Social Protection Research Articles

Impact of Social Protection Programmes on Reducing Inequality in Education in Sri Lanka: A Matching Estimator Approach

This empirical study examined the impact of social protection programs in reducing inequality in education in Sri Lanka. In the present study, information was collected from 378 randomly selected households with a total of 536 children of school age. Data collection was done through a structured questionnaire, while the selection of the sample was carried out using a combination of purposive and random sampling techniques. Selection was done on purpose, based on two criteria: the poverty ratio and the percentage of informal sector workers. Districts such as Colombo, Nuwara-Eliya, Batticaloa, Puttalam, Anuradhapura, and Rathnapura were selected along with all their Divisional Secretariat divisions and Grama Niladhari divisions. Households from within these areas were selected randomly. It includes social protection programs supporting education with free school uniforms, textbooks, stationery, scholarships, mid-day meals, and milk. The present study identified the use of the Propensity Score Matching technique to identify the impact of social protection programs on reducing educational inequality. The key findings revealed that students who received at least one form of social protection had over a 13 per cent higher probability of attending school frequently when compared with a student who received no social protection. It can be concluded from this that social protection programs ensure regular attendance in school among students who experience a multitude of disadvantages and, therefore, reduce educational inequality. Based on these findings, the research recommends introducing a school-funded scholarship program that would increase the capacity of poor households and promote current social protection programs more efficiently to suit the differing needs of disadvantaged students.

Transformation of Criminal Law in Indonesia: An Analysis of Social Rights Protection through a Qualitative Descriptive Approach

This research aims to analyze the protection of human rights in criminal law in Indonesia, considering the importance of integrating human rights protection into a fair and effective criminal law system. This study uses a qualitative descriptive research method, utilizing primary data from case studies related to human rights violations and secondary data in the form of scientific literature, laws, and official documents from related institutions. Data were collected through documentation study techniques and media content analysis, which allowed for in-depth exploration of various cases and legal policies that had been implemented. Content analysis was used to identify key themes in legal documents and literature studies, while theoretical modeling helped formulate a theoretical model that links criminal law to human rights protection. The results of the study indicate that there is a discrepancy in several implementations of criminal law with human rights principles, especially in terms of protecting victims and fulfilling the rights of the accused. The conclusions obtained highlight the need for criminal law reform to ensure the fulfillment of basic rights for all individuals in accordance with international standards. This study provides recommendations for policymakers to integrate human rights protection more systematically into the criminal law system in Indonesia.

Resilience of unaccompanied refugee children in foster care at Tongogara Refugee Camp Zimbabwe

This article explores and discusses the resilience of refugee children under foster care in Zimbabwe. It advances the argument that there are resilience factors associated with unaccompanied refugee children under the foster care programme at the Tongogara Refugee Camp. Data were gathered using an exploratory qualitative research design using document analyses, 10 refugee children under foster care and 10 key informant interviews, which were conducted to gain a deeper understanding of the lives of refugee children under foster care at the Tongogara Refugee Camp. Evidence from the sources shows that there are several factors enhancing resilience among unaccompanied minors in foster care, such as religious, personal and macro support from foster parents, agencies involved in childcare, and educational support. It is recommended that the National Orphan Care Policy of 1999 be reviewed and the provisions of social protection programmes for unaccompanied refugee children under foster care be strengthened.

“You get the money after waiting for long and you get less than you anticipated”: Experiences of persons with disabilities in accessing the district special grant in Uganda

In 2010, Uganda scrapped an ambitious tax incentive provision in the Persons with Disabilities Act, 2006 that had allowed employers to claim up to 15% tax reduction in annual income provided that they hired at least 10 persons with disabilities at any job level. As though it were a trade-off, the 15% tax incentive was replaced with the special grant, a grant intended for persons with disabilities organized in small groups to generate income. The special grant started off as a pilot in 48 districts before it was rolled out nationally. Since 2019, the responsible ministry has been implementing two models of the special grant: the district special grant and the national special grant. This study focused on the district special grant, and primarily explored the experiences of persons with disabilities in accessing and utilizing the district special grant, and the difference the grant is making. The study adopted a qualitative research approach using interviews and focus group discussions to collect data from 10 beneficiary groups drawn from 6 districts. Focus group discussions were conducted with special grant beneficiary groups while district officials responsible for the special grant and disability union representatives were individually interviewed. Data were analyzed using template coding and thematic analysis. Study findings revealed limited access to the district grant, dismal grant amounts, significant deviations from implementation guidelines, operational dilemmas and overlooking disability related expenses like the costs for moving with a personal assistant. Nonetheless, participants commended the special grant for enabling them to build social networks, gain self-confidence and start small income generating activities. The small grant amount disbursed to big group size groups that lack business start-up skills did not support impactful business initiatives. The study revealed a strong evidence from individual grants as opposed to a group grants for starting income generating activities. The ministry of gender should consider remodeling the special grant into a social protection scheme that awards small grants to individual income generating activities.

