Effect of Peer-Led Educational Intervention on Knowledge of Obstetric Danger Signs Among Pregnant Adolescents in Rural Tanzania: A Mixed-Methods Quasi-Experimental Study

Background: Pregnancy-related complications remain a major contributor to morbidity and mortality among adolescent girls globally. In Tanzania, adolescent pregnancy continues to be a significant public health challenge, with a substantial proportion of girls aged 15–19 years having begun childbearing. Despite the availability of routine antenatal care (ANC) services, adolescent girls often experience unique barriers, including stigma, limited decision-making autonomy, inadequate access to adolescent-friendly information, and insufficient psychosocial support. These challenges may reduce their ability to recognize obstetric danger signs and seek timely care.Aim: To evaluate the effect of peer-led educational intervention on knowledge of obstetric danger signs among pregnant adolescents and explore how social support and coping mechanisms influence adolescents’ experiences during pregnancy.Methods: A mixed-methods quasi-experimental study employing a single-group pre-test/post-test design was conducted among pregnant adolescents in Mkuranga and Kisarawe districts, Tanzania, between June 2019 and June 2020. Quantitative data were collected using structured questionnaires administered before and after a peer-led educational intervention (“Nipo Nawe!”). The qualitative component complemented the quantitative findings by exploring participants’ lived experiences, social support networks, and coping strategies that may influence knowledge acquisition and care-seeking behaviours. Quantitative data were analyzed using paired-sample t-tests, while qualitative data from in-depth interviews were analyzed using thematic analysis.Results: Mean knowledge scores increased significantly from 1.04 (SD=1.169) before intervention to 6.96 (SD=1.976) after intervention (mean difference=5.92, p<0.01). Recognition of key obstetric danger signs improved substantially after the intervention. Qualitative findings demonstrated that peer-led educational intervention provided adolescents with a supportive and relatable learning environment, improving confidence, reducing isolation, and strengthening pregnancy-related coping strategies.Conclusion: Peer-led educational intervention significantly improves knowledge of obstetric danger signs among pregnant adolescents and provides important psychosocial support. Integration of structured peer-led educational programs into routine adolescent antenatal care services may improve sustainability, accessibility, and adolescent-centered maternal health outcomes.