Despite the rapid proliferation of digital technologies in the Global South, most academic research on social media and adolescent well-being has primarily focused on the Global North. This review investigates how social media impacts adolescent well-being in the Global South. We first review five regions (Sub-Saharan Africa, Middle East & North Africa, Latin America, China and South & South-East Asia) to highlight the complex ways social media interacts with well-being around the world. We then outline research gaps in the current understanding of the impacts of social media use on adolescent populations in diverse cultural contexts. We finally highlight potential lines of inquiry that future researchers could explore to build a nuanced, contextual perspective of the risks and opportunities of social media use.
Sakshi Ghai, Lucía Magis‐Weinberg, Mariya Stoilova et al.
Worldwide, political violence shatters the rights and well-being of children, families, and communities. It would be a pleasure to write this foreword if political violence were being rolled back and made a thing of the past. In reality, we see the opposite. The numbers of children who are displaced and otherwise affected by political violence have mushroomed, as the United Nations Children’s Fund (UNICEF) estimates that one child in four lives in a war zone or disaster-affected area. As indicated by the horrific use of chemical weapons against civilians in Syria and the mass starvation of civilians in Yemen, the nature of armed conflict and political violence continues to morph in ways that damage children’s lives. Although progress is being made in sectors such as child protection and mental health and psychosocial support (MHPSS), millions of children in zones of political violence lack adequate protection and bear heavy burdens of psychological and social suffering and distress in settings where there are few, if any, trained psychologists and psychiatrists to help.
BACKGROUND: The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. This study evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as part of routine service delivery. METHODS: This exploratory feasibility study was undertaken at two health facilities in Afghanistan that did not have specialist mental health workers. Women who had given birth in the past 12 months were screened for depressive symptoms with the PHQ9 and invited to participate in a psychological intervention which was offered through an infant feeding scheme. RESULTS: Of the 215 women screened, 131 (60.9%) met the PHQ9 criteria for referral to the intervention. The screening prevalence of postnatal depression was 61%, using a PHQ9 cut-off score of 12. Additionally, 29% of women registered as suicidal on the PHQ9. Several demographic and psychosocial variables were associated with depressive symptoms in this sample, including nutritional status of the infant, anxiety symptoms, vegetative and mood symptoms, marital difficulties, intimate partner violence, social isolation, acute stress and experience of trauma. Of the 47 (65%) women who attended all six sessions of the intervention, all had significantly decreased PHQ9 scores post-intervention. CONCLUSION: In poorly resourced environments, where the prevalence of postnatal depression is high, a shift in response from specialist-based to primary health care-level intervention may be a viable way to provide maternal mental health care. It is recommended that such programmes also consider home-visiting components and be integrated into existing infant and child health programmes. Manualised, evidence-based psychological interventions, delivered by non-specialist health workers, can improve outcomes where resources are scarce.
Mark Tomlinson, Deepika Nayar Chaudhery, Habibullah Ahmadzai et al.
Importance: Multidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions. Objective: To evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment. Design, Setting, and Participants: In this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial's secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2000, through February 25, 2022. Interventions: Health, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods. Main Outcomes and Measures: Cognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool. Results: The mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group. Conclusions and Relevance: Multidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children's development warrant further evaluation. Trial Registration: Clinical Trials Registry-India CTRI/2017/06/008908.
Ravi Prakash Upadhyay, Sunita Taneja, Ranadip Chowdhury et al.
Despite government interest in promoting birth registration, more than a third of Indonesian children do not have a birth certificate, affecting the realisation of both their human and citizen rights. While barriers to registering children's births in Indonesia have been assessed, there is limited research on how communities perceive the importance of having a birth certificate. This study used focus group discussions to explore parental motivations around birth registration. The results of a thematic analysis found that perceived use of birth certificates, perceived control over the application process and social norms related to certificate ownership affect the intention to apply.
Anaise Williams, Santi Kusumaningrum, Cyril Bennouna et al.
Parenting while experiencing intimate partner violence (IPV), depression, and poor diet quality can contribute to child health inequities. Syndemic theory offers a framework to understand how maternal conditions can lead to inequitable child health outcomes, such as diarrheal disease: a risk factor for childhood mortality and stunting. This study uses the 2022 Nepal Demographic and Health Survey to test an intergenerational syndemic model addressing three key questions: (1) Do IPV, depression, and absent dietary iron intake co-occur among mothers? (2) Does the probability of child diarrhea increase with concurrent maternal exposures to these three factors? (3) Are these relationships stronger in disadvantaged households? The analysis included 2,019 mother-child dyads. Interaction models on additive and multiplicative scales were constructed to predict child diarrhea as a function of maternal syndemic exposures, accounting for complex survey design. The prevalence of single exposure to IPV, depression, and absent dietary iron intake was higher among mothers in poorer households. In disadvantaged households (two lowest household wealth quintiles), children's odds of diarrhea were higher when mothers experienced syndemic vulnerability (IPV, depression, and absent iron intake) on multiplicative (aOR=1.321, 95%CI:1.000, 1.745) and additive scales (B = 0.027, 95%CI:-0.002, 0.055). Household disadvantage may exacerbate the synergistic effects of IPV, depression, and iron deficiency, increasing the likelihood of child diarrhea. Interventions targeting these maternal health adversities in disadvantaged households may reduce the impact on child health.
Luissa Vahedi, Ilana Seff, Alexander C. Tsai et al.
