nutrition, personal health, and hygiene, followed by subjective opinions and perceptions of the participants' body image. SPSS version-16 was applied for statistical analysis. Twelve attributes were used in the dichotomous questionnaires that found 67% were overweight cum obese. The study revealed 12% anemic, 13% excess hair loss, 62% skin conditioning issues, 65.4% acne or pimples,65% menstruation issues, and 4.5% depression. The study analyzed all the personal attributes to assess their image perception and nutritional status as well. Image complexion is not always essential, but some participants expressed their feeling about their improper appearance. Above all, everyone accepted that proper nutrition is always a significant factor for good health.

Impacts of two-year multisectoral cash plus programs on young adolescent girls\u2019 education, health and economic outcomes: Adolescent Girls Initiative-Kenya (AGI-K) randomized trial

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.

Associations of Age at Marriage With Marital Decision-Making Agency Among Adolescent Wives in Rural Niger

PurposeChild marriage is associated with multiple adverse health and social outcomes. Although evidence suggests that child marriage is associated with reduced participation in personal and household decisions for women, less is known about the association between age at marriage and decision-making among married adolescent girls. This study assesses associations between adolescents' age at marriage and two dimensions of decision-making (participation and satisfaction) in the high early marriage prevalence settings of Niger. MethodsCross-sectional data from a cluster-randomized control trial of a community-level program to increase the use of modern contraceptives among married adolescents in the Dosso region of Niger were analyzed. Multiple logistic regression models were used to determine the association of age at marriage with married girls' participation in and satisfaction with decision-making processes. ResultsMore than half of married adolescents (N = 796) were married before reaching the age of 15 years. Older age at marriage was associated with adolescents' increased participation in decisions related to economics (adjusted odds ratio: 1.23; 95% confidence interval: 1.05–1.43) and health-care access (adjusted odds ratio: 1.18; 95% confidence interval: 1.01–1.40), but not with greater reported satisfaction with their control over these decisions. ConclusionsThe study suggests that marrying as a very young adolescent places girls in even more disadvantaged positions regarding decision-making. These findings indicate the need to design programs targeted at addressing inequitable gender norms to reduce early child marriage and increase participation in decision-making. Further study of satisfaction with participation in decision-making is recommended, including consideration of whether it is related to gender norms for participation in decisions rather than actual participation.

Perspectives of Caregivers on Pubertal Changes among Young Adolescent Girls with Cerebral Palsy: a Qualitative Analysis

Disability, CBR and Inclusive Development aims to enhance knowledge in the field of disability and inclusive development, addressing the needs of practitioners, policy makers, DPOs and the scientific community.

Analysis of antenatal care, intranatal care and postnatal care utilization: Findings from the 2017 Indonesian Demographic and Health Survey.

Background and objectiveMaternal healthcare utilization by young women and adolescent girls is associated with maternal health outcomes and plays a critical role in reducing maternal mortality rates in low- and middle-income countries. This study sought to analyze current data on antenatal care (ANC), intranatal care (INC), and postnatal care (PNC) utilization with a focus on mothers aged 15–24 years in Indonesia.MethodsThis study was a secondary analysis of data from the 2017 Indonesian Demographic and Health Survey. The unit data analyzed 2,584 mothers aged 15–24 years who had delivered babies within the five-year period preceding the survey. Bivariate analysis and multiple logistic regression utilizing descriptive statistics were used to explore correlations between the independent variables and ANC, INC, and PNC visits.ResultsAmong the mothers included in the study, the prevalence of service utilization was 90.9% for ANC, 79.4% for INC, and 68.9% for PNC. Women’s age, education level, number and birth order of children, difference in age between the mother and her husband, her husband’s occupation, wealth index, access to the health service, and regional factors were significantly associated with the utilization of ANC, INC, and PNC services.ConclusionThis study provides insights for policymakers on how to strengthen healthcare policies and laws with the aim to improve maternal healthcare services for mothers aged 15–24 years. To improve maternal healthcare utilization among young mothers, national policy should focus on service equality, accessibility, and reliable implementation.

