A community-based mentoring scheme for pregnant and parenting adolescents in Sierra Leone: Protocol for a hybrid pilot cluster randomised controlled trial

PLoS One. 2024 Mar 25;19(3):e0294538. doi: 10.1371/journal.pone.0294538. eCollection 2024.

Abstract

Background: Sierra Leone has a very high maternal mortality rate, and this burden falls heavily on adolescents, a particularly vulnerable group; this is usually driven by poverty, lack of education and employment opportunities. In 2017, a local grassroots organisation, Lifeline Nehemiah Projects, developed a community-based mentoring intervention '2YoungLives' (2YLs) for adolescent girls in Eastern Freetown. We aim to formally assess the feasibility and implementation of the 2YL mentorship scheme in new communities in Sierra Leone.

Methods: A hybrid type 2 pilot cluster randomised controlled trial of the 2YL mentoring scheme in urban and rural communities living around twelve peripheral health units (PHU) across five districts in Sierra Leone. Clusters will be matched into pairs and randomisation will be determined by computer-generated random numbers via a secure web-based system hosted by MedSciNet. All under-eighteen adolescents identified as pregnant in the community and/or the PHU are included. Feasibility (recruitment, retention, and attrition rates; data collection and completeness; sample calculation) and primary clinical outcome data (composite of maternal deaths, stillbirths, neonatal deaths) will be collected. A mixed-methods process evaluation will explore implementation outcomes, mechanisms of change, contextual factors, experiences of care, and health and wellbeing. A concurrent cost-consequence analysis will be undertaken. Main trial analysis will be pragmatic, by intention to treat, and a complementary per protocol analysis will also be included.

Discussion: Improving health and wellbeing for adolescent girls (including sexual and reproductive health) remains a top priority in Sierra Leone indicated by several government policies targeted to this group, in which maternal and infant mortality are still persistently high. Supporting these girls and facilitating their wellbeing is imperative, along with sensitisation of communities, strengthening of youth friendly services and collaboration with stakeholders at all levels (government, regional, community, family). We believe 2YL supports the global holistic agenda to integrate and implement interventions across health, education, and social systems in order to protect, nurture, and support the health and development potential of every adolescent girl, and thus become a model of good practice for adolescent pregnancy, to be adopted more widely in Sierra Leone and elsewhere.

Trial registration: ISRCTN registry ISRCTN32414369. Prospectively registered on 14/03/2022.

Publication types

  • Clinical Trial Protocol

MeSH terms

  • Adolescent
  • Female
  • Humans
  • Infant, Newborn
  • Mentoring*
  • Mentors
  • Parenting
  • Pregnancy
  • Pregnancy in Adolescence*
  • Randomized Controlled Trials as Topic
  • Sierra Leone

Grants and funding

This study has undergone full external peer review as part of the funding process. This research is funded by the National Institute for Health and Care Research (NIHR) (ID: NIHR33232) using UK aid from the UK Government to support global health research. JS and CFT are supported by the NIHR Applied Research Collaboration (ARC) South London. JS is a NIHR Senior Investigator and CFT is supported by a NIHR Development and Skills Award (ID: NIHR301603). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Government. The funders have no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.