Balancing privacy and public health: The impact of South Africa's cannabis legalization

The Cannabis for Private Purposes Act, enacted in South Africa in 2024, marks a significant shift in national drug policy by legalizing private cannabis use while aiming to balance individual privacy rights with public health and safety. This paper examines the Act’s impacts on socioeconomic dynamics, public health, and crime within South Africa, a context shaped by poverty, inequality, and strained healthcare resources. The study highlights potential economic benefits, such as job creation and formal market opportunities, alongside risks, including increased pressure on mental health services and complex implications for crime and gender-based violence. Drawing from government reports, recent studies, and international case comparisons, the analysis reveals how legalization might reduce the burden on the criminal justice system while also introducing challenges in public safety and healthcare capacity. The findings emphasize the need for robust governance frameworks that prioritize health system preparedness, social protections, and crime prevention. The discussion provides targeted policy recommendations for government agencies, healthcare providers, and law enforcement, addressing the importance of public education, regulatory oversight, and mental health support. This study offers valuable insights into the nuanced consequences of cannabis legalization in an emerging economy, contributing to global discussions on drug policy. By aligning policy with the realities of public health and safety, South Africa can leverage the potential benefits of legalization while mitigating its social costs.

A EFETIVIDADE DO DIREITO PREVIDENCIÁRIO E A IMPORTÂNCIA DA JUSTIÇA GRATUITA NA JUSTIÇA FEDERAL: DESAFIOS E PERSPECTIVAS

This article aims to analyze the effectiveness of Social Security Law at a global level, highlighting its purpose, objectives and challenges faced. The effectiveness of Social Security Law in society is crucial to guarantee financial support and dignity to people in times of vulnerability, such as old age, illness or disability. To obtain social security benefits, it is necessary to meet specific requirements, such as presenting complete documentation and proving disability or minimum age. Through bibliographic research and inductive methods, it is noted that Social Security is a vital tool for social protection, but faces bureaucratic challenges, lack of information and regional inequalities that can make access difficult. It is essential to continue improving public policies to ensure that all citizens can exercise their social security rights effectively and equitably. Therefore, the application of free justice at the federal level, highlighting its main objectives and developments, in order to guarantee everyone the right to seek judicial protection free of charge. Because of this, it promotes more inclusive justice. Furthermore, through specific rules and regulations, it allows low-income citizens to have their rights protected, regardless of their economic conditions.

Законодавчо-правове регулювання платформної зайнятості у контексті соціальної стійкості держави

The article considers the issue of maintaining the state social resilience through the prism of the development of digital platforms and the emergence of the digital labor market as a new reality for the information-network economy. Attention is focused on the fact that the transformation of traditional models of social and labor relations prompts the search for ways and means of the regulation of non-standard forms of employment, in particular platform employment related to work on digital (online-, Internet-) platforms. The authors carry out an analytical assessment of international approaches to regulating the activities of digital platforms and recommendations for improving working conditions for platform employment. Shown various legal peculiarities and the variety of national practices of labor regulation in the platform economy in different countries. The article presents variants of terminology on the subject, and the most common areas of application of legislation and regulations regarding digital platforms and employees of such platforms in the ILO’s member states. Revealed the directions of domestic legislative and legal regulation of certain forms of non-standard employment, such as remote work, work with the use of flexible working time, labor relations with non-fixed working time. It is noted that a separate case of such forms of non-standard employment can be considered platform employment, the specifics of whose regulation are not taken into account in Ukraine’s legislation. The authors summarize the recommendations on the regulation of platform economy and platform employment based on modern international approaches and practices. The main legally regulated aspects of platform employment are identified, being among the most important of them the issues of concluding labor contracts, extending social protection standards to platform employees, transparency in the use of algorithms, and guaranteeing the right to appeal decisions made by artificial intelligence. It is emphasized that special attention should be paid to the creation of a tripartite committee in Ukraine for the preparation by the parties of national social partnership of consolidated approaches to the regulation of platform employment. Proposed various guidelines for legal regulation of platform employment, which would minimize its precarization potential and contribute to social resilience in post-war Ukraine.

