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This factsheet presents key findings from the first-ever Humanitarian Violence Against Children and Youth Survey conducted in refugee settlements across Uganda.
This factsheet presents key findings from the second-ever Humanitarian Violence Against Children and Youth Survey conducted in refugee camps across Ethiopia.
Background Oral diseases are among the most common noncommunicable conditions globally, yet oral health remains poorly integrated into primary health care (PHC) and universal health coverage, especially in fragile, low-limited settings. As Somalia rebuilds its health system through the Health Sector Strategic Plan III 2022–2026, the Essential Package of Health Services 2020, the Investment Case for the Somali Health Sector 2022–2027, and community health reforms, this study examined the place of oral health within national health policies. It identified barriers to integration and explored feasible pathways for strengthening PHC-based oral health. Methods The study used a qualitative policy and health-systems analysis combining documentary review with 13 key-informant interviews. Participants represented national policymakers, health-system technical advisers, regulators, academics, professional associations, and providers at public hospital, and private dental settings. Data were analyzed thematically and mapped against the WHO health-system building blocks, PHC principles, and the WHO Global Strategy and Action Plan on Oral Health 2023–2030. Results Somalia's policy environment offers opportunities for oral health integration, but stakeholders highlighted a persistent gap between policy recognition and implementation within routine PHC. Seven interrelated themes were identified: (1) policy recognition without operationalization; (2) fragmented governance, weak regulation, and limited coordination; (3) reliance on out-of-pocket financing and private-sector; (4) workforce, education, and task-sharing constraints; (5) predominantly curative, urban, hospital-based service with weak linkage to maternal and child health (MCH) and PHC; (6) limited oral health data and evidence generation; and (7) opportunities for phased integration through PHC, MCH, school health, community health workers, and NCD platforms Policymakers emphasized the need for stronger policy implementation, financing, regulation, standards, and data systems, while service providers highlighted unaffordable care, delayed care-seeking, workforce and infrastructure shortages, and missed opportunities for prevention. Conclusion Oral health integration in Somalia is a broader health system challenge rather than solely a dental-service issue. The most feasible approach is a phased, system-based model that prioritizes strengthened governance, a defined minimum oral health within PHC, workforce task-sharing, screening, counselling, referral pathways, private-sector regulation, essential commodities, and oral health indicators in District Health Information System 2 (DHIS2), followed by the gradual expansion of curative and rehabilitative services.
Saido Gedi, Salma Ali Ossoble, Mohamoud M. Dahir et al.
The Baobab Research Programme Consortium (Baobab) is an Africa- based, African-led consortium, spearheaded by the Population Council, Inc., in partnership with the Population Council–Kenya and the African Population and Health Research Centre (APHRC), that is reshaping the narrative around sexual and reproductive health and rights (SRHR) research in refugee settings. Across Africa’s most challenging humanitarian landscapes, Baobab is proving that evidence can ignite action. Starting with the first-ever Humanitarian Violence Against Children and Youth Surveys in Uganda and Ethiopia, Baobab turned data into solutions—co-designing a school-based sexual violence screening model with governments, UNHCR, and civil society. By embedding trained para-social workers (PSWs) in schools, this approach ensures proactive identification, on the spot psychological first aid, rapid referral (where needed), and consistent care for child survivors of sexual violence, all while strengthening existing systems. Uganda’s Ministry of Gender, Labour and Social Development co-designed the model, building upon its existing National PSW Programme, and integrating it into national training and guidance manuals, a bold step toward systemic change. With a proven model now embedded in national systems, Baobab is helping translate frontline success into wider policy influence by elevating Africa-led solutions onto the global stage. Baobab has partnered with the African Child Policy Forum to amplify Africa’s voice globally, shaping commitments from the first-ever Global Ministerial Conference to End Violence Against Children held in Bogota, to ARISE Africa: Accelerating Action to End Violence Against Children. This case study is a blueprint for scalable, replicable interventions that transform crises into opportunities for protection, accountability, and African leadership on the world stage.
Stella Muthuri
Abstract Background Early marriage, although it remains a common practice in sub-Saharan Africa, has detrimental effects on women’s sexual and reproductive health, social networks, and educational attainment. We sought to investigate the association between attitudes towards early marriage and marital status among adolescent girls in Ethiopia. Methods A cross-sectional study was conducted among 3,013 adolescent girls aged 13-17 years of age, living in four districts of the Oromia region of Ethiopia. Sociodemographic characteristics and were participants’ attitudes towards early marriage were measured using a pre-tested structured questionnaire. Results The prevalence of early marriage among adolescent girls was 8.3% and approximately 87.0% of girls had an overall positive attitude towards early marriage. Compared to adolescent girls who were unmarried, those who were married or living with a partner were less likely to believe they should have a say whether they want to marry or not (OR=0.32; 95%CI: 0.18-0.57), believe they should get to decide when to marry (OR=0.52; 0.31-0.88), and believe they should have the final decision over the decision to marry (OR=0.48; 0.32-0.73). Conclusions Interventions to prevent early marriage should strengthen women decision-making processes and promote women’s agency.
Hanna Gulema, Ayah Hamdan, Jessica Gingles et al.
Ethiopia has recently seen a remarkable fall in the proportion of girls who marry in early adolescence, reflecting the country’s lauded efforts to tackle child marriage. However, aggregate national figures mask a more complex reality. This article explores this complexity, drawing on qualitative data with adolescent girls and boys, their caregivers, service providers and community leaders, from the Gender and Adolescence: Global Evidence (GAGE) longitudinal study baseline. Our findings highlight the complex interplay between cultural norms, economic factors, individual voice and agency, and collective support thereof, on the part of leaders and service providers, from grassroots to national levels.
