Project description:BackgroundDespite the negative impact of chronic school absenteeism on the psychological and physical health of adolescents, data on the burden of adolescent chronic school absenteeism (ACSA) and interventions and programs to address it are lacking. We estimated the global, regional and national level prevalence of ACSA and its correlation with violence and unintentional injury, psychosocial, protective, lifestyle, and food security-related factors among in-school adolescents across low and middle-income, and high-income countries (LMICs-HICs).ObjectivesThis study aimed to estimate the prevalence of chronic school absenteeism (CSA) as well as to determine its associated factors among in-school adolescents across 71 low-middle and high-income countries.MethodsWe used data from the most recent Global School-based Student Health Survey of 207,107 in-school adolescents aged 11-17 years in 71 LMICs-HICs countries across six WHO regions. We estimated the weighted prevalence of ACSA from national, regional and global perspectives. Multiple binary logistic regression analyses were used to estimate the adjusted effect of independent factors on ACSA.ResultsThe overall population-weighted prevalence of CSA was 11·43% (95% confidence interval, CI: 11·29-11·57). Higher likelihood of CSA was associated with severe food insecurity, peer victimisation, loneliness, high level of anxiety, physically attack, physical fighting, serious injury, poor peer support, not having close friends, lack of parental support, being obese, and high levels of sedentary behaviours. Lower likelihood of CSA was associated with being female (odds ratio, OR = 0·76, 95% CI: 0·74-0·78).ConclusionOur findings indicate that a combination of different socio-economic factors, peer conflict and injury factors, factors exacerbate CSA among adolescents. Interventions should be designed to focus on these risk factors and should consider the diverse cultural and socioeconomic contexts.
Project description:PurposeA lack of data, intervention studies, policies, and targets for nutrition in school-age children (SAC) and adolescents (5-19 years) is hampering progress towards tackling malnutrition. To stimulate and guide further research, this study generated a list of research priorities.MethodsUsing the Child Health and Nutrition Research Initiative (CHNRI) method, a list of 48 research questions was compiled and questions were scored against defined criteria using a stakeholder survey. Questions covered all forms of malnutrition, including micronutrient deficiencies, thinness, stunting, overweight/obesity, and suboptimal dietary quality. The context was defined as research focused on SAC and adolescents, 5 to 19 years old, in low-and middle-income countries, that could achieve measurable results in reducing the prevalence of malnutrition in the next 10 years.ResultsBetween 85 and 101 stakeholders responded per question. Respondents covered a broad geographical distribution across 38 countries, with the largest proportion focusing on work in East and Southern Africa. Of the research questions ranked in the top ten, half focused on delivery strategies for reaching adolescents and half on improving existing interventions. There were few differences in the ranked order of questions between age groups but those related to in-school children and adolescents had higher expert agreement than those for out-of-school adolescents. The top ranked research question focused on tailoring antenatal and postnatal care for pregnant adolescent girls.ConclusionNutrition programmes should incorporate implementation research to inform delivery of effective interventions to this age group, starting in schools. Academic research on the development and tailoring of existing nutrition interventions is also needed; specifically, on how to package multisectoral programmes and how to better reach vulnerable and underserved sub- groups, including those out of school.
Project description:Excessive work among adolescents may compromise educational development. Without home appliances, household work can take over 50 h a week and an additional 30 h when an infant is present. School-aged girls are often tasked with doing laundry, which is time-consuming and inflexible without a washing machine. We determined the association between washing machine ownership and school attendance among adolescents ages 10-19 years in 19 middle-income countries between 2000 and 2021 (N = 1,622,514). We controlled for socioeconomic and demographic characteristics, all neighborhood-level factors, and examined differences by sex, age, household wealth, and period. No relationship between washing machine ownership and school attendance was found in most countries: However, there was a substantial association for girls in Türkiye and a small to moderate association for girls in Egypt and Albania. In Türkiye, for example, girls living in households with a washing machine had 28% (95% CI 19, 37) greater school attendance compared to girls living in households which did not. No association was observed for boys. The results suggest that household ownership of a washing machine does generally not improve school attendance among girls, except possibly in specific contexts.
