1
|
Abrahams N, Mhlongo S, Chirwa E, Dekel B, Ketelo A, Lombard C, Shai N, Ramsoomar L, Mathews S, Labuschagne G, Matzopoulos R, Prinsloo M, Martin LJ, Jewkes R. Child abuse and neglect-related murders in South Africa: a comparison of two national surveys in 2009 and 2017. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:589-599. [PMID: 38944051 DOI: 10.1016/s2352-4642(24)00110-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Population-based statistics on deaths from child abuse and neglect are only routinely available in countries that have reliable national statistics on child murder. For low-income and middle-income countries, relatively little is known about prevalence trends of child murder. South Africa is an exception, having conducted dedicated national studies on child murders for 2009 and 2017 to provide data on child murders overall and on child abuse and neglect-related murders. We aimed to compare child abuse and neglect-related murders in South Africa across two surveys to determine any change between 2009 and 2017. METHODS We conducted two retrospective national mortuary-based surveys on murder of children aged 0-17 years for 2009 and 2017 from a proportionate random sample of medico-legal laboratories in South Africa. A sampling frame of medico-legal laboratories for each study year was prepared with stratification by medico-legal laboratory size. A minimum of 2 years after the crime was allowed before data collection to enable progression of the investigation process. Child abuse and neglect-related murders were identified using both medico-legal laboratory post-mortem autopsy reports and police data. To identify a child abuse and neglect-related murder, we primarily used the framework of abuse happening within the context of responsibility of care arrangements but broadened this to include all perpetrators and abuse identified from the data. We stratified age into 0-4, 5-9, 10-14, and 15-17 years and further stratified children younger than 5 years into early neonates (newborns killed within 6 days of birth), 7 days to 11 months, and 1-4 years. We calculated incidence rate ratios (IRR) with 95% CIs to compare rates between 2009 and 2017. FINDINGS An estimated 458 (95% CI 377-539) children in 2009 and 213 (179-247) children in 2017 were murdered in circumstances of child abuse and neglect. The percentage of all child murders that were child abuse and neglect-related declined from 2009 to 2017 (458 [45·0%] of 1018 in 2009 vs 213 [25·0%] of 851 in 2017), with the overall age-standardised rate decreasing from 2·6 to 1·1 per 100 000 children aged 0-17 years (IRR 0·43 [95% CI 0·35-0·54]). Girls represented 276 (60·3%) of 458 murders in 2009, which declined to 96 (45·1%) of 213 murders in 2017, and boys represented 178 (38·9%) of 458 murders in 2009 and 109 (51·4%) of 213 murders in 2017. The decrease was statistically significant for girls in the 0-4 year (IRR 0·33 [0·22-0·49]) and 5-9 year (0·33 [0·15-0·73]) age groups and for boys in the 0-4 year age group (0·49 [0·33-0·71]). Among early neonates (within 6 days of birth), the decrease in child abuse and neglect-related murders was more pronounced among girls than among boys (IRR 0·33 [95% CI 0·19-0·56] vs 0·46 [0·28-0·77]). INTERPRETATION Child abuse and neglect-related murders are common in South Africa but our study shows that they can be reduced. The high rate of these murders points to the need to continue research and monitoring to inform priority targeted interventions and to better understand the impact of child support policies. FUNDING Ford Foundation and South African Medical Research Council.
Collapse
Affiliation(s)
- Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bianca Dekel
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Asiphe Ketelo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; Stellenbosch University, Cape Town, South Africa
| | - Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Shanaaz Mathews
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Gérard Labuschagne
- Department of Forensic Medicine & Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Megan Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health, University of Cape Town, Cape Town, South Africa; University of Greenwich, London, UK
| | - Lorna J Martin
- Division of Forensic Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa; Wits School of Public Health, Wits University, Johannesburg, South Africa
| |
Collapse
|
2
|
Franchino-Olsen H, Orkin M, Meinck F. Toward a Contextually Sensitive Understanding of Polyvictimization: A Latent Class Analysis of Violence, Risks, and Protections Among South African Adolescents From Highly Deprived Settings. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3591-3618. [PMID: 38407004 PMCID: PMC11283737 DOI: 10.1177/08862605241233273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
South African adolescents experience a high prevalence of violence victimization alongside the health and economic burdens of HIV/AIDS and poverty. Polyvictimization is a useful theory and framework that allows for a nuanced understanding of lived adolescent experience patterns. Polyvictimization examinations are further enriched by person-centered analytical approaches. This study used latent class analysis to differentiate a sample of South African adolescents from highly deprived communities by their polyvictimization profiles and contextual violence risk and protective factors. Adolescents were sampled twice (2010/2011; 2011/2012), and data reflected their lifetime (sexual abuse) or recent (all other forms of assessed abuse/violence) violence victimizations, as well as individual, household, and community characteristics. Model fit indices supported a seven-class model with adolescents in high, moderate, and low polyvictimization classes. Adolescents in the high polyvictimization classes experienced a heavy burden of poverty and multiple forms of violence across contexts and were distinguished by HIV/AIDS and disability. Adolescents in the low polyvictimization class experienced relatively little violence, despite living in violent communities, and low household and individual burdens of HIV/AIDS and disability. Findings emphasize the importance of considering adolescent violence through a contextually sensitive polyvictimization lens to understand the complex web of violence that adolescents experience. This work supports previous research in low-resource South African settings highlighting the interconnected nature of violence, poverty, disability, and HIV/AIDS. Future research should explore these complex violence patterns and their effects, while program and policy actions must target and prevent adolescent violence especially for those impacted by poverty, disability, and HIV/AIDS.
