The difference in prevalence of undernutrition and two-week disease history in women and children in Oromia, Ethiopia was compared between two intervention groups: nutrition only (comparison group) and integrated water, sanitation, and hygiene (WASH) and nutrition (integrated group).In both groups, health care workers were trained in community management of acute malnutrition and infant and young child feeding practices.Health care workers in turn organized events and household visits to identify and treat acutely malnourished infants and children, convey messaging regarding proper infant and young child feeding, and provide vegetable seeds for household gardens.The integrated group additionally received water tap construction and community-led total sanitation and hygiene.Four years post initiation, a household and child anthropometric survey (n=1,007) of mothers of children 0-59 months was conducted in 12 villages (6 per group).Accounting for sample design, logistic regression was used to determine adjusted odds ratios for child nutritional outcomes and child and maternal two-week disease history by intervention group.At follow up, intervention groups were similar in demographics, diet and feeding practices, immunization, supplementation, and access to water and hygiene.Access to an improved sanitation facility was greater in the integrated group (48%) than in the comparison group (28%) (p=0.02).Children from the integrated group had a 16 percentage point (95% CI: 0-32 percentage points) and 14 percentage point (95% CI: 5-22 percentage points) lower prevalence of stunting and fever, respectively, than children from the comparison group.The adjusted odds of stunting and fever in children from the integrated group were 50% (OR: 0.50, 95% CI: 0.26, 0.97) and 49% (OR: 0.51, 95% CI: 0.36, 0.74) lower than the odds of stunting and fever in children from the comparison group.Stratifying by intervention group, mean height-forage Z-score increased with sanitation facility among children from the comparison group only.There was no difference in maternal history of disease between groups.Integration of WASH and nutrition was associated with less stunting and disease in children 0-59 months in a setting with poor WASH conditions.Differences in sanitation may contribute to the gains in growth seen among children in the integrated group.
Jennifer Head, Helena Pachón, Catholic Relief Services, Addis Ababa, Ethiopia et al.
BACKGROUND: Little is known about the impact of food-assisted maternal and child health programs (FA-MCHN) on child wasting. OBJECTIVES: We assessed the impact of Tubaramure, a FA-MCHN program in Burundi, on child (0 to 24 months) wasting and the differential impacts by socio-economic characteristics and age. The program targeted women and their children during the first 1000 days and included 1) food rations, 2) strengthening and promotion of use of health services, and 3) behavior change communication (BCC). METHODS: We conducted a 4-arm, cluster-randomized, controlled trial (2010-2012). Clusters were defined as "collines" (communities). Impact was estimated using repeated cross-sectional data (n = ∼2620 children in each round). Treatment arms received household and individual (mother or child in the first 1000 days) food rations (corn-soy blend and micronutrient-fortified vegetable oil) from pregnancy to 24 months (T24 arm), from pregnancy to 18 months (T18), or from birth to 24 months (TNFP). All beneficiaries received the same BCC for the first 1000 days. The control arm received no rations or BCC. RESULTS: Wasting (weight-for-length Z-score <2 SD) increased from baseline to follow-up in the control group (from 6.5% to 8%), but Tubaramure had a significant (P < 0.05) protective effect on wasting [treatment arms combined, -3.3 percentage points (pp); T18, -4.5 pp] and on the weight-for-length z-score (treatment arms combined, +0.15; T24, +0.20; T18, +0.17). The effects were limited to children whose mother and household head had no education, and who lived in the poorest households. The largest effect was found in children 6 to 12 months of age: the group with the highest wasting prevalence. CONCLUSIONS: FA-MCHN programs in highly food-insecure regions can protect the most disadvantaged children from wasting. These findings are particularly relevant in the context of the economic crisis due to the coronavirus disease 2019 pandemic, which is expected to dramatically increase child wasting.
