The impact and cost of child marriage prevention in three African settings

Girls in sub-Saharan Africa are disproportionately affected by child marriage; by 2050, half of the girls married during childhood will reside in Africa. The negative consequences of the practice are numerous and powerful, spanning health, welfare, development, and demographic domains. Yet, there is limited evidence on what works to delay child marriage in different cultural contexts and even less information on programmatic cost. This study develops and tests the most effective and minimum basic package approaches to delay marriage among older and younger adolescent girls, and estimates the cost and cost-effectiveness of implementing the different approaches, in Burkina Faso, Ethiopia, and Tanzania. In each study country, four approaches were tested: 1) community sensitization to address social norms, 2) provision of school supplies to encourage retention in school, 3) a conditional asset transfer to girls and their families, and 4) one study area that included all the approaches. The study aims to provide information on how best to design programs that are scalable and sustainable within poor settings, and which can provide support for the millions of girls in developing countries at risk of child marriage

The impact and cost of child marriage prevention in rural Burkina Faso

The negative impact of child marriage, frequently prevalent in rural locations of poor countries, spans health, development, and demographic consequences. While evidence is limited, a systematic review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that empower girls by offering incentives such as conditional cash transfers. However, most impact evaluations of community-based programs lack rigorous costing data, a particular weakness of cash transfer schemes where programmatic cost would affect the ability to scale up successful interventions for large populations. To address the limited information on cost and scalability of conditional cash transfer programs, the Population Council and its partners designed a study to determine if simple, cost-contained interventions could be effective at delaying marriage in African countries where child marriage is prevalent. This brief outlines the results of the research in the Cascades Region of Burkina Faso, and includes rigorous costing data, providing evidence for subsequent expansion of successful approaches

The impact and cost of child marriage prevention in rural Tanzania

The negative impact of child marriage, frequently prevalent in rural locations of poor countries, spans health, development, and demographic consequences. While evidence is limited, a systematic review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that empower girls by offering incentives such as conditional cash transfers. However, most impact evaluations of community-based programs lack rigorous costing data, a particular weakness of cash transfer schemes where programmatic cost would affect the ability to scale up successful interventions for large populations. To address the limited information on cost and scalability of conditional cash transfer programs, the Population Council and its partners designed a study to determine if simple, cost-contained interventions could be effective at delaying marriage in African countries where child marriage is prevalent. This brief outlines the results of the research in the Tabora region of Tanzania, and includes rigorous costing data, providing evidence for subsequent expansion of successful approaches

The impact and cost of child marriage prevention in rural Ethiopia

The negative impact of child marriage, frequently prevalent in rural locations of poor countries, spans health, development, and demographic consequences. While evidence is limited, a systematic review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that empower girls by offering incentives such as conditional cash transfers. However, most impact evaluations of community-based programs lack rigorous costing data, a particular weakness of cash transfer schemes where programmatic cost would affect the ability to scale up successful interventions for large populations. To address the limited information on cost and scalability of conditional cash transfer programs, the Population Council and its partners designed a study to determine if simple, cost-contained interventions could be effective at delaying marriage in African countries where child marriage is prevalent. This brief outlines the results of the research in the Amhara region of Ethiopia, and includes rigorous costing data, providing evidence for subsequent expansion of successful approaches

Sub-Saharan Africa's Mothers, Newborns, and Children: How Many Lives Could Be Saved with Targeted Health Interventions?

As part of the series on maternal, neonatal, and child health in sub-Saharan Africa, Robert Black and colleagues estimated mortality reduction for 42 countries and conclude that the use of local data is needed to prioritize the most effective mix of interventions

Reproductive Cycle-associated Mood Symptoms In Women With Major Depression And Bipolar Disorder

