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      Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort

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          Abstract

          The Sustainable Development Goals (SDGs) are a visionary and multi-sectoral agenda for human development. With less than a decade left to reach these targets, it is important to identify those at greatest risk of not meeting these ambitious targets. Adolescent mothers and their children are a highly vulnerable group. We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Questionnaires using validated scales were completed by 10- to 24-year-old adolescent girls and young women who had their first child before age 20 in an HIV-endemic district in the Eastern Cape province of South Africa. Maternal outcomes included 26 SDG-aligned indicators, while child-related outcomes included 9 indicators. Data was collected by trained researchers, following informed voluntary consent by the adolescent mothers and their caregivers. Frequencies and chi-square tests were conducted to compare progress along SDG-aligned indicators among adolescent mothers by HIV status. Overall, adolescent mothers reported low attainment of SDG-aligned indicators. While four in five adolescent mothers lived in poor households, nearly 93% accessed at least one social cash transfer and 80% accessed a child support grant for their children. Food security rates among adolescent mothers (71%) were lower than among their children (91%). Only two-thirds of adolescent mothers returned to school after childbirth, and only one-fifth were either studying or employed. Over half of adolescent mothers had experienced at least one type of violence (domestic, sexual or community). HIV-positive status was associated with higher rates of hunger and substance use, poorer school attendance, and higher rates of exposure to violence. Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs.

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            Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study.

            Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors. We carried out a retrospective cohort study of 3,886,364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States. All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results. Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.
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              Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration).

              Both young and advanced maternal age is associated with adverse birth and child outcomes. Few studies have examined these associations in low-income and middle-income countries (LMICs) and none have studied adult outcomes in the offspring. We aimed to examine both child and adult outcomes in five LMICs.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysis
                Role: Data curationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Formal analysis
                Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                8 December 2022
                2022
                : 17
                : 12
                : e0278163
                Affiliations
                [1 ] Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
                [2 ] Department of Sociology, University of Cape Town, Cape Town, South Africa
                [3 ] Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
                [4 ] Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
                [5 ] Institute for Global Health, University College London, London, United Kingdom
                [6 ] Department of Statistics, University of Leeds, Leeds, United Kingdom
                [7 ] Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
                [8 ] Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
                Medical Research Council, SOUTH AFRICA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-3800-3173
                https://orcid.org/0000-0002-5040-0905
                https://orcid.org/0000-0001-8828-5685
                https://orcid.org/0000-0002-6449-9838
                Article
                PONE-D-22-08959
                10.1371/journal.pone.0278163
                9731463
                36480550
                31bf526b-6cac-4a0b-ab65-8339dd5a402b
                © 2022 Toska et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 March 2022
                : 11 November 2022
                Page count
                Figures: 0, Tables: 2, Pages: 13
                Funding
                Funded by: UK Medical Research Council (MRC)
                Funded by: UK Department for International Development (DFID)
                Funded by: National Institutes of Health Research (NIHR)
                Award ID: MR/R022372/1
                Funded by: European Research Council (ERC)
                Award ID: European Union’s Horizon 2020 research and innovation programme (n° 771468)
                Funded by: UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub
                Award ID: ES/S008101/1
                Funded by: Fogarty International Center, National Institute on Mental Health, National Institutes of Health
                Award ID: K43TW011434
                Funded by: funder-id http://dx.doi.org/10.13039/501100007936, International AIDS Society;
                Award ID: 2018/625-TOS
                Funded by: Research England
                Award ID: 0005218
                Funded by: UNICEF Eastern and Southern Africa Regional Office (UNICEF-ESARO)
                Funded by: Economic Social Research Council PhD studentships
                Award ID: ES/R501037/1
                Award Recipient :
                Funded by: Economic Social Research Council PhD studentships
                Award ID: UBEL-DTP (UK) KR0001
                Award Recipient :
                The HEY BABY study was jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, and by the Department of Health Social Care (DHSC) through its National Institutes of Health Research (NIHR) [MR/R022372/1]; the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (n° 771468); the UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (Grant Ref: ES/S008101/1); the Fogarty International Center, National Institute on Mental Health, National Institutes of Health under Award Number K43TW011434, the content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health; a CIPHER grant from International AIDS Society [2018/625-TOS], the views expressed do not necessarily reflect the official policies of the International AIDS society; Research England [0005218] and UNICEF Eastern and Southern Africa Regional Office (UNICEF-ESARO) KJR and JJ are funded by Economic Social Research Council PhD studentships [JJ: ES/R501037/1, KR through UBEL-DTP (UK) KR0001]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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                All research data will be made available on request subject to participant consent and having completed all necessary documentation. All data requests should be sent to acceleratehub@ 123456uct.ac.za or to the Principal Investigators ( https://www.heybaby.org.za/contact).

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