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Yendork JS, Kliewer W, Cyrus JW. Child marriage and well-being in Central and Western Africa: A scoping review of costs and potential benefits for girls. J Adolesc 2024. [PMID: 39363513 DOI: 10.1002/jad.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 09/18/2024] [Accepted: 09/25/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION Child marriage is practiced widely in West and Central Africa with established links to several negative outcomes, particularly for girls. Although some reviews on predictors of the practice of child marriage exist, to date no review has focused on the costs and potential benefits to girls who have experienced child marriage. METHOD We conducted a scoping review of PubMed, African Index Medicus, Embase, PsycINFO, Web of Science, and Global Health and in the grey literature for studies on child marriage and adjustment up to October 2023. Studies were included if they assessed marriages where the female was younger than 18 at the time of marriage, were conducted in Central and Western African countries, explored positive and/or negative indicators of well-being and mental health in the context of child marriage, were written in English, were published in a peer-reviewed journal, or was a published thesis or dissertation, grey literature, or technical report, were conducted between 2014 and 2023, and presented qualitative, quantitative, or mixed-method data. RESULTS Based on the inclusion criteria, we included nine qualitative and four quantitative studies. Using the lens of Self-Determination Theory, we found that overall child marriage compromised needs for autonomy, competence, and relatedness. Further, child marriage was linked to negative mental health outcomes. However, for some girls, child marriage was associated with some benefits including social recognition and elevated status in society. CONCLUSION Future research on adjustment within the context of child marriage should focus on all aspects of well-being as well as the processes associated with adjustment for girls.
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Affiliation(s)
| | - Wendy Kliewer
- Department of Psychology, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - John W Cyrus
- Research & Education Department, VCU Libraries & Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
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Samuels F, Petroni S, Burgess RA, Omobowale O, Casey J, Sadd E. Mental health consequences of child marriage. THE LANCET. CHILD & ADOLESCENT HEALTH 2024:S2352-4642(24)00202-5. [PMID: 39303736 DOI: 10.1016/s2352-4642(24)00202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Fiona Samuels
- Wolfson Institute for Population Health, Queen Mary University of London, London, UK.
| | | | - Rochelle A Burgess
- UCL Global Network on Mental Health and Child Marriage, Institute for Global Health, University College London, London, UK
| | - Olubukola Omobowale
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Siddiqi M, Greene ME, Stoppel A, Allegar C. Interventions to Address the Health and Well-Being of Married Adolescents: A Systematic Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300425. [PMID: 39054061 PMCID: PMC11349501 DOI: 10.9745/ghsp-d-23-00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/21/2024] [Indexed: 07/27/2024]
Abstract
Child marriage, defined by the United Nations as marriage before the age of 18 years, is a widespread practice with serious health and social consequences. We systematically reviewed academic and gray literature to learn what is known about the current state of the evidence for interventions to respond to the needs of married adolescents. Our analysis of the 29 included intervention studies identified variability across sectors, with most programs focusing on sexual and reproductive health (SRH) and maternal health. We found that interventions occur mostly at a small scale, are geographically concentrated, and focus on SRH to the neglect of other sectors. There is a need for programs to focus on improving educational and economic outcomes among married girls, as well as increased efforts to support equitable marital relations and engage men and boys. The emphasis on preventing child marriage must be matched by efforts to mitigate and respond to the practice.