Background: We sought to determine the prevalence of, and association between, reproductive cycle-associated mood symptoms in women with affective disorders. We hypothesized that symptoms would correlate with each other across a woman's reproductive life span in both major depression (MDD) and bipolar I disorder (BP). Methods: 2412 women with, MDD or BP were asked standardized questions about mood symptoms prior to menstruation, within a month of childbirth and during perimenopause. Lifetime rates for each of these symptom types were determined and an odds ratio was calculated correlating each of the types with the others. Results: Of 2524 women with mood disorders, 67.7% reported premenstrual symptoms. Of those at risk, 20.9% reported postpartum symptoms and 26.4% reported perimenopausal symptoms. The rates did not differ between women with MDD and BP but were significantly different from women who were never ill. The symptoms were significantly correlated in women with MDD with odds ratios from 1.66 to 1.82, but were not in women with BP. Limitations: This is a secondary analysis of a sample that was collected for other purposes and is based upon retrospecitve reporting. Conclusions: Reproductive cycle-associated mood symptoms were commonly reported in women with mood disorders and did not differ based on diagnosis. In MDD, but not BP, the occurrence of these symptoms was trait-like as the presence of one predicted the occurrence of the others. Further prospective study is required to clarify the determinants of this trait

Development And Evaluation Of A Multimodal Marker Of Major Depressive Disorder

This study aimed to identify biomarkers of major depressive disorder (MDD), by relating neuroimage-derived measures to binary (MDD/control), ordinal (severe MDD/mild MDD/control), or continuous (depression severity) outcomes. To address MDD heterogeneity, factors (severity of psychic depression, motivation, anxiety, psychosis, and sleep disturbance) were also used as outcomes. A multisite, multimodal imaging (diffusion MRI [dMRI] and structural MRI [sMRI]) cohort (52 controls and 147 MDD patients) and several modeling techniques—penalized logistic regression, random forest, and support vector machine (SVM)—were used. An additional cohort (25 controls and 83 MDD patients) was used for validation. The optimally performing classifier (SVM) had a 26.0% misclassification rate (binary), 52.2 ± 1.69% accuracy (ordinal) and r = .36 correlation coefficient (p < .001, continuous). Using SVM, R2 values for prediction of any MDD factors were <10%. Binary classification in the external data set resulted in 87.95% sensitivity and 32.00% specificity. Though observed classification rates are too low for clinical utility, four image-based features contributed to accuracy across all models and analyses—two dMRI-based measures (average fractional anisotropy in the right cuneus and left insula) and two sMRI-based measures (asymmetry in the volume of the pars triangularis and the cerebellum) and may serve as a priori regions for future analyses. The poor accuracy of classification and predictive results found here reflects current equivocal findings and sheds light on challenges of using these modalities for MDD biomarker identification. Further, this study suggests a paradigm (e.g., multiple classifier evaluation with external validation) for future studies to avoid nongeneralizable results

Genome-wide interaction study of a proxy for stress-sensitivity and its prediction of major depressive disorder

Individual response to stress is correlated with neuroticism and is an important predictor of both neuroticism and the onset of major depressive disorder (MDD). Identification of the genetics underpinning individual differences in response to negative events (stress-sensitivity) may improve our understanding of the molecular pathways involved, and its association with stress-related illnesses. We sought to generate a proxy for stress-sensitivity through modelling the interaction between SNP allele and MDD status on neuroticism score in order to identify genetic variants that contribute to the higher neuroticism seen in individuals with a lifetime diagnosis of depression compared to unaffected individuals. Meta-analysis of genome-wide interaction studies (GWIS) in UK Biobank (N = 23,092) and Generation Scotland: Scottish Family Health Study (N = 7,155) identified no genome-wide significance SNP interactions. However, gene-based tests identified a genome-wide significant gene, ZNF366, a negative regulator of glucocorticoid receptor function implicated in alcohol dependence (p = 1.48x10-7; Bonferroni-corrected significance threshold p < 2.79x10-6). Using summary statistics from the stress-sensitivity term of the GWIS, SNP heritability for stress-sensitivity was estimated at 5.0%. In models fitting polygenic risk scores of both MDD and neuroticism derived from independent GWAS, we show that polygenic risk scores derived from the UK Biobank stress-sensitivity GWIS significantly improved the prediction of MDD in Generation Scotland. This study may improve interpretation of larger genome-wide association studies of MDD and other stress-related illnesses, and the understanding of the etiological mechanisms underpinning stress-sensitivity