Digital agriculture and decent working conditions of smallholder farmers and farmworkers in Ghana

Digitalisation of the agriculture sector has been argued as the solution to the threat of food insecurity in the Global South. However, its adoption brings serious ramifications to the working conditions of farmers in terms of job creation, worker rights, social protection, and social dialogue. Given the role of the state in ensuring that all forms of employment are organised decently it is however uncertain how digitalisation of the agriculture affects the working conditions of farm workers and farmers. The study therefore examined the effects of digital agriculture on the working conditions of smallholder farmers and farmworkers in the Bono East region of Ghana. The study adopted a qualitative approach to enable us to have a deeper understanding of farmers’ experiences of using digital agriculture solutions. The participants who were purposively selected were adopters of digital agricultural technology. In-depth interviews and focus group discussions were some of the methods adopted to collect data for the study. The results from the study show that the adoption of digital agriculture has not improved the working conditions in terms of job creation, workers’ rights social protection, and social protection. Digital agriculture was however found to promote the organisation of farmers into groups to undertake activities for their benefit. The study therefore recommends the development of a digital agricultural policy that incorporates decent working conditions for farmers.

A Systematic Bibliometric Review of Fiscal Redistribution Policies Addressing Poverty Vulnerability

The elimination of poverty in all its forms is the first global goal of the United Nations’ 2030 Agenda for Sustainable Development. Achieving this goal is recognized as a long-term process that is complicated by persistent vulnerabilities stemming from factors such as natural disasters, food insecurity, health challenges, educational disparities, and social inequality. This systematic bibliometric review provides a comprehensive survey of the impact of social protection-based policies in mitigating poverty vulnerability, focusing on selected countries and regions, including America, Europe, Oceania, and part of Asia and Africa. Our analysis reveals that 81% of the studies examine poverty vulnerability from a single dimension, predominantly focusing on food security and nutrition (23%), climate change shocks (18%), and health-related vulnerabilities (14%). The geographic distribution indicates that the United Kingdom and the United States lead research in this field, contributing 36 and 32 papers, respectively, followed by China (16 papers), South Africa (15 papers), and Canada (10 papers). The results indicate that these fiscal redistribution policies significantly contribute to reducing poverty and inequality and have positive impacts on other Sustainable Development Goals (SDGs), particularly SDG 1 (No Poverty), SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 10 (Reduced Inequalities). However, notable gaps remain, especially regarding the integration of these policies with environmental sustainability goals like SDG 13 (Climate Action), which are addressed in only a minority of studies. This study concludes by recommending the adoption of more holistic and integrated policy frameworks that bridge the gap between social protection and environmental sustainability, thereby advancing the entire 2030 Agenda for Sustainable Development.

Patriarchy Driven Invisible Exploitation Among Putting Out System Women Workers in Moslem Democracy Country

Most workers in the Putting-out System (POS) are dominated by women who come from poor families, are married and have children, have low education and do not have skills who work because of family economic pressures. This homework is informal work that is vulnerable to exploitation by not getting decent wages, long working hours, and not getting social protection such as work accident insurance and insecure job status. The Indonesian Home Workers Network (Jaringan Pekerja Rumahan Indonesia/JPRI) is an organization that accommodates homeworkers to carry out social movements to obtain decent work. However, the involvement of female homeworkers in this movement is still very low. This study aims to describe how female workers are increasingly exploited because they are not considered worthy of their rights as workers and how the patriarchal system perpetuates this exploitation by placing women in the domestic sphere and examines JPRI efforts to raise this issue by utilizing social movements. This study is a descriptive study with a qualitative feminist approach. The selection of informants was carried out by snowballing method to members of JPRI and the Trade Union Rights Center (TURC) as an NGO accompanying JPRI. The results of the study show that female homeworkers’ choice of jobs reflects invisible exploitation based on gender discrimination and this is reinforced by the dominance of men over women through a patriarchal system that is perpetuated through the institutions of family, economic and nation. The study recommends that at the macro level, the government needs to recognize the existence of home workers by making regulations related to home workers so that their problems are exposed. Meanwhile, at the micro level, JPRI needs to continuously build awareness among female home workers that they are also real workers by taking individual and group approaches.