Eliminating malaria in southeast Asia requires more attention on adolescent girls

Malaria is one of the leading causes of death among adolescent girls in southeast Asia. Young adolescent girls (aged 10–14 years), for whom malaria is the eighth highest cause of mortality, are most affected.1 On the basis of the most recent data (which is for the year 2016), the malaria mortality rate for young adolescent girls in southeast Asia is 28% higher than for young adolescent boys (1·75 deaths vs 1·37 deaths [per 100 000 of the population at risk]).1

Human Papillomavirus Vaccines.

Human papillomavirus (HPV) vaccines are among the most effective vaccines available, the first to prevent infection by a mucosatropic sexually transmitted infectious agent and to do so without specific induction of mucosal immunity. Currently available prophylactic HPV vaccines are based on virus-like particles that self-assemble spontaneously from the L1 major capsid protein. The first HPV vaccine was licensed in 2006. All vaccines target HPV-16 and HPV-18, types which cause the majority of HPV-attributable cancers. As of 2020, HPV vaccines had been introduced into national immunization programs in more than 100 countries. Vaccination polices have evolved; most programs target vaccination of young adolescent girls, with an increasing number also including boys. The efficacy and safety found in prelicensure trials have been confirmed by data from national immunization programs. The dramatic impact and effectiveness observed has stimulated interest in ambitious disease reduction goals.

Malignant Germ cell Tumor of Ovary: An Unusual Combination and An Irony of Fate

Malignant mixed ovarian germ cell tumors are very rare malignant ovarian germ cell tumors, with a very high degree of malignancy. They are aggressive cancers affecting young adolescent girls. The commonest combination reported in literature is dysgerminoma and endodermal sinus tumors. Fertility sparing surgery followed by combination chemotherapy is the treatment of choice. The objectives of this case report are the advanced age of presentation, unusual histopathological combination, and the irony of infertility treatment. We report a rare case of 40-year-old woman with Malignant mixed germ cell tumor comprising of components of endodermal sinus tumor, immature teratoma, dysgerminoma and embryonal carcinoma. Patient was on hormonal therapy for the cause of infertility, presented with complains of lower abdominal pain, constipation and incomplete evacuation of bladder for 2months. Transvaginal ultrasonography and CT scan showed a large multicystic space occupying lesion with predominant solid component in midline abdominopelvic location. Tumor markers i.e., AFP, Prolactin and CA125 were raised. Total abdominal hysterectomy and bilateral salpingoophorectomy, pelvic and retroperitoneal node resection, peritonectomy and omentectomy was performed.

Healthcare providers and caregivers\u2019 perspectives on factors responsible for persistent malnutrition of under 5 children in Buhweju district, South Western Uganda; a phenomenological qualitative study

BackgroundUnacceptably high levels of childhood malnutrition have been registered in all regions of Uganda over the years. Buhweju district alone contributed 46% prevalence of childhood malnutrition to the 47.8% estimated national prevalence for the whole of western Uganda in 2014. This study assessed health provider and caregiver opinions on factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties.MethodsIn this phenomenological qualitative study, we conducted two key informant interviews and six focus group discussions with Village Health Team members and care takers of under five children in Engaju and Nyakishana sub-counties respectively.to explore their opinions on the factors responsible for persistent malnutrition in Buhweju District in May 2018. Data were thematically analyzed manually and using Atals Ti 7.5.ResultsHistorical and geographical challenges, poverty and economic occupation, parental alcoholism and domestic violence as well as inadequate childcare services were identified as factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties.ConclusionPersistent malnutrition in under five children is mainly due to historical and geographical challenges and its associated factors that include poverty and economic occupation, parental alcoholism and domestic violence and inadequate childcare services. Thus literacy education for mothers and young adolescent boys and girls through engaging local leaders, local nongovernmental organizations and Companies operating in the district to contribute to social services provision would limit the domestic violence and increase sensitization on male responsibilities in the children care in Buhweju district.

