Our series of four policy briefs, commissioned by the United Nations Population Fund’s (UNFPA) East and Southern Africa Regional Office (ESARO), highlight the need for the enactment of robust legislative and policy frameworks, which are clear, consistent, and in line with international and regional human rights standards; including the Southern African Development Community Model Law on Eradicating Child Marriage and Protecting Children Already in Marriage (SADC Model Law).
Combating child marriage and the intergenerational sexual abuse of girls in South Africa
The legal and policy frameworks governing marriage in many African countries often presume gender neutrality, thereby failing to address the deeply gendered nature of child marriage and sexual exploitation and abuse. Data from UNICEF and other sources consistently show that child marriage disproportionately affects girls, with significantly fewer boys involved in the practice. Far from ensuring equal protection and benefit of the law, many existing legal provisions reinforce gender inequality by allowing exceptions to the minimum age of marriage or by setting a lower marriageable age for girls, thereby legitimising harmful practices against girls by virtue of these legal loopholes. Focusing on South Africa, the paper illustrates how current marriage laws violate girls’ rights to equal protection and freedom from sexual exploitation. For example, girls aged 15 or older may marry without ministerial or judicial consent, whereas all boys under 18 require such approval. This legal disparity leaves girls uniquely exposed and under-protected compared to their male peers, reinforcing patriarchal norms through discrimination entrenched in legislation. Adopting a feminist and intersectional lens, the article also explores how customary practices such as lobolo and ukuthwala continue to legitimise child marriage. These practices, when intersecting with gender-discriminatory laws, intensify the vulnerability of girls and exacerbate systemic abuse. The article critically examines international, African regional, and sub-regional child rights instruments to assess their gender sensitivity and responsiveness in protecting children, especially girls, from early and forced marriage. Finally, the article calls for urgent legal and policy reforms, including the removal of gender-discriminatory provisions and the implementation of substantive equality measures, alongside efforts to empower girls through legal, educational, and social interventions. These reforms must be accompanied by the dismantling of patriarchal structures and an acknowledgment of the diverse lived realities of girlhood, both essential to ending the systemic legitimisation of child marriage and achieving equal protection for all children.
This scoping review aims to systematically map and synthesize the existing peer-reviewed evidence on the multidimensional nature of screen exposure (SE) and its associations with developmental outcomes among children aged 0–5 years. The review moves beyond the traditional focus on total screen time and considers screen exposure as a multidimensional construct encompassing duration and quantity, content quality and type, context of use, interactivity, caregiver mediation, device type, background exposure, age of onset, and exposure trajectories. The review will examine evidence across three main developmental domains: (1) language and communication development, including receptive and expressive language and vocabulary; (2) cognitive development and executive function, including attention, inhibitory control, working memory, and general cognitive abilities; and (3) socio-emotional development and behavior, including emotional regulation, behavioral difficulties, prosocial behavior, and peer relationships. The review will follow established scoping review methodology, including the methodological framework described by Arksey and O’Malley and updated guidance from the Joanna Briggs Institute (JBI). Reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The eligibility framework will be structured using Population, Concept, and Context (PCC). The population will include children aged 0–5 years, including typically developing children and community-based samples. Studies focused exclusively on clinical populations without normative or community-based data will be excluded. The concept of interest is multidimensional screen exposure and its relationship with developmental outcomes. No geographic restrictions will be applied, although evidence from the Middle East and North Africa (MENA) region will be specifically identified and examined. A systematic search will be conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language publications published from January 2016 through July 2026. Eligible studies will include primary empirical research using quantitative measures of screen exposure and validated developmental outcome assessments, as well as relevant observational, experimental, qualitative, and mixed-methods studies. Reviews, editorials, opinion articles, conference abstracts without full text, dissertations, theses, government reports, and other grey literature will be excluded. Study selection will involve independent title/abstract and full-text screening by two reviewers, with disagreements resolved through discussion and consultation with a third reviewer when necessary. Cohen’s kappa will be used to assess inter-rater reliability. Data will be extracted using a standardized and piloted extraction form, including study characteristics, participant characteristics, screen exposure measures, developmental outcome measures, and key findings. Due to expected heterogeneity across study designs, populations, exposure measures, and developmental outcomes, findings will be synthesized narratively and organized according to the three developmental domains. The expected outcome of this review is a comprehensive map of how different dimensions of screen exposure have been investigated in relation to early childhood development. The review is expected to identify consistent and inconsistent patterns across developmental domains, clarify the roles of content, context, caregiver mediation, and exposure trajectories, and highlight important evidence gaps. Particular attention will be given to the limited evidence available from Saudi Arabia and the wider MENA region. Ultimately, the findings are expected to inform future research and support the development of culturally relevant, multidimensional approaches to assessing screen exposure among young children. The review will also provide an evidence base for the development of a multidimensional screen exposure measurement tool appropriate for use with children in the Saudi Arabian context and potentially the broader Middle Eastern region.
