Prevalence of adolescent mental disorders in Kenya, Indonesia, and Viet Nam measured by the National Adolescent Mental Health Surveys (NAMHS): a multi-national cross-sectional study.

BACKGROUND: Mental disorders are the leading global cause of health burden among adolescents. However, prevalence data for mental disorders among adolescents in low-income and middle-income countries are scarce with often limited generalisability. This study aimed to generate nationally representative prevalence estimates for mental disorders in adolescents in Kenya, Indonesia, and Viet Nam. METHODS: As part of the National Adolescent Mental Health Surveys (NAMHS), a multinational cross-sectional study, nationally representative household surveys were conducted in Kenya, Indonesia, and Viet Nam between March and December, 2021. Adolescents aged 10-17 years and their primary caregiver were interviewed from households selected randomly according to sampling frames specifically designed to elicit nationally representative results. Six mental disorders (social phobia, generalised anxiety disorder, major depressive disorder, post-traumatic stress disorder, conduct disorder, and attention-deficit hyperactivity disorder) were assessed with the Diagnostic Interview Schedule for Children, Version 5. Suicidal behaviours and self-harm in the past 12 months were also assessed. Prevalence in the past 12 months and past 4 weeks was calculated for each mental disorder and collectively for any mental disorder (ie, of the six mental disorders assessed). Prevalence of suicidal behaviours (ie, ideation, planning, and attempt) and self-harm in the past 12 months was calculated, along with adjusted odds ratios (aORs) to show the association with prevalence of any mental disorder in the past 12 months. Inverse probability weighting was applied to generate national estimates with corresponding 95% CIs. FINDINGS: Final samples consisted of 5155 households (ie, adolescent and primary caregiver pairs) from Kenya, 5664 households from Indonesia, and 5996 households from Viet Nam. In Kenya, 2416 (46·9%) adolescents were male and 2739 (53·1%) were female; in Indonesia, 2803 (49·5%) adolescents were male and 2861 (50·5%) were female; and in Viet Nam, 3151 (52·5%) were male and 2845 (47·4%) were female. Prevalence of any mental disorder in the past 12 months was 12·1% (95% CI 10·9-13·5) in Kenya, 5·5% (4·3-6·9) in Indonesia, and 3·3% (2·7-4·1) in Viet Nam. Prevalence in the past 4 weeks was 9·4% (8·3-10·6) in Kenya, 4·4% (3·4-5·6) in Indonesia, and 2·7% (2·2-3·3) in Viet Nam. The prevalence of suicidal behaviours in the past 12 months was low in all three countries, with suicide ideation ranging from 1·4% in Indonesia (1·0-2·0) and Viet Nam (1·0-1·9) to 4·6% (3·9-5·3) in Kenya, suicide planning ranging from 0·4% in Indonesia (0·3-0·8) and Viet Nam (0·2-0·6) to 2·4% (1·9-2·9) in Kenya, and suicide attempts ranging from 0·2% in Indonesia (0·1-0·4) and Viet Nam (0·1-0·3) to 1·0% (0·7-1·4) in Kenya. The prevalence of self-harm in the past 12 months was also low in all three countries, ranging from 0·9% (0·6-1·3) in Indonesia to 1·2% (0·9-1·7) in Kenya. However, the prevalence of suicidal behaviours and self-harm in the past 12 months was significantly higher among those with any mental disorder in the past 12 months than those without (eg, aORs for suicidal ideation ranged from 7·1 [3·1-15·9] in Indonesia to 14·7 [7·5-28·6] in Viet Nam). INTERPRETATION: NAMHS provides the first national adolescent mental disorders prevalence estimates for Kenya, Indonesia, and Viet Nam. These data can inform mental health and broader health policies in low-income and middle-income countries. FUNDING: The University of Queensland in America (TUQIA) through support from Pivotal Ventures, a Melinda French Gates company.

"I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls.

BACKGROUND: While the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15-19 in two Kenya counties with the highest rate of teenage pregnancy. METHODS: We used the "In Their Hands" (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls' reasons for having unintended pregnancy. RESULTS: Overall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22-2.20), had primary or no formal education (AOR 1.50 95% CI 1.11-2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25-2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies. CONCLUSION: A massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.

RéSUMé: CONTEXTE: Alors que le gouvernement kenyan déploie des stratégies de haut niveau pour mettre fin aux grossesses chez les adolescentes d'ici 2030, il est nécessaire de bien cerner les facteurs qui favorisent les grossesses précoces non planifiées dans le pays. Dans cette étude, nous déterminons la prévalence, les facteurs associés et les causes des grossesses non planifiées chez les adolescentes sexuellement actives (âgées de 15 à 19 ans) dans deux comtés du Kenya où le taux de grossesse adolescente est le plus élevé. MéTHODOLOGIE: Nous avons utilisé les données d'évaluation de base du programme « In Their Hands ¼ (ITH). L'étude a adopté une approche mixte comprenant 1110 adolescentes sexuellement actives dans la composante quantitative et 19 adolescentes enceintes ou allaitantes dans la composante qualitative. Nous avons utilisé une régression logistique ajustée et non ajustée pour modéliser les facteurs associés à une grossesse non planifiée chez les répondantes. Pour ce qui est des données qualitatives, nous avons procédé à une analyse thématique afin d'examiner les facteurs expliquant les grossesses non planifiées chez les filles. RéSULTATS: Globalement, 42 % des répondantes ont vécu une grossesse non planifiée ; toutefois, des proportions plus élevées ont été observées chez les filles âgées de 19 ans (49,4 %), celles doublement orphelines (53,6 %), celles qui n'ont jamais utilisé de moyens contraceptifs (49,9 %), celles non scolarisées (53,8 %) et chez celles qui étaient mariées (55,6 %). Après ajustement des covariables pertinentes, les probabilités de grossesse non planifiée étaient plus élevées chez les filles qui résidaient dans des zones rurales (AOR:1,64, IC 95%:1,22-2,20), avaient un niveau d'éducation primaire ou aucune éducation formelle (AOR:1,50 IC 95%:1,11-2,02), et n'avaient jamais utilisé de contraceptifs (AOR:1,69 IC 95%-1,25-2,29) par rapport à leurs congénères. La fréquentation scolaire actuelle était associée à une réduction de 66 % de la probabilité d'être confrontée à une grossesse non planifiée. Les participantes à l'étude qualitative ont déclaré que le désir d'entretenir une relation, une mauvaise connaissance des contraceptifs, de fausses informations sur les effets secondaires des contraceptifs et le manque de mentors de confiance étaient les principales raisons de leurs grossesses non planifiées. CONCLUSION: Un lourd fardeau lié aux grossesses non désirées existe parmi les adolescentes sexuellement actives de la zone étudiée. Les adolescents, garçons et filles, doivent avoir un meilleur accès à l'éducation sexuelle et aux contraceptifs dans la zone étudiée afin de réduire les grossesses non planifiées précoces.