Aims This study aims to enhance understanding of child maltreatment (CM) in connection with problematic parental substance use (PPSU) and to identify related individual and familial support needs. Methods Using inductive qualitative content analysis, we examined the life stories of trained experts-by-experience (N = 11) who had experienced PPSU and various forms of CM, including physical and emotional violence and neglect in their family during childhood and adolescence. Results Several family-related and parental risk factors for CM emerged, such as intergenerational transmission of substance use, socioeconomic disadvantage, unemployment or excessive work, parental physical and mental health issues, social wellbeing challenges such as social isolation, violent behaviour, and inadequate parenting practices. Participants also described mitigating factors that partly buffered adverse effects. Conclusions The findings highlight diverse and persistent support needs. PPSU can expose children to a wide range of harmful CM experiences. Effective early identification of both PPSU and related CM requires close collaboration between social and health services, as well as inclusive and active client engagement. A holistic understanding of individual and family circumstances affected by PPSU is essential for preventing CM and its intergenerational transmission.
The global community is becoming increasingly fragile, plagued with intensifying armed violence, fracturing democratic governance processes, diminishing commitments and actions to protect basic human rights, and raging climate crises. Amid these complexities, children and youth are disproportionately impacted, and all signs point to increased precarity of their rights. Young people affected by armed violence are particularly suffering, thus understanding their rights and needs during and post conflict is essential to building effective peace and security. This research features the peace perspectives of 50 children and youth, all impacted by armed violence, and demonstrates the power of listening to young people's visions for peace. The key findings illustrate the importance of interpersonal peace, learning peacebuilding skills, and the essential role that children and youth play in building peace in their homes, schools, and communities. Recommendations for meaningful child engagement in the development of a Children, Peace, and Security Agenda are featured.
Background Robust measurement of gender-related beliefs and attitudes is essential for understanding how gender norms operate in higher-education settings. However, little is known about how these constructs are structured among Ghanaian university students or whether widely used instruments retain validity in this context. This study examined the factor structure, reliability, and measurement invariance of adapted versions of the Gender Norm Attitudes Scale (GNAS) and Gender Equitable Men (GEM) Scale among Sociology and Social Work students in Ghana. Methods A cross-sectional survey was conducted among 631 students (98.3% response rate) from two public universities, split for Explorative Factor Analysis (EFA) (n = 339) and Confirmatory Factor Analysis (CFA) (n = 364). EFA used principal axis factoring with oblique rotation on polychoric correlation matrices; parallel analysis guided factor retention. CFA was estimated under maximum likelihood and WLSMV estimators. Reliability was assessed using Cronbach's alpha and McDonald's omega. Measurement invariance was tested across sex, university, programme, and year level using the standard nested sequence of configural, metric, and scalar models, and was evaluated by changes in fit indices (ΔCFI, ΔRMSEA, ΔTLI, and ΔSRMR); differential item functioning (DIF) was assessed using ordinal logistic regression. Data were managed and described using SPSS Version 32; all factor-analytic, reliability, invariance, and DIF analyses were conducted in R (psych and lavaan packages). Results The GNAS yielded a two-factor, 11-item structure reflecting beliefs supporting men's privileges (α = 0.824, ω = 0.868) and equity for girls and women (α = 0.830, ω = 0.898), with strong fit (CFI = 0.960; TLI = 0.949; RMSEA = 0.057). Polychoric EFA confirmed this, indicating ordinal estimation did not alter the solution. After empirically driven item reduction, the adapted GEM Scale emerged as a modified version of the original instrument, with narrower domain coverage and near-complete loss of the Reproductive Health and Disease Prevention domain; the retained 16-item, four-factor structure covered violence, domestic chores and daily life, sexual relationships, and household authority and obedience, explaining 52.6% of variance with acceptable fit (CFI = 0.888; TLI = 0.865; RMSEA = 0.058), though the Household Authority and Obedience factor rested on only two items and the subscales showing weak Cronbach's alpha values. The students generally rejected inequitable norms, though attitudes toward household authority and domestic roles were more variable. For the GNAS, configural and metric invariance held across sex and university (ΔCFI ≤ 0.005); scalar invariance held across university (ΔCFI = 0.006) and was only partial across sex (ΔCFI = 0.022). For the adapted GEM Scale, metric invariance held across university (ΔCFI = 0.006) but not sex (ΔCFI = 0.016), and scalar invariance was not supported in either grouping. Conclusion Although preliminary, the adapted GNAS shows acceptable structural validity, adequate-to-strong reliability, and metric invariance across sex and university and scalar invariance across university. In contrast, the adapted GEM Scale should be interpreted cautiously as a substantially modified measure with reduced domain coverage and less stable invariance properties, for which scalar invariance is not yet established. Further validation, confirmation of these invariance results using ordinal (WLSMV) estimators, and exploration of 5- or 7-point response formats are needed before either adapted scale is used confidently in broader research or programme evaluation.
