Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Jun 30.
Published before final editing as: Fam Soc. 2026 May 18:10.1177/10443894261434644. doi: 10.1177/10443894261434644

Preliminary Effects of the ANZANSI Family Program on Caregiver Outcomes in Northern Ghana: A Pilot Study

Ozge Sensoy Bahar 1,*, William Byansi 2,*, Abdallah Ibrahim 3, Alice Boateng 4, Kingsley Kumbelim 5, Frederick Goodwill Amissah 6, Saltanat Childress 7, Fred M Ssewamala 8, Mary M McKay 9
PMCID: PMC13313615  NIHMSID: NIHMS2179431  PMID: 42376584

Abstract

High levels of poverty and entrenched gender norms in Northern Ghana increase the risk of adolescent girls leaving school, engaging in child labor, and migrating unaccompanied. Caregivers play a vital role in reducing these risks, but few interventions focus on family-level support for girls’ education. The ANZANSI Family Program combines economic empowerment with family strengthening to address child labor. A pilot randomized clinical trial (n = 97) was conducted across 10 schools, assessing caregiver-reported outcomes at baseline, 9 months, and 15 months. Results from linear mixed-effects models showed significant improvements in caregiver educational support at both follow-ups. These preliminary findings suggest caregiver-focused, multi-component interventions are feasible in settings facing resource constraints and educational inequities and may enhance caregivers’ involvement in supporting girls’ education.

Keywords: adolescent girls, caregiver support, school dropout, family economic empowerment, multiple family groups, child labor

Introduction

Enduring economic and educational inequities rooted in historical contexts shape constraints that families navigate, often affecting adolescent girls’ education and overall well-being (Michalopoulos & Papaioannou, 2016; Roessler et al., 2020). Northern Ghana’s contemporary educational inequities and patterns of child labor and migration are inseparable from sociohistorical forces that include the transatlantic slave trade, domestic slavery, and colonial rule and their afterlives (Pierre, 2020; Roessler et al., 2020). These historical processes have been linked to long-run pathways shaping spatial inequality, material deprivation, and institutional trust across sub-Saharan Africa and Ghana, with consequences for schooling access and opportunity structures that persist across generations (Michalopoulos & Papaioannou, 2016; Nunn, 2008; Roessler et al., 2020).

Within this context, poverty and gender norms are not only proximate risks for girls’ schooling but also reflect historical and geographical inequalities that shape caregivers’ and adolescents’ choices, constraints, and exposure to exploitative labor arrangements. Caregivers in these settings, particularly in Northern Ghana, often face economic constraints, family dynamics, and cultural factors that necessitate difficult choices, affecting the educational and developmental trajectory of adolescent girls. This environment contributes to the widespread issue of child labor, a prominent concern across the African continent, with approximately one fifth of African children, around 92 million, engaged in various forms of work, including a considerable proportion within Ghana (ILO & UNICEF, 2021). Such circumstances increase the vulnerability of adolescent girls to early school dropout, transactional migration, and exploitative labor practices (Hamenoo et al., 2018; Jariego & Jariego, 2021; Mussa et al., 2019). Therefore, understanding the experiences and decisions of caregivers is critical. This study examines how a family intervention impacts caregiver-reported outcomes, focusing on strengthening child–caregiver support, enhancing family cohesion, improving caregivers’ educational support, and increasing family assets. These caregiver and family processes are pivotal for promoting school attendance, reducing child labor, and mitigating the intention to migrate among adolescent girls.

While broad structural barriers to adolescent girls’ education and the prevalence of child labor in poverty contexts are essential to acknowledge, it is equally important to acknowledge the pivotal role of caregivers in mediating these challenges. Caregiver influence on girls’ educational trajectories is therefore best understood as context-driven rather than separable from the historical and structural conditions families navigate. Recognizing caregivers as pivotal does not minimize structural injustice but clarifies how caregiving practices and family decision-making are shaped by, and can sometimes buffer, historically rooted constraints in schooling, labor markets, and social valuation of Northern Ghanaian communities (Roessler et al., 2020). In this study, we conceptualize caregiver support as a family process that operates within these conditions and can be strengthened through locally adapted interventions delivered through trusted school-community systems.

Poverty and gender inequality are well-known factors that lead to school dropout among adolescent girls (Gubbels et al., 2019; UNESCO, 2023). In Northern Ghana, these risks also reflect longer-term sociohistorical and political-economic processes, including colonialism and the afterlives of slavery, that have shaped inequality, educational opportunity structures, and gendered labor expectations. Within these historically produced constraints, growing evidence highlights the strong influence caregivers have on girls’ educational trajectory (Kwarteng et al., 2022; Murphy-Graham, 2024). The family unit serves as a primary determinant of educational attainment, with both biological and nonbiological caregivers directly impacting a child’s school engagement or withdrawal, particularly in environments marked by financial insecurity and material deprivation (Wang & Eccles, 2012). Cohesive family dynamics, characterized by strong emotional bonding, consistent parental monitoring, and open communication, are protective factors that enhance girls’ likelihood of remaining in school (Basharpoor & Heidari, 2022; Kung & Ching-Yi, 2015; Osuji et al., 2018; Wang et al., 2021). Family cohesion, which refers to the level of emotional connectedness, mutual support, and harmony among family members, has been linked to increased school completion and reduced dropout rates during adolescence (Fortin et al., 2013; Maynard & Olson, 1987; Olson et al., 2019). Conversely, adolescents from less cohesive or more dysfunctional family environments face elevated risks of educational disengagement (Gordon & Nandy, 2012). Importantly, we conceptualize caregiver educational support and family cohesion as ways through which broader structural conditions are experienced, negotiated, and sometimes buffered within families, rather than as factors separable from the larger historical and structural determinants of educational inequality.

