Peer-reviewed article
Examining the recent trends in adolescent sexual and reproductive health in five countries of sub-Saharan Africa based on PMA and DHS household surveys.
Rornald Muhumuza Kananura, Peter Waiswa, Dessalegn Y Melesse, Cheikh Faye, Ties Boerma ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines trends in adolescent sexual and reproductive health among girls aged 15-19 in five sub-Saharan African countries using Performance Monitoring and Accountability (PMA) surveys and Demographic and Health Surveys (DHS). Researchers compared data on sexual behaviour, marriage, pregnancy, and contraceptive use across Ethiopia, Ghana, Kenya, Nigeria, and Uganda. The study finds that PMA surveys are reliable for tracking adolescent reproductive health trends, despite some statistical differences with DHS data. Overall, the analysis shows slow progress in improving adolescent reproductive health outcomes across these countries, with significant disparities between nations.
Key points
- PMA and DHS survey methodologies were similar with minimal impact on indicator values where differences existed
- Statistically significant differences appeared in 12 of 20 comparisons, most common for sexual behaviour indicators (4/5 countries) and least for contraceptive use (2/5 countries)
- Time trends were consistent between annual PMA surveys in Ethiopia, Kenya, and Nigeria but less consistent in Ghana and Uganda
- Both surveys revealed slow progress in adolescent reproductive health indicators with major disparities between countries
- PMA surveys are considered a valuable data source for monitoring levels and trends of adolescent fertility, marriage, and sexual behaviour in sub-Saharan Africa
Limitations
This is a methodological assessment of survey consistency rather than an evaluation of outcomes or interventions, so it cannot tell us what actually improves adolescent reproductive health or which programmes work. The study focuses only on girls aged 15-19 and does not examine boys or younger adolescents.
Abstract
BACKGROUND: The annual collection of fertility, marriage, sexual behaviour, and contraceptive use data in the nationally representative rounds of Performance Monitoring and Accountability (PMA) surveys in sub-Saharan Africa may contribute to the periodic monitoring of adolescent sexual and reproductive health (ASRH). However, we need to understand the reliability of these data in monitoring the ASRH indicators. We assessed the internal and external consistencies in ASRH indicators in five countries. METHODS: We included countries with at least three nationally representative rounds of PMA surveys and two recent DHS: Ethiopia, Ghana, Kenya, Nigeria, and Uganda. Our analysis focused on four current status indicators of ASRH among girls 15-19 years: ever had sex, currently married, has given birth or currently pregnant, and currently using modern contraceptives among sexually active unmarried girls. We compared the PMA survey and DHS data and tested for statistical significance and assessed trends over time using Jonckheere-Terpstra test statistic. RESULTS: PMA and DHS survey methodologies were similar and, where there were differences, these were shown to have minimal impact on the indicator values. The comparison of the data points from PMA and DHS for the same years showed statistically significant differences in 12 of the 20 comparisons, which was most common for sexual behaviour (4/5) and least for contraceptive use (2/5). This is partly due to larger confidence intervals in both surveys. The time trends were consistent between the annual PMA surveys in most instances in Ethiopia, Kenya, and Nigeria but less so for Ghana and Uganda. However, both surveys highlight slow progress in adolescent and reproductive health indicators with major disparities between the countries. CONCLUSIONS: Despite the differences between PMA 2020 surveys and DHS surveys conducted in the same year, and inconsistencies of the PMA survey time series for several indicators in some countries, we found no systematic issues with PMA surveys and consider PMA surveys a valuable data source for the assessment of levels and trends of ASRH beyond contraceptive use and family planning for indicators of fertility, marriage, and sex among adolescent girls in sub-Saharan Africa.