Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers' schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi: the PROMOTE Project pilot randomized controlled trial protocol.

INTRODUCTION: Girls' and women's health as well as social and economic wellbeing are often negatively impacted by early childbearing. In many parts of Africa, adolescent girls who get pregnant often drop out of school, resulting in widening gender inequalities in schooling and economic participation. Few interventions have focused on education and economic empowerment of adolescent mothers in the region. We aim to conduct a pilot randomized controlled trial in Blantyre (Malawi) and Ouagadougou (Burkina Faso) to examine the acceptability and feasibility of three interventions in improving educational and health outcomes among adolescent mothers and to estimate the effect and cost-effectiveness of the three interventions in facilitating (re)entry into school or vocational training. We will also test the effect of the interventions on their sexual and reproductive health (SRH) and mental health. INTERVENTIONS: The three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training, subsidized childcare, and life skills training offered through adolescent mothers' clubs. The life skills training will cover nurturing childcare, SRH, mental health, and financial literacy. Community health workers will facilitate the clubs. Each intervention will be implemented for 12 months. METHODS: We will conduct a baseline survey among adolescent mothers aged 10-19 years (N = 270, per site) enrolled following a household listing in select enumeration areas in each site. Adolescent mothers will be interviewed using a structured survey adapted from a previous survey on the lived experiences of pregnant and parenting adolescents in the two sites. Following the baseline survey, adolescent mothers will be individually randomly assigned to one of three study arms: arm one (adolescent mothers' clubs only); arm two (adolescent mothers' clubs + subsidized childcare), and arm three (adolescent mothers' clubs + subsidized childcare + cash transfer). At endline, we will re-administer the structured survey and assess the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training attendance during the intervention period. We will also compare baseline and endline measures of SRH and mental health outcomes. Between the baseline and endline survey, we will conduct a process evaluation to examine the acceptability and feasibility of the interventions and to track the implementation of the interventions. DISCUSSION: Our research will generate evidence that provides insights on interventions that can enable adolescent mothers to continue their education, as well as improve their SRH and mental health. We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings. Trial registration number AEARCTR-0009115, May 15, 2022.

Correction to: Malawi at the Crossroads: Does the Fear of Contracting COVID-19 Affect the Propensity to Vote?

[This corrects the article DOI: 10.1057/s41287-020-00353-1.].

Malawi at the Crossroads: Does the Fear of Contracting COVID-19 Affect the Propensity to Vote?

The new coronavirus disease (COVID-19) has paralysed many sectors of human life, including economic, social-cultural and political processes. In the political arena, several countries have postponed elections due to the COVID-19 pandemic. Other countries, including Malawi, went ahead with their planned elections. Malawi held a presidential election at a time when the number of COVID-19 cases was increasing rapidly. In this paper, we assess the effect of the perceived risk of catching COVID-19 on willingness to vote in the Malawi presidential election that was held on 23 June 2020. Turn out in this election was ten percentage points lower than in the general elections that were held a year earlier. The paper draws on a nationally representative survey of adult Malawians (n = 1155). In our main analysis, we use instrumental variables to account for potential endogeneity. We find that nearly two thirds of Malawians thought that they were likely to catch COVID-19 at some point. Notwithstanding the COVID-19 risk, 86% of the country's citizens were willing to vote. Our analysis shows that an individual's perceived risk of catching COVID-19 is associated with a lower likelihood of voting (ß = - 0.096; p < 0.05). This suggests that voter turnout in Malawi's fresh presidential election may have been highly affected by the perceived risk of catching COVID-19. The policy implication is that instituting and enforcing primary preventive measures may help reduce the perceived risk of catching COVID-19 and mitigate voter apathy.

La nouvelle maladie à coronavirus (COVID-19) a paralysé de nombreux secteurs de la vie humaine, y compris au niveau économique, socioculturel et politique. Au niveau politique, plusieurs pays ont reporté des élections en raison de la pandémie de COVID-19. D'autres pays, comme le Malawi, ont maintenu les élections qui étaient prévues. Le Malawi a organisé l'élection présidentielle au moment où le nombre de cas de COVID-19 augmentait rapidement. Dans cet article, nous évaluons l'effet que la perception du risque de contracter la COVID-19 a eu sur la volonté de se rendre aux urnes à l'occasion de l'élection présidentielle qui s'est tenue le 23 juin 2020 au Malawi. Le taux de participation à cette élection était inférieur de dix points de pourcentage à celui des élections générales qui ont eu lieu un an plus tôt. L'étude s'appuie sur une enquête nationale représentative des personnes adultes du Malawi (n = 1155). Dans notre analyse principale, nous utilisons des variables instrumentales pour tenir compte d'un potentiel biais d'endogénéité. Nous constatons que près de deux tiers des Malawites pensaient qu'ils étaient susceptibles de contracter la COVID-19 à un moment ou à un autre. En dépit du risque de contracter la COVID-19, 86% des citoyens et citoyennes du pays étaient prêt.es à voter. Notre analyse montre que la perception du risque qu'a une personne de contracter la COVID-19 est associée à une probabilité plus faible de se render aux urnes (ß = − 0.096; p < 0.05). Cela suggère que la participation électorale à la nouvelle élection présidentielle au Malawi a pu être fortement impactée par la perception du risque de contracter la COVID-19. En terme de politique, cela signifie que la mise en place et l'application de mesures de prévention primaire peuvent aider à réduire la perception du risque de contracter la COVID-19 et ainsi permettre d'atténuer l'apathie des électeurs.

Evaluation of mainstreaming youth-friendly health in private clinics in Malawi.

BACKGROUND: High fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. The objective of the evaluation was to assess the effects of a Population Services International (PSI)-sponsored YFHS training package on voluntary uptake of family planning among youth and perceptions of service quality by youth and trained healthcare providers in Malawi. METHODS: In 2018, a mixed-methods convergent parallel design was used to assess relevant monitoring and evaluation documents and service statistics from PSI Malawi and qualitative data on perceptions of service quality from Malawian youth and healthcare providers. The data were assessed through separate descriptive and thematic analysis and integrated to generate conclusions. RESULTS: Results show that the number of family planning clients ages 15-24 increased from 72 to 2278 per quarter during the implementation of the YFHS training packages, however, positive trends in client numbers were not sustained after youth outreach activities ended. Focus group discussions with 70 youth and adolescents indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Interviews with ten healthcare providers indicated that many made efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community. CONCLUSIONS: The findings support research showing positive effects of mainstreaming YFHS when training for healthcare staff is combined with additional YFHS programming components. Furthermore, the findings provide evidence that provider training alone, though beneficial to perceived service quality, is not sufficient to sustain increases in the number of adolescent and youth family planning clients.