¹Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
²Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
³Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa
⁴Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States
⁵Institute for Global Health, University College London, London, United Kingdom

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Introduction: Healthcare for adolescents in low-income countries receives little attention despite their growing population share, significant health challenges and the critical role of youth in shaping future health outcomes. Current research remains largely cross-sectional, despite the rapid changes seen in adolescence, limiting capacity to assess causal processes relating to care need and use. We therefore used longitudinal data to examine adolescent healthcare use in rural Burkina Faso, to identify potential gaps in service delivery and thus targets for intervention.

Methods: We analyzed healthcare needs and access among adolescents aged 12-20 in a two-round population-representative cohort in rural Burkina Faso in 2017-2018. Outcomes were healthcare need and level of unmet need. Key predictors were education, wealth, age, sexual activity, injury, pregnancy, and experiences of bullying or violence. We used regression models with individual fixed-effects to account for time-invariant characteristics and isolate time-varying effects.

Results: Around half of 1271 adolescents reported healthcare need at each wave. 766 visits to a healthcare provider have been reported in wave 1 of questioning. 66.8% of all visits were to a clinic, 15.0% to a hospital and 18.1% to a traditional healer. The most common reasons for using healthcare services were mainly acute care like the treatment of malaria, injuries, stomach pain or headaches, followed by maternal and childcare.

Higher education was associated with reduced healthcare need (Odds Ratio [OR] 0.78; 95% Confidence Interval [CI]: 0.64–0.97), while acute events like injuries (OR 7.93; 95% CI: 3.18–19.76) and bullying (OR 1.81; 95% CI: 0.95–3.43) increased them. Bullying was also associated with higher unmet healthcare need (OR 5.65; CI: 1.54–20.7).

Demographic changes, like age, household index and schooling over our observation period did not predict perceived access.

Conclusion: The main time-varying factors influencing rural adolescent Burkinabe healthcare need and access were precipitating events and education, rather than sociodemographic factors. While most need was met, that associated with bullying was least well supported. Preventive programs seem not yet to be broadly implemented among our study group. Mental health is not being reported despite becoming an area of greater awareness and concern not only in high but low income countries also.

Our longitudinal approach identified key time-varying factors shaping adolescent healthcare needs and access, illustrating the added value of panel data in advancing adolescent health research and interventions.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.