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Affiliation(s)
- Manahil Siddiqi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
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Nhampoca JM, Maritz JE. Early marriage, education and mental health: experiences of adolescent girls in Mozambique. Front Glob Womens Health 2024; 5:1278934. [PMID: 38933453 PMCID: PMC11199522 DOI: 10.3389/fgwh.2024.1278934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction and background Early marriage and maternity represent a violation of human rights and a barrier to achieving gender equality in education. Studies conducted across various regions and countries, including Mozambique, have highlighted the negative consequences of early marriage and maternity, particularly on adolescent girls' physical, educational and mental health. Adolescent girls who marry before the age of 18 are more prone to a broad spectrum of mood, anxiety, and other psychiatric disorders. In the districts of Maganja da Costa and Morrumbala in Zambézia Province, Mozambique, high rates of early marriage persist despite government policies and interventions. Purpose statement This study aims to understand early marriage's socio-cultural, economic, and psychological drivers and impacts on adolescent girls' lives, focusing on education, mental health, and well-being. Design and methods This paper used a qualitative research design. We employed a life-story approach and used purposeful sampling to identify participants. Semi-structured interviews were conducted with 25 participants and the data were analysed using Tesch's thematic analysis approach. Results Elements contributing to early marriage and pregnancy are intricately linked with socio-cultural elements. These include the induction into specific societal roles, the affirmation of childbearing, the perceived importance of dowry, the impact of rite-of-passage ceremonies, and the cultural significance associated with a girl's initial menstruation. School dropout often originates from geographical and transportation challenges, nudging adolescent girls towards early marriage. In some instances, termination of pregnancy was viewed as a solution, while engaging in sexual activities was seen as a means to inject purpose into their lives or as a response to poverty. Positive changes and emotions were evident, yet regrettably, the ramifications of early pregnancy and marriage were primarily detrimental. These influenced the adolescent girls' interpersonal connections, educational and career opportunities, emotional well-being, and access to support networks. Conclusions The modern perspective, which advocates for equal educational rights for boys and girls and posits that marriage should occur after the age of 18, contradicts the socio-cultural perspective of adulthood. Contribution This study adds to the ongoing efforts to prevent and combat early marriage and maternity in Africa.
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Affiliation(s)
| | - Jeanette E. Maritz
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Pourtaheri A, Mahdizadeh M, Tehrani H, Jamali J, Peyman N. Socio-ecological factors of girl child marriage: a meta-synthesis of qualitative research. BMC Public Health 2024; 24:428. [PMID: 38341573 PMCID: PMC10858465 DOI: 10.1186/s12889-023-17626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/31/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Child marriage of girls is one example of human rights violations, and is increasingly recognized as a key obstacle to global public health. Given the importance of a comprehensive understanding of the motivations for child marriage, this study aimed to identify socio-ecological factors contributing to gills child marriage. METHODS A comprehensive search was conducted of all English-language studies measuring causes of child marriage between 2000 and October 2022 in the Web of Science, PubMed, Scopus, PsycInfo, ProQuest, Poplin and Google Scholar databases. Girl child marriage is defined as a marriage under the age of 18. In this study, the CASP evaluation checklist was used to collect data. Two independent reviewers reviewed all articles. RESULTS A total of 34 eligible qualitative articles were included. The most salient causes of child marriage among girls include low skills and knowledge, internal and external beliefs and motivations, and physical advantages at the individual level. Family characteristics and structure contribute to child marriage at the interpersonal level, while environmental and economic factors play a role at the community level. Social factors and cultural norms, as well as the shortcomings and weaknesses of legislation, are also contributing factors at the society level. CONCLUSION The results showed that cultural beliefs supporting gender inequality and economic status were the most important causes of child marriage. These results can help policymakers and decision-makers implement strategies to reduce gender inequality to prevent child marriage.
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Affiliation(s)
- Asma Pourtaheri
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrsadat Mahdizadeh
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Tehrani
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Cordova-Pozo KL, Anishettar SS, Kumar M, Chokhandre PK. Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals. Int J Equity Health 2023; 22:250. [PMID: 38053079 PMCID: PMC10696679 DOI: 10.1186/s12939-023-02060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Child marriage remains a prevalent issue in low- and middle-income countries (LMIC) despite global declines. Girls are disproportionately affected, facing health risks, limited education, and restricted decision-making power. We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions. METHODS This study used World Bank datasets to assess progress in addressing child marriage in LMIC countries. Statistical analyses, including trend analysis and compound annual growth rate (CAGR), were conducted to evaluate indicators of first marriage, sexual violence, and sexual intercourse. Countries with sufficient data were categorized based on prevalence rates and trends, and detailed analysis focused on significant indicators. RESULTS While significant reductions were observed in the prevalence of child marriage before the age of 15 and 18 and early sexual intercourse in most countries, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. Overall, many countries showed a decline in sexual violence and early sexual intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibited an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone for women, and Namibia, Zambia, and Kenya for men, experienced substantial decline in early sexual intercourse. CONCLUSION There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent from the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at the societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.