Building on the influence of family cohesion, the quality of parenting has a further significant impact on adolescent girls’ engagement with school. Positive parenting practices, characterized by warmth, consistent guidance, and open communication, are consistently associated with improved educational and psychosocial outcomes (Blondal & Adalbjarnardottir, 2014; Blum et al., 2014; Murphy-Graham, 2024). Adolescents who can communicate openly with their caregivers tend to develop robust self-efficacy and problem-solving skills, which are crucial for mitigating school-related challenges such as academic stress, peer pressure, or emotional distress (Offrey & Rinaldi, 2017; Osuji et al., 2018; Yan et al., 2024). Active parental involvement, which includes checking homework, engaging with teachers, and supporting school activities, reinforces the perceived value of education and directly facilitates school attendance (Basharpoor & Heidari, 2022; Wang et al., 2021). Conversely, a lack of caregiver support leaves girls more vulnerable to school disengagement stemming from issues such as bullying, poor academic performance, or menstruation-related barriers (Jariego & Jariego, 2021; Olsson et al., 2017; Sommer, 2010).

Beyond direct parental involvement, broader social networks influence girls’ schooling, including extended family members, mentors, and community leaders. These secondary caregivers provide emotional and practical support in many low-resource contexts, buffering adolescents from adverse life circumstances (Miller et al., 2015). Adolescents who perceive strong social support report higher school satisfaction and are less likely to consider dropping out (Bradley et al., 2021). Furthermore, parents who receive social support are often better equipped to manage household stressors, thereby enhancing their parental competence and self-efficacy in supporting their children’s academic pursuits and well-being (Fierloos et al., 2023).

Despite the importance of caregiver support, household poverty remains a powerful predictor of school dropout for adolescent girls in low-resource settings. Numerous studies from sub-Saharan Africa and other Low- and Middle-Income Countries confirm that poverty increases irregular attendance and early withdrawal due to both direct and opportunity costs associated with schooling (Chikhungu et al., 2020; Reiss, 2013; Wray & Ed, 2015). Even with nominally free basic education, families often struggle with non-tuition costs, such as transportation, uniforms, or supplies. In the context of material deprivation, adolescent girls are often required to work at home or in markets, thereby reducing the time and energy available for school (Chikhungu et al., 2020; Wray & Ed, 2015). Economic shocks, such as illness or unemployment of a household member, can also prompt families to withdraw girls from school as a coping strategy (Bermudez et al., 2020; Van de Waal et al., 2024). These poverty-related constraints are often compounded by entrenched gender norms that devalue girls’ education and promote early domestic responsibilities (Bermudez et al., 2020; Van de Waal et al., 2024). In Ghana, girls who delay marriage or prioritize schooling can face stigma or pressure to conform to normative roles (Akurugu, 2022), with parental endorsement of traditional beliefs directly reducing school attendance and increasing dropout rates (Van de Waal et al., 2024). These intersecting barriers are particularly pronounced in Northern Ghana, where poverty, infrastructural deficits, and gender norms converge to produce significant educational inequalities, leading to stark regional disparities in school completion (Ghana Statistical Service, 2022; Molini & Paci, 2015). When caregivers prioritize education and invest in schooling, girls are more likely to remain enrolled (Murphy-Graham, 2024; Ssewamala, 2015; Ssewamala et al., 2009), whereas prioritizing short-term economic gain or traditional norms often leads to school withdrawal and practices like the migration of adolescent girls to urban centers for head porter work (Bermudez et al., 2020; Nartey et al., 2023).

Despite the well-established influence of caregiver and family-level factors on school disengagement and retention, interventions explicitly targeting these domains to prevent school dropout among adolescent girls in Ghana have been limited. Given the documented nexus between family-level interventions and improved school attendance, strategies that strengthen family–school partnerships and support caregiver capacity can reduce absenteeism and prevent dropout (Wang et al., 2021). In response to this gap, the ANZANSI Family Program (meaning “resilience” in a local language) was developed as a multicomponent intervention in Northern Ghana. Led by researchers from the United States and Ghana, as well as nonprofit organizations in Northern Ghana, ANZANSI aims to support vulnerable adolescent girls and their families affected by migration and child labor. The program integrates a family-level economic empowerment (FEE) strategy, including matched child development accounts (CDAs), financial workshops, and income-generating trainings, with a family-strengthening intervention delivered through multiple family group (MFG) sessions. These sessions focus on building protective factors for healthy parent–child relationships, addressing familial and community stressors, and discussing important topics such as child roles, gender norms, and child labor (Sensoy Bahar et al., 2020). The overarching goal is to reduce the risk of school dropout and unaccompanied migration for child labor among adolescent girls. The FEE component, grounded in asset theory (Rothwell & Han, 2010; Sherraden, 1991), included financial literacy training, sessions on income-generating activities, and the establishment of CDAs co-owned by the adolescent and a caregiver. Family contributions to the CDAs were matched 2:1, up to a maximum of US$90 over 9 months.

