Over the past year, I have been a student on the Masters in International Public Health. It was an enlightening and rewarding experience; from the didactic lectures delivered by seasoned experts in research and various fields of public health to the group work and interactive learning from experienced colleagues from all over the world, my postgraduate year was a total learning package. The highlight of the year however was writing my dissertation. I had the distinct privilege of working with Dr Charles Ameh of the Centre for Maternal and Newborn Health as my supervisor on my dissertation which focused on assessing the utilisation of maternal health services (MHS) by adolescent mothers in Kenya. The topic piqued my interest based on my previous experience working in adolescent reproductive health in Nigeria, with the Lagos State Adolescent Youth Friendly Centre (Hello Lagos).
Evidence shows that globally, the second leading cause of death among girls aged 15-19 years old is complications during pregnancy and childbirth. Earlier estimates in year 2000 suggest that adolescents aged 15-19years old have double the risk of dying during childbirth as older women 20-24 years old. More recently however, estimates from 144 countries showed that though the risk is higher among adolescents, it is not quite as high as was previously estimated. The solution put forward for this is the utilisation of maternal health services (MHS) across the continuum of care (antenatal, delivery (by skilled birth attendant) and postnatal) which has been shown to reduce pregnancy-related illness and maternal death of adolescent mothers.
Based on this, we aimed to characterize Kenyan adolescent mothers, find out who they are, their socio-demographics, what is their pattern of utilization of MHS in comparison with older mothers aged 20 to 49 years and what factors influence their utilization of MHS. To achieve this, initial questions raised were “Who had done this or any similar work before and how did they do it? and “Where do you get relevant, robust and good quality data?” These questions led us to conducting a systematic review on studies done to assess MHS utilisation by adolescent mothers in developing countries and make consultations with key stakeholders in adolescent health in Kenya. Both activities provided a plethora of information on how we moved forward. First, in terms of data source, there really are only two options: collect primary data in the form of a survey or leverage existing secondary data.
Effort required for primary data collection were at the least colossal. Aside from the huge cost and logistics of collecting data from a nationally representative sample, adolescent mothers are difficult to reach, not unconnected to the fact that the issue of adolescents getting pregnant remains a culturally complex one in many developing countries and as such capacity to survey sufficiently large numbers for sensible analysis may be further complicated.
Secondary data on the other hand revealed a different set of challenges. What pre-existing comprehensive and nationally representative dataset would contain all the information about adolescent mothers and their MHS utilization? And how do you assure its quality? From my systematic review, the answer to this for most studies was the demographic health surveys (DHS). Data collection processes for DHS are generally deemed as robust and of good quality.
With permission from Measure DHS, we used data from the Kenyan Demographic Health Survey 2008/2009 with which we were able to achieve all objectives of the study. I had the opportunity to put the nascent quantitative research skills just acquired over the previous weeks into the dissertation project, with unflinching support from my supervisor and members of the faculty at the Liverpool School of Tropical Medicine. The result of the months of intensive research was a scholarly work that extended the discussion on adolescent MHS utilisation forward in a new way, providing evidence that may be critical in the post-2015 era, when the United Nations has declared that “no one will be left behind”, including adolescent mothers. Two major outputs of the research are a systematic review which can be viewed as a ‘one-stop shop’ for researchers, policy makers and non-profit programme managers to understand adolescent MHS utilisation, particularly vulnerable adolescents in Low and Middle Income Countries and the most up-to-date analysis of adolescent maternal health service utilisation in Kenya which will be essential in policy and programmatic choices in the country going forward.
For my dissertation, I was scored a distinction mark and subsequently awarded the prestigious Liverpool School of Tropical Medicine’s Ken Newell bursary award, which is a prize given “to exceptional students studying on LSTM’s Masters in International Public Health” to support dissemination of my research findings in international peer reviewed journals.
I ‘walked’ into my first lecture September 2014 naïve as regards what the year had in store. However, through it all, I ‘worked’ hard during my time at LSTM and indeed my post-graduate experience was an unforgettable one!! Now I am “waltzing” out into the real world, armed with core knowledge of a plethora of key theoretical concepts, expanded research capacity, improved fund-raising, programmatic and policy-making skills as well as a wider network of future public health experts (My many colleagues and friends from all over the world! J). I would surely recommend LSTM for young public health professionals, particularly those interested in maternal and newborn health like me. My own experience made a world of difference!!
About the author
Dr Oluwasola Banke-Thomas is a Nigerian trained medical doctor. She recently completed her Masters in International Public Health with distinction at LSTM. Her dissertation focused on understanding utilisation of maternal health services of Kenyan adolescent mothers, under the supervision of CMNH's Dr Charles Ameh. She was awarded the Ken Newell bursary to support the publication of her research findings in peer-reviewed journals