Women who inject drugs (WID) face barriers to healthcare, harm reduction, and social support, alongside stigma, violence, and legal risk. Evidence from Nigeria remains limited. This study explored how WID experience access to healthcare and harm reduction services and examined the social and structural conditions shaping that access. We used a phenomenological qualitative design in three Nigerian states: Abia, Gombe, and Oyo. Data were collected through 24 key informant interviews and six focus group discussions (FGDs) with WID (10 participants per group). Interview guides explored service availability, preferred access points, perceived quality of care, sexual and reproductive health needs, safety and violence, and barriers to service use. Data were audio-recorded, transcribed, de-identified, and analyzed thematically using ATLAS.ti 24. Four themes were identified: patterns of women's injecting drug use, access to healthcare and harm reduction services, experiences of gender-based violence, and social and structural barriers. Sterile needles and syringes, HIV and sexually transmitted infection (STI) testing, and some family planning services were reported to be more consistently available through one-stop shops and outreach services, while antenatal care and prevention of mother-to-child transmission (PMTCT) services were mainly accessed through formal health facilities and were less frequently used due to stigma and fear of disclosure. Access through informal drug-use locations ("bunks") and peer networks was frequently preferred due to convenience, anonymity, and reduced stigma. Improving access for WID requires integration of sexual and reproductive health services within harm reduction platforms, expansion of community-based and outreach delivery models, strengthening of trauma-informed care within health facilities, and establishment of safe and confidential referral systems that reduce exposure to stigma and law enforcement risk.
Perinatal mental health among women in Somalia represents a critical yet neglected public health emergency shaped by three decades of protracted conflict, gender-based violence, internal displacement, and one of the world's weakest health systems. With a maternal mortality ratio of 621 per 100,000 live births and fewer than 21% of births occurring in health facilities, depression and anxiety affect approximately one in four perinatal women-yet remain entirely absent from routine maternal care. This Perspective examines the structural, policy, and systemic barriers that perpetuate this neglect and proposes evidence-informed pathways for urgent action: integration of screening and brief interventions into primary healthcare, task-shifting to community health workers, culturally adapted psychosocial interventions, and strengthened governance frameworks. We emphasize that addressing perinatal mental health is foundational to Somalia's health system recovery, critical for reducing maternal and neonatal mortality, and essential for safeguarding the development and wellbeing of a generation of Somali children.
Background Existing reviews have documented a range of factors associated with care entry or re-entry for children, with much less attention given to the intervention literature. In addition, there has been no systematic attempt to bring these two bodies of evidence together. In this overview of systematic reviews we aimed to identify and synthesise evidence on both risk/protective factors and interventions for preventing care entry/re-entry and to identify potential entry points for policy intervention. Methods We identified systematic reviews related to children's care entry/re-entry, in high-income countries, published since 2013. Selection and data extraction were performed in duplicate, and AMSTAR-2 was used to appraise review quality. We combined findings using narrative synthesis, categorising factors into non-modifiable or modifiable (using the Dahlgren-Whitehead model of health determinants), and linking interventions with these factors where appropriate. Results Of the 33 systematic reviews included, 15 focused on risk/protective factors and 18 on interventions. Modifiable factors and related interventions were categorised into individual and lifestyle factors (maternal mental ill-health/substance misuse, child health), social and community factors (social support, child maltreatment), and living and working conditions (socioeconomic and service-level factors). This overview highlighted the multifaceted risk and protective factors associated with children's entry and re-entry into care, and the interacting and cumulative effect of risk factors. Reviews on the effectiveness of interventions reported limited or inconsistent evidence, often due to different study designs (experimental vs observational), small numbers of included primary studies, or the heterogeneity of interventions. Individual programmes rather than structural policies tended to be the focus in reviews, and most programmes were conducted in the US. Conclusions Factors associated with care entry/re-entry are multifaceted and involve complex interactions between upstream and downstream drivers. A range of interventions have been evaluated, but robust evaluations of interventions focusing on context-specific policies are needed to better understand and improve outcomes for children and families.