The MFG component, originally developed in the United States and later implemented in the sub-Saharan context, is informed by family systems and social learning theories (Dennison, 2005; McKay et al., 1995), and focused on the 4Rs (Rules, Responsibility, Relationships, Respectful Communication) and 2Ss (Stress and Social Support) (McKay et al., 1995). The Dang-Malgu (Family Togetherness) adaptation was conducted to build upon local knowledge and conceptualization of family relations. In Northern Ghana, family togetherness, reciprocal responsibility, and integrity are historically and contemporarily articulated through community concepts and practices that signal mutual assistance and moral standing. The intervention, therefore, emphasizes respectful communication and shared responsibility in ways that build upon family strengths and support caregivers’ capacity to encourage schooling under conditions in which adolescents face competing demands and risks. The 16 weekly sessions, each lasting 60 to 90 minutes and facilitated by trained school health coordinators, aimed to improve family functioning, communication, and support. Sessions were adapted to include content on child labor, child work, and girls’ education to address local norms and beliefs. This approach has previously demonstrated promise in enhancing caregiver–child relationships and family cohesion in both Uganda and Ghana (Brathwaite et al., 2022; Byansi et al., 2024; Sensoy Bahar et al., 2024).

We use the term culturally sensitive and contextually appropriate specifically to mean (a) adapting session content to address locally salient stressors (child labor, migration, gender norms), (b) delivering the intervention through school-based personnel embedded in community systems, and (c) emphasizing family strengths and shared responsibility in ways intended to resonate with locally meaningful practices. This does not imply that the intervention fully addresses the historical and structural conditions shaping educational inequality, but rather identifies family-level pathways that warrant further study alongside broader structural efforts.

Preliminary research on ANZANSI has already demonstrated promising findings for adolescent girls, indicating that participation in the intervention improves psychosocial outcomes, including enhanced self-esteem and improved emotional and social self-efficacy (Byansi et al., 2025). Notably, the program has also increased family cohesion among adolescent girls, a critical factor for sustaining educational engagement in low-resource settings (Sensoy Bahar et al., 2024). Furthermore, initial pilot results suggest that the intervention reduced the risk of school dropout and, over a more extended period, significantly decreased the intention to migrate among adolescent girls (Sensoy Bahar et al., 2025). This current study extends these findings by hypothesizing that caregivers in the intervention group will demonstrate improved outcomes over time, specifically enhanced family cohesion, stronger caregiver–adolescent relationships, increased caregiver educational support, and improved family assets, relative to their counterparts in the control group.

Method

Funded by the National Institute of Child Health and Human Development, this pilot randomized clinical trial aimed to address the risk of school dropout among adolescent girls, with the overall goal of reducing their likelihood of migrating independently to the South for child labor (see study protocol for more details) (Sensoy Bahar et al., 2020). Longitudinal data from caregivers of adolescent girls (n = 97) participating in the ANZANSI study (R21HD099508; PI Sensoy Bahar, 2019–2022) were analyzed for this study. The study involved dyads of caregivers and their adolescents. However, the analysis in this paper used only caregiver data. Adolescent data have been published elsewhere (Byansi et al., 2025; Sensoy Bahar et al., 2024, 2025).

Study Setting

The study was conducted in the northern region of Ghana, a region experiencing high levels of multidimensional poverty alongside strong community systems and locally mobilized resources. This region has the highest incidence (81%) of multidimensional poverty, the highest rates (35%) of child labor, and the lowest school attendance rates in the country (Ghana Statistical Service, 2021; Molini & Paci, 2015). In this predominantly Muslim region, only 35% of girls aged 6 years and older are considered literate, compared to 66% at the national level (Ghana Statistical Service, 2021). Early marriage and polygamy are common, with 38% of women reporting that their partners have additional wives, versus the national average of 14.0% (Ghana Statistical Service, 2021, 2022). The language of instruction in the Ghanaian educational system is English, and the academic year consists of three terms. At the same time, describing Northern Ghana solely through deprivation indicators obscures the substantial social, cultural, and economic resources that families and communities mobilize, including agricultural production and other forms of material and relational support that sustain households and markets throughout Ghana (Lee & Hudson, 2011).

Participants

The list of public junior high schools in the Tamale Metropolitan District with the highest female student dropout rates was compiled. Ten schools, located within a 5-km radius of each other to prevent contamination, were selected based on their dropout rates. Randomization for the clinical trial was conducted at the school level, with five schools assigned to the intervention group and five to the control group (see study protocol for more details) (Sensoy Bahar et al., 2020). The study enrolled 10 adolescent girls and their caregivers from each school.

The inclusion criteria for adolescent girls were: (1) enrolled in school and living within a family (defined broadly—not necessarily biological parents); (2) ages 11 to 14; (3) capable of giving assent; and (4) skipping school in the past academic term (with at least 10% of unexcused absences) (Sensoy Bahar et al., 2020). Due to their time constraints, three families withdrew before baseline data collection. School administrators distributed the study flyer, introducing the project to students and caregivers. All caregivers with an eligible child (ren) were encouraged to contact the school for details. The study team then organized meetings with families from each of the selected schools to present the study and address their questions and concerns. The research team then met with potential participants to engage them in the screening and informed consent process. Adolescent girls were contacted for assent only after the study team received consent from their caregivers to contact them. Written informed consent and assent were obtained from caregivers and adolescents, respectively.

