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Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi

BACKGROUND: School dropout has been linked to early pregnancy and marriage but less is known about the effect of school performance. We aimed to assess whether school performance influenced age at sexual debut, pregnancy and marriage, and from what age school drop-out and performance were associated...

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Autores principales: Glynn, Judith R., Sunny, Bindu S., DeStavola, Bianca, Dube, Albert, Chihana, Menard, Price, Alison J., Crampin, Amelia C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951561/
https://www.ncbi.nlm.nih.gov/pubmed/29758040
http://dx.doi.org/10.1371/journal.pone.0196041
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author Glynn, Judith R.
Sunny, Bindu S.
DeStavola, Bianca
Dube, Albert
Chihana, Menard
Price, Alison J.
Crampin, Amelia C.
author_facet Glynn, Judith R.
Sunny, Bindu S.
DeStavola, Bianca
Dube, Albert
Chihana, Menard
Price, Alison J.
Crampin, Amelia C.
author_sort Glynn, Judith R.
collection PubMed
description BACKGROUND: School dropout has been linked to early pregnancy and marriage but less is known about the effect of school performance. We aimed to assess whether school performance influenced age at sexual debut, pregnancy and marriage, and from what age school drop-out and performance were associated with these later life events. METHODS: Data from 2007–2016 from a demographic surveillance site in northern Malawi with annual updating of schooling status and grades, and linked sexual behaviour surveys, were analysed to assess the associations of age-specific school performance (measured as age-for-grade) and status (in or out of school) on subsequent age at sexual debut, pregnancy and marriage. Landmark analysis with Cox regression was used to estimate hazard ratios of sexual debut, pregnancy and marriage by schooling at selected (landmark) ages, controlling for socio-economic factors. RESULTS: Information on at least one outcome was available for >16,000 children seen at ages 10–18. Sexual debut was available on a subset aged ≥15 by 2011. For girls, being out of school was strongly associated with earlier sexual debut, pregnancy and marriage. For example, using schooling status at age 14, compared to girls in primary, those who had dropped out had adjusted hazard ratios of subsequent sexual debut, pregnancy and marriage of 5.39 (95% CI 3.27–8.86), 2.39 (1.82–3.12), and 2.76 (2.08–3.67) respectively. For boys, the equivalent association with sexual debut was weak, 1.92 (0.81–4.55), but that with marriage was strong, 3.74 (2.28–6.11), although boys married later. Being overage-for-grade was not associated with sexual debut for girls or boys. For girls, being overage-for-grade from age 10 was associated with earlier pregnancy and marriage (e.g. adjusted hazard ratio 2.84 (1.32–6.17) for pregnancy and 3.19 (1.47–6.94) for marriage, for those ≥3 years overage compared to those on track at age 10). For boys, overage-for-grade was associated with earlier marriage from age 12, with stronger associations at older ages (e.g. adjusted hazard ratio 2.41 (1.56–3.70) for those ≥3 years overage compared to those on track at age 14). For girls ≥3 years overage at age 14, 39% were pregnant before they were 18, compared to 18% of those who were on track. The main limitation was the use of reported ages of sexual debut, pregnancy and marriage. CONCLUSIONS: School progression at ages as young as 10 can predict teenage pregnancy and marriage, even after adjusting for socio-economic factors. Early education interventions may reduce teenage pregnancy and marriage as well as improving learning.
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spelling pubmed-59515612018-05-25 Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi Glynn, Judith R. Sunny, Bindu S. DeStavola, Bianca Dube, Albert Chihana, Menard Price, Alison J. Crampin, Amelia C. PLoS One Research Article BACKGROUND: School dropout has been linked to early pregnancy and marriage but less is known about the effect of school performance. We aimed to assess whether school performance influenced age at sexual debut, pregnancy and marriage, and from what age school drop-out and performance were associated with these later life events. METHODS: Data from 2007–2016 from a demographic surveillance site in northern Malawi with annual updating of schooling status and grades, and linked sexual behaviour surveys, were analysed to assess the associations of age-specific school performance (measured as age-for-grade) and status (in or out of school) on subsequent age at sexual debut, pregnancy and marriage. Landmark analysis with Cox regression was used to estimate hazard ratios of sexual debut, pregnancy and marriage by schooling at selected (landmark) ages, controlling for socio-economic factors. RESULTS: Information on at least one outcome was available for >16,000 children seen at ages 10–18. Sexual debut was available on a subset aged ≥15 by 2011. For girls, being out of school was strongly associated with earlier sexual debut, pregnancy and marriage. For example, using schooling status at age 14, compared to girls in primary, those who had dropped out had adjusted hazard ratios of subsequent sexual debut, pregnancy and marriage of 5.39 (95% CI 3.27–8.86), 2.39 (1.82–3.12), and 2.76 (2.08–3.67) respectively. For boys, the equivalent association with sexual debut was weak, 1.92 (0.81–4.55), but that with marriage was strong, 3.74 (2.28–6.11), although boys married later. Being overage-for-grade was not associated with sexual debut for girls or boys. For girls, being overage-for-grade from age 10 was associated with earlier pregnancy and marriage (e.g. adjusted hazard ratio 2.84 (1.32–6.17) for pregnancy and 3.19 (1.47–6.94) for marriage, for those ≥3 years overage compared to those on track at age 10). For boys, overage-for-grade was associated with earlier marriage from age 12, with stronger associations at older ages (e.g. adjusted hazard ratio 2.41 (1.56–3.70) for those ≥3 years overage compared to those on track at age 14). For girls ≥3 years overage at age 14, 39% were pregnant before they were 18, compared to 18% of those who were on track. The main limitation was the use of reported ages of sexual debut, pregnancy and marriage. CONCLUSIONS: School progression at ages as young as 10 can predict teenage pregnancy and marriage, even after adjusting for socio-economic factors. Early education interventions may reduce teenage pregnancy and marriage as well as improving learning. Public Library of Science 2018-05-14 /pmc/articles/PMC5951561/ /pubmed/29758040 http://dx.doi.org/10.1371/journal.pone.0196041 Text en © 2018 Glynn et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Glynn, Judith R.
Sunny, Bindu S.
DeStavola, Bianca
Dube, Albert
Chihana, Menard
Price, Alison J.
Crampin, Amelia C.
Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi
title Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi
title_full Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi
title_fullStr Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi
title_full_unstemmed Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi
title_short Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi
title_sort early school failure predicts teenage pregnancy and marriage: a large population-based cohort study in northern malawi
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951561/
https://www.ncbi.nlm.nih.gov/pubmed/29758040
http://dx.doi.org/10.1371/journal.pone.0196041
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