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Affiliation(s)
| | | | - Manish Kumar
- Population Research Centre, JSS Institute of Economic Research Center, Dharwad, Karnataka, India
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Laurenzi CA, Toska E, Tallarico R, Sherr L, Steventon Roberts KJ, Hansen M, Tolmay J, Jochim J, Ameyan W, Yates R. Key normative, legal, and policy considerations for supporting pregnant and postpartum adolescents in high HIV-burden settings: a critical analysis. Sex Reprod Health Matters 2023; 31:2249696. [PMID: 37712411 PMCID: PMC10506436 DOI: 10.1080/26410397.2023.2249696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Rates of adolescent pregnancy within sub-Saharan Africa are increasing. Adolescent mothers ages 10-19 years face a distinct set of risks to their own and their children's health, compounded by many economic, social, and epidemiological challenges, such as living with HIV. In navigating this complex developmental period, many adolescent mothers face structural barriers impeding safe transitions to adulthood and motherhood. Drawing on existing literature and emerging data, we outline three normative, legal, and policy issues - violence and gender inequity, access to sexual and reproductive health services, and access to social and structural supports - which affect the health, wellbeing and development of adolescent mothers and their children. We also highlight emergent evidence about programming and policy changes that can better support adolescent mothers and their children. These key proposed responses include removing barriers to SRH and HIV service integration; ensuring implementation of return-to-school policies; and extending social protection systems to cater for adolescent mothers. Despite ongoing global crises and shifts in funding priorities, these normative, legal, and policy considerations remain critical to safeguard the health and wellbeing of adolescent mothers and their children.
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Affiliation(s)
- Christina A. Laurenzi
- Senior Researcher, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Elona Toska
- Associate Professor, Centre for Social Science Research, Department of Sociology, University of Cape Town, Rondebosch, South Africa; Co-director, Accelerate Hub, University of Cape Town, Rondebosch, South Africa; Associate Professor, Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom
| | - Renata Tallarico
- Youth Team Lead and SYP Regional Coordinator, United Nations Population Fund, Eastern and Southern Regional Office, Johannesburg, South Africa
| | - Lorraine Sherr
- Professor, Clinical and Health Psychology, University College London, London, United Kingdom
| | - Kathryn J. Steventon Roberts
- Postdoctoral Researcher, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Postgraduate Researcher, Institute for Global Health, University College London, London, United Kingdom
| | - Maja Hansen
- Technical Advisor, Gender Equality, United Nations Population Fund, Dar es Salaam, Tanzania
| | - Janke Tolmay
- Quantitative Research Assistant, Accelerate Hub, Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa
| | - Janina Jochim
- Postdoctoral Research Officer, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Wole Ameyan
- Technical Officer, Adolescent HIV, Global HIV Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Yates
- Strategic Advocacy Lead, Accelerate Hub, University of Oxford, Oxford, United Kingdom
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Miller FA, Dulal S, Rai A, Gram L, Harris-Fry H, Saville NM. "Can't live willingly": A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002279. [PMID: 37871001 PMCID: PMC10593245 DOI: 10.1371/journal.pgph.0002279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/13/2023] [Indexed: 10/25/2023]
Abstract
In South Asia, early marriage has been associated with a range of adverse outcomes during pregnancy and infancy. This may partly be explained by early marriage leading to a younger maternal age, however it remains unclear which other factors are involved. This review aimed to synthesise the qualitative evidence on experiences of pregnancy following early marriage or early pregnancy in South Asia, to inform our understanding of the mechanisms between early marriage and adverse pregnancy outcomes. We searched MEDLINE, EMBASE, Scopus, Global Index Medicus, CINAHL, PsycINFO, Web of Science, and grey literature on 29/11/2022 to identify papers on experiences of pregnancy among those who married or became pregnant early in South Asia (PROSPERO registration number: CRD42022304336, funded by an MRC doctoral training grant). Seventy-nine papers from six countries were included after screening. We appraised study quality using an adapted version of the Critical Appraisal Skills Programme tool for qualitative research. Reporting of reflexivity and theoretical underpinnings was poor. We synthesised findings thematically, presenting themes alongside illustrative quotes. We categorised poor pregnancy experiences into: care-seeking challenges, mental health difficulties, and poor nutritional status. We identified eight inter-connected themes: restrictive social hierarchies within households, earning social position, disrupted education, social isolation, increased likelihood of and vulnerability to abuse, shaming of pregnant women, normalisation of risk among younger women, and burdensome workloads. Socioeconomic position and caste/ethnic group also intersected with early marriage to shape experiences during pregnancy. While we found differences between regions, the heterogeneity of the included studies limits our ability to draw conclusions across regions. Pregnancy experiences are largely determined by social hierarchies and the quality of relationships within and outside of the household. These factors limit the potential for individual factors, such as education and empowerment, to improve experiences of pregnancy for girls married early.