Project description:Suicide attempts are the most important known predictor of death by suicide. The aim of this study is to examine the prevalence, distribution, and associated factors of suicide attempts among young adolescents in 40 low-income and middle-income countries. We used data from the Global School-Based Student Health Survey (2009-2013) and a nationally representative study in China (2010), which are school-based surveys of students primarily aged 12-18 years that assess health behaviors using an anonymous, standardized, self-reported questionnaire. We calculated the prevalence of suicide attempts in young adolescents from 40 low-income and middle-income countries using the surveys. Multilevel logistic models were used to estimate the associations between suicide attempts and potential risk factors, adjusting for gender, age, school and survey year. Results show that the mean 12-month prevalence of suicide attempts was 17.2%, ranging from 6.7% in Malaysia to 61.2% in Samoa. The overall prevalence of suicide attempts was higher for girls than for boys (18.2% vs 16.2%, P<0.05). Among the suicide attempts, the proportion of suicide attempts with a plan was higher for girls than for boys (62.7% vs 53.2%, P<0.05). Both the prevalence of suicide attempts and the proportion of suicide attempts with a plan increased with age. Factors associated with suicide attempts included poor socioeconomic status, history of bullying, loneliness and anxiety, tobacco and alcohol use, and weak family and social relationships. In conclusion, suicide attempts are frequent among young adolescents in low-income and middle-income countries. Girls and older adolescents tend to make suicide attempts with a plan. The data demonstrate the need to strengthen suicide intervention and prevention programs for young adolescents in low-income and middle-income countries.
Project description:Improving school quality in low and middle income countries (LMICs) is a global priority. One way to improve quality may be to improve the management skills of school leaders. In this systematic review, we analyze the impact of interventions targeting school leaders' management practices on student learning. We begin by describing the characteristics and responsibilities of school leaders using data from large, multi-country surveys. Second, we review the literature and conduct a meta-analysis of the causal effect of school management interventions on student learning, using 39 estimates from 20 evaluations. We estimate a statistically significant improvement in student learning of 0.033 standard deviations. We show that effect sizes are not related to program scale or intensity. We complement the meta-analysis by identifying common limitations to program effectiveness through a qualitative assessment of the studies included in our review. We find three main factors which mitigate program effectiveness: (1) low take-up; (2) lack of incentives or structure for implementation of recommendations; and (3) the lengthy causal chain linking management practices to student learning. Finally, to assess external validity of our review, we survey practitioners to compare characteristics between evaluated and commonly implemented programs. Our findings suggest that future work should focus on generating evidence on the marginal effect of common design elements in these interventions, including factors that promote school leader engagement and accountability.
Project description:Within the global context of the nutrition and physical activity transition it is important to determine the relationship between adiposity and active school transport (AST) across different environmental and socio-cultural settings. The present study assessed the association between adiposity (that is, body mass index z-score (BMIz), obesity, percentage body fat (PBF), waist circumference) and AST in 12 country sites, in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).The analytical sample included 6797 children aged 9-11 years. Adiposity indicators included, BMIz calculated using reference data from the World Health Organization, obesity (BMIz ⩾+2 s.d.), PBF measured using bioelectrical impedance and waist circumference. School travel mode was assessed by questionnaire and categorized as active travel versus motorized travel. Multilevel linear and non-linear models were used to estimate the magnitude of the associations between adiposity indicators and AST by country site and sex.After adjusting for age, sex, parental education and motorized vehicle availability, children who reported AST were less likely to be obese (odds ratio=0.72, 95% confidence interval (0.60-0.87), P<0.001) and had a lower BMIz (-0.09, s.e.m.=0.04, P=0.013), PBF (least square means (LSM) 20.57 versus 21.23% difference -0.66, s.e.m.=0.22, P=0.002) and waist circumference (LSM 63.73 cm versus 64.63 cm difference -0.90, s.e.m.=0.26, P=0.001) compared with those who reported motorized travel. Overall, associations between obesity and AST did not differ by country (P=0.279) or by sex (P=0.571).AST was associated with lower measures of adiposity in this multinational sample of children. Such findings could inform global efforts to prevent obesity among school-age children.
Project description:BACKGROUND:Global physical activity levels are low. Active commuting to school is a low-cost and sustainable behaviour that promotes adolescents' physical activity levels. Despite its importance, data on low- and middle-income countries is scarce. This study aimed to assess the relationship between active commuting to school and physical activity (PA) levels among 11-16 years-old adolescents from 63 low- and middle-income countries and six world regions. METHODS:Data were from the GSHS database. Participants were 187,934 adolescents (89,550 boys), aged 11-16 years-old, from 63 low- and middle-income countries. Active commuting to school and PA were self-reported as the number of days adolescents walked or cycled to school and engaged in physical activity for at least 60 min in the past 7 days. RESULTS:Boys and girls who actively commuted to school presented higher prevalence of attaining the PA recommendations, but only for the 13-14 (boys: 16.6% versus 22.0%; girls: 9.8% versus 14.6%) and 15-16 (boys: 16.3% versus 21.6%; girls: 8.0% versus 14.0%) year-old age groups. Only for Oceania, Central Asian, Middle Eastern, and North African girls and Sub-Saharan African boys no difference was found in the prevalence of attaining the PA recommendations between those who actively commuted to school and those who did not. Boys who actively commuted to school were 42% (95% CI: 1.37, 1.46) more likely to achieve the PA recommendations, while girls were 66% (95% CI: 1.59, 1.73) more likely to achieve the PA recommendations. CONCLUSIONS:Active commuting to school is associated with the adolescents' physical activity levels. However, it may have a lesser influence in helping younger adolescents attaining physical activity recommendations. Public health authorities should promote active commuting to school among adolescents in order to improve the PA levels and promote health.
