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. 2023 Oct 18;3(10):e0002347.
doi: 10.1371/journal.pgph.0002347. eCollection 2023.

Effect and cost-effectiveness of human-centred design-based approaches to increase adolescent uptake of modern contraceptives in Nigeria, Ethiopia and Tanzania: Population-based, quasi-experimental studies

Catarina Krug  1 , Melissa Neuman  1   2 , James E Rosen  3 , Michelle Weinberger  3 , Stefanie Wallach  4 , Mary Lagaay  4 , Melanie Punton  4 , Annapoorna Prakash  1 , Mussa Kelvin Nsanya  5 , Philip Ayieko  1   2   5 , Saidi Kapiga  1   5 , Yewande P Ajayi  6 , Emily E Crawford  6 , Eskindir Tenaw  7 , Mohammed Mussa  7 , Som Kumar Shrestha  1 , Christian Bottomley  1   2 , James R Hargreaves  8 , Aoife Margaret Doyle  1   2
Affiliations

Effect and cost-effectiveness of human-centred design-based approaches to increase adolescent uptake of modern contraceptives in Nigeria, Ethiopia and Tanzania: Population-based, quasi-experimental studies

Catarina Krug et al. PLOS Glob Public Health. .

Erratum in

Abstract

Around half of adolescent pregnancies in low- and middle-income countries are unintended, contributing to millions of unsafe abortions per year. Adolescents 360 (A360), a girl-centred initiative, aimed to increase voluntary uptake of modern contraceptives among adolescents in Nigeria, Ethiopia and Tanzania. We evaluated the effectiveness and cost-effectiveness of A360 in increasing modern contraceptive use in selected geographies. We used before-and-after cross-sectional studies of adolescent girls in four settings. Two Nigerian settings had purposefully selected comparison areas. Baseline and endline household surveys were conducted. The primary study outcome was modern contraceptive prevalence rate (mCPR). Secondary outcomes mapped onto the A360 Theory of Change. Interpretation was aided by a process evaluation along with secular mCPR trends and self-reported A360 exposure data. Incremental design and implementation costs were calculated from implementer systems, site visits, surveys, and interviews. mCPR change was modelled into maternal disability-adjusted life years (DALY) averted to calculate incremental cost-effectiveness ratios. In Oromia, Ethiopia, mCPR increased by 5% points (95% CI 1-10; n = 1,697). In Nigeria, there was no evidence of an effect of A360 on mCPR in Nasarawa (risk ratio: 0·96, 95% CI: 0·76-1·21; n = 5,414) or in Ogun (risk ratio: 1·08, 95% CI: 0·92-1·26; n = 3,230). In Mwanza, Tanzania, mCPR decreased by 9% points (-17 to -0.3; n = 1,973). Incremental cost per DALY averted were $30,855 in Oromia, $111,416 in Nasarawa, $30,114 in Ogun, and $25,579 in Mwanza. Costs per DALY averted were 14-53 times gross domestic product per capita. A360 did not lead to increased adolescent use of modern contraceptives at a population level, except in Oromia, and was not cost-effective. This novel adolescent-centred design approach showed some promise in addressing the reproductive health needs of adolescents, but must be accompanied by efforts to address the contextual drivers of low modern contraceptive use.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram.
HH, households, SA, fecund and sexually active girls during the 12 months before the interview.
See this image and copyright information in PMC

References

    1. World Health Organization [WHO]. World Health Organization 2020 [cited 2022 July 1]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/adolescent-pregnancy.
    1. Alano A, Hanson L. Women’s perception about contraceptive use benefits towards empowerment: A phenomenological study in Southern Ethiopia. PloS one 2018; 13 (suppl 9). doi: 10.1371/journal.pone.0203432 - DOI - PMC - PubMed
    1. Gottschalk LB, Ortayli N. Interventions to improve adolescents’ contraceptive behaviors in low-and middle-income countries: a review of the evidence base. Contracept 2014; 90 (suppl 3): 211–25. doi: 10.1016/j.contraception.2014.04.017 - DOI - PubMed
    1. Chandra-Mouli V, Lane C, Wong S. What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices. Global Health: Sci Pract 2015; 3 (suppl 3): 333–40. doi: 10.9745/GHSP-D-15-00126 - DOI - PMC - PubMed
    1. Atchison CJ, Mulhern E, Kapiga S, Nsanya MK, Crawford EE, Mussa M, et al. Evaluating the impact of an intervention to increase uptake of modern contraceptives among adolescent girls (15–19 years) in Nigeria, Ethiopia and Tanzania: the Adolescents 360 quasi-experimental study protocol. BMJ open 2018; 8 (suppl 5). doi: 10.1136/bmjopen-2018-021834 - DOI - PMC - PubMed

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