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Affiliation(s)
- Faith A. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Sophiya Dulal
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Anjana Rai
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Lu Gram
- Institute for Global Health, University College London, London, United Kingdom
| | - Helen Harris-Fry
- Department of Population Health, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Naomi M. Saville
- Institute for Global Health, University College London, London, United Kingdom
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Vikram K, Visaria A, Ganguly D. Child marriage as a risk factor for non-communicable diseases among women in India. Int J Epidemiol 2023; 52:1303-1315. [PMID: 37159526 DOI: 10.1093/ije/dyad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Child marriage, defined as marriage under the age of 18 years, remains pervasive in India. Global evidence documents a negative association between child marriage and women's reproductive and sexual health outcomes; however, its relationship with non-communicable diseases (NCDs) remains underexplored. METHODS We utilize biomarkers and self-reported data from the nationally representative National Family and Health Survey 4 (2015-2016) to examine the associations between child marriage and hypertension, diabetes, heart disease, asthma and thyroid disorder among currently married women (N = 421 107). We use regression models adjusted for a range of demographic and socio-economic controls to assess the association between child marriage and NCDs among women in India. We further assess whether and to what extent these relationships are mediated by early motherhood using the Karlson, Holm and Breen method of decomposition. RESULTS Child marriage was associated with hypertension [adjusted odds ratio 1.20 (95% CI: 1.17-1.24)], diabetes [1.29 (1.22-1.37)], heart disease [1.27 (1.18-1.36)], asthma [1.19 (1.11-1.28)] and thyroid disorder [1.10 (1.02-1.18)]. Early motherhood also increased the risk of NCDs among women. Furthermore, it emerged as a pathway linking child marriage with hypertension, diabetes and heart disease; however, it provided a partial explanation for the disadvantage associated with child marriages. CONCLUSIONS Child marriage emerges as a risk factor for NCDs among women in India. Health systems need to recognize the enduring influence of child marriages on women's health and ensure early detection and effective treatment of NCDs for this vulnerable group.
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Affiliation(s)
- Kriti Vikram
- Department of Sociology and Anthropology, National University of Singapore, Singapore
| | - Abhijit Visaria
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Dibyasree Ganguly
- Centre for the Study of Regional Development, Jawaharlal Nehru University, India
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Child Marriage and Later-Life Risk of Obesity in Women: A Cohort Analysis Using Nationally Representative Repeated Cross-Sectional Data from Tajikistan. WOMEN 2023. [DOI: 10.3390/women3010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Child marriage, defined as union before age 18 years, has detrimental health and socioeconomic consequences. This study examines whether women married as children have a disproportionately higher risk of being obese at adulthood compared to their peers married as adults. Using data from the 2012 and 2017 waves of the Tajikistan Demographic and Health Survey, we matched women aged 25 to 49 years by birth year and month to create four birth cohorts. We fitted multivariable logistic regressions to assess the differential odds of being obese and estimated simultaneous quantile regression models to examine the differences in average body mass index (BMI) between women married as adults and as children within birth cohorts. We found that the adjusted odds of being obese for women married as children were 1.5 (CI: 1.3–1.7) times those of those who were married as adults, after controlling for sociodemographic correlates along with birth cohort and survey wave fixed effects. Results of the quantile regression analyses suggest higher expected BMI levels among women married as children compared to those of women married as adults across different quantiles of BMI. The differences though were more pronounced in the younger cohorts than in the older cohorts.
