Reaching adolescents with health services: a multi-country study of adolescent health check-ups in low and middle-income countries (Y-Check study)
Many young people in low-and-middle income countries (LMICs) go through adolescence without ever receiving preventive or promotive health services. Those who do, often do so late due to multiple barriers, including lack of money for transport and payment of health services, needing permission from an adult or unwillingness to disclose health concerns to health workers, lack of health equipment and lack of trained staff. This is a missed opportunity for health services to identify and treat issues early, and for adolescents to develop positive health care seeking behaviours. WHO provides clear, evidence-based guidance for national public health systems to provide routine health check-ups for children and older persons. However, this is lacking especially for adolescents in LMICs and is not clear of the content, frequency, best delivery approach and its effectiveness. To address this, the Y-Check intervention aims to provide and evaluate health-check-up services in adolescents.
To develop and evaluate an intervention programme to screen and treat or refer adolescents aged 10-19 years for a range of common conditions using routine health check-ups in three LMIC urban contexts (Chitungwiza-Zimbabwe; Mwanza-Tanzania; and Cape Coast-Ghana).
Phase 1: Formative research was conducted between 2020 and 2021 to co-create the intervention with adolescents, parents, teachers, service providers and national policy makers. This included defining the content and delivery strategies for the health check-ups in adolescents. Stakeholders supported the idea of providing routine health check-ups for adolescents and proposed venues to conduct these check-ups (schools and community venues), health conditions to check for and advised that counselling and family planning be included in the intervention.
Phase 2: During this current phase, implementation research will be conducted to rigorously evaluate the feasibility, acceptability, coverage, fidelity, and yield of previously undiagnosed conditions. We will also determine the cost of the health check-ups, linked where necessary, to on-the-spot treatment, counselling or advice and/or supported referral to specialist or longer-term care. In Tanzania, the intervention will be implemented in Nyamagana and Ilemela districts in Mwanza city in primary and secondary schools and selected community venues. There will be an initial check-up and follow up after 4 months. It will target younger adolescents around puberty onset (10-14 years), and older adolescents when many become sexually active (15-19 years).
Phase 3: If supported by phase 2 findings, a cluster randomised controlled trial will be conducted to evaluate the population-based coverage of the adolescent health and wellbeing check-ups that can be achieved in a routinely-delivered programme, their cost and health impact.
Multi-country Chief Investigator: World Health Organisation (WHO), Switzerland: Prerna Banati
MITU, Tanzania/National Institute for Medical Research, Tanzania: Gerry Mshana, Mwita Wambura; London School of Hygiene & Tropical Medicine (LSHTM), UK: Helen Weiss, Aoife Doyle; University of Ghana School of Public Health, Ghana: Ben Weobong, Franklin Glozah; Biomedical Research and Training Institute, Zimbabwe: Grace McHugh; LSHTM,UK/BRTI, Zimbabwe: Rashida Ferrand; WHO, Switzerland: Valentina Baltag; Independent Consultant: David Ross