Project description:Aims Adolescent suicide is a severe public health problem in low- and middle-income countries (LMICs), and adolescents who are victims of bullying have a higher risk of suicidal behaviours. However, detailed global data concerning the association between bullying victimisation and suicide are lacking; thus, further multicontinental studies exploring the association of bullying victimisation at different frequencies and types with suicidal behaviours are urgent. Methods The data were extracted from the Global School-based Student Health Survey (GSHS) (2010–2017) conducted in 40 LMICs (n = 151 184, mean age: 14.77 years, s.d.: 1.59, 54.2% females). Data concerning past-30-day bullying victimisation, past 12-month suicidal behaviours (suicidal ideation, suicidal plans and suicidal attempts) and other adverse health behaviours or outcomes were collected. Chi-square tests were used to explore the correlations among the main variables. A multivariable logistic regression and stratified logistic regressions were conducted to assess the associations. Results The overall prevalence of bullying victimisation, suicidal ideation, suicidal plans and suicidal attempts were 28.72, 12.64, 11.84 and 10.79%, respectively. The results showed a positive association of different frequencies and types of bullying victimisation with suicidal behaviours: suicidal ideation (odds ratio (OR) = 2.43, 2.06–2.87), suicidal plans (OR = 2.69, 2.28–3.17) and suicidal attempts (OR = 3.23, 2.73–3.82). Adolescents also reported the effects of being made fun of because of their religion: suicidal ideation (OR = 1.63, 1.41–1.88), suicidal plans (OR = 1.44, 1.24–1.66) and suicidal attempts (OR = 1.73, 1.50–1.98). Moreover, these associations varied among teenagers of different gender and body mass indexes (BMIs) and were stronger among males and adolescents who were underweight, overweight or obese. Conclusions Different types of bullying victimisation were positively related to suicidal behaviours; these associations varied among adolescents by gender and BMI. This study offers a theoretical basis for the identification of adolescents at a high risk of suicide and is beneficial for informing effective psychological interventions for constructing sound school environments, improving adolescents’ mental health and reducing the risk of suicide to promote health in LMICs and globally.
Project description:BackgroundSchools have a crucial role to play in preventing youth smoking. However, the well-known long-term health consequences of youth smoking may be insufficient to convince education stakeholders to devote efforts to implement school-based programmes. However, if youth smoking were to have short-term consequences, this evidence could prompt education stakeholders' action. In this article, we investigate the link between smoking and school absenteeism.MethodsWe used data from the 2011 wave of the European School Survey Project on Alcohol and Other Drugs, on adolescents aged 15-16. We applied logistic models to assess the risk of more than 3 missed school days, by cause, as function of smoking intensity, adjusting for age, sex, socioeconomic status, academic performance, parental involvement and other risk behaviours (alcohol and cannabis consumption). Consistency was assessed by replicating the analyses for each sex and age group and further adjusting for depression and self-esteem.ResultsSmoking more than five cigarettes per day was significantly linked to school absenteeism, with a 55% excess risk of missing more than 3 school days per month due to illness (OR = 1.55, 95% CI 1.46-1.64), and a more than two times excess risk due to skipping (OR = 2.29; 95% CI 2.16-2.43). These findings were consistent across age and sex groups.ConclusionWe observed an association between smoking intensity and absenteeism among youth in Europe. This implies that, to the extent that this association is causal, school tobacco control policies may reduce the short-term consequences of smoking on adolescents' education and health.
Project description:Achieving universal primary education is one of the Millennium Development Goals. In low- and middle-income developing countries (LMIC), child labor may be a barrier. Few multi-country, controlled studies of the relations between different kinds of child labor and schooling are available. This study employs 186,795 families with 7- to 14-year-old children in 30 LMIC to explore relations of children's work outside the home, family work, and household chores with school enrollment. Significant negative relations emerged between each form of child labor and school enrollment, but relations were more consistent for family work and household chores than work outside the home. All relations were moderated by country and sometimes by gender. These differentiated findings have nuanced policy implications.