Collapse
Affiliation(s)
| | - Mark Orkin
- University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Franziska Meinck
- University of Edinburgh, UK
- University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- North-West University, Vanderbijlpark, South Africa
| |
Collapse
|
3
|
Mercera G, Kooijmans R, Leijdesdorff S, Heynen E, van Amelsvoort T. Risk and Protective Factors for Sexual Exploitation in Male and Female Youth From a Cross-Cultural Perspective: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1966-1984. [PMID: 37818954 DOI: 10.1177/15248380231201815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Youth are at elevated risk of becoming victims of sexual exploitation, which has a detrimental impact on their physical and psychological well-being. Understanding factors associated with sexual exploitation is key for prevention efforts and adequate and timely treatment. This systematic review sheds more light on this by providing an overview of both risk and protective factors for sexual exploitation in male and female youth from a cross-cultural perspective. In all, 65 studies were selected meeting the inclusion criteria: qualitative or quantitative peer-reviewed studies in English, Dutch, or German with findings on risk and protective factors associated with sexual exploitation in youth aged up to 24 years. Results show that there are common risk factors in male and female youth worldwide (e.g., adverse childhood experiences, lack of a social network, substance use, and running away). Positive and supportive relationships are an important protective factor in mitigating the risk of sexual exploitation. Geographic differences were found. In non-Western continents, more environmental factors (e.g., economic vulnerabilities, residential instability) were cited. Research in countries outside the United States is limited and protective factors and males are underexamined. To fully understand vulnerabilities in youth, their interactions, and possible gender differences and to address the needs of diverse populations, more insight should be gained into the broader range of risk and protective factors worldwide. This systematic review has made a valuable contribution to this by providing practice, policy, and research guidance in the establishment of more targeted prevention efforts, adequate treatment, and areas to address in future research.
Collapse
Affiliation(s)
- Gabriëlle Mercera
- Koraal Center of Expertise, Sittard, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands
| | - Roel Kooijmans
- Koraal Center of Expertise, Sittard, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | - Sophie Leijdesdorff
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands
| | - Evelyn Heynen
- Department of Clinical Psychology, Open University, Heerlen, The Netherlands
| | | |
Collapse
|
4
|
Mercera G, Noteboom F, Timmermans C, Leijdesdorff S, Heynen E, van Amelsvoort T. Sexual exploitation of young men: Background characteristics and needs from a life-course perspective. CHILD ABUSE & NEGLECT 2024; 152:106794. [PMID: 38636156 DOI: 10.1016/j.chiabu.2024.106794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/22/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Sexually exploited young men are prevalent, yet underrepresented in clinical practice, policy and research. There are multiple barriers that often prevent young men to disclose and to seek or receive support, such as gender norms, limited awareness of victimization and feelings of guilt and shame. OBJECTIVE By gaining more insight into the background characteristics of young men who experienced sexual exploitation and their needs, this study aims to raise awareness and to better inform policymakers, care- and educational professionals on adequate prevention and intervention efforts. METHODS Twenty-six young men (age 14-32) who experienced sexual exploitation or other forms of sexual violence in their youth or were at high-risk, participated in this qualitative study that was conducted in The Netherlands. By means of semi-structured interviews and case-file analyses, data was collected to identify risk and protective factors in their life-course and support needs. RESULTS Several vulnerabilities (e.g. previous experiences of abuse and neglect, household dysfunction, social rejection, running away, substance use) and a lack of positive and supportive relationships led young men into high-risk situations. Among these were involvement in pay dates, criminality and having to survive from day to day, which contributed to victimization. Prevailing gender norms and experiences of stigmatization were often a barrier to express vulnerabilities and to disclose victimization. There was a wide variety in support needs, including peer-to-peer support, therapy, support with day-to-day practices and anonymous support. CONCLUSIONS These results will contribute to adequate prevention and trauma-informed intervention strategies that meet the unique needs of young men at risk for, or victim of sexual exploitation.
Collapse
Affiliation(s)
- Gabriëlle Mercera
- Department of Psychiatry and Neuropsychology, Maastricht University, Vijverdalseweg 1, 6226 NB Maastricht, the Netherlands; Koraal, Poststraat 1, 6135 KR Sittard, the Netherlands.
| | - Frank Noteboom
- Stichting Fier, Holstmeerweg 1, 8936 AS Leeuwarden, the Netherlands.
| | | | - Sophie Leijdesdorff
- Department of Psychiatry and Neuropsychology, Maastricht University, Vijverdalseweg 1, 6226 NB Maastricht, the Netherlands.
| | - Evelyn Heynen
- Department of Clinical Psychology, Open University, Valkenburgerweg 177, 6419 AT Heerlen, the Netherlands.
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Vijverdalseweg 1, 6226 NB Maastricht, the Netherlands; Koraal, Poststraat 1, 6135 KR Sittard, the Netherlands.
| |
Collapse
|
5
|
Tamambang R, Kusi-Mensah K, Bella-Awusah T, Ogunmola O, Afolayan A, Toska E, Hertzog L, Rudgard W, Evans R, Omigbodun O. Identifying potential catalysts to accelerate the achievement of Sustainable Development Goals (SDGs) among adolescents living in Nigeria. PSYCHOL HEALTH MED 2024; 29:868-887. [PMID: 38305209 DOI: 10.1080/13548506.2023.2289476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 11/22/2023] [Indexed: 02/03/2024]
Abstract
Investing in adolescents in Africa holds great promise for the development of the continent. The steps involved in identifying factors linked to interventions that may accelerate the attainment of multiple SDGs for adolescents in Nigeria are described. Data from a survey to investigate the well-being of 1800 adolescents aged 10-19 years in Southwest Nigeria was analysed. A four-step process was employed: 1) Mapping of variables deemed as suitable proxies for SDG targets; 2) Mapping hypothesised protective factors (accelerators) from the study instruments. Consequently, SDG targets related to elimination of hunger, good health, gender equality and peace; and seven accelerators (safe schools, parenting support, good mental health, no survival work, food security, stable childhood, and regular physical activity) were identified; 3) evaluating associations using bivariate analysis and multivariable logistic regression, 4) calculating adjusted probabilities. The mean age of the adolescents was 15.02 ± 2.27 years (48.6% female). Good mental health, not doing survival work, safe schools, stable childhood and parental support were significantly associated with at least two SDG targets. For example, food security was significantly associated with the highest number of SDG outcomes: one SDG target related to child survival (no substance use: x2 = 3.39, p = <0.001); three SDG targets related to educational outcomes (school progression: x2 = 5.68, p = 0.017, ability to concentrate in school: x2 = 26.92, p = <0.001, and school attendance: x2 = 25.89, p = <0.001); and four SDG targets related to child protection (no risky sexual behaviours: x2 = 16.14, p = <0.001, no perpetration of violence: x2 = 15.74, p = <0.001, no community violence: x2 = 39.06, p =<0.001, and no sexual abuse: x2 = 7.66, p = 0.006). Interventions centred around good mental health, not doing survival work, safe schools, small family size, stable childhood and parental support are potential accelerators for the attainment of SDG outcomes by adolescents living in Nigeria.
Collapse
Affiliation(s)
- Rita Tamambang
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kwabena Kusi-Mensah
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Tolulope Bella-Awusah
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olusegun Ogunmola
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeola Afolayan
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, Oxford University, Oxford, UK
| | - Lucas Hertzog
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | | | - Robin Evans
- Department of Statistics, Oxford University, Oxford, UK
| | - Olayinka Omigbodun
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Olié L, Maternowska MC, Fry D. Addressing violence against children: A systematic review on interventions to accelerate the achievement of the UN sustainable development goal in Europe and Africa. CHILD ABUSE & NEGLECT 2023; 145:106427. [PMID: 37660427 DOI: 10.1016/j.chiabu.2023.106427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Violence against children (VAC) is a global public health issue. In the context of limited resources, the United Nations Development Programme has coined the concept of a Sustainable Development Goals (SDG) accelerator for preventing and responding to VAC. An 'accelerator' is a provision that simultaneously leads to progress across multiple SDGs targets and goals. OBJECTIVES This systematic review synthesizes the literature on violence prevention evaluation studies using robust methods according to the SDG accelerator framework for children aged 0-18 in Western Europe and Central and West Africa. It also provides a lens for analyzing research inequities between the global North and South, examining the challenges and differences undermining knowledge production across regions, particularly in research output. METHOD We systematically searched 30 electronic databases and grey literature in English and French. The quality of included studies was assessed using the Cochrane Risk of Bias tool. RESULTS Nine evaluation studies related to four SDG goals and ten targets were included in the analysis. As a result, no intervention was identified as an accelerator for children in West and Central Africa. In contrast, three promising interventions were identified as accelerators in Western Europe. Two school-based interventions reduce bullying, depression, and substance abuse and improve psychological well-being; and one home-based intervention reduces child abuse, the severity of neglect, and mental health problems and improves school attendance. Moreover, this review also uncovered a lack of research from the Global South that points to serious disadvantages for authors and institutions and global violence prevention efforts, as it hinders the flow of knowledge and innovative practices. CONCLUSIONS The results highlight the need for future VAC prevention trials to integrate the SDG accelerators concept further. Additionally, more effort should be made to support scholars in the global South to address knowledge inequities and to enhance understanding of how accelerators work in different field settings and conditions. This effort will ensure that interventions accelerate SDG goals and impact the world's most vulnerable children.
Collapse
Affiliation(s)
- Louis Olié
- CIRAD, UMR MoISA (Univ. of Montpellier, Cirad, IAMM, INRAE, l'Institut Agro, IRD), La Réunion, France; Bordeaux School of Economics, Univ Bordeaux, BxSE, UMR 6060, F-33600 Pessac, France.
