Cluster randomized evaluation of Adolescent Girls Empowerment Programme (AGEP): study protocol

Abstract

BackgroundAdolescents in less developed countries such as Zambia often face multi-faceted challenges for achieving successful transitions through adolescence to early adulthood. The literature has noted the need to introduce interventions during this period, particularly for adolescent girls, with the perspective that such investments have significant economic, social and health returns to society. The Adolescent Girls Empowerment Programme (AGEP) was an intervention designed as a catalyst for change for adolescent girls through themselves, to their family and community. Methods/designAGEP was a multi-sectoral intervention targeting over 10,000 vulnerable adolescent girls ages 10–19 in rural and urban areas, in four of the ten provinces of Zambia. At the core of AGEP were mentor-led, weekly girls’ group meetings of 20 to 30 adolescent girls participating over two years. Three curricula ― sexual and reproductive health and lifeskills, financial literacy, and nutrition ― guided the meetings. An engaging and participatory pedagogical approach was used. Two additional program components, a health voucher and a bank account, were offered to some girls to provide direct mechanisms to improve access to health and financial services. Embedded within AGEP was a rigorous multi-arm randomised cluster trial with randomization to different combinations of programme arms. The study was powered to assess the impact across a set of key longer-term outcomes, including early marriage and first birth, contraceptive use, educational attainment and acquisition of HIV and HSV-2. Baseline behavioural surveys and biological specimen collection were initiated in 2013. Impact was evaluated immediately after the program ended in 2015 and will be evaluated again after two additional years of follow-up in 2017. The primary analysis is intent-to-treat. Qualitative data are being collected in 2013, 2015 and 2017 to inform the programme implementation and the quantitative findings. An economic evaluation will evaluate the incremental cost-effectiveness of each component of the intervention.DiscussionThe AGEP program and embedded evaluation will provide detailed information regarding interventions for adolescent girls in developing country settings. It will provide a rich information and data source on adolescent girls and its related findings will inform policy-makers, health professionals, donors and other stakeholders.Trial registration ISRCTN29322231. March 04 2016; retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4280-1) contains supplementary material, which is available to authorized users.

The impact of the Adolescent Girls Empowerment Program (AGEP) on short and long term social, economic, education and fertility outcomes: a cluster randomized controlled trial in Zambia

“…Adolescent girls 1 in Zambia face risks and vulnerabilities that challenge their healthy development into young women including early marriage and childbearing, sexual-and gender-based violence, unwanted pregnancy and the acquisition of HIV and other sexuallytransmitted infections [1]. As indicated by the 2013-2014 Zambia Demographic and Health Survey (DHS) data, nearly one in three girls aged 20-24 had married by age 18, with a similar percentage having begun childbearing [2].…”

Transitions to adulthood and the changing body mass index of adolescent girls in Zambia

“…Adolescents’ anthropometric data were also collected. Further details on AGEP, its evaluation design, and the embedded nutritional education intervention are reported elsewhere …”

A comment on the state of research into women’s empowerment and family planning

“…In fact, a search of trial registries indicates that there are at least some RCTs currently underway. For example, the evaluation of adolescent girls empowerment program (AGEP) in Zambia is testing the effectiveness of different empowerment interventions on a range of outcomes including knowledge about and use of contraceptives, experiencing wanted and unwanted pregnancy, and a host of other outcomes (Hewett, et al, 2017). The outcome of this trial is not yet known as it is ongoing; furthermore, it concentrates on a tightly defined population (adolescent girls aged 10-19 in four provinces of Zambia), meaning that its success or otherwise is just the first step towards being able to quantify the relationship between empowerment and family planning.…”