Measures

Family Cohesion

We measured participants’ family cohesion (Moos, 1994) using a 7-item scale adapted from the Family Environment Scale and the Family Assessment Measure (Skinner et al., 1983). The 7-item scale asked participants specific questions such as, “Do your family members ask each other for help before asking non-family members for help?” “Do your family members like to spend free time with each other?” The 7-item scale had a 5-point Likert-type scale response options ranging from always to never, with 5 = always, 4 = most of the time, 3 = about half the time, 2 = sometimes, 1 = never. The theoretical range was 7 to 35. We coded the items and summed them for total scores, with higher scores indicating higher family cohesion. The average total score on family cohesion was 27.67 (SD = 6.28), representing higher levels of family cohesion among participants (Cronbach’s alpha = 0.81).

Gender Norms

We assessed gender norms among caregivers using a 10-item scale adapted from the Gender Norm Attitudes Scale (Waszak et al., 2001), which measures participants’ understanding of the appropriateness of behaviors as they relate to being female and male. The items in the scale encompass aspects related to educational performance, future expectations for both genders, family support, encouragement, decision-making, and involvement in intimate relationships and behaviors. A few examples of the scale items are: “It is important that sons have more education than daughters” and “Women should leave politics to the men.” The Cronbach’s alpha was 0.74, indicating an acceptable level of internal consistency. The scale items featured binary responses (Agree = 1 and Disagree = 0). To create a summation score, items in the reverse direction were appropriately reverse-coded, with higher scores denoting more egalitarian gender norms and beliefs, reflecting equal consideration for both girls and boys.

The perceived child–caregiver relationship scale assesses relationships on two dimensions: (1) acceptance and warmth—the extent to which the caregiver perceives as involved in their child’s life, and (2) psychological autonomy—the extent to which the caregiver employs a noncoercive, democratic discipline and encourages the child to express individuality within the family (Skinner et al., 1983). Participants were asked to rate the adults they live with on each of the 16 items (range: 35–79, alpha = 0.81), on a 5-point scale (1 = “never” and 5 = “always”). Sample items include: “Can your child count on you to help her if she has a problem?” and “Do you keep challenging your child to do her best in whatever she does?” Summary mean scores were created, with higher scores indicating a more positive child–caregiver relationship. We used the same items for both caregivers and adolescent girls to measure the perceived child–caregiver relationship.

Caregiver Educational Support

Caregiver educational support was assessed with three questions asking whether caregivers provided support to their children during the previous school term, with a yes/no response. The questions were: (1) Talked to your child about her schoolwork? (2) Asked your child if she needed help with her homework, and (3) Talked to your child about her future plans? The responses were coded and summed. Using a theoretical range of 0 to 3, the average score was 2.74 out of 3, indicating higher levels of caregiver educational support.

Family Assets

Participants’ family assets were assessed using a 21-item scale, where participants answered yes or no to questions about whether their families owned various assets, including land, houses, rental properties, gardens, or farm animals. The responses were coded and summed. With a theoretical range of 0 to 21, the average score on the family asset index (which includes land, houses, transportation options, communication, gardens, farm animals, and small businesses) was 7.37 out of 21, indicating lower levels of the asset index captured by this measure, which does not fully capture informal or locally valued resources.

Analytical Approach

To assess baseline equivalence between the control and ANZANSI Family Program arms, we examined descriptive statistics for all five outcome variables (family cohesion, perceived caregiver–child relationships, caregiver educational support, family assets, and gender norms) at baseline. We calculated means and standard deviations (SD) for each group for these continuous outcomes. We present these descriptive statistics in Table 1 to provide an overview of the sample characteristics at the start of the study and to evaluate the comparability of the intervention and control groups before the intervention was implemented. We used robust standard errors clustered by school ID using the Wald chi-square statistic for continuous outcomes and the Rao-Scott F-statistic for categorical variables to account for within-school correlation. To examine the preliminary impact of the pilot ANZANSI Family Program on caregiver-reported outcomes, we employed linear mixed-effects models to account for the clustered nature of the data, with caregivers nested within schools and across time. We analyzed five continuous outcomes: family cohesion, perceived child–caregiver relationship, caregiver educational support, family assets, and gender norms.

Table 1.

Description of Sociodemographic Characteristics of Caregivers at Baseline.

Characteristics Control, N = 50 †n (%) or ‡M (SD) Treatment, N = 47, n (%) or M (SD) Total, N = 97, n (%) or M (SD) F-test or Wald Chi- square p-value
Adolescent’s Characteristics
Age (years: 20–85) 39.62 (13.07) 42.49 (10.54) 41.01 (11.95) 2.80 0.13
Gender of caregivers 0.53 0.45
 Male 23 (46%) 17 (36%) 40 (41%)
 Female 27 (54%) 30 (64%) 57 (59%)
Caregiver outcome scores at baseline.
 Family cohesion (range 8–35) 28.64 (5.59) 26.64 (6.85) 27.67 (6.28) 2.23 0.17
 Perceived child-caregiver relationship (range 35–79) 61.92 (8.82) 61.40 (10.01) 61.67 (9.37) 0.05 0.82
 Caregiver educational support (range 0–3) 2.82 (0.56) 2.66 (0.79) 2.74 (0.68) 1.07 0.33
 Family assets (range 1–15) 6.78 (2.66) 8.00 (3.76) 7.37 (3.28) 2.89 0.12
 Gender norms (range 0–9) 2.06 (2.19) 2.44 (2.17) 2.44 (2.17) 8.18 0.02
Open in a new tab

Note.

†

n = sample per group, %=percentage per group

‡

=mean and standard deviation.

To examine group differences at baseline, we used robust standard errors clustered by school ID using the Wald chi-square statistic for continuous outcomes and the Rao-Scott F-statistic for categorical variables.

We fitted a linear mixed model for each outcome, including fixed effects for study assignment (ANZANSI Family Program vs. control) and time as a categorical variable (baseline, 9 months post-intervention, and 15 months post-intervention). We also included the interaction between study assignment and time to assess how the intervention and control groups differed in their changes over time. Random intercepts were included at the school and participant levels to account for the correlation of outcomes over time. We also specified an unstructured covariance structure for the residuals across the three time points within each individual. All models were estimated using the “mixed” command in Stata SE, version 17. The results of these analyses, presenting unstandardized coefficients (b) and 95% confidence intervals (CI), are detailed in Table 2.

Table 2.

Regression Coefficients and 95% Confidence Intervals for Psychosocial Outcomes Among Caregivers of Adolescent Girls in Northern Ghana (N = 97).

Family cohesion
 Gender norms
 Perceived child–caregiver relationship
Model components b (95% CI) p-value b (95% CI) p-value b (95% CI) p-value
Study group χ2(df) χ2(1) =0.05 0.82 χ2(1) =2.07 0.15 χ2(1) =0.47 0.49
Control group (ref category)
ANZANSI intervention group −1.98 (−5.34, 1.37) 0.25 0.80 (−0.17, 1.78) 0.12 −0.53 (−4.67, 3.63) 0.80
Time, χ2 (df) χ2(2) =014.32 0.001 χ2(1) =4.30 0.12 χ2(2) =0.98 0.61
Baseline (ref category)
9 months −1.32 (−3.74, 1.10) 0.28 0.78 (−0.10, 1.66) 0.08 −1.48 (−4.28, 1.32) 0.30
15 months 1.28 (−0.55, 3.11) 0.17 0.64 (−0.10, 1.38) 0.09 −1.36 (−4.13, 1.41) 0.34
Group#Time, χ2 (df) χ2(2) =3.28 0.19 χ2(2) =0.69 0.71 χ2(2) =2.50 0.27
9 months # ANZANSI intervention group 3.05 (−0.44, 6.53) 0.09 −0.26 (−1.53, 1.02) 0.70 3.03 (−0.99, 7.05) 0.14
15 months # ANZANSI intervention group 1.89 (−0.74, 4.52) 0.16 −0.45 (−1.51, 0.61) 0.41 1.40 (−2.58, 5.38) 0.49
Constant 28.64 (26.29, 30.99) 2.06 (1.38, 2.74) <.001 61.92 (59.01, 64.82) <.001
Caregiver educational support
 Family assets
Model components b (95% CI) p-value b (95% CI) p-value
Study group χ2(df) χ2(1) = 1.08 0.30 χ2(1) = 1.75 0.19
Control group (ref category)
 ANZANSI intervention group −0.16 (−0.43, 0.11) 0.24 1.24 (−0.15, 2.62) 0.08
Time, χ2(df) χ2(2) = 6.53 0.04 χ2(2) = 0.19 0.91
Baseline (ref category)
 9 months −0.13 (−0.36, 0.11) 0.30 0.38 (−0.42, 1.18) 0.35
 15 months 0.02 (−0.19, 0.23) 0.85 0.12 (−0.64, 0.88) 0.76
Group#Time, χ2 (df) χ2(2) = 5.49 0.06 χ2(2) = 2.17 0.34
 9 months # ANZANSI intervention group 0.38 (0.04, 0.72) 0.03 −0.86 (−2.01, 0.30) 0.15
 15 months # ANZANSI intervention group 0.32 (0.02, 0.62) 0.04 −0.48 (−1.58, 0.62) 0.39
 Constant 2.82 (2.63, 3.01) <.001 6.78 (5.82, 7.74) <.001
Open in a new tab

χ2 = Chi-Square; df=degrees of freedom; b=beta coefficient; CI=confidence intervals.

Sample Characteristics

Table 1 shows the baseline characteristics of the caregivers in the control and treatment groups. The average age of the caregivers was 41.01 years (SD = 11.95), with more than half of the caregivers identifying as female (59%). There was a significant difference between the control and treatment groups in gender norms (F = 8.18, p = .02), with the treatment group showing more egalitarian gender norms (M = 2.44; SD = 2.17) than the control group (M = 2.06; SD = 2.19). There were no significant differences between the control and treatment groups on the other caregiver outcome scores at baseline.

Preliminary Impact of ANZANSI Intervention on Caregiver Outcomes

Table 2 presents the results of the linear mixed-effects model examining the impact of the ANZANSI Family Program on family cohesion, gender norms, child–caregiver relationship, caregiver educational support, and family assets. There were no significant effects of time, interaction between groups, and time for family cohesion, child–caregiver relationship, family assets, and gender norms. This suggests that the changes in these outcomes over time did not differ significantly between the intervention and control groups. However, the results moved in the hypothesized direction (see Figures 1–5).

Figure 1.

Figure 1.

Open in a new tab

Family Cohesion Treatment vs. Control Group Over Time.

Figure 5.

Figure 5.

Open in a new tab

Family Assets Across the Treatment and Control Group Over Time.

For caregiver educational support, there was no significant main effect of the intervention group (b = −0.16, 95% CI: −0.43, 0.11, p = .24), and no significant main effects of time at 9 months (b = −0.13, 95% CI: −0.36, 0.11, p = .30) or 15 months (b = 0.02, 95% CI: −0.19, 0.23, p = .85) compared to baseline. However, there were significant interactions between group and time at both 9 months (b = 0.38, 95% CI: 0.04, 0.72, p = .03) and 15 months (b = 0.32, 95% CI: 0.02, 0.62, p = .04). These interactions indicate that the intervention group showed a greater increase in caregiver educational support at both 9 and 15 months compared to the control group.

Discussion

This study makes a new contribution to the literature on avenues to overcome barriers to girls’ well-being in Africa by offering a first look at the impact of the ANZANSI intervention. Preliminary findings from this study indicate modest effects of the ANZANSI intervention on specific caregiver outcomes. While no statistically significant changes were observed in family cohesion, gender norms, child–caregiver relationship, and family assets, the trends generally moved in the expected direction, suggesting potential for positive change. Notably, the intervention was associated with statistically significant improvements in caregiver educational support at both 9 and 15 months compared to the control group. One plausible mechanism is that Dang-Malgu’s emphasis on shared responsibility and respectful communication and the economic empowerment component may have reinforced existing family strengths and values or may have introduced new ways of approaching caregiver responsibilities and understanding of the importance of education for girls in ways that made it easier for caregivers to engage in concrete educational support behaviors (e.g., discussing schoolwork and future plans), even when structural constraints remained unchanged over the study time frame (Pierre, 2020; Shumway, 2018; Shumway & Getz, 2017).

These findings, though initial, provide early evidence that the ANZANSI program may boost caregivers’ involvement in supporting their children’s education. These findings are consistent with the asset theory (Sherraden, 1991), which argues that assets not only offer tangible economic benefits but also enhance psychological well-being by reducing financial stress and fostering future orientation. These results imply that economic empowerment components could create a supportive environment for improved caregiving. These preliminary findings should also be interpreted within ongoing debates about education and development interventions in historically marginalized contexts. Critiques of girl-centered and poverty-targeted education initiatives caution that programs framed narrowly around human capital accumulation can reproduce deficit narratives and align with logics of colonial development, particularly when they fail to engage the historical and structural forces that shape schooling, labor, and mobility (Moeller, 2013; Pierre, 2020). In this pilot study, the economic empowerment component was not intended as a standalone solution to structural injustice but was paired with a family-strengthening approach that sought to support caregiver capacity and relational processes linked to schooling. Still, the pilot design and follow-up period limit our ability to assess long-term educational futures, structural change, and whether participants gain opportunities and skills to navigate broader systems critically.

Consistent with calls for a renewed social contract for education that foregrounds justice, dignity, and collective futures, future iterations and scale-up research can more explicitly situate family-level supports within wider educational and social transformations, including attention to historically produced inequalities and the conditions that shape girls’ educational trajectories beyond school completion (United Nations Educational Scientific and Cultural Organization, 2021). This includes examining how interventions can support caregivers and adolescents not only in remaining in school but also in anticipating and responding to persistent barriers in labor markets, gendered expectations, and regional inequalities.

These findings are also broadly consistent with several previous studies (Byansi et al., 2022; Cavazos-Rehg et al., 2021; Filiatreau et al., 2023) in Africa that have documented how family economic empowerment interventions improve financial and emotional well-being, showing that they reduce economic stress and promote a supportive environment for adolescents. Adolescent girls reported that the ANZANSI intervention led to meaningful improvements in family cohesion. While statistical differences between groups were not observed at follow-up, girls in the intervention group reported greater improvements in family relationships over time compared to those in the control group (Sensoy Bahar et al., 2024). Qualitative findings supported these trends, with participants describing more respectful communication, stronger emotional connections, and better cooperation within their families. They also noted changes in how responsibilities were shared and how conflicts were handled at home (Sensoy Bahar et al., 2024). These results suggest that combining family economic empowerment with family strengthening can enhance family cohesion, offering a promising strategy to support adolescent well-being in settings where family stressors are high and formal services are unevenly distributed, and families often rely on extended kin and community-based support.

Understanding the impact of the ANZANSI intervention and others like it, which stress the role of caregivers, is important for addressing the widespread barriers to girls’ well-being and equality of opportunity in Africa. Caregiver educational support, family cohesion, perceived child–caregiver relationship, and egalitarian gender norms play a crucial role in shaping the well-being and life paths of adolescent girls, especially in low-resource settings like Northern Ghana (Murphy-Graham, 2024; Yan et al., 2024). In environments characterized by poverty, limited educational chances, child labor, and gender inequality, strong caregiver involvement can act as a protective factor against early school dropout, child labor, and unaccompanied migration (Bradley et al., 2021; Fierloos et al., 2023; Miller et al., 2015). For example, when caregivers actively support their daughters’ education, it not only emphasizes the importance of schooling but also helps girls overcome structural and social barriers that often block academic success. Likewise, close family relations and fair gender norms contribute to girls’ psychological safety and empowerment (Bermudez et al., 2020; Osuji et al., 2018; Wang et al., 2021). Therefore, it is essential for programs tailored to address the needs of adolescents to incorporate caregiver components. In this regard, the ANZANSI program (Sensoy Bahar et al., 2020), which combines economic empowerment with family-strengthening elements, demonstrates a well-positioned avenue to influence these areas by increasing caregivers’ capacity, motivation, and skills to invest in their children’s futures. By using a culturally sensitive and contextually appropriate approach, the program may help change family dynamics in ways that support adolescent girls’ well-being and resilience. Additional research with larger, adequately powered samples would likely show further and more statistically generalizable evidence of the program’s effectiveness and inform strategies for broader implementation.

These findings should be interpreted in light of the following limitations. As a pilot study mainly focused on assessing feasibility and acceptability, it was not sufficiently powered to identify statistically significant differences in outcomes. Although the initial findings are promising, larger-scale studies are needed to evaluate the intervention’s effectiveness more thoroughly. In addition, data collection occurred after COVID-19 lockdowns, a period that may have increased participants’ stress levels and affected their overall psychosocial functioning, possibly influencing the results.

Implications for Social Work Practice

Although preliminary, these findings provide early insights into how the ANZANSI program, if scaled up, could support adolescent girls in low-resource settings, such as Northern Ghana, in overcoming barriers to education through strengthened caregiver support. The observed improvements in caregiver educational support suggest that programs combining family strengthening with economic components could enhance caregiver involvement in girls’ education, an essential protective factor against school dropout, child labor, and unaccompanied migration. These results highlight the opportunity for social workers to design and implement interventions that target adolescents directly, as well as the family systems that shape their educational trajectories and overall well-being.

At the same time, the absence of statistically significant changes in other caregiver outcomes, despite trends in the expected direction, reinforces the need for cautious interpretation. For practice and policy, this suggests that ongoing investment in family-based interventions addressing both individual and structural barriers is critical. Social workers are well-positioned to advocate for the integration of caregiving-focused elements into broader adolescent development programs, ensuring that interventions are culturally grounded and contextually relevant. Programs such as ANZANSI merit further development, testing, and refinement in similar low-resource settings, with social workers playing a central role in shaping, scaling, and evaluating their impact.

Supplementary Material

Appendix 1

Supplemental Material

Supplemental material for this article is available online.

Figure 2.

Figure 2.

Open in a new tab

Gender Norm Across the Treatment and Control Group Over Time.

Figure 3.

Figure 3.

Open in a new tab

Perceived Child–Caregiver Support.

Figure 4.

Figure 4.

Open in a new tab

Caregiver Educational Support txt vs. Control Group Over Time.

Acknowledgments

We are grateful to the adolescent girls and their caregivers who participated in this study, as well as the schools that agreed to collaborate with us; this work would not be possible without them. Special thanks to our implementing partners, Basic Needs Ghana and Joe Osei at BIBIR Ghana. Lastly, we thank the research teams at Washington University in St. Louis and University of Ghana.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under Award Number NICHD R21HD099508 (PI: Ozge Sensoy Bahar, PhD). The content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD or the National Institutes of Health.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

  1. Akurugu JA (2022). Factors influencing school dropout among female junior high school pupils in the Pusiga district. International Journal of Social Sciences and Management Review, 5(2), 31–39. 10.37602/IJSSMR.2022.5203 [DOI] [Google Scholar]
  2. Basharpoor S, & Heidari F (2022). The model of structural relationships of family cohesion/adaptability, academic self-concept and social acceptability with school adjustment: The mediator role of educational engagement. Journal of School Psychology, 11(2), 6–20. 10.22098/jsp.2022.1712 [DOI] [Google Scholar]
  3. Bermudez LG, Bahar OS, Dako-Gyeke M, Boateng A, Ibrahim A, Ssewamala FM, & McKay M (2020). Understanding female migrant child labor within a cumulative risk framework: The case for combined interventions in Ghana. International Social Work, 63(2), 147–163. 10.1177/0020872818788398 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Blondal KS, & Adalbjarnardottir S (2014). Parenting in relation to school dropout through student engagement: A longitudinal study. Journal of Marriage and Family, 76(4), 778–795. 10.1111/jomf.12125 [DOI] [Google Scholar]
  5. Blum RW, Astone NM, Decker MR, & Mouli VC (2014). A conceptual framework for early adolescence: A platform for research. International Journal of Adolescent Medicine and Health, 26(3), 321–331. 10.1515/ijamh-2013-0327 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bradley GL, Ferguson S, & Zimmer-Gembeck MJ (2021). Parental support, peer support and school connectedness as foundations for student engagement and academic achievement in Australian youth. In Dimitrova R & Wiium N (Eds.), Handbook of positive youth development: Advancing research, policy, and practice in global contexts (pp. 219–236). Springer. [Google Scholar]
  7. Brathwaite R, Ssewamala FM, Sensoy Bahar O, McKay MM, Neilands TB, Namatovu P, Kiyingi J, Zmachinski L, Nabayinda J, & Huang KY (2022). The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on oppositional defiant disorder and impaired functioning among children in Uganda: Analysis of a cluster randomized trial from the SMART Africa-Uganda scale-up study (2016–2022). Journal of Child Psychology and Psychiatry, 63(11), 1252–1260. 10.1111/jcpp.13566 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Byansi W, Sensoy Bahar O, Ibrahim A, Boateng A, Kumbelim K, Amissah FG, Nartey PB, Ssewamala FM, Nabunya P, & McKay MM (2025). Addressing psychosocial outcomes among vulnerable adolescent girls: The preliminary impact of the ANZANSI family program in Northern Ghana. Journal of the Society for Social Work and Research, 2025, Article 735708. 10.1086/735708 [DOI] [Google Scholar]
  9. Byansi W, Sensoy Bahar O, Small L, Namatovu P, Nabayinda J, Kiyingi J, Mwebembezi A, Nakigozi G, Hoagwood K, & McKay MM (2024). The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016–2022). Family Process, 63(4), 1851–1866. 10.1111/famp.13007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Byansi W, Ssewamala FM, Neilands TB, Bahar OS, Nabunya P, Namuwonge F, & McKay MM (2022). The short-term impact of a combination intervention on depressive symptoms among school-going adolescent girls in southwestern Uganda: The Suubi4Her cluster randomized trial. Journal of Adolescent Health, 71(3), 301–307. 10.1016/j.jadohealth.2022.04.008 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cavazos-Rehg P, Byansi W, Xu C, Nabunya P, Sensoy Bahar O, Borodovsky J, Kasson E, Anako N, Mellins C, Damulira C, Neilands T, & Ssewamala FM (2021). The impact of a family-based economic intervention on the mental health of HIV-infected adolescents in Uganda: Results from Suubi + adherence. Journal of Adolescent Health, 68(4), 742–749. 10.1016/j.jadohealth.2020.07.022 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Chikhungu L, Kadzamira E, Chiwaula L, & Meke E (2020). Tackling girls dropping out of school in Malawi: Is improving household socio-economic status the solution? International Journal of Educational Research, 103, Article 101578. 10.1016/j.ijer.2020.101578 [DOI] [Google Scholar]
  13. Dennison ST (2005). A multiple family group therapy program for at risk adolescents and their families. Charles C Thomas. [Google Scholar]
  14. Fierloos IN, Windhorst DA, Fang Y, Hosman CM, Jonkman H, Crone MR, Jansen W, & Raat H (2023). The association between perceived social support and parenting self-efficacy among parents of children aged 0–8 years. BMC Public Health, 23(1), Article 1888. 10.1186/s12889-023-16710-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Filiatreau LM, Tutlam N, Brathwaite R, Byansi W, Namuwonge F, Mwebembezi A, Sensoy-Bahar O, Nabunya P, Neilands TB, & Cavazos-Rehg P (2023). Effects of a combination economic empowerment and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls and young women: Analysis of a cluster randomized controlled trial (Suubi4Her). Journal of Adolescent Health, 72(5), S33–S40. 10.1016/j.jadohealth.2022.11.250 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Fortin L, Marcotte D, Diallo T, Potvin P, & Royer É (2013). A multidimensional model of school dropout from an 8-year longitudinal study in a general high school population. European Journal of Psychology of Education, 28(2), 563–583. 10.1007/s10212-012-0129-2 [DOI] [Google Scholar]
  17. Ghana Statistical Service. (2021). Population and housing census: Population of regions and districts (Ghana Statistical Service, Issue). https://census2021.statsghana.gov.gh/subreport.php?readreport=MjYzOTE0MjAuMzc2NQ==&Ghana-2021-Population-and-Housing-Census-General-Report-Volume-3B [Google Scholar]
  18. Ghana Statistical Service. (2022). Ghana 2021 population and housing census: General report highlights (Vol. 3). http://www.census2021.statsghana.gov.gh/ [Google Scholar]
  19. Gordon D, & Nandy S (2012). Measuring child poverty and deprivation. In Minujin A & Nandy S (Eds.), Global child poverty and well-being (pp. 57–102). Policy Press. [Google Scholar]
  20. Gubbels J, van der Put CE, & Assink M (2019). Risk factors for school absenteeism and dropout: A meta-analytic review. Journal of Youth and Adolescence, 48, 1637–1667. 10.1007/s10964-019-01072-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hamenoo ES, Dwomoh EA, & Dako-Gyeke M (2018). Child labour in Ghana: Implications for children’s education and health. Children and Youth Services Review, 93, 248–254. 10.1016/j.childyouth.2018.07.026 [DOI] [Google Scholar]
  22. ILO, & UNICEF. (2021). Child labour statistical profile: Africa. https://www.ilo.org/sites/default/files/2024-11/Statistical_Profile_01_Africa_ENGLISH_FINAL_20220114_NEW.pdf
  23. Jariego IM, & Jariego M (2021). Community prevention of child labor. Springer. [Google Scholar]
  24. Kung H-Y, & Ching-Yi L (2015). Influence of academic achievement and dropout on economically disadvantaged students: An investigation of the “context–self–action–result” self-system model of motivational development. Journal of Research in Education Sciences, 60(4), Article 55. 10.6209/JORIES.2015.60(4).03 [DOI] [Google Scholar]
  25. Kwarteng P, Asiamah F, Twumasi AO, Nkansah JO, Issaka J, & Afetