Effects of an adolescent sexual and reproductive health intervention on health service usage by young people in northern Ghana: a community-randomised trial.
BACKGROUND
While many Ghanaian adolescents encounter sexual and reproductive health problems, their usage of services remains low. A social learning intervention, incorporating environment, motivation, education, and self-efficacy to change behaviour, was implemented in a low-income district of northern Ghana to increase adolescent services usage. This study aimed to assess the impact of this intervention on usage of sexual and reproductive health services by young people.


METHODS
Twenty-six communities were randomly allocated to (i) an intervention consisting of school-based curriculum, out-of-school outreach, community mobilisation, and health-worker training in youth-friendly health services, or (ii) comparison consisting of community mobilisation and youth-friendly health services training only. Outcome measures were usage of sexually-transmitted infections (STIs) management, HIV counselling and testing, antenatal care or perinatal services in the past year and reported service satisfaction. Data was collected, at baseline and three years after, from a cohort of 2,664 adolescents aged 15-17 at baseline.


RESULTS
Exposure was associated with over twice the odds of using STI services (AOR 2.47; 95%CI 1.78-3.42), 89% greater odds of using perinatal services (AOR 1.89; 95%CI 1.37-2.60) and 56% greater odds of using antenatal services (AOR 1.56; 95%CI 1.10-2.20) among participants in intervention versus comparison communities, after adjustment for baseline differences.


CONCLUSIONS
The addition of targeted school-based and outreach activities increased service usage by young people more than community mobilisation and training providers in youth-friendly services provision alone.
Navrongo Health Research Centre, Navrongo, Ghana; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Gifty Apiung
GA
Aninanya
Navrongo Health Research Centre, Navrongo, Ghana.
Cornelius Y
CY
Debpuur
Navrongo Health Research Centre, Navrongo, Ghana.
Timothy
T
Awine
Navrongo Health Research Centre, Navrongo, Ghana.
John E
JE
Williams
Research and Development Division, Ghana Health Service, Accra, Ghana.
Abraham
A
Hodgson
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Natasha
N
Howard
D000293:Adolescent; D005260:Female; D005869:Ghana; D006801:Humans; D008297:Male; D015980:Public Health Practice; D060728:Reproductive Health; D012725:Sexual Behavior / Q000523:psychology