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Salako J, Bakare D, Colbourn T, Isah A, Adams O, Shittu F, Uchendu O, Bakare AA, Graham H, McCollum ED, Falade AG, Burgess RA, King C. Maternal mental well-being and recent child illnesses-A cross-sectional survey analysis from Jigawa State, Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001462. [PMID: 36962998 PMCID: PMC10121178 DOI: 10.1371/journal.pgph.0001462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/11/2022] [Indexed: 03/06/2023]
Abstract
Child health indicators in Northern Nigeria remain low. The bidirectional association between child health and maternal well-being is also poorly understood. We aim to describe the association between recent child illness, socio-demographic factors and maternal mental well-being in Jigawa State, Nigeria. We analysed a cross-sectional household survey conducted in Kiyawa local government area, Jigawa State, from January 2020 to March 2020 amongst women aged 16-49 with at least one child under-5 years. We used two-stage random sampling. First, we used systematic random sampling of compounds, with the number of compounds based on the size of the community. The second stage used simple random sampling to select one eligible woman per compound. Mental well-being was assessed using the Short Warwick-Edinburgh Mental Wellbeing Score (SWEMWBS). We used linear regression to estimate associations between recent child illness, care-seeking and socio-demographic factors, and mental well-being. Overall 1,661 eligible women were surveyed, and 8.5% had high mental well-being (metric score of 25.0-35.0) and 29.5% had low mental well-being (metric score of 7.0-17.9). Increasing wealth quintile (adj coeff: 1.53; 95% CI: 0.91-2.15) not being a subsistence farmer (highest adj coeff: 3.23; 95% CI: 2.31-4.15) and having a sick child in the last 2-weeks (adj coeff: 1.25; 95% CI: 0.73-1.77) were significantly associated with higher mental well-being. Higher levels of education and increasing woman's age were significantly associated with lower mental well-being. Findings contradicted our working hypothesis that a recently sick child would be associated with lower mental well-being. We were surprised that education and late marriage, which are commonly attributed to women's empowerment and autonomy, were not linked to better well-being here. Future work could focus on locally defined tools to measure well-being reflecting the norms and values of communities, ensuring solutions that are culturally acceptable and desirable to women with low mental well-being are initiated.
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Affiliation(s)
- Julius Salako
- Department of Health Promotion and Education, University College Hospital, Ibadan, Nigeria
| | - Damola Bakare
- Department of Epidemiology and Medical Statistics, University College Hospital, Ibadan, Nigeria
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | - Osebi Adams
- Save the Children International, Abuja, Nigeria
| | - Funmilayo Shittu
- Department of Health Promotion and Education, University College Hospital, Ibadan, Nigeria
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Obioma Uchendu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayobami A Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Hamish Graham
- Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Adegoke G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | | | - Rochelle A Burgess
- Institute for Global Health, University College London, London, United Kingdom
| | - Carina King
- Institute for Global Health, University College London, London, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Rose-Clarke K, B. K. P, Magar J, Pradhan I, Shrestha P, Hassan E, Abou Jaoude GJ, Haghparast-Bidgoli H, Devakumar D, Carrino L, Floridi G, Kohrt BA, Verdeli H, Clougherty K, Klein Rafaeli A, Jordans M, Luitel NP. School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost. Glob Ment Health (Camb) 2022; 9:416-428. [PMID: 36618751 PMCID: PMC9806967 DOI: 10.1017/gmh.2022.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
Background Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost. Methods We recruited 32 boys and 30 girls (aged 13-19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0-2 weeks after IPT), and follow-up (8-10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective. Results Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70-95); functional impairment decreased by 288% (249-351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity. Conclusions School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
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Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Prakash B. K.
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Indira Pradhan
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Pragya Shrestha
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Eliz Hassan
- Department of Global Health and Social Medicine, King's College London, London, UK
| | | | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Ludovico Carrino
- Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy
| | - Ginevra Floridi
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Helen Verdeli
- Teachers College, Columbia University, New York, NY, USA
| | - Kathleen Clougherty
- Psychological Services, Ruth and Allen Ziegler Student Services, Tel Aviv University, Tel Aviv, Israel
| | - Alexandra Klein Rafaeli
- Psychological Services, Ruth and Allen Ziegler Student Services, Tel Aviv University, Tel Aviv, Israel
| | - Mark Jordans
- Centre for Global Mental Health, King's College London, London, UK
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