Journal Articles

Through a rapid review drawing on pandemics and epidemics with associated school closures, this article aims to understand first, the state of the evidence on impacts of school closures on select child protection outcomes and second, how governments have responded to school closures to protect the most vulnerable children. Only 21 studies out of 6433 reviewed met the inclusion criteria, with most studies exploring the effects of Ebola. While few studies were identified on harmful practices, a more robust evidence base was identified in regards to adolescent pregnancy, with studies pointing to its increase due to the epidemic or infection control measures, including school closures. The evidence base for studies exploring the impact on violence outcomes was limited, with sexual violence and exploitation located in a few studies on Ebola. Important lessons from this exercise can be applied to the COVID-19 response, particularly the inclusion of the most vulnerable children in programming, policy and further research.

We present evidence on the overall impacts of state-sponsored cash transfer programmes in sub-Saharan Africa, using data from three impact evaluations of government programmes. All three programmes were a key component of the poverty reduction strategy of the respective governments at the time of the evaluations. We show effects across nine broad domains including both protection, production and human development, using baseline and follow-up household surveys on treatment and control groups. We relate the pattern of impacts to programme design parameters to further understand the constraints faced by ultra-poor rural households.

All three programmes have strong effects on their primary objective—food security or food consumption, as well as on secondary objectives that include livelihood strengthening and children’s well-being. The largest and most consistent impacts occur in Malawi, where transfer values are in line with international best practice and payments were made regularly during the study period. All programmes show a positive income multiplier, with the multiplier largest in Malawi at 2.94.

The overall results across three national programmes add to the growing evidence from Africa that government unconditional cash transfers have important positive effects on households, that these effects are not limited to just food security, and that programme design features influence the pattern and size of impacts.

The COVID-19 pandemic could increase violence against children at home. However, collecting empirical data on violence is challenging due to ethical, safety, and data quality concerns. This study estimated the anticipated effect of COVID-19 on violent discipline at home using multivariable predictive regression models.

Participants
Children aged 1–14 years and household members from the Multiple Indicator Cluster Surveys (MICS) conducted in Nigeria, Mongolia, and Suriname before the COVID-19 pandemic were included.

Methods
A conceptual model of how the COVID-19 pandemic could affect risk factors for violent discipline was developed. Country specific multivariable linear models were used to estimate the association between selected variables from MICS and a violent discipline score which captured the average combination of violent disciplinary methods used in the home. A review of the literature informed the development of quantitative assumptions about how COVID-19 would impact the selected variables under a “high restrictions” pandemic scenario, approximating conditions expected during a period of intense response measures, and a “lower restrictions” scenario with easing of COVID-19 restrictions but with sustained economic impacts. These assumptions were used to estimate changes in violent discipline scores.

Results
Under a “high restrictions” scenario there would be a 35%–46% increase in violent discipline scores in Nigeria, Mongolia and Suriname, and under a “lower restrictions” scenario there would be between a 4%–6% increase in violent discipline scores in these countries.

Conclusion
Policy makers need to plan for increases in violent discipline during successive waves of lockdowns.

This is the protocol for a Campbell review. The review aims to systematically collect, appraise, map and synthesise the evidence from systematic reviews on the differential gender impacts of social protection programmes in Low‐ and Middle‐Income Countries (LMICs). Therefore, it will answer the following questions: (1) What is known from systematic reviews on the gender‐differentiated impacts of social protection programmes in LMICs? (2) What is known from systematic reviews about the factors that determine these gender‐differentiated impacts? (3) What is known from existing systematic reviews about design and implementation features of social protection programmes and their association with gender outcomes?

We examine whether a government cash transfer program, paired with a health insurance premium waiver and targeted to pregnant women and mothers of young children in Ghana, reduced intimate partner violence (IPV). The evaluation took place in two northern regions and followed a 24-month longitudinal quasi-experimental design. Findings show significant decreases in the 12-month frequency of emotional, physical and combined IPV (0.09 – 0.12 standard deviations). Analysis of pathways indicate improvements in economic security and women’s empowerment may account for reductions in IPV. Results indicate a promising role for social protection in improving the lives of pregnant women and new mothers.