Critical Insights into Gig Economy: A Peninsular Malaysia Case Study

The rise of the gig workers has transformed the employment landscape, presenting both opportunities and challenges for workers globally. It has disrupted the traditional meaning of ‘employee’ with ambiguous and complex aspects, especially gig workers’ status. Practically, gig workers are individuals working under a contract for service with flexibility and independence elements that give them a sense of autonomy in performing their work. This study delves into the specific case of Peninsular Malaysia, investigating the issues and challenges gig workers face in the thriving market. The research adopts both library research and qualitative research methods, including interviews using a semi-structured approach. A total of 10 respondents were interviewed using a semi-structured method. The findings revealed that the challenges dwell in the issues of gig workers, which require high-time intervention of governance, policies, and legislation; there is still no definition of gig workers. There is a lack of social protection, an absence of employment contracts, an absence of price regulatory control, poor operational services, a gap between platform owners and the government, and a piecemeal institutional framework. Hence, this study offered recommendations on how to improve the enforcement.

Litigation as a Governance Strategy: Courts, Bureaucracies and the Welfare Rights of Irregular Migrants

ABSTRACTOver the last few years, the welfare rights of illegalized migrants living in Belgium have become increasingly restricted. Without a legal residence status, such rights are limited to (conditional) access to public healthcare. Welfare courts have, however, sometimes gone against the grain and granted social assistance benefits to irregularized applicants, based on fundamental rights principles. Conflicting jurisprudential trends have emerged and are still debating the ambiguous, and multiple meanings of ‘human dignity’ especially for those with a precarious immigration status. This article delves into the role of courts in the implementation of migrants' welfare rights. Based on ethnographic fieldwork within welfare courts, in public administrations and amongst migrants, it shows how litigation has become part of the daily governance of social protection. This allows certain categories of migrants to gain access to financial assistance, yet creates lengthy, complex procedures and leading to great uncertainty for claimants.

Psicologia institucional na assistência social

The field of social assistance is a promising area for psychologists to work in. The tools and theoretical foundations of this field are under constant self-assessment in order to improve ethical practice in the community. The aim of this study is to reflect on the experience of a one-year extracurricular internship in Basic Social Protection, assessing the practice of psychologists and the challenges of going beyond the role of social technician. The research uses José Bleger’s institutional psychology, normative documents from the Ministry of Social Development and CREPOP’s technical references to carry out a conceptual analysis. This analysis aims to introduce, reflect on and support the training of psychology students to work in the area of social assistance, explaining the possibility of including institutional psychology in this field. The study works with Bleger’s concept of “psycho-hygiene”, applied to the work of social workers and institutional psychologists. It concludes that the work of these professionals can contribute to preventing situations of illness within institutions. Bleger’s work remains relevant and coherent in the ethical training of psychology professionals.

Assessing Social Sustainability Efficiency in European Countries: Focusing on Health and Well‐Being

ABSTRACTThis study investigates the challenges of achieving social sustainability efficiency in European countries, especially in health and well‐being, under sustainable development goal 3 amid demographic aging pressures. Using an innovative modified circular dynamic three‐stage systematic network data envelopment analysis model, this research evaluates the influence of social protection investments on healthcare and well‐being systems. The findings reveal that Denmark, Estonia, France, and Germany demonstrate optimal efficiency, while Lithuania, Luxembourg, the Netherlands, and Slovenia require strategic improvements, particularly in healthcare efficiency. Policy recommendations underscore the need for enhanced healthcare technology, occupational safety, and adaptive strategies to support social sustainability across 24 countries from 2016 to 2020. This approach offers a comprehensive efficiency framework and actionable insights to guide future policy development to address European healthcare efficiency gaps.

Urban Nutrition in the Global South: A Narrative Review of Current Research.

