Child labor remains a concern in sub‐Saharan Africa. Yet, evidence‐based preventive efforts are limited. We analyzed longitudinal data from Ghanaian adolescent girls in a pilot randomized clinical ...trial testing the preliminary impact of a combination intervention on family cohesion as a protective factor against child labor and school dropout. While there was no statistical difference between the control and intervention groups at 9 months, the results show that family cohesion scores improved significantly from baseline to 9 months for the ANZANSI intervention group. Qualitative results indicated improved family cohesion in the intervention group. Hence, future studies should further examine this promising social work intervention.
During adolescence, youth experience several physical, psychosocial, and cognitive changes. Self-esteem and self-concept are identified as protective factors for adolescents in high-income countries, ...but studies are limited in sub-Saharan Africa. We examined the associations of self-esteem and self-concept with life satisfaction and attitudes toward school using baseline data from 97 Ghanaian adolescent girls at risk of school dropout. Ordinary Least Squares regression models were fitted to examine the association between self-esteem and self-concept on school attitudes and life satisfaction. Self-esteem was positively associated with life satisfaction. Self-concept was associated with more positive attitudes toward school. Hence, self-esteem and self-concept may be critical protective factors in promoting adolescent girls' life satisfaction and positive attitudes toward school.
Background
Oppositional Defiant Disorders (ODDs) and other Disruptive Behavior Disorders (DBDs) are common among children and adolescents in poverty‐impacted communities in sub‐Saharan Africa. ...Without early intervention, its progression into adulthood can result in dire consequences. We examined the impact of a manualized family strengthening intervention called Amaka Amasanyufu designed to reduce ODDs and other DBDs among school‐going children residing in low‐resource communities in Uganda.
Methods
We used longitudinal data from the SMART Africa‐Uganda study (2016–2022). Public primary schools were randomized to: (1) Control condition (receiving usual care comprising generalized psychosocial functioning literature), 10 schools; (2) intervention delivered via parent peers (Amaka‐parents), 8 schools or; (3) intervention delivered via community healthcare workers (Amaka‐community), 8 schools. All the participants were blinded. At baseline, 8‐ and 16‐weeks postintervention initiation, caregivers completed the Iowa Conners Scale, which measured Oppositional Defiant Disorder (ODD) and Impairment Rating Scale to evaluate children’s overall impairment and impaired functioning with peers, siblings, and parents; impaired academic progress, self‐esteem, and family functioning. Three‐level linear mixed‐effects models were fitted to each outcome. Pairwise comparisons of postbaseline group means within each time point were performed using Sidak’s adjustment for multiple comparisons. Only children positive for ODD and other DBDs were analyzed.
Results
Six hundred and thirty‐six children screened positive for ODDs and other DBDs (Controls: n = 243; Amaka‐parents: n = 194; Amaka‐community: n = 199). At 8 weeks, Amaka‐parents’ children had significantly lower mean scores for overall impairment compared to controls, (mean difference: −0.71, p = .001), while Amaka‐community children performed better on ODD (mean difference: −0.84, p = .016). At 16 weeks, children in both groups were performing better on ODD and IRS than controls, and there were no significant differences between the two intervention groups.
Conclusions
The Amaka Amasanyufu intervention was efficacious in reducing ODD and impaired functioning relative to usual care. Hence, the Amaka Amasanyufu intervention delivered either by Amaka‐community or Amaka‐parents has the potential to reduce negative behavioral health outcomes among young people in resource‐limited settings and improve family functioning.
Trial registration: ClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017.
The rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for ...adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment.
We carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect of a family economic empowerment (EE) intervention on viral suppression in five districuts in Uganda. In total, 39 accredited health care clinics from study districts with existing procedures tailored to adolescent adherence were eligible to participate in the trial. We used data from 288 youth with detectable HIV viral loads (VL) at baseline (158 -intervention group from 20 clinics, 130 -non-intervention group from 19 clinics). The primary end point was undetectable plasma HIV RNA levels, defined as < 40 copies/ml. We used Kaplan-Meier (KM) analysis and Cox proportional hazard models to estimate intervention effects.
The Kaplan-Meier (KM) analysis indicated that an incidence of undetectable VL (0.254) was significantly higher in the intervention condition compared to 0.173 (in non-intervention arm) translated into incidence rate ratio of 1.468 (CI: 1.064-2.038), p = 0.008. Cox regression results showed that along with the family-based EE intervention (adj. HR = 1.446, CI: 1.073-1.949, p = 0.015), higher number of medications per day had significant positive effects on the viral suppression (adj.HR = 1.852, CI: 1.275-2.690, p = 0.001).
A family economic empowerment intervention improved treatment success for ALWHIV in Uganda. Analyses of cost effectiveness and scalability are needed to advance incorporation of this intervention into routine practice in low and middle-income countries.
In the context of the COVID-19 pandemic, we investigated associations between specific COVID-19-related changes and its impact on generalized anxiety disorder (GAD) levels among vulnerable young ...adults living with HIV (YALHIV) in a low-resource setting in Southern Uganda. This research utilized data from 500 YALHIV aged 19 to 25 from the Suubi+Adherence-R2 COVID-19 Supplement study. Disruptions were assessed using an 8-item modified Coronavirus Impact Scale, while anxiety was measured with the GAD-7 questionnaire. Hierarchical logistic regression analysis and multivariate linear regression were employed, guided by the Social Determinants of Health framework. Key findings highlighted changes in routines, family income, stress from the pandemic, changes in family stress and discord, and reduced access to mental health services heightened levels of probable GAD for YALHIV during the pandemic. Additionally, female young adults showed greater levels than males. These results underscore the urgency to develop tailored support mechanisms for YALHIV, especially during challenging and unprecedented times.
Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33-41; Research in Nursing and Health, 2016, 39(4), 229-243). Yet, there is ...limited research on the impact of evidence-based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa-Uganda study (2016-2022), a cluster randomized clinical trial testing an evidence-based family-strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8-13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post-intervention completion. The intervention effectiveness was evaluated via a three-level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent-peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.
We evaluate the mid-intervention (8 weeks) and short-term (16 weeks) impact of a culturally adapted multiple family group (MFG) intervention, "Amaka Amasanyufu," on the mental health of children with ...disruptive behavior disorders (DBDs) and primary caregivers in Uganda.
We analyzed data from the Strengthening mental health and research training in Sub-Saharan Africa (SMART) Africa-Uganda study. Schools were randomized to the following: a control group; an MFG facilitated by parent peers (MFG-PP); or an MFG facilitated by community health workers (MFG:CHW). All participants were blinded to interventions provided to other participants and study hypotheses. At 8 weeks and 16 weeks, we evaluated differences in depressive symptoms and self-concept among children and in mental health and caregiving-related stress among caregivers. Three-level linear mixed-effects models were fitted. Pairwise comparisons of post-baseline group means were performed using the Sidak adjustment for multiple comparisons and standardized mean differences. Data from 636 children with DBDs and caregivers (controls: n = 243, n = 10 schools; MFG-PP: n = 194, n = 8 schools; MFG-CHW: n = 199, n = 8 schools) were analyzed.
There were significant group-by-time interactions for all outcomes, and differences were observed mid-intervention, with short-term effects at 16 weeks (end-intervention). MFG-PP and MFG-CHW children had significantly lower depressive symptoms and higher self-concept, whereas caregivers had significantly lower caregiving-related stress and fewer mental health problems, than controls. There was no difference between intervention groups.
Amaka Amasanyufu MFG intervention is effective for reducing depressive symptoms and improving self-concept among children with DBDs while reducing parental stress and mental health problems among caregivers. Given the paucity of culturally adapted mental health interventions, this provides support for adaptation and scale-up in Uganda and other low-resource settings.
SMART Africa (Strengthening Mental Health Research and Training); https://clinicaltrials.gov/: NCT03081195.
Women engaged in sex work (WESW) are at heightened risk of experiencing intimate partner violence (IPV) compared to women in the general population. This study examines the impact of an economic ...empowerment intervention on IPV among WESW in Southern Uganda. We used data from 542 WESW in Southern Uganda recruited from 19 HIV hotspots between June 2019 and March 2020. Eligible participants were 18+ years old, engaged in sex work—defined as vaginal or anal sexual intercourse in exchange for money, alcohol, or other goods, reported at least one episode of unprotected sexual intercourse in the past 30 days with a paying, casual, or regular sexual partner (spouse, main partner). We analyzed data collected at baseline, 6, and 12months of follow up. To examine the impact of the intervention on IPV, separate mixed-effects logistic regression models were run for each type of IPV (physical, emotional, and sexual) as experienced by participants in the last 90 days.
Results show that the intervention was efficacious in reducing emotional and physical IPV as evidenced by a statistically significant intervention main effect for emotional IPV, χ2(1) = 5.96, p = 0.015, and a significant intervention-by-time interaction effect for physical IPV, χ2(2) = 13.19, p < 0.001. To qualify the intervention impact on physical IPV, pairwise comparisons showed that participants who received the intervention had significantly lower levels of physical IPV compared to those in the control group at six months (contrasts = −0.12 (95% CI: −0.22, −0.02), p = 0.011). The intervention, time, and intervention-by-time main effects for sexual IPV were not statistically significant. Our findings suggest economic empowerment interventions as viable strategies for reducing emotional IPV among WESW. However, it is also essential to understand the role of interventions in addressing other forms of IPV especially for key populations at high risk of violence, HIV, and STI.
The study was registered at ClinicalTrials.gov, ID: NCT03583541.
•Women engaged in sex work (WESW) in Southern Uganda face heightened risks of Intimate Partner Violence (IPV).•Among WESW, physical and emotional IPV are predominant forms of experienced violence.•Economic empowerment interventions significantly reduce both emotional and physical IPV among WESW.
Sub-Saharan Africa is home to two-thirds of people living with HIV globally. Adolescent girls and young women are twice as likely to be living with HIV compared to young men. Sexual risk-taking ...behaviors put adolescent girls at risk for adverse health outcomes, including HIV/AIDS. In this study, we conducted semi-structured in-depth interviews to explore multi-level factors that influence decisions to engage in sexual risk-taking among 58 school-going adolescent girls in Uganda. Both protective and risk factors cut across personal, proximal, and distal contexts. At the personal level, future goals and fear of negative health outcomes were identified as the most common protective factors. Positive family relations and peers were cited most frequently as protective factors at the proximal level. At the distal level, poverty was the most common risk factor. Relatedly, families’ ability to provide for adolescent girls’ needs was a protective factor. Study results point to the need for multilevel combination interventions to reduce sexual risk-taking among adolescent girls in Uganda.
In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective ...interventions for DBDs have been developed and tested in high‐poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence‐based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children’s drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.
Resumen
En Uganda, uno de cada cinco niños presenta problemas de salud mental, incluidos los trastornos del comportamiento disruptivo (TCD). Los TCD pueden continuar hasta la adultez y tener consecuencias negativas. Se han desarrollado intervenciones eficaces para los TCD, las cuales se han evaluado en comunidades con altos índices de pobreza en países desarrollados. Sin embargo, la mayoría de los países africanos, como Uganda, carecen de dichas intervenciones. Este artículo describe el proceso de adaptación de una intervención factual de origen estadounidense para optimizar su adaptación al contexto con la fidelidad de la intervención como parte de un ensayo aleatorizado realizado con jóvenes que presentan problemas conductuales y sus cuidadores en 30 escuelas de Uganda. El proceso consistió en reuniones iniciales con directores y maestros para presentar el estudio y los conceptos principales de la intervención; una revisión inicial del manual centrada en el contenido de la intervención “4Rs and 2 Ss” por parte del equipo de Uganda; la participación de partes interesadas de la comunidad para obtener comentarios adicionales sobre el contenido y la relevancia cultural; la revisión final del manual; y la recopilación de dibujos de los niños para la ilustración del manual. Este artículo describe tanto las similitudes como las diferencias entre el contenido de la intervención original y la adaptada y los métodos de implementación. Los resultados también destacan la importancia de hacer participar a las partes interesadas en el proceso de adaptación.
摘要
在乌干达，每五个儿童中就有一个孩子存在这样或那样的心理健康问题，其中包括破坏性行为障碍(DBDs )。 DBDs 可以持续到成年期，带来诸多不良后果。在发达国家的高度贫困社区，针对DBDs的有效干预措施已经得到开发和测试。但是在乌干达这样的大多数非洲国家，相关的干预措施仍属罕见。该论文描述了一项源自美国的循证干预措施在乌干达的国情下如何尽可能优化并保持原有效度的调适过程。作为一项随机测试的部分内容，本文调查研究了乌干达的30所学校中表现出行为问题的青少年及其他们的照顾者。研究过程涉及以下方面：初期组织校长和老师参加集会，介绍本研究的内容和干预措施的主要概念；在起始阶段组织乌干达团队对4Rs和2Ss相关内容进行了整体学习；邀请社区利益相关者积极参与并针对干预措施的内容和文化相关性提供更多的反馈；指导手册的最终修订版；收集儿童的绘画作品，以供编辑手册时使用。本文描述了原有干预措施和调整后的干预方案在内容方面以及实施方法上的异同。研究结果还强调了让社区利益相关者参与调适修改过程的重要性。
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