This paper adds to the thin empirical literature estimating the long-term effects of exposure to conflict from in utero to adolescence on adult well-being. The effects through adolescence of the two worst genocides in recent history – those occurring in Rwanda (1994) and Cambodia (1975–79) – are examined. The Rwandan genocide is shown to have produced long-term health outcomes among women exposed to the conflict during adolescence. A further contribution is the analysis of gendered effects during adolescence, which is enabled by the availability of data on men’s height for Rwanda. The long-term effects are confirmed for men, however this appears to be the consequence of exposure during adolescence later than for women, a result that is consistent with the biological literature on the differential timing of the onset of puberty by gender. No significant effects are detected in the case of the Cambodian genocide and we discuss some issues that may influence this result. Although more research and better data are needed, our results are suggestive of adolescent-specific effects of the Rwandan genocide, which may be comparable or larger than those previously found for younger children.

The COVID-19 pandemic has exposed the urgent need to tackle the crisis of mental health among children and young people. We call for a multi-stakeholder Global Mental Health Alliance for Children, which would achieve the following objectives: to strengthen evidence and understanding of mental health and well-being, causes and risks for children and young people; to scale up investment in mental health programming for children and young people, and particularly expanding the global cadre of health workers, social workers and community workers, with a focus on prevention and promotion of mental health; to support youth-led, evidence- and rights-based initiatives; to expand advocacy and knowledge of mental health for children and young people among the wider public, and reduce stigma, marginalization and discrimination against those experiencing mental ill-health; and to enhance funding from both the public and private sectors for promotion of mental health, prevention of ill-health and treatment of mental health disorders.

Objetivo. Describir lo que se sabe acerca de la prevalencia nacional de la violencia por parte de la pareja íntima (VPI) contra las mujeres en las Américas, en los diversos países y en el transcurso del tiempo, incluida la cobertura geográfica, calidad y comparabilidad de los datos nacionales. 

Métodos. Se realizó una revisión sistemática y reanálisis de las estimativas nacionales de la VPI basadas en la población de 1998 a 2017 en las Américas. Las cifras se reanalizaron para comparabilidad o se extrajeron de los informes, incluida la prevalencia por tipo (física; sexual; o física y/o sexual), marco temporal (alguna vez;
durante el último año) y perpetrador (cualquiera pareja en la vida; pareja actual/más reciente). En los países con tres (3+) rondas de datos, se aplicaron las pruebas de Cochran-Armitage y de ji cuadrada de Pearson para evaluar si los cambios en el transcurso del tiempo fueron significativos (p < 0,05).

Resultados. Se encontraron encuestas elegibles en 24 países. Las mujeres reportaron haber sufrido alguna vez violencia física y/o sexual por parte de la pareja íntima con tasas que variaron desde el 14% a 17% en Brasil, Panamá y Uruguay hasta más de la mitad (58,5%) en Bolivia. La prevalencia de violencia física y/o sexual por parte de la pareja íntima durante el último año varió desde 1,1% en el Canadá hasta 27,1% en Bolivia. La evidencia preliminar sugiere una posible disminución en la prevalencia reportada para ciertos tipos de VPI en ocho países; sin embargo, algunos cambios fueron pequeños, ciertos indicadores no se modificaron significativamente y se observaron incrementos significativos en la prevalencia reportada de violencia física por parte de la pareja íntima durante el último año en la República Dominicana.

Conclusiones. La VPI contra las mujeres sigue siendo un problema de salud pública y de derechos humanos en las Américas; sin embargo, la base de evidencia al respecto tiene deficiencias, lo que apunta a la necesidad de datos de mejor calidad y más comparables, a fin de movilizar y monitorear a la prevención y la
respuesta ante la violencia.

• The initial impression that paediatric infection is uncommon and generally mild has been replaced by a more nuanced understanding of infectious manifestations in children across countries and by income group, with recognition of a widening disease spectrum.
• Critical knowledge gaps remain that have significant public policy and programme implications.
• Insufficient age and race/ethnicity disaggregated data are hindering efforts to assess fully the prevalence of SARS-CoV-2 infection and COVID-19 in children and the role of children in transmission.
• Potential biologic differences in susceptibility to infection and transmissibility between children and adults need to be explored.
• Determination of mother-to-child SARS-CoV-2 transmission requires appropriate samples obtained with proper timing, lacking in most studies.
• Predictors of disease progression and morbidity and mortality in children need to be determined, particularly as the pandemic moves to low-income and middle-income countries.
• The full spectrum of SARS-CoV-2 infection in children remains to be defined, and surveillance for and investigation of the pathogenesis of postinfectious sequelae, such as multisystem inflammatory syndrome, are vital.

HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents’ uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services.

Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexuallyactive adolescents.

We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.