According to the Global Food Policy Report 2017, nearly 90% of the projected urban population increase by 2050 is going to be concentrated in Africa and Asia. Parallel evidence suggests that poverty and related challenges of food insecurity and undernutrition are also urbanizing. The dynamics underlying urban nutrition is different from rural ones but also arguably represents a more complex scenario. In this review, we synthesize available evidence on urban nutrition (in)security in the Global South. Although focused on nutrition-centric literature, our review also identifies and discusses studies in the contexts of the broader notion of urban food systems. Articles that analyzed any form of mal/nutrition were eligible for inclusion. One hundred sixty-nine articles were shortlisted based on a systematic search strategy, then expanded through a backward and forward literature survey. Our review identifies key emergent themes from a large body of research on urban food systems, noting that surprisingly few address nutrition directly. Rather, current literature on urban nutrition is scattered and skewed with an overt focus on urban agriculture. Our review reveals that the existing literature with direct nutrition relevance in an urban context can be systematically organized across three themes, i.e., urban agriculture, nutrition transition, and social protection. Noticeably, this literature also draws upon successful interventions having implications for urban nutrition. Finally, the review identifies a few research gaps that hinder a holistic view of urban nutrition. These gaps pertain to gender, equity, water (along with sanitation and hygiene), and local governance.

Konsep Pengasuhan Positif Berdasarkan Falsafah Sapa Sira Sapa Ingsun Sebagai Solusi Toxic Parenting

The Indonesian Central Statistics Agency reports that 30.2 million children require adequate social, economic, and educational protection, yet toxic parenting systems often become the main obstacle. The high prevalence of child abuse indicates the need for positive and culturally-based parenting approaches. This study aims to explore and test the Sapa Sira Sapa Ingsun philosophy as a positive parenting approach to address toxic parenting. The first study involved in-depth interviews with figures from the Surakarta Palace, revealing parenting principles such as the balance between intellectual, spiritual, and emotional intelligence, and two-way communication. The second study confirmed these findings through the opinions of parenting experts. The third study, a psychodrama experiment with 34 parents, demonstrated that positive parenting based on the Sapa Sira Sapa Ingsun philosophy is effective in reducing toxic parenting. Paired samples t-test results showed a significant difference between pre-test and post-test scores, with t(33) = 9.84 and p < 0.001. The effect size calculated using Cohen's d was 1.69, indicating a very large effect of the intervention. This shows a statistically significant difference between pre-test and post-test scores, suggesting a meaningful change after the intervention. In conclusion, the Sapa Sira Sapa Ingsun philosophy can be widely applied as a positive parenting solution to overcome toxic parenting.

METHODOLOGICAL APPROACHES TO ASSESSING AND REALIZING THE INVESTMENT POTENTIAL OF THE COUNTRY’S ECONOMY IN THE CONTEXT OF SUSTAINABLE DEVELOPMENT

THE PURPOSE OF THE ARTICLE is to study methodological approaches to assessing and realizing the investment potential of the country’s economy in the context of sustainable development. RESEARCH METHODS. In writing the article, the following research methods were used: analytical method – to study the indicators of the country’s investment potential, study trends and previous studies in this area; theoretical analysis – in analyzing modern theoretical approaches to assessing and realizing investment potential in the context of sustainable development; method of empirical research and comparative analysis – to identify advantages and disadvantages; case study – to identify factors of successful realization of investment potential, taking into account the principles of sustainable development. PRESENTING MAIN MATERIAL. In the context of globalization and increasing environmental risks, the issue of rational use of investment potential in the context of sustainable development is of particular relevance, where investments are becoming a key element that ensures economic growth, improvement of social welfare and environmental protection. The investment potential of a national economy is a set of resources and conditions that enable the attraction and efficient use of investments in various sectors of the economy, including: economic resources; social resources; natural resources; and institutional resources. Among the methodological approaches to assessing investment potential, the most popular is the classical approach, where the assessment of investment potential is based on the analysis of such indicators as the level of domestic and foreign investment, GDP structure, level of savings and investment activity of enterprises. In the context of sustainable development, the assessment of investment potential takes into account additional factors such as environmental risks, the level of social responsibility, and the availability of green investment projects. Innovations and the introduction of green technologies are key elements in the context of sustainable development, where government support is directed to funding research and supporting green investments. Countries that have succeeded in realizing their investment potential in the context of sustainable development are characterized by: a developed institutional framework (availability of effective institutions that support investment activities), a high level of innovation activity (active implementation of innovations in various sectors of the economy), and effective environmental policy (active state support for environmentally friendly technologies and projects). Therefore, approaches to assessing and realizing investment potential take into account the main aspects of innovative development and the introduction of green technologies, where the state helps to create a favorable investment climate and support sustainable development by stimulating investment, developing infrastructure and supporting innovation. CONCLUSIONS. In today’s world, the concept of sustainable development is central to the economic development strategies of countries, where one of the key aspects is the effective use of investment potential to ensure sustainable economic growth. The main approaches to realizing investment potential include: creating a favorable investment climate (legislative regulation that stimulates investment in low-carbon sectors; reducing bureaucratic barriers for foreign and domestic investors; developing infrastructure that supports sustainable production and consumption); integrating sustainable development principles into investment projects (assessing the impact of projects on the environment and social aspects; implementing investments in energy efficiency and renewable energy). It has been established that the realization of the country’s investment potential in the context of sustainable development requires an integrated approach and systematic integration of economic, social and environmental requirements, which requires active cooperation between government, business, academia and the public to achieve common goals of sustainable development and provide future generations with a stable and environmentally friendly living environment. KEYWORDS: investment potential; national economy; sustainable development; methodological approaches; economic development of the country; economic growth; assessment and implementation; investment climate; investment projects; financing; infrastructure.

