by Jordan Wingate
This article originally appeared in the School of Social Work 2023 Fall Impact Report.
Researchers from UNC School of Social Work, Muhimbili University of Health and Allied Sciences in Tanzania, and Duke University are working together to ensure young people in East Africa are able to benefit from accessible health services.
Through their collaborative project known as Vijana Tambua Afya, or “youth health check” in Swahili, the research team aims to help teens have early positive experiences with health clinics so that they will seek out services on their own if they need them later in life, especially those at greatest risk of unintended pregnancies or sexually transmitted infections.
The project is funded by an R01 grant from the National Institutes of Health and focuses on bridging partnerships between community health clinics, local schools, parents and local public health agencies. Rather than wait for youth to seek out health services, Vijana Tambua Afya brings entire classrooms of students into clinics for wellness visits.
Thus far, the project has engaged over 1,000 adolescents from 20 primary schools to study how a wellness visit impacts adolescents’ use of health services. To conduct the study, the research team trained more than 60 local health providers to offer wellness clinical visits — including vision, nutrition, dental, and mental health screenings, as well as reproductive health information and services — for adolescents in 10 of the selected schools.
This proactive and preventive intervention flips the traditional health services model by prioritizing adolescent health in low- and middle-income countries, where youth health typically is addressed only after a health issue has emerged. By contrast, Vijana Tambua Afya prioritizes the health of all adolescents up front by working with partner schools to bring these youth to health clinics during their last year of primary school.
“We need to start paying attention to all youth instead of waiting for them to have problems so we can build their confidence engaging with healthcare providers,” said project principal investigator Joy Noel Baumgartner, Ph.D., associate professor and Wallace Kuralt Early Career Distinguished Scholar in the School of Social Work.
Beyond identifying students’ current health issues, the study’s further payoff will come in 30 months, when the research team reconnects with these adolescents to assess whether their clinic visit increased their likelihood of obtaining follow-up care. They will also study whether the clinic visit increased students’ health-promoting behaviors in later adolescence, especially testing for HIV, which is endemic in Tanzania.
The timing of the wellness visit — occurring around age 13 or 14 — is crucial. Not only does universal school enrollment often end after primary school in lower-resource settings, but the end of primary school also often coincides with puberty and risky activities that can lead to unintended pregnancies and sexually transmitted infections.
This school-facilitated, clinic-based visit model required the deep community buy-in that results from long-term commitments founded on collaboration and trust. It helps that Baumgartner and her co-principal investigator Sylvia Kaaya, MD, Ph.D., professor of psychiatry and mental health at Muhimbili University, have collaborated on adolescent-focused and mental health initiatives in Tanzania for over 20 years.
If results of the final follow-up (scheduled for 2025) show that the clinic visits increased adolescents’ use of health services, Baumgartner and Kaaya plan to expand the reach of this intervention to promote a culture of health and autonomy among Tanzania’s youth. Even more broadly, they hope to show the benefits of elevating adolescent health in primary care globally.
“Our work is occurring at an opportune time, policy-wise,” said Kaaya. “With broader adolescent health services now further prioritized in Tanzania’s health agenda, we can look ahead to a preventative health care service platform, too.”
This work has potentially positive implications for adolescent health care in North Carolina and the United States, too. Although many U.S. youth have regular yearly health checkups, they may be less common in communities without the resources or infrastructure to provide them. A school-facilitated health care model may offer a promising strategy for timely, high-impact health check-ups.
THE BIG PICTURE
- Project supported by $3M, 5-year R01 grant from the National Institutes of Health;
- International partnership between UNC School of Social Work and Muhimbili University of Health and Allied Sciences in Tanzania;
- Engaged over 1,000 adolescents in a study cohort from 20 primary schools in Tanzania;
- Trained approximately 60 health providers and school health staff across 10 health facilities in the intervention; and
- Staff and health provider training facilitated by 12 local experts from Tanzania.
To read more articles in the School of Social Work 2023 Fall Impact Report, click here.
