Factors associated with school dropout and sexual and reproductive health: a cross-sectional analysis among out-of-school girls in western Kenya.

Introduction: Out-of-school girls are at higher risk of sexual and reproductive health (SRH) harms. Schools provide a protective environment for adolescents and lessen their exposure to such risks. This paper explores factors associated with school dropout, sexual activity, marriage and pregnancy among out-of-school girls in western Kenya. Methods: Eligible adolescents were systematically recruited from area households in Siaya County. Generalised linear models were fit to obtain adjusted ORs (aOR) and 95% CIs of key covariates against individual outcomes. Factors with p values <0.1 in the univariate analysis were added to a multivariable model using backward stepwise regression techniques, and factors significant at p<0.05 were retained in the final adjusted models. Models were bootstrapped at 1000 replications to validate factor selection. Results: Of the 915 girls enrolled (mean 18.3 years, SD: 1.3), 2.1% had never attended school. Of those who started school, 34.6% dropped out during primary education. Reasons for dropout included marriage, pregnancy and needing childcare (42.5%), financial reasons (eg, lack of school fees, needing to work, 42.5%), lack of interest (5.6%), illness (3.0%), failing school (2.2%) and other factors (4.1%). Reaching menarche prior to age 13 (aOR 1.50, 95% CI 1.00 to 2.23, p=0.048), experiencing physical violence (aOR 1.48, 95% CI 1.01 to 2.17, p=0.042) or sexual partner violence (aOR 2.16, 95% CI 1.08 to 4.34, p=0.030) were associated with not completing primary school. Experiencing sexual harassment (aOR 2.20, 95% CI 1.35 to 3.58, p=0.002) or needing to engage in transactional sex (aOR 1.74, 95% CI 1.20 to 2.51, p=0.003) were associated with being sexually active. Low socioeconomic status (aOR 1.98, 95% CI 1.36 to 2.90, p<0.001), having an older partner (aOR 1.65, 95% CI 1.10 to 2.47, p=0.016) and higher parity (aOR 2.56, 95% CI 1.42 to 4.62, p=0.002) were associated with being married or cohabiting with a partner. Girls identified provision of school fees and schooling items (67.9%) as the primary solution to resuming school; obtaining counselling, mentorship and support services (22.2%) for their general health; and provision of menstrual products (24.2%) for daily challenges. Conclusions: Out-of-school girls in western Kenya face numerous SRH challenges related to menstruation, sexual and physical violence, and poverty. Social and financial support and interventions for school re-entry are warranted for this neglected population. National policies and multisectoral strategies to support adolescent girls' education and health should be prioritised, enforced and monitored for impact.