Time-varying factors predicting adolescent healthcare needs and utilization in a rural Burkina Faso cohort: A two-way fixed effects analysis

Adolescent healthcare 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, limiting capacity to assess causal processes relating to care need and use. We used longitudinal data to examine adolescent need for and use of healthcare in rural Burkina Faso, to identify service gaps and thus targets for intervention. We analyzed subjective healthcare needs and utilization among adolescents aged 12–20 in a two-round population-representative cohort in 2017–2018. Outcomes were subjective need for healthcare and levels of unmet need. We used individual fixed-effects regression to account for time-invariant characteristics and isolate time-varying effects. Around half of 1271 adolescents reported healthcare need at each wave, mostly for malaria, injuries, and headaches. Attending school was associated with reduced perceived need (Odds Ratio [OR] 0.52, 95 % confidence interval [CI] 0.15-1.80), while injuries (OR 8.43; CI 3.34-21.30]) and bullying (OR 1.77; CI 0.93-3.40) increased it. Bullying was also associated with higher unmet need (OR 4.79; CI 1.24–18.4). Short-term demographic changes did not predict utilization. The main time-varying factors influencing subjective health need and utilization of care were precipitating events and educational attainment, rather than sociodemographic factors. Most healthcare contacts were due to acute events and infectious diseases, not prevention programs or non-communicable diseases. Experience of bullying led to significantly higher perceived unmet need—a troubling result suggesting possible interventions both in the short- and long-term. • Longitudinal studies are too rarely conducted in rural Burkina Faso among adolescents. • A two-way fixed effects analysis allows for controlling for observed time-varying factors. • Pregnancy, bullying and injuries are key drivers of perceived healthcare needs. • Bullying is the main driver of unmet healthcare need among adolescents. • Psychosocial experiences strongly influence adolescents’ healthcare use.