| | - M Catherine Maternowska
- End Violence Lab, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Deborah Fry
- End Violence Lab, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| |
Collapse
|
8
|
Rudgard WE, Obiesie S, Desmond C, Casale M, Cluver L. Assessing the cost-effectiveness of economic strengthening and parenting support for preventing violence against adolescents in Mpumalanga Province, South Africa: An economic modelling study using non-randomised data. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001666. [PMID: 37590179 PMCID: PMC10434898 DOI: 10.1371/journal.pgph.0001666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
There is limited evidence around the cost-effectiveness of interventions to reduce violence against children in low- and middle-income countries. We used a decision-analytic model to evaluate the cost-effectiveness of three intervention scenarios for reducing adolescent emotional, physical, and sexual abuse in Mpumalanga Province, South Africa. The intervention scenarios were: 1) Community grant outreach to link households to South Africa's Child Support Grant (CSG) if they are eligible, but not receiving it; 2) Group-based parenting support; and 3) Group-based parenting support 'plus' linkage to the CSG. We estimated average cost-effectiveness ratios (ACERs) for intervention scenarios over a ten-year time horizon, and compared them to a South Africa-specific willingness-to-pay (WTP) threshold (USD3390). Health effects were expressed in disability-adjusted life years (DALYs) averted. Our model considered four combinations of routine service versus trial-based costing, and population-average versus high prevalence of violence. Under routine service costing, ACERs for grant outreach and parenting support were below the WTP threshold when considering a population-average prevalence of violence USD2850 (Lower: USD1840-Upper: USD10,500) and USD2620 (USD1520-USD9800) per DALY averted, respectively; and a high prevalence of violence USD1320 (USD908-USD5180) and USD1340 (USD758-USD4910) per DALY averted, respectively. The incremental cost-effectiveness of parenting support plus grant linkage relative to parenting support alone was USD462 (USD346-USD1610) and USD225 (USD150-USD811) per DALY averted at a population-average and high prevalence of violence, respectively. Under trial-based costing, only the ACER for grant outreach was below the WTP threshold when considering a high prevalence of violence USD2580 (USD1640-USD9370) per DALY averted. Confidence intervals for all ACERs crossed the WTP threshold. In conclusion, grant outreach and parenting support are likely to be cost-effective intervention scenarios for reducing violence against adolescents if they apply routine service costing and reach high risk groups. Combining parenting support with grant linkage is likely to be more cost-effective than parenting support alone.
Collapse
Affiliation(s)
- William E. Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Sopuruchukwu Obiesie
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Chris Desmond
- School of Economics and Finance, University of Witwatersrand, Johannesburg, South Africa
| | - Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
9
|
Steventon Roberts KJ, Du Toit S, Mawoyo T, Tomlinson M, Cluver LD, Skeen S, Laurenzi CA, Sherr L. Protocol for the OCAY study: a cohort study of orphanhood and caregiver loss in the COVID-19 era to explore the impact on children and adolescents. BMJ Open 2023; 13:e071023. [PMID: 37263702 DOI: 10.1136/bmjopen-2022-071023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Globally, no person has been untouched by the COVID-19 pandemic. Yet, little attention has been given to children and adolescents in policy, provision and services. Moreover, there is a dearth of knowledge regarding the impact of COVID-19-associated orphanhood and caregiver loss on children. This study aims to provide early insights into the mental health and well-being of children and adolescents experiencing orphanhood or caregiver loss in South Africa. METHODS AND ANALYSIS Data will be drawn from a quantitative longitudinal study in Cape Town, South Africa. A sample of children and adolescents between the ages of 9 and 18 years, experiencing parental or caregiver loss from COVID-19, will be recruited together with a comparison group of children in similar environments who did not experience loss. The study aims to recruit 500 children in both groups. Mental health and well-being among children will be explored through the use of validated and study-specific measures. Participants will be interviewed at two time points, with follow-up data being collected 12-18 months after baseline. A combination of analytical techniques (including descriptive statistics, regression modelling and structural equation modelling) will be used to understand the experience and inform future policy and service provision. ETHICS AND DISSEMINATION This study received ethical approval from the Health Research Ethics Committee at Stellenbosch University (N 22/04/040). Results will be disseminated via academic and policy publications, as well as national and international presentations including high-level meetings with technical experts. Findings will also be disseminated at a community level via various platforms.
Collapse
Affiliation(s)
- Kathryn J Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Institute for Global Health, University College London, London, UK
| | - Stefani Du Toit
- Institute for Life Course Health Reseach, Department of Global Health, Stellenbosch Univeristy, Stellenbosch, South Africa
| | - Tatenda Mawoyo
- Institute for Life Course Health Reseach, Department of Global Health, Stellenbosch Univeristy, Stellenbosch, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Reseach, Department of Global Health, Stellenbosch Univeristy, Stellenbosch, South Africa
- School of Nursing & Midwifrey, Queens University, Belfast, UK
| | - Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry & Mental Health, Univeristy of Cape Town, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Reseach, Department of Global Health, Stellenbosch Univeristy, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social & Behavioural Sciences, Univeristy of Amsterdam, Amsterdam, Netherlands
| | - Christina A Laurenzi
- Institute for Life Course Health Reseach, Department of Global Health, Stellenbosch Univeristy, Stellenbosch, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
10
|
Jochim J, Cluver L, Sidloyi L, Kelly J, Ornellas A, Mangqalaza H, Coakley C, Nogoduka C, Pillay M, Nokama B, George G, Toska E, Eastern Cape TAG. Improving educational and reproductive outcomes for adolescent mothers in South Africa: A cross-sectional analysis towards realising policy goals. Glob Public Health 2023; 18:2206465. [PMID: 37158293 DOI: 10.1080/17441692.2023.2206465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention. Adolescent mothers aged 12-24 from rural and urban communities of South Africa's Eastern Cape completed study questionnaires between 2017-2019. Using multivariate multi-level analysis, we simultaneously estimated associations between hypothesized provisions and protective variables and all policy-aligned goals. School return was associated with using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Grade promotion was associated with greater exposure to friendly and respectful health staff, using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Pregnancy/HIV prevention (condom use) was moderately associated with greater exposure to friendly and respectful health staff. There was evidence of synergies of provisions whereby a combination of protective characteristics showed larger positive effects than receipt of any single factor alone. This study provides essential evidence for operationalising South Africa's new policy on the Prevention and Management of Learner Pregnancy in Schools, and points to implementation strategies that provide low-cost opportunities to promote educational and health outcomes for adolescent mothers.
Collapse
Affiliation(s)
- Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lulama Sidloyi
- Oxford Research South Africa, University of Oxford, Oxford, UK
| | - Jane Kelly
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Abigail Ornellas
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Hlokoma Mangqalaza
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Chelsea Coakley
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Coceka Nogoduka
- National Department of Basic Education, Pretoria, South Africa
| | - Managa Pillay
- National Department of Basic Education, Pretoria, South Africa
| | - Busisa Nokama
- National Department of Basic Education, Pretoria, South Africa
| | - Gavin George
- Health Economic and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
11
|
Sherr L, Haag K, Tomlinson M, Rudgard WE, Skeen S, Meinck F, Du Toit SM, Steventon Roberts KJ, Gordon SL, Desmond C, Cluver L. Understanding accelerators to improve SDG-related outcomes for adolescents-An investigation into the nature and quantum of additive effects of protective factors to guide policy making. PLoS One 2023; 18:e0278020. [PMID: 36607964 PMCID: PMC9821522 DOI: 10.1371/journal.pone.0278020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/08/2022] [Indexed: 01/07/2023] Open
Abstract
Recent evidence has shown support for the United Nations Development Programme (UNDP) accelerator concept, which highlights the need to identify interventions or programmatic areas that can affect multiple sustainable development goals (SDGs) at once to boost their achievement. These data have also clearly shown enhanced effects when interventions are used in combination, above and beyond the effect of single interventions. However, detailed knowledge is now required on optimum combinations and relative gain in order to derive policy guidance. Which accelerators work for which outcomes, what combinations are optimum, and how many combinations are needed to maximise effect? The current study utilised pooled data from the Young Carers (n = 1402) and Child Community Care (n = 446) studies. Data were collected at baseline (n = 1848) and at a 1 to 1.5- year follow-up (n = 1740) from children and young adolescents aged 9-13 years, living in South Africa. Measures in common between the two databases were used to generate five accelerators (caregiver praise, caregiver monitoring, food security, living in a safe community, and access to community-based organizations) and to investigate their additive effects on 14 SDG-related outcomes. Predicted probabilities and predicted probability differences were calculated for each SDG outcome under the presence of none to five accelerators to determine optimal combinations. Results show that various accelerator combinations are effective, though different combinations are needed for different outcomes. Some accelerators ramified across multiple outcomes. Overall, the presence of up to three accelerators was associated with marked improvements over multiple outcomes. The benefit of targeting access to additional accelerators, with additional costs, needs to be weighed against the relative gains to be achieved with high quality but focused interventions. In conclusion, the current data show the detailed impact of various protective factors and provides implementation guidance for policy makers in targeting and distributing interventions to maximise effect and expenditure. Future work should investigate multiplicative effects and synergistic interactions between accelerators.
Collapse
Affiliation(s)
- Lorraine Sherr
- University College London, Institute for Global Health, London, United Kingdom
- * E-mail:
| | - Katharina Haag
- University College London, Institute for Global Health, London, United Kingdom
| | - Mark Tomlinson
- Department of Global Health, Stellenbosch University, Institute for Life Course Health Research, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
| | - William E. Rudgard
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
| | - Sarah Skeen
- Department of Global Health, Stellenbosch University, Institute for Life Course Health Research, Cape Town, South Africa
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
- Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
| | - Stefani M. Du Toit
- Department of Global Health, Stellenbosch University, Institute for Life Course Health Research, Cape Town, South Africa
| | | | - Sarah L. Gordon
- Department of Global Health, Stellenbosch University, Institute for Life Course Health Research, Cape Town, South Africa
| | | | - Lucie Cluver
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
12
|
Langwenya N, Toska E, Stöckl H, Cluver L. Which groups are most affected by sexual violence? A disaggregated analysis by sex, age, and HIV-status of adolescents living in South Africa. CHILD ABUSE & NEGLECT 2022:105981. [PMID: 36473807 DOI: 10.1016/j.chiabu.2022.105981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Estimates on sexual violence (SV) among adolescents are rarely disaggregated by key indicators. OBJECTIVE We examine the independent effects of sex, age, HIV status and mode of HIV acquisition on the exposure to SV using generalised estimating equations models and proportional hazard model. PARTICIPANT AND SETTING Data from a 4-year prospective cohort study of 1447 adolescents (ages 10-19, 57% girls, 76% living with HIV) in South Africa. METHODS We describe the lifetime prevalence of three forms of SV: non-contact (unwanted showing of private parts), contact (coerced sexual debut, attempted and completed forced penetrative or oral sex,) and exploitative (sex in exchange for goods/money). RESULTS Overall, 23.9% (95%CI = 21.7%-26.1%) reported exposure to SV at some point in their lives: non-contact = 5.7%, contact = 9.0% and exploitative = 15.8%. While girls reported higher rates of exploitative (18.4% vs 12.3%; p < 0.001) and contact SV (12.3% vs 4.6%; p < 0.001), there were no differences in levels of non-contact SV by sex (6.5% vs 4.6%; p = 0.086). Exposure to any SV doubled in late adolescence (10-14 years = 7.0% vs ≥15 years = 31.7%; aIRR = 2.07; 95%CI = 1.82-2.37). Though level of SV were comparable between those living with HIV and those HIV-uninfected (22.9% vs 26.2%; p = 0.182), adolescents who recently acquired HIV were twice as likely to experience SV compared to adolescents who perinatally acquired HIV (42.3% vs 15.7%; aIRR = 2.03; 95%CI = 1.73-2.39). This association persisted when analysis was restricted to incidence SV during follow-up (aIRR = 1.53; 95%CI = 1.23-2.10). CONCLUSION Exposure to SV was high for both sexes, increased with age and more prevalent among adolescents who recently acquired HIV. SV prevention and response services must also be offered to boys and strengthened in HIV care services.
Collapse
Affiliation(s)
- Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Nuffield College, University of Oxford, Oxford, United Kingdom.
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa; Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
13
|
Grzejszczak J, Gabryelska A, Gmitrowicz A, Kotlicka-Antczak M, Strzelecki D. Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13958. [PMID: 36360840 PMCID: PMC9657348 DOI: 10.3390/ijerph192113958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/09/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.
Collapse
Affiliation(s)
- Jagoda Grzejszczak
- Department of Child and Adolescent Psychiatry, Medical University of Lodz, 90-151 Lodz, Poland
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-151 Lodz, Poland
| | - Agnieszka Gmitrowicz
- Department of Child and Adolescent Psychiatry, Medical University of Lodz, 90-151 Lodz, Poland
| | | | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 90-151 Lodz, Poland
| |
Collapse
|
14
|
Mebrahtu H, Skeen S, Rudgard WE, Du Toit S, Haag K, Roberts KJ, Gordon SL, Orkin M, Cluver L, Tomlinson M, Sherr L. Can a combination of interventions accelerate outcomes to deliver on the Sustainable Development Goals for young children? Evidence from a longitudinal study in South Africa and Malawi. Child Care Health Dev 2022; 48:474-485. [PMID: 34907593 DOI: 10.1111/cch.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to identify possible entry points for interventions that can act as development accelerators for children and adolescents in South Africa and Malawi. METHODS This study was a secondary data analysis. Data were sourced from the Child Community Care longitudinal study which tracked child well-being outcomes among 989 children (4-13 years) and their caregivers affected by HIV and enrolled in community-based organizations in South Africa and Malawi. We examined associations between five hypothesized accelerating services/household provisions-measured as access at baseline and follow-up and 12 child outcomes that relate to indicators within the Sustainable Development Goals (SDGs) framework. We calculated the adjusted probabilities of experiencing each SDG aligned outcome conditional on receipt of single, combined or all identified accelerators. RESULTS The results show household food security is associated with positive child education and cognitive development outcomes. Cash grants were positively associated with nutrition and cognitive development outcomes. Living in a safe community was positively associated with all mental health outcomes. Experiencing a combination of two factors was associated with higher probability of positive child outcomes. However, experiencing all three accelerators was associated with better child outcomes, compared with any of the individual factors by themselves with substantial improvements noted in child education outcomes. CONCLUSIONS Combined delivery of specific interventions or services may yield greater improvements in child outcomes across different developmental domains. It is recommended that multiple support avenues in combination like improving food security and safe communities, as well as social protection grants, should be provided for vulnerable children to maximize the impact.
Collapse
Affiliation(s)
- Helen Mebrahtu
- Institute for Global Health, University College London, London, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - William E Rudgard
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK
| | - Stefani Du Toit
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Katharina Haag
- Institute for Global Health, University College London, London, UK
| | | | - Sarah L Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mark Orkin
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK.,MRC-NRF Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lucie Cluver
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
15
|
Chipanta D, Estill J, Stöckl H, Hertzog L, Toska E, Chanda P, Mwanza J, Kaila K, Matome C, Tembo G, Keiser O, Cluver L. Associations of Sustainable Development Goals Accelerators With Adolescents’ Well-Being According to Head-of-Household’s Disability Status–A Cross-Sectional Study From Zambia. Int J Public Health 2022; 67:1604341. [PMID: 35283719 PMCID: PMC8916123 DOI: 10.3389/ijph.2022.1604341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/07/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: We examined associations between accelerators (interventions impacting ≥2 SDG targets) and SDG-aligned well-being indicators among adolescents 16–24 years old in Zambia. Methods: We surveyed adults from 1,800 randomly sampled households receiving social cash transfers. We examined associations between accelerators (social cash transfers, life-long learning, mobile phone access) and seven well-being indicators among adolescents using multivariate logistic regressions. Results: The sample comprised 1,725 adolescents, 881 (51.1%) girls. Mobile phone access was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p < 0.001), informal cash transfers (aOR 1.82, p = 0.004), and seeking mental health support (aOR 1.61, p = 0.020). Social cash transfers were associated with no disability-related health restrictions (aOR 2.56, p = 0.004) and lesser odds of seeking mental health support (aOR 0.53, p = 0.029). Life-long learning was associated with informal cash transfers (aOR 3.49, p < 0.001) and lower school enrollment (aOR 0.70, p = 0.004). Adolescents with disabled head-of-household reported worse poverty, good health but less suicidal ideation. Conclusions: Social cash transfers, life-long learning, and mobile phone access were positively associated with well-being indicators. Adolescents living with disabled head-of-household benefited less. Governments should implement policies to correct disability-related inequalities.
Collapse
Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
- *Correspondence: David Chipanta,
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lucas Hertzog
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Patrick Chanda
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Kelly Kaila
- Disability Inclusion Project Luapula, International Labour Organisation, Lusaka, Zambia
| | | | - Gelson Tembo
- Palm Associates Limited, Lusaka, Zambia
- Economics and Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
16
|
Sherr L, Cluver L, Desmond C, Dhaliwal M, Webb D, Aber JL. Accelerating achievement for Africa's adolescents - an innovative initiative. PSYCHOL HEALTH MED 2022; 27:1-13. [PMID: 36471485 DOI: 10.1080/13548506.2022.2147962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Lucie Cluver
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Chris Desmond
- Centre for Rural Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Mandeep Dhaliwal
- HIV and Health Group, United Nations Development Programme (UNDP), New York, USA
| | - Douglas Webb
- Health and Innovative Financing, HIV and Health Group, United Nations Development Programme (UNDP), New York, USA
| | - J Lawrence Aber
- Steinhardt School of Culture, Education, and Human Development, New York University New York, NY, United States
| |
Collapse
|
17
|
Du Toit S, Haag K, Skeen S, Sherr L, Orkin M, Rudgard WE, Marlow M, Mehbratu H, Steventon Roberts K, Tomlinson M. Accelerating progress towards improved mental health and healthy behaviours in adolescents living in adversity: findings from a longitudinal study in South Africa. PSYCHOL HEALTH MED 2022; 27:14-26. [PMID: 35941826 DOI: 10.1080/13548506.2022.2108081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Adolescents exposed to high levels of adversity are vulnerable to developing mental health challenges, with long-lasting adverse consequences. Promoting the psychological well-being of adolescents and protecting them from adverse experiences is crucial for their quality of life. There is a need for evidence on which combinations of protective factors can improve the wellbeing of adolescents to inform future programming efforts. We used data from a longitudinal study that took place in Khayelitsha, South Africa, a semi-urban impoverished community in Cape Town. Data were collected from adolescents when they were 12-14 years of age (n = 333) and again at follow-up when they were aged 16-19 years (n = 314). A path analysis was used to estimate associations between access to service, food security, safe environment, family support, and social support and five outcomes related to adolescent mental health and risky behaviours. The fitted model was used to calculate adjusted mean differences comparing different combinations of risk factors. Two protective factors (food security and safe environment) were positively associated with three outcomes relating to mental health and the absence of risky behaviours. Further investigation revealed that the presence of high food security and safer environments was associated with higher adjusted mean scores: +16.2% (p < .0001) in no substance use; +16.5% (p < .0001) in no internalising behaviour, +19.5% (p < .0001) in self-esteem; +12.2% (p < .0001) in positive peer relationships; and +11.4% (p < .0001) in no suicidal ideation. Interventions targeting adolescents, that aim to improve food security together with improving the safety of their environment, are likely to impact their well-being.
Collapse
Affiliation(s)
- Stefani Du Toit
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Mark Orkin
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK.,MRC-NRF Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - William E Rudgard
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Mehbratu
- Institute for Global Health, University College London, London, UK
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| |
Collapse
|
18
|
Hertzog L, Banougnin BH, Stöckl H, Toska E. Accelerating ontological security for South African adolescents living in high HIV-prevalence areas: a longitudinal study. PSYCHOL HEALTH MED 2022; 27:27-48. [PMID: 35929899 PMCID: PMC9729385 DOI: 10.1080/13548506.2022.2108079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ontological security is the personal need to build fundamental certainty about the continuity of life events. It is central to long-term human development, particularly among adolescents in highly vulnerable communities in South Africa. We examined the cumulative effects of eight hypothesised provisions (development accelerators) in reducing the risks of ontological insecurity outcomes aligned with Sustainable Development Goals (SDGs) targets. Three waves of survey data from adolescents living in high HIV prevalence areas in South Africa were analysed. We used standardised tools to measure twelve outcomes linked to two dimensions of ontological security: mental health and violence. Sustained receipt (at baseline and follow-ups) of eight hypothesised accelerators were examined: emotional and social support, parental/caregiver monitoring, food sufficiency, accessible health care, government cash transfers to households, basic economic security, positive parenting/caregiving, and participation in extramural activities. Associations of all accelerators with outcomes were evaluated using multivariable regressions controlling for age, sex, orphanhood and HIV status, rural/urban location, and informal housing. Cumulative effects were tested using marginal effects modelling. Of 1,519 adolescents interviewed at baseline, 1,353 (89%) completed the interviews at two follow-ups. Mean age was 13.8 at baseline; 56.6% were female. Four provisions were associated with reductions in twelve outcomes. Combinations of accelerators resulted in a percentage reduction risk in individual indicators up to 18.3%. Emotional and social support, parental/caregiver monitoring, food sufficiency and accessible health care by themselves and in combination showed cumulative reductions across twelve outcomes. These results deepen an essential understanding of the long-term effects of consistent exposure to accelerators on multi-dimensional human development. They could be directly implemented by existing evidence-based interventions such as peer-based psychosocial support, parenting programmes, adolescent-responsive healthcare and food support, providing safer and healthier environments for South African adolescents to thrive.
Collapse
Affiliation(s)
- Lucas Hertzog
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | | | - Heidi Stöckl
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa,Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom,Department of Sociology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
19
|
Haag K, Du Toit S, Skeen S, Steventon Roberts K, Chideya Y, Notholi V, Sambudla A, Gordon S, Sherr L, Tomlinson M. Predictors of COVID-related changes in mental health in a South African sample of adolescents and young adults. PSYCHOL HEALTH MED 2022; 27:239-255. [PMID: 35950705 DOI: 10.1080/13548506.2022.2108087] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has substantially affected the lives of young people living in sub-Saharan Africa (SSA), leading to poorer short-term mental health outcomes. However, longitudinal data investigating changes in mental health from pre-COVID levels and their predictors are lacking. Our longitudinal sample comprised N = 233 young people (mean age: 17.8 years at baseline, 55.6% female) living in a deprived neighbourhood near Cape Town, South Africa. Symptoms of depression (PHQ-9), anxiety (GAD-7) and alcohol use (AUDIT) were assessed during two waves of data collection, pre-pandemic (2018/19) and via phone interviews in June to October 2020, during South Africa's first COVID wave and subsequent case decline. Latent change score models were used to investigate predictors of changes in mental health. Controlling for baseline levels, we found increases in depression and anxiety but not alcohol use symptoms during the COVID-19 pandemic. Higher baseline symptoms were associated with smaller increases on all measures. Socio-economic deprivation (lack of household income, food insecurity) before and during COVID were associated with higher anxiety and depression symptom increases. Having had more positive experiences during COVID was associated with lower post-COVID onset anxiety and depression increases, and marginally with less alcohol use, while negative experiences (household arguments, worries) were linked to stronger symptom increases. Overall, in a sample of young people from an adverse environment in South Africa, we found increased mental health difficulties during the COVID-19 pandemic, though higher baseline symptoms did not necessarily predict stronger increases. Several factors pre- and post-COVID onset were identified that could be relevant for determining risk and resilience. In the long term, it will be key to address these structural drivers of well-being and to ensure mental health needs of young people are being met to support SSA countries in building back successfully from COVID-19 and preparing for future shock events.
Collapse
Affiliation(s)
- Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Stefani Du Toit
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Yeukai Chideya
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Vuyolwethu Notholi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Akhona Sambudla
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| |
Collapse
|
20
|
Meinck F, Orkin M, Cluver L. Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis. BMC Med 2021; 19:263. [PMID: 34758838 PMCID: PMC8580740 DOI: 10.1186/s12916-021-02137-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets ("accelerators") within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. METHODS Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. RESULTS Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. CONCLUSION Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.
Collapse
Affiliation(s)
- Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD UK
- OPTENTIA, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Orkin
- MRC-Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
21
|
Adegboye D, Williams F, Collishaw S, Shelton K, Langley K, Hobson C, Burley D, van Goozen S. Understanding why the COVID-19 pandemic-related lockdown increases mental health difficulties in vulnerable young children. JCPP ADVANCES 2021; 1:e12005. [PMID: 34485985 PMCID: PMC8250118 DOI: 10.1111/jcv2.12005] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 01/05/2023] Open
Abstract
Background The mental health consequences of school closure, social isolation, increased financial and emotional stress, and greater exposure to family conflicts are likely to be pronounced for primary school children who are known to be vulnerable. Data from prior to the pandemic are needed to provide robust assessments of the impact of COVID‐19 on vulnerable children. Method The present study capitalises on an ongoing study of primary school children (4–8 years) identified as ‘at‐risk’ for mental health problems by teachers. We collected mental health and socio‐economic data prior to the pandemic and re‐assessed this cohort (n = 142) via researcher‐led video calls during the pandemic to evaluate the social and emotional impacts of COVID‐19 for these families. Results Mental health problems, particularly anxiety, increased significantly in these children. Parental mental health difficulties (anxiety and depression) were also prevalent. There were higher reports of financial stress during lockdown amongst low‐income families previously identified as living in poverty, prior to the COVID‐19 pandemic. Financial strain was found to indirectly predict increases in child mental health problems through parental mental health. Conclusion These findings show that the pandemic exacerbated mental health problems in already vulnerable children. These negative outcomes were explained by financial stress (e.g., lost employment, loss of income and inability to pay bills), which was negatively linked to parental mental health.
Collapse
Affiliation(s)
- Dolapo Adegboye
- Department of Psychology Cardiff University Cardiff South Glamorgan UK
| | - Ffion Williams
- Department of Psychology Cardiff University Cardiff South Glamorgan UK
| | - Stephan Collishaw
- Department of Psychological Medicine and Neurology Cardiff University School of Medicine Cardiff South Glamorgan Wales
| | - Katherine Shelton
- Department of Psychology Cardiff University Cardiff South Glamorgan UK
| | - Kate Langley
- Department of Psychology Cardiff University Cardiff South Glamorgan UK
| | | | - Daniel Burley
- Department of Psychology Cardiff University Cardiff South Glamorgan UK
| | | |
Collapse
|