Using WhatsApp support groups to promote responsive caregiving, caregiver mental health and child development in the COVID-19 era: A randomised controlled trial of a fully digital parenting intervention.

Objective: Digital interventions hold important potential for supporting parents when face-to-face interventions are unavailable. We assessed the feasibility and effectiveness of a digital parenting intervention in Zambia and Tanzania. Methods: Using a randomised controlled trial, we evaluated the Sharing Stories digital parenting intervention for caregivers of children aged 9-32 months with access to a smartphone in their household. Caregivers were stratified based on child age and randomly assigned to the intervention or waitlist control arm. The intervention was delivered via facilitated WhatsApp groups over 6 weeks to promote caregiver wellbeing and responsive caregiving through shared reading activities. Primary outcomes were caregiver-reported responsive caregiving, child language and socio-emotional development. Secondary outcomes were caregiver mental health and parental stress. Masked assessors conducted assessments at baseline and immediate follow-up. Results: Between October 2020 and March 2021, we randomly assigned 494 caregiver-child dyads to the intervention (n = 248) or waitlist control (n = 246) arm. Caregivers in the intervention group reported more responsive caregiving (OR = 2.55, 95% CI: 1.15-5.66, p = 0.02), time reading or looking at books (ß = 0.45, p = 0.04) and telling stories (ß = 0.72, p = 0.002). Intervention caregivers reported significantly lower symptoms of depression (ß = -0.64, p = 0.05) and anxiety (ß = -0.65, p = 0.02). Child development and parental stress did not differ significantly between groups. Conclusions: Digital parenting interventions using WhatsApp can effectively promote responsive caregiving and caregiver mental health in low-resource settings, with great potential for scalability. Trial registration: ISRCTN database, ISRCTN77689525.

Adolescent pregnancy and young motherhood in rural Zimbabwe: Findings from a baseline study.

Pregnant adolescents and young mothers comprise a vulnerable group, particularly in low and middle income countries, yet there is limited research describing this population, particularly in rural Zimbabwe. Using tablet-administered questionnaires concerning maternal and child health, sexual and reproductive health, psychosocial well-being and parenting, we recruited 442 pregnant and young mothers (14-24 years) with the support of social workers from health facilities. We found high levels of poverty amidst increased rates of marriage, including child marriage (almost 20%). Participants had poor sexual and reproductive health knowledge and uptake of contraception was low (only 35% respondents reported current use). Although almost 60% girls had completed Form 2, 24% had only completed Grade 1 and just 4% were still engaged in schooling. Girls reported inadequate social support amidst high caretaking responsibilities and change in relocation for marriage, compromising mental health. Most of the pregnancies were unintended (approximately 60%) which had consequences on attachment and parenting where roughly 40% of our sample reported difficulties and lack of enjoyment in caring for their babies. Investments in interventions that address these vulnerabilities for pregnant adolescents and young mothers, and capitalise on available resources, are critical to improve health and interrupt cycles of risk for the next generation.

Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review.

BACKGROUND: Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective. AIMS: This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269). METHOD: A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10-24 years) in LMICs. RESULTS: Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver-adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only. CONCLUSIONS: Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.

Integrating Psychosocial Support for Children in the Education Sector in Zambia: Lessons from the Programme Implementation Process.

Literature suggests that psychosocial support programmes can improve wellbeing and mental health among learners. There is however limited documentation on methodologies and factors that shape integration of such programmes within the education sector. This qualitative study aimed to contribute towards addressing this knowledge gap by analysing the implementation process of the Mainstreaming of Psychosocial Support in the Education Sector programme in Zambia. The study showed that the programme contributed to improved school culture and learning involvement. This transformation led to reduction in school dropout, as well as improved students' wellbeing and performance. These positive results motivated Zambia and other countries to integrate psychosocial support into the education systems. Community engagement, outreach activities, group forums and partnerships were the key programme methodologies that facilitated the integration process. However, limited stakeholder involvement in developing the monitoring process complicated the integration process in the initial stages. In conclusion, effectively facilitating programme integration requires ensuring that the programme is credible, inclusive and has clear implementation guidelines.