During the COVID-19 pandemic, women and girls across the globe faced increased reliance on the digital space to access education, social support, and health and gender-based violence (GBV) services. While research from the last three years has explored how women and girls navigated and responded to their new virtual reality, minimal evidence has been generated from low-resource settings where access to technology may be limited. Further, no studies to date have examined these dynamics in Iraq, where women and girls already face numerous threats to safety due to various forms of structural violence and patriarchal family structures. This qualitative study aimed to examine women and girls' experiences in the digital space during COVID-19 in Iraq, including the benefits and risks of engagement as well as how access to the digital space was controlled. Data for the present analysis come from the authors' larger multi-country study investigating women and girls' safety and access to GBV services in the context of the COVID-19 pandemic and related public health measures employed to control the spread of the virus. In Iraq, semi-structured key informant interviews were conducted virtually with fifteen GBV service providers. Following the translation and transcription of interviews, the thematic analysis highlighted several benefits and challenges women and girls experienced as they tried to access and utilize technology for schooling, support services, and obtaining and spreading information. While many women and girls increasingly and successfully relied on social media to spread awareness of GBV cases, key informants noted that women and girls also faced increased risks of experiencing electronic blackmail. In addition to a substantial digital divide in this context-which manifested as differential access to technology by gender, rural/urban status, and socioeconomic status-intrahousehold control of girls' access to and use of technology left many adolescent girls unable to continue schooling and contributed to their further marginalization and consequent decline in well-being. Implications for women's safety and mitigation strategies are also discussed.
Najat Qushua, Alli Gillespie, Dechol Ramazan et al.
While family functioning interventions show promise for improving adolescent girls’ well-being in humanitarian contexts, few programs employ a gender-transformative approach to maximize benefits for adolescent girls. This paper presents findings from a mixed-methods pilot evaluation of a whole-family, gender-transformative intervention conducted with Syrian refugee families in Jordan. The Siblings Support of Adolescent Girls in Emergencies program was implemented with 60 Syrian refugee households in Azraq and Za’atari camps in Jordan. A quantitative survey was administered to 18 households at baseline and endline, and researchers conducted qualitative interviews and focus group discussions with caregivers, paired interviews and participatory discussions with adolescents, and key informant interviews with program mentors. Paired t-tests revealed statistically significant improvements in mental distress, resilience, and gender equitable attitudes in the full sample and for girls only and marginally significant improvements in family functioning. Qualitative findings revealed improvements in four domains of girls’ well-being—self-efficacy, self-confidence, pro-social behavior, and mental health—through three primary pathways: family members’ increased gender equitable attitudes, healthier intrahousehold communication, and greater affective involvement. Findings from this mixed-methods evaluation point to the potential value in merging gender-transformative and whole-family approaches in humanitarian programming to maximize positive impacts for adolescent girls.
PURPOSE: Newcomer adolescent girls from the Middle East and North Africa region face intersectional challenges and opportunities upon resettlement. This study employs PhotoVoice participatory research methodology to explore perspectives on well-being and belonging shared by six students who resettled to Chicago from Iraq and Syria. METHODS: Two programme sessions consisted of participants reflecting on their photographic responses to four prompts in focus group discussions. The subsequent four sessions included qualitative analysis skill building, participant-led generation of thematic codes and diagrams using their data, and the creation of action plan posters to share back with the community. The research team then analysed all data using a grounded theory approach with constant comparative analysis. RESULTS: Four major themes emerged: 1) public spaces served as a vehicle for exploring well-being and belonging; 2) intersectional inclusion in public spaces was deemed a vital priority; 3) schools held an important role in facilitating belonging and access to public spaces; and 4) language was a critical barrier and facilitator to access and inclusion. CONCLUSIONS: Findings highlight the need for holistic approaches to support refugee youth in urban contexts and emphasize the role of schools in facilitating inclusive access to public spaces to strengthen newcomer students' well-being and belonging.
Alli Gillespie, Zahyyeh Abu-Rubieh, Lily Coll et al.
Global guidance indicates that protections for gender and equity issues, such as gender-based violence (GBV), should be mainstreamed across sectors. One novel strategy that can be leveraged to illustrate the cross-cutting impacts of GBV is to investigate GBV syndemically. This systematic review identified, evaluated, and synthesized quantitative studies conducted in LMICs that tested syndemic theories involving GBV. A systematic search of the peer-reviewed literature was conducted in Medline, Global Health, Scopus, Anthro Source, Anthropology Plus, Web of Science, PsychInfo, and Gender Watch. Peer-reviewed empirical research published in English that used quantitative methods to test syndemic theories involving GBV in LMICs were included. 4068 references were retrieved, 2160 studies were screened against their titles/abstracts, and 227 studies were assessed for full text eligibility. Overall, 45 studies met the inclusion criteria. Most articles conceptualized GBV as an exposure that clustered with other epidemics. More than half of the evidence base investigated combinations of GBV, mental health, substance use, and HIV/AIDS. Research articles investigating the SAVA syndemic among men who have sex with men (MSM) and transgender women provided the strongest evidence, particularly in India. Notable analytical gaps pertained to GBV measurement challenges and statistical approaches to test contextual factors in LMICs. The current evidence base is predominantly focused on GBV syndemic models that inform response/harm mitigation efforts rather than prevention. Future research should concentrate on how the political environment perpetuates clustering and interactions, expanding the contexts studied beyond upper middle-income countries, and improving methodological rigor in terms of GBV measurement. • Syndemic theory posits that epidemics do not occur in isolation of one another and the wider context. • Global health research demonstrates that GBV is syndemic with HIV and substance use. • This systematic review synthesized studies that quantitatively tested GBV syndemics in LMICs. • GBV syndemics involving perpetration, maternal-child health co-morbidities, and in humanitarian settings were less studied. • Future research should focus on integrating context and robustly estimating the population prevalence of clustering.
Luissa Vahedi, Ilana Seff, Alexander C. Tsai et al.