Adolescent girls and young women (AGYW) are disproportionately burdened by new HIV infections in eastern and southern Africa. Data on co-occurrence of behavioral risk factors and associations with sexual HIV risk behaviors can inform layered and targeted HIV prevention efforts. Using nationally representative data of AGYW aged 13-24 years from the 2018 Lesotho Violence Against Children and Youth Survey, we categorized the population into distinct adversity groups comprised of different pattens of sexual violence exposure, substance use, and moderate/severe mental distress. We estimated associations of adversity groups with infrequent condom use and past-year multiple sexual partners. We observed significant associations between some groups and infrequent condom use and multiple sexual partners. Interventions to prevent sexual violence and substance use, in particular, may help reduce sexual HIV risk behaviors and thus HIV prevalence among this population in Lesotho.
Although common, sibling aggression among youth is not well studied. This is a major omission in the literature, as sibling relationships have been found to influence other relationships. As such, the current study evaluates the links between self-reported sibling proactive and reactive aggression and peer proactive and reactive aggression six months later in a sample of 290 (54.8% male) elementary school-age youth who reported having at least one sibling. Gender differences in associations were also examined. Findings indicated that sibling reactive aggression was positively associated with peer reactive aggression six months later, over and above the stability of sibling proactive aggression and peer reactive aggression. Similarly, sibling proactive aggression was associated with peer proactive aggression over and above the stability of sibling reactive aggression and peer proactive aggression. However, gender differences were evident for proactive aggression. That is, sibling proactive aggression was associated with subsequent peer proactive aggression for boys only. Findings indicated that both sibling proactive and reactive aggression are associated with subsequent peer aggression within an academic year, suggesting the need to better understand sibling aggression for the prevention of aggression across relationships. Further, it appears that sibling proactive aggression is more influential on proactively aggressive behaviors toward peers for boys than girls.
In Canada, approximately 44% of women will experience intimate partner violence (IPV) in their lifetime. Given that the majority of women who face IPV are within childbearing years, IPV often co-occurs with being a mother. While research exists on mothering and IPV, a gap in the literature exists with respect to how mothers with histories of IPV experienced the COVID-19 pandemic. This qualitative study addressed this gap using an interpretive description approach underpinned by intersectionality and informed by Ford-Gilboe's strengthening capacity to limit intrusion theory. Twelve, semi-structured virtual interviews were completed with mothers that had experienced IPV greater than 6 months prior to study enrollment. Mothers described experiencing structural violence during the pandemic, impacting their financial stability, access to affordable housing, and access to legal/community supports. Mothers also described the negative impact of the pandemic on their mental health, their difficulty accessing counselling services, and the challenges associated with managing an increased workload. Despite these experiences, many mothers described how their relationship with their child strengthened. Implications of this study include the need for policy changes to address the structural violence experienced by mothers with a history of IPV in the aftermath of the pandemic.
BackgroundADHD is a prevalent neurodevelopmental disorder frequently accompanied by psychiatric comorbidities. While international evidence is well-established, data from South Africa - particularly in younger children - remain limited.AimTo describe psychiatric comorbidities and associated factors in children aged 7-12 years with primary ADHD at the Child, Adolescent, and Family Unit (CAFU), Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).MethodsA retrospective cross-sectional record review of children aged 7-12 years with primary ADHD at CAFU between January 2020 and December 2022. Data were analysed using SPSS version 26.ResultsOf 573 records screened, 108 were included. The combined subtype was most prevalent (72.2%). Almost all children (95.5%) had at least one comorbidity. The most frequent were generalised anxiety disorder (52.8%), intellectual disability (38.9%), and oppositional defiant disorder (29.6%). Females were more likely to present with oppositional defiant disorder (p = .007) and males with autism spectrum disorder (p = .032). High rates of domestic violence (29.6%), parental substance abuse (33.3%), and parental psychiatric history (30.6%) were documented.ConclusionPsychiatric comorbidities are highly prevalent in South African children with ADHD, exceeding international estimates, and reflect the broader psychosocial context of the setting. Comprehensive, multidisciplinary, and trauma-informed assessments are essential.