Nicola Jones, Elizabeth Presler-Marshall, Guday Kassahun et al.
Abstract Background Despite child marriage receiving increased attention over the past two decades, research on child marriage in humanitarian settings remains scarce. This study sought to quantify child marriage among Somali adolescent girls residing in Kobe refugee camp in Ethiopia and to identify its correlates and consequences. Methods A cross-sectional survey was conducted using multi-stage cluster-based sampling with probability proportional to size. We randomly sampled households that have at least one female aged 15–49 and at least one adolescent female aged 10–19. In addition to calculating the proportion of girls married under age 18, we used survival methods – namely Kaplan Meier graphs and Cox proportional hazard models – to identify risk factors associated with child marriage in this context. We also used descriptive statistics to describe marital age preferences among female adults and presented measures of important sexual and reproductive health indicators among married adolescent girls. Results A total of 603 adult women were surveyed and a household roster was created with information on 3319 household members, of whom 522 were adolescent girls aged 15–19. Of those, 14% were currently married (95% Confidence Interval [CI] 0.11–0.18), and 11% were ever married under age 18 (95% CI 8–15%). Several variables were found to be significantly associated with hazard of child marriage including schooling, sex and employment status of head of household, as well as number of girls under age 18 in the childhood home.. Adult women tended to incorrectly identify minimum legal age at marriage and preferred low marital age for boys and girls – particularly in households of child brides. Among married adolescent girls, contraceptive use was very low (11%; 95% CI 4.94–22.40), and early childbearing was common (60%; 95% CI 45.56–72.89). Conclusions This research contributes to the evidence base on child marriage in humanitarian settings. Insights generated from this study have the potential to inform programs and interventions aiming to prevent and mitigate the impacts of this harmful practice.
Shatha Elnakib, Kara Hunersen, Janna Metzler et al.
Marriages below the age of 18 are either forced or by own interest, influenced by different factors. The objective of this paper is to describe the role of marriage brokers in adolescent girls’ marriage in West Hararghe, Oromia region, Eastern Ethiopia. Qualitative data were drawn from a formative baseline (March to August 2016) and consecutive studies including the mid-term (May 2018 to August 2018) studies of Abdiboru, a Girls’ SRH and empowerment project. As findings demonstrate, adolescent girls below the legal age of marriage are forced to accept marriage proposals convinced by intermediaries/marriage brokers. Marriage brokers can be peers, relatives, elders or any skillful people in convincing and persuading girls. Marriage brokerage is commercialized and as a result, girls go through the burdens of early marriage and early child bearing. Marriage brokerage is a common act in the study area resulting in brokers to have a significant role on adolescent girls’ marriage. They play an inevitable role in arranging potential matches for adolescent girls. Programmers working on ending child marriage and related areas need to include these influential people in designing interventions.
Anene Tesfa
Background: Immunization is one of the cost-effective public health interventions, and can be used to prevent life-threatening childhood illnesses. This study aimed to assess disparities in child immunization coverage in Ethiopia. Method: Data from the 2012 Ethiopian Expanded Program for Immunization coverage survey was used. In this study, absolute and relative equity analysis was employed based on socioeconomic variables Result: Equity analysis was conducted in 3,748 subjects out of 3,762 child caregivers’ data. The concentration index among the poorest and richest group for BCG immunization coverage was 11%, OPV 3 was 13.3%, Pneumococcal 3 was 38.6%, Pentavalent 3 was 21.5%, Measles was 12.9%, Vitamin A supplementation was 8.9%, and full immunization was 38.6%. Conclusion: Inequalities were observed in child immunization coverage across the socioeconomic groups, with the better-off wealth status, urban residents, and children from an educated mother being more likely to be vaccinated.
Dereje Y. Yada
Background Though Ethiopia has achieved remarkable progress in immunisation services, there is limited evidence on comprehensive national immunisation coverage. Therefore, this national study evaluated the performance of life-course immunisation services. Methods This study was conducted in all Ethiopian regions and city administrations from March to July 2023. Two-stage stratified cluster sampling was used. About 13666 children aged 12-35 months, 5338 adolescent girls (15–18) and 13843 adults aged 12 years or more were included in the study. Child vaccination status was assessed through reviewing immunisation cards/health facility registration books/caregivers’ recall. A descriptive analysis was done with an adjusted sampling weight. Results Three-fourths of children aged 12-23 months received the first dose of the pentavalent vaccine, and two-thirds received the third dose of the Pentavalent Vaccine. About two-thirds and half of the children received the first and second doses of the Measles vaccine, respectively. The dropout rates for Pentavalent was 14.1% and for Measles, was 19.9%. Full immunisation coverage was 43.9%, and zero-dose children accounted for 24.7%. About 85% of mothers received the first dose of the Tetanus-Diphtheria vaccine. Half of adolescent girls received their first vaccination, and a quarter of them received a second dose of the HPV vaccine. Conclusions Although Ethiopia has made strides in child immunisation, coverage remains below national and global targets. Tetanus-diphtheria vaccine uptake was initially high but dropped significantly by the fourth and fifth doses. HPV vaccine coverage was suboptimal, with most not receiving the second or booster doses. Strengthening national efforts to address both demand and supply barriers is vital for increasing vaccine uptake.
Berhanu Fikadie Endehabtu, Getasew Amare, Yohannes Ayanaw et al.