Mshari Alghadier, Ragab K Elnaggar, Abdulaziz Ghandurah et al.
AbstractSystems ensure the attainment of goals at any educational level, including quality early childhood education. Various studies focus on the benefits and components of quality early childhood education, yet none emphasise systems that will support early childhood development (ECD) centres in offering quality education. This study explored existing systems that support ECD centres in providing quality education to young children. The study adopted a qualitative research approach and collected data through document analysis and face-to-face interviews with eight participants purposively selected from four ECD centres situated in Pretoria. The data were analysed thematically. The findings revealed that national policies, internally generated policies and financial systems support the participating centres in offering quality education. However, many of the participants did not know the existing national policies. The findings also revealed that ECD centres in the township area do not have financial systems to help them provide quality education. The study recommends effective implementation strategies to foster awareness and enforce strict adherence to government policies at ECD centres. The study contributes to awareness and adherence to quality early childhood education by suggesting that ECD centres, principals and teachers should engage in relevant and practical training on effectively establishing systems from the available national education policies that will help them offer quality education.Contribution: This study adds to the body of knowledge by filling in the gaps on how ECD principals and teachers understand national policies and translate them into systems that assist them in managing their centres on a daily basis. The novelty of this study is the empirical input from different disciplines (Early Childhood Education and Management and Policies Studies), in a way that enables one to comprehend the role of educational management and policies studies at the early childhood learning centres in South Africa, which is the emphasis of the Journal for Transdisciplinary Research in Southern Africa.
This study explored the challenges and opportunities in the utilization of the Constituency Development Fund (CDF) for maternal and child health improvement in Vubwi Constituency, Zambia. The study was motivated by the increasing role of CDF in promoting decentralized development and financing community-based health interventions aimed at improving maternal and child health outcomes. Despite its potential, concerns remain regarding the effective utilization of CDF resources and the factors that influence the implementation, accountability, and sustainability of funded health interventions. A qualitative case study design was employed to gain an in-depth understanding of stakeholders' experiences and perceptions regarding the utilization of CDF for maternal and child health improvement. The target population comprised health facility staff, CDF committee members, local leaders, and community members. A sample of 30 participants was selected using purposive and simple random sampling techniques. Data were collected through semistructured interviews and focus group discussions and analyzed using thematic analysis. The findings revealed that the utilization of CDF created significant opportunities for improving maternal and child health through investments in health infrastructure, enhanced access to health services, strengthened stakeholder collaboration, and increased community participation in identifying and prioritizing local health needs. Community involvement promoted ownership of CDF-funded projects, improved transparency, and enhanced accountability in resource utilization. However, the study also identified several challenges that constrained the effective utilization of CDF. These included inadequate awareness of CDF guidelines and processes, limited technical and financial management capacity among stakeholders, unequal participation in decision-making, weak communication between governance structures and communities, delays in project implementation, and insufficient monitoring and accountability mechanisms. The findings further indicated that effective coordination among CDF committees, local authorities, health institutions, and community representatives was essential for ensuring that funded interventions addressed local maternal and child health priorities and remained sustainable. The study concluded that the Constituency Development Fund has considerable potential to improve maternal and child health services in Vubwi Constituency when supported by transparent governance, inclusive participation, effective stakeholder coordination, and strengthened institutional capacity. The study recommends enhancing community sensitization on CDF processes, strengthening participatory planning and monitoring, improving stakeholder collaboration, and reinforcing accountability mechanisms to maximize the contribution of CDF investments to maternal and child health improvement.
The increasing prevalence of depression is a growing global concern, including among early childhood development practitioners. However, there is a dearth of studies on the mental health of these practitioners in South Africa. The objective of this study was to screen for the prevalence and severity of depression symptoms among practitioners. The Patient Health Questionnaire-9 (PHQ-9) and a socio-demographic questionnaire were used to collect data from 402 practitioners. Descriptive analysis of the data was performed using Stata 14. The Pearson chi-square test and logistic regression model were applied to explore associations between socio-demographic variables and PHQ-9 scores and to identify factors significantly associated with depression symptoms. Nearly half of the participants (47.26%) tested positive for depression symptoms across various severity categories, including mild (27.11%), moderate (15.92%), moderately severe (3.48%), and severe (0.75%). Key variables such as the location of the center, the number of children living with the practitioner, substance use, the number of practitioners in the center, the number of children per class, and the total number of children in the center were significantly associated with depression symptoms (p ≤ 0.05). The study recommends the development and implementation of tailored interventions to address the mental health needs of practitioners, thereby improving both the academic and non-academic outcomes of learners.
ABSTRACT Increasing health issues and rising poverty rates in Nigeria have adversely impacted child health care utilization. This study X‐rays the wealth access and regional variations nexus in child healthcare utilization. The generalized linear model (GLM) approach and the concentration index were adopted, employing data elicited from the Nigeria demographic and health survey (NDHS) conducted in 2008 and 2018. The study identified a substantial variation in child healthcare utilization among households with varying wealth access levels, implying that as households' access to wealth increases, inequality in healthcare utilization reduces among children. Regional analysis shows that the northeast and northwest geopolitical zones exhibited a higher prevalence in child healthcare utilization inequality, due to distinct socioeconomic status, cultural, and religious practices. The study therefore recommends that to support and maintain the initiatives for health system reform, a communication plan and an efficient regionally based health management information system must be created. Again, to increase child healthcare accessibility and utilization, such programmes should include a thorough health promotion strategy that raises awareness and provides relevant education to low‐income households.
Anthony Orji, Celine Onyinyechi Obochi, Onyinye Imelda Anthony-Orji et al.
ABSTRACT Background Rapidly urbanising complex ecosystems present several challenges to the organisation, availability, and accessibility of healthcare services. This study describes the availability and distribution of health facilities offering services, with a focus on maternal and newborn health services in the seven health districts of Grand Conakry, Methods This study using primary data from a census of health facilities (June 2025). Finally, healthcare landscape was drawn up using the GPS coordinates collected, based on the boundaries of the seven including health districts. The census started with an existing list of 459 facilities and snowball sampling was used to identify facilities that were not initially on the list. We collected information on basic facility characteristics and GPS coordinates. Results A total of 795 health facilities exist in Grand Conakry, with 564 facilities which were not on the initial lists, 104 were either closed, out of service, or refused to participate. The questionnaire was completed by 691 health facilities. The private sector dominated the landscape and was mainly concentrated in the Ratoma and Matoto health districts; with most facilities (63%) not reporting to the national health information system, in contrast to those in public sector (85.7%). 332/691 facilities reported providing childbirth care, and 132 of them (40%) offered caesarean section, while 87 (26%) offered blood transfusions. Conclusion Despite the high number of facilities, geographic imbalances in distribution exist. Equitable access to healthcare in rapidly urbanising Grand Conakry requires strengthening urban health planning and public-private collaboration regarding ongoing rapid urbanisation in Grand Conakry. Key messages What is already known on this topic? The rapid urbanisation of Grand Conakry is accompanied by an expansion in healthcare provision, but information on the geographical distribution and characteristics of healthcare facilities, particularly for maternal and neonatal care is limited and incomplete. What this study adds? A significant number of healthcare facilities operating in Grand Conakry are missing from existing health authority lists. Healthcare provision is largely dominated by the private sector. The availability of comprehensive emergency obstetric and neonatal care services remains limited, and only 4% of facilities offer childbirth care that is completely free of charge (all public). How this study might affect research, practice or policy? The comprehensive facility list generated by this census strengthens healthcare system planning for maternal and neonatal care provision, including improving referral networks in Grand Conakry.
Nafissatou Dioubate, Aline T. Semaan, Rehema Ouko et al.
Abstract Research highlights the benefits of singing in early childhood for the development of cognitive, language, emotional and social skills. Grounded in this theoretical framework, this article draws on data from Statistics South Africa’s, The General Household Survey (2023), to examine patterns of parental singing across different socioeconomic groups. This survey does not measure the efficacy of singing in early childhood, but it does provide insights into disparities in the exposure to home singing among young children. Various analytical techniques were used to analyze the data, such as descriptive analysis, bivariate analysis, regression analysis, and multivariate analysis. The findings of the analyses highlight the disparities in music exposure and singing practices across socioeconomic backgrounds and educational levels in South Africa. Children from high socio-economic backgrounds have access to regular singing activities in the home as well as access to better early childhood development programmes that incorporate regular singing activities. The findings underscore the need for policy intervention and structured programmes that promote access to singing opportunities in early childhood particularly for children in low socio-economic communities.
Abstract Background Neonatal mortality remains disproportionately high in sub-Saharan Africa (SSA), accounting for nearly half of all deaths in children under five. Although antenatal care, skilled birth attendance, and postnatal care are individually associated with improved newborn survival, few studies have examined whether their integrated receipt as a continuum of care (CoC) confers additional protection against neonatal death, particularly after accounting for sociodemographic confounding and heterogeneity across country contexts. Methods A pooled cross-sectional analysis was conducted using DHS-8 Births Recode files from five countries: Nigeria (2024), Mali (2023–2024), Congo DRC (2023–2024), Kenya (2022), and Lesotho (2023–2024). The analytical sample comprised 37,351 births within the 36-month postnatal care reference window. Complete CoC was defined as receipt of adequate antenatal care (≥4 visits with first-trimester initiation), skilled birth attendance, and postnatal care within 48 hours for the mother or newborn. Neonatal mortality was defined as death within 27 days of birth. Survey-weighted logistic and log-Poisson regression models estimated adjusted odds ratios (aOR) and adjusted prevalence ratios (aPR). G-computation quantified the population attributable fraction (PAF). Country-specific heterogeneity was examined through random-effects meta-analysis (DerSimonian-Laird method) and a two-level multilevel logistic regression model. Results The overall neonatal mortality rate was 29.3 per 1,000 live births (95% CI: 27.6–31.0). Complete CoC prevalence was 19.2% (95% CI: 18.5–19.9%), ranging from 7.8% in Congo DRC to 47.8% in Lesotho. In unadjusted analysis, complete CoC was associated with a 24% reduction in neonatal death odds (cOR: 0.764, 95% CI: 0.583–1.000, p = 0.050). After adjustment for wealth, education, residence, parity, maternal age, child sex, and country, the association was substantially attenuated and non-significant (aOR: 0.961, 95% CI: 0.717–1.289; aPR: 0.962, 95% CI: 0.722–1.282). The PAF under universal complete CoC was 3.2%. The pooled meta-analytic estimate was aOR 0.718 (95% CI: 0.447–1.152), with moderate heterogeneity (I² = 38.9%; τ² = 0.089). Country-specific estimates ranged from aOR 0.455 (95% CI: 0.256–0.810) in Kenya to 1.447 (95% CI: 0.496–4.220) in Lesotho. Conclusion Complete continuity of maternal healthcare was not independently associated with reduced neonatal mortality after full adjustment, suggesting that the unadjusted benefit was attributable to sociodemographic selection rather than a direct causal pathway. These findings underscore the insufficiency of service utilisation metrics in isolation and highlight the need to address the structural and contextual determinants that simultaneously constrain both care access and neonatal survival. Country-level heterogeneity in the CoC-mortality relationship points to the importance of tailored, context-specific interventions.
