BACKGROUND:
Sierra Leone has high maternal and neonatal mortality rates, particularly among adolescent girls, who are most vulnerable due to poverty, lack of education, and limited employment opportunities.

OBJECTIVES:
To evaluate the feasibility and impact of a community-based mentoring intervention from pregnancy to one year postpartum for adolescents and their babies (2YoungLives).

METHODS:
Methods: A pilot cluster-randomised hybrid trial of the introduction of 2YoungLives in rural and urban communities served by twelve peripheral health units in five districts of Sierra Leone. The primary outcome was a composite of maternal and perinatal deaths (stillbirths and neonatal deaths). Analysis by intention to treat (ISRCTN 32414369).

RESULTS:
Between July 2022 and November 2023, 673 girls were included in the trial; six clusters (372 girls) allocated to 2YoungLives (intervention group) and six clusters (301 girls) allocated to the control group. Loss to follow up <10% in both groups. The incidence of the primary composite outcome was significantly lower in the intervention group (23 [6.4%]) compared to the control group (35 [12·5%]); aRR 0·52, 95% CI 0·34 to 0·81); RD-0·05%, 95% CI -0·10 to -0·01. The number needed to treat with 2YoungLives to prevent one maternal/perinatal death was 18.

CONCLUSIONS:
Our study demonstrates that 2YoungLives, a community-based mentoring intervention for adolescents from pregnancy up to one year after birth, was feasible to implement in urban and rural communities in Sierra Leone and signiJcantly reduced acomposite of maternal deaths, stillbirths and neonatal deaths.

KEY MESSAGE:
2YoungLives, a locally developed community based mentoring intervention for adolescent girls in Sierra Leone, saves lives! Adolescent care (including three-minute presentation competition)