Jef L J P Leroy, Deanna Kelly Olney, Marie T. Ruel
Recent studies suggest that the existence of a well-structured and functioning child protection system positively impacts on the well-being of children. Such arguments have been supported by theories, for instance, the child-centered general systems theory and ecological model. While such discussions remain prominent, children’s well-being calls for close interconnectedness between the system components structure, process of care, continuum of care and ensuring paramount accountability. Currently, the child protection system in Uganda is not only weak but also mute in terms of its operationalization. The situation is worse especially in refugee settlements where many children are living on their own. This article seeks to establish the relationship between the selected system components of continuum of care, process of care and accountability on child well-being components that have been contextually selected using Nyumanzi refugee settlement in Adjumani district in Uganda. This study’s findings unveil how and the extent to which the two variables relate. A correlational study design was adopted employing mainly quantitative data collection and analysis approach. The article argues that discovery of such selected system components on process and continuum of care to child well-being is paramount. Additionally, the data indicates that the process of care and continuum of care are crucial in ensuring child wellbeing.
Monitoring and evaluation systems rarely begin as right fits; instead, they evolve over time, often to meet the demands of internal learning, external accountability, and a given stage of program development. This case follows Invisible Children Uganda as it formalizes its monitoring and evaluation system in response to increased visibility, the demands of traditional donors, and an internal desire to understand impact. Readers will consider how Invisible Children’s first logical framework—a rough equivalent of a theory of change—lays the foundation for a right-fit monitoring and evaluation system. Readers will also analyze the broader challenges of commissioning high-quality impact evaluations and the importance of clearly defining them.
AbstractFunding decisions to support vulnerable children are tied to child labour statistics, hence the importance of an accurate measurement. The author analyses whether the type of respondent plays an important role in explaining variations in child labour statistics. Using data from two sites in Tanzania, the analysis shows that “whom we ask” matters considerably when estimating the prevalence of child labour. The results suggest that prevalence increases by approximately 35 to 65 per cent when using child self‐reports rather than proxy reports. This bias affects 14 to 31 per cent of the sample, depending on the indicator. Discrepancies decrease as the child ages and increase if proxy attitudes demonstrate opposition to child labour.
Abstract This chapter presents the evidence on the impact of incomplete financial and insurance markets on the supply of child labour. Shocks substantially alter household decisions. In particular, a negative shock increases the probability that a child will work. Coupled with evidence from other research that child labour shows a high degree of persistence as in the case of the Rwanda genocide, this finding highlights the importance of protection from shocks. Risk-reduction schemes also have a beneficial and substantial effect on child work as, confirmed by experimental evidence regarding increased access to health insurance. However, shocks might also alter the returns to child labour and lead households to increase child labour in the presence of a positive shock. Such changes in the incentives facing the household must be kept in mind when designing actual policies.
Introduction The COVID-19 pandemic disrupted healthcare provision and access in sub-Saharan Africa. Lockdowns and travel restrictions, coupled with fear of contracting the virus, disrupted services, especially for women’s and children’s health, derailing progress on sustainable development goals. This paper examines the impact of the COVID-19 pandemic on routine child immunisation coverage in Ethiopia and Kenya at both national and subnational levels. Methods Health management information systems data were used to estimate changes in child immunisation. Mean differences in coverage between the pre-COVID-19 and during COVID-19 were tested at a 5% significance level. Geospatial maps for coverage and differences between the two periods were created using aggregated proportions. Interrupted time series analyses provided counterfactual coverage assessments, assuming no COVID-19 impact. Results At the national level, minor short-term disruptions in coverage were observed following pandemic peaks in Kenya and Ethiopia, which were considered statistically insignificant. In Ethiopia, a subnational assessment reveals that full vaccination coverage remained relatively stable, with significant changes observed in the southeast regions of Somali and Dire Dawa. Specific vaccines such as BCG, diphtheria, pertussis and tetanus 3 and polio (OPV3) showed considerable coverage changes in most regions except Oromia, Gambela and Sidama. Measles vaccine coverage experienced major changes across almost all regions of Ethiopia. In Kenya, full vaccination coverage experienced significant changes in eight counties, including Kisii, Turkana and Marsabit, with most Kenyan counties experiencing significant changes in measles vaccine coverage. Conclusion In conclusion, while routine immunisation services were mostly sustained with short-term disruptions at the national level in Ethiopia and Kenya, subnational levels experienced notable changes. The resilience of child immunisation was due to the implementation of community-based healthcare, mobile vaccinations and collaboration and partnerships for mass vaccination campaigns. The temporary disruptions were likely due to pandemic-related fears and supply chain restrictions.
Chifuniro Somanje Mankhwala, Chimwemwe Chifungo, Themba Mzembe et al.
Abstract Contemporary theories of positive youth development (PYD) emphasize dynamic, mutually beneficial relationships between individuals and their contexts as a pathway to thriving and contribution. However, there remains a critical gap in longitudinal, theory‐driven research examining youth strengths (e.g., purpose) and contextual assets (e.g., program quality) in Majority World contexts, particularly within structured youth programming. The present study examined reciprocal relationships between perceived program quality (a higher‐order factor of the Big Three) and youth purpose using three waves of longitudinal data from a sample of 615 adolescents (50.3% female; ages 9–16, M age = 12.5, SD age = 2.3) participating in Compassion International youth development programs in Uganda. Results using cross‐lagged panel models revealed positive, reciprocal associations between perceived program quality and youth purpose, such that higher program quality predicted subsequent higher youth purpose, and stronger youth purpose predicted more positive later perceptions of program quality. Temporal precedence tests indicated that neither construct emerged as a dominant developmental driver, and therefore supported a pattern of mutual influence. These findings advance PYD theory by providing longitudinal evidence for dynamic person⇔context coactions between perceived program quality and youth purpose, consistent with dynamic, relational developmental systems perspectives.
Ruoying Zhang, Roya Abbasi‐Asl, Margaret Mackin et al.
Christian parents in Eastern Africa find themselves at a paradoxical position. On one hand they are one of the most individually devout believers globally, yet most of them are unable to translate their devotion into deliberate faith formation within their respective homes. This article examines the gap between private religious practice and intentional parental discipleship among Christian parents across seven Eastern Africa countries: Burundi, Ethiopia, Rwanda, South Sudan, Tanzania, and Uganda. It draws on survey data from the OneHope Faith Foundations Eastern Africa Report (2025), which surveyed 758 Christian parents from the aforementioned Eastern Africa countries. The report reveals that while 69% of parents pray daily, and 75% attend church weekly, only 36% discuss the Bible with their children frequently, and fewer than 10% feel fully equipped to disciple their children at home. The study employs a quantitative survey design, supplemented by interviews with 31 church leaders, to assess the frequency of spiritual practices, perceived barriers and parental confidence in faith transmission. Findings reveal that the primary obstacles are not spiritual indifference but a deficit of practical knowledge and confidence, compounded by an over-reliance on institutional structures such as the church to carry out what is fundamentally a parental responsibility. This article concludes that the most strategic investment Eastern Africa churches and ministries can make in the next generation is the equipping of parents with simple, culturally relevant, and accessible tools for practising faith at home, beyond daily church attendance.
Research on meaning-making in development policy is scarce, yet essential for contextualizing development interventions. The study demonstrates that policy implementation in post-conflict situations is vulnerable to meaning displacement when locally constructed meanings and the social capital through which they are produced and circulated are overlooked, with consequential effects for programme legitimacy, participation and effectiveness. A phenomenological research design adopting focus group discussions with former beneficiaries of the Youth Livelihood Programme and in-depth interviews with key informants was conducted in Kitgum District. The study used a content thematic analysis based on descriptive phenomenology to analyse the data. The findings indicate that the youth constructed several meanings and perceptions of the Youth Livelihood Programme, including (i) perceived political meanings, (ii) free money perception, (iii) pocket money from the President meaning, (iv) drinking money narrative, (v) loot without fear perception, (vi) the mimic perception “money for the community poorest people”, and (vii) our tax money being returned perception. In conclusion, as community-directed interventions enter the community with an official, formal meaning, these meanings are not automatically reproduced at the community level. Instead, informal meanings are socially reconstructed through interactions building on existing community social capital, resulting in meaning displacement. Thus, development policy actors ought to pay attention to socially constructed meanings in order to align programme and make policy adjustments required for effective policy implementation.