The Intersection of Power and Gender: Examining the Relationship of Empowerment and Gender-Unequal Norms Among Young Adolescents in Kinshasa, DRC

PurposeTo examine how perceptions of gender norms and expressions of empowerment are related among disadvantaged young adolescent boys and girls in Kinshasa, DRC. MethodsWe included data from 2,610 adolescent boys and girls between 10 and 14 years old. We examined correlations between three dimensions of perceived gender norms (a sexual double standard, gender stereotypical roles, and gender stereotypical traits) and two domains of agency (voice and decision-making), overall and by sex. We conducted sex-stratified simple and multivariable linear regression models to assess these associations, adjusting for sociodemographic factors. We also tested for differences in the association between gender norm perceptions and agency by sex. ResultsCorrelations between gender norm perceptions and agency scores were low (under 0.15). Among boys, greater perception of a sexual double standard was related to more voice (p=0.001) and more decision-making power (p=0.008). Similar patterns were observed among girls for the relationship between sexual double standard and voice (p≤.001), but not for decision-making. Increased perceptions of gender stereotypical traits were related to more voice among girls (p≤.001), while conversely girls who perceived greater gender stereotypical roles had less decision-making power (p=0.010). ConclusionsThis study demonstrated that gender norm perceptions and agency are distinct but related constructs. Interventions aimed to promote gender equality must consider gender unequal norms and gender-unequal divisions of power as important but different dynamics.

A Case of a Rare Malignant Mixed Ovarian Germ Cell Tumor Masquerading as an Ectopic Pregnancy

Malignant ovarian germ cell tumors (MOGCTs) are rare but disproportionately affect young women and adolescent girls. Although clinical presentation varies, these tumors can present with an adnexal mass and raised serum beta-human chorionic gonadotrophin (beta-hCG), mimicking an ectopic pregnancy. We present the case of a 20-year-old nulliparous woman, who was initially treated both medically and surgically as an ectopic pregnancy, and was eventually diagnosed with a malignant mixed germ cell tumor (MMGCT) following laparoscopy. We highlight the diagnostic challenges of ectopic pregnancies versus MOGCTs, and the importance of adopting a fertility-sparing approach in young nulliparous women. J Clin Gynecol Obstet. 2021;10(2):55-58 doi: https://doi.org/10.14740/jcgo743

IDEAL AGE AT FIRST MARRIAGE IS STILL BELOW THE LEGAL AGE OF MARRIAGE- THE CASE OF ADOLESCENT GIRLS IN WEST HARARGE ZONE, EASTERN ETHIOPIA

BACKGROUND Early marriage is a harmful practice associated with serious adverse health and social outcome. It is common practice in a male-dominated society. Ethiopia has legislative provisions and stakeholders advocating for the abolition of early marriage, however, the practice appears to continue due to perceived ideal age, which has not been monitored regularly. The aim of this study was to determine the ideal age at first marriage among adolescent girls and assess the role of influencers for early marriage in West Hararge Zone, Eastern Ethiopia. METHODS Descriptive analysis of the ideal age for first marriage was done as part of a large cross-sectional survey. Participants were female adolescent girls 13-17 years of age, male reference groups, and female reference groups. Both quantitative and qualitative data were used. Data were cleaned with (SPSS version 20) and analyzed by STATA/SE version 13 and summarized by descriptive statistics. A thematic data analysis approach was utilized to summarize qualitative data. RESULTS The reported mean ideal age at first marriage by adolescent girls was 16.96 (95% CI: 16.81,17.11). The qualitative component of the study also revealed that girls still marry between the ages of 12 and 15 years. Family, peer pressure, marriage intermediaries, and community as a whole were found to influence decisions of young adolescent girls to marry early. CONCLUSION In conclusion, the Ideal age at first marriage of adolescent girls’ in selected districts of West Hararge is below the legal age of marriage in Ethiopia which is 18 years. This implies early marriage is still common practice in this study area. Since the role of family, peers, religious and community leaders were found significant, in addition to young adolescent girls, working with all influential group and community as a whole could be necessary to decrease and eliminate early marriage Keywords: Ideal age at first marriage, Legal age, early marriage

Girl-only clubs\u2019 influence on SRH knowledge, HIV risk reduction, and negative SRH outcomes among very young adolescent girls in rural Malawi

BackgroundEarly adolescence is an important period to lay the foundation for positive sexual health development that can overcome sexual and reproductive health (SRH) challenges faced by very young adolescents (VYAs) as they reach puberty and sexual debut. In this study, we explored the following questions: first, what are the experiences of VYA girls on DREAMS’ Go Girl club participation? Second, how does club participation influence the VYAs SRH knowledge to reduce their risk for HIV and negative sexual health outcomes?MethodsThis was a qualitative study in which twenty-three in-depth interviews were conducted with VYA girls aged 12–14 years. These girls were enrolled in girl-only clubs in two rural southern districts in Malawi. The clubs were a part of larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. Interventions included improved access to key health services, education support, social skills, asset building, and economic strengthening. Narrative inquiry was used to generate first-hand accounts of the girls’ experiences with club participation. Thematic analysis was used to generate themes from the transcribed stories.ResultsSix main themes were generated: 1) reasons for joining the clubs with desire to learn about SRH as a motivation for joining the clubs.; 2) influence on gender norms and roles whereby participants described a change of gender roles and norms at home; 3) influence on child abuse practices whereby participants reported a decline in child abusive practices at home;4) influence on life skills and social networks whereby participants described learning about networking; 5) support to go back to school whereby out-of-school girls described how economic empowerment of their guardians facilitated their return to school; and 6) influence of clubs on SRH knowledge acquisition and behaviours whereby participants described acquiring knowledge on sexual health issues.ConclusionGirls-only HIV and SRH programs coupled with economic empowerment for their families can be effective in keeping VYA girls in school and improving SRH knowledge and health seeking behavior.

Gastric symptoms and low perceived maternal warmth are associated with eating disorder symptoms in young adolescent girls.

This study sought to determine whether gastric symptoms are associated with later eating disorder (ED) symptoms during early adolescence, and whether this relationship is moderated by parental warmth/acceptance and/or the child's sex. Longitudinal data from the Adolescent Brain Cognitive DevelopmentSM Study were utilized. Participants ages 9-10 years old (N=4,950; 2,370 female) completed measures at baseline and 1 year later (Y1). At baseline, gastric symptoms were measured by parent-reported items from the Child Behavior Checklist (CBCL), and perceived parental acceptance was measured by youth report on the Children's Report of Parent Behavior Inventory (CRPBI) Acceptance subscale separately for mothers and fathers. ED symptoms at Y1 were assessed by parent report on a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Linear mixed-effects models were conducted separately for maternal and paternal acceptance to test relationships among variables. A three-way interaction between baseline gastric symptoms, sex, and maternal acceptance predicted Y1 ED symptoms (𝛽=0.08; p < .01). Post-hoc analyses revealed that the interaction between gastric symptoms and maternal acceptance was significant for girls only (𝛽=-0.06, p < .01), such that low maternal acceptance was associated with a stronger relationship between baseline gastric symptoms and Y1 ED symptoms. No statistically significant main effects or interactions were found in the model for paternal acceptance. Gastric symptoms and low perceived maternal acceptance may interact to result in heightened risk for EDs in young adolescent girls.

Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018

IntroductionZambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth.MethodsWe carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013–14, and 2018). We calculated the percentage of women and men ages 15–24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months.ResultsHIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20–24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30–1.84], among men; and aOR = 1.74 [1.40–2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32–1.88]) and in a union (aOR = 2.44 [1.83–3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82–17.19]). Education-based inequity was considerably widened among women than men by 2018.ConclusionHTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.