Unmet Health Care Needs Among Older People in Canada: Does Household Food Insecurity Matter?

Canada is undergoing a demographic shift, with projections indicating that over 25% of the country's population will be 65 years or older by 2063. While this has raised critical concerns about Canada's preparedness to meet the social and health-care needs of an aging population, the increasing incidence of food insecurity is particularly affecting vulnerable groups, such as older Canadians, with implications for their health-care service utilization. Despite this observation, there are nascent studies examining the role of household food insecurity status on unmet health-care needs among older people in Canada. The main objective of our study is to assess the association between household food insecurity and unmet health-care needs among older Canadians. We used data from a selected sample of 21,178 participants as part of the 2017-18 Canadian Community Health Survey and applied logistic regression analysis. Our findings indicate that older people experiencing any type of food insecurity, that is, either moderate (OR=3.07, p<.01) or severe (OR=4.09, p<.01) were more likely to have reported unmet health-care needs compared to their counterparts in food secure households, even after controlling for a range of demographic, socioeconomic, and health and health-care variables. Our finding is concerning, considering that older people in Canada who are in most need of health-care services due to their food insecurity status are instead reporting unmet health-care needs. This revelation calls for urgent policy attention to reduce the episodes of household food insecurity among older people in Canada. Specifically, to improve their access to health-care services, providing them with periodic grocery rebates as part of the social protection package for seniors in Canada would help mitigate the problem of food insecurity among them.

Experiences of Pregnant and Parenting Adolescents and Young Women During COVID-19 Pandemic: A Mixed-Methods Study Among Girls and Women in Kenya

PurposeThis study examines the experiences of pregnant/parenting adolescents and young women during the first two years of the coronavirus disease 2019 (COVID-19) pandemic. MethodsThis explanatory sequential mixed-methods study leverages quantitative data collected among a cohort of adolescents and young people aged 15–22 years in three Kenyan counties; Nairobi, Kisumu, and Kilifi at three time points (2020, 2021, 2022), and two rounds of qualitative interviews in the same settings conducted in 2020 and 2022. ResultsAmong 2337 (2020), 1438 (2021), and 1669 (2022) respondents, pregnant/parenting adolescents and youth comprised 140 (6%), 101 (7%), and 83 (5%) individuals, respectively. Across the three time points, the experience of depressive symptoms was similar between pregnant/parenting adolescents and those not pregnant/parenting. Pregnancy and parenting was associated with twice the odds of skipping health services (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.43–3.35), in 2020, and 85% higher odds (aOR 1.85, 95% CI 1.14–3.02) in 2021, and 90% higher odds of skipping meals (aOR 1.90, 95% CI 1.19–3.03) in 2022. Qualitative findings indicated experiences of psychological distress, food insecurity, and inadequate access to health care services among pregnant/parenting young people during the pandemic. DiscussionThe pandemic increased pre-existing challenges associated with adolescent and young people's health, predisposing young pregnant/parenting women to greater adversity than their nonpregnant/parenting counterparts. Targeted and responsive approaches during emergencies and crises such as social protection, food security, and mental health programs for this group of vulnerable people are required and need to be integrated into disaster response plans.

Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort study

Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. We conducted a population-based national retrospective cohort study of children (0-9 years) and adolescents (10-17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9-3.1) and did not receive DOT (2.3, 1.9-2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2-2.0), illicit drug use (4.2, 3.4-5.1), tobacco use (1.6, 1.3-2.1), HIV infection (2.7, 2.2-3.4), and not receiving DOT (2.6, 2.3-2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3-0.9). In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.