Adolescent Pregnancy and its Determinants in Burera District, Northern Rwanda, and Nyarugenge District, Kigali City, Rwanda

Diplôme Thèse Adolescent Pregnancy and its Determinants in Burera District, Northern Rwanda, and Nyarugenge District, Kigali City, Rwanda eng 2026-01-20 2026-01-20 author Isano Sandra 405424 director Blanchet Karl 0000-0003-0498-8020 932568 Geneva Centre of Humanitarian Studies (MCERA) 150 10.13097/archive-ouverte/unige:191914 urn:nbn:ch:unige-1919141 Sc. Bioméd. - S. Glob. 061 Adolescent pregnancy remains a significant public health and socio-economic challenge in sub-Saharan Africa, including Rwanda. It increases risks of maternal morbidity and mortality, obstetric complications, and poor neonatal outcomes. Beyond health effects, it disrupts education, limits economic opportunities, and reinforces poverty and gender inequality. It is shaped by structural and social factors, including limited access to sexual and reproductive health (SRH) information and services, poverty, restrictive gender norms, and power imbalances. Despite progress in reproductive health, disparities persist, especially in rural areas. This dissertation applies a multi-level framework to examine individual, interpersonal, community, health system, and structural determinants of adolescent pregnancy in Rwanda. The research comprised four papers. Paper I was a systematic review and meta-analysis of adolescent pregnancy in East Africa, focusing on structural drivers such as low education and poverty. Paper II used a mixed-methods design in Burera (rural) and Nyarugenge (urban). A cross-sectional survey of 441 girls aged 12–19 years was analyzed using descriptive statistics and logistic regression. Paper III used a phenomenological approach with 20 in-depth interviews to explore adolescent mothers’ lived experiences. Paper IV surveyed healthcare providers to assess SRH service accessibility and barriers. The review estimated a pooled prevalence of 23.6% across East Africa. In Rwanda, survey prevalence was 12.7%, higher in rural Burera. Protective factors included secondary education, delayed sexual debut, and access to SRH education. Risk factors included poverty, parental unemployment, and limited decision-making power. Qualitative findings highlighted limited SRH knowledge, early sexual initiation, coercion by older partners, weak parental guidance, peer pressure, stigma, and restrictive gender norms. Access to adolescent-friendly services was constrained by confidentiality concerns and limited availability, particularly in rural areas and for abortion care and HIV self-testing. Economic hardship and unequal access to education further increased vulnerability. Despite challenges, adolescent mothers showed resilience and aspirations for education and economic independence. Providers noted general service availability but emphasized urban–rural disparities and ongoing access barriers. Adolescent pregnancy Disparities Rural-Urban Rwanda Dewey 613 66 Institut de santé globale 22A1 false dffb6689-c602-4f71-b44b-ff97c4de0a02 Thesis Public PhD_Dissertation_Sandra_Isano__FINA.pdf 15879018 application/pdf 0a75db5eb32061c6a9be992004a055a3093f479e8a1044aed79aac7f0dca24cc e9ef3ad5-4c70-4299-8734-0bdebd745b50 Imprimatur Public Imprimatur_SI_AG.pdf 176792 application/pdf 398befc52a134cee7080ede58f135da2ea06b79dfdeb54d7951fff94eb791191 openAccess Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de santé globale

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Adolescent Pregnancy and its Determinants in Burera District, Northern Rwanda, and Nyarugenge District, Kigali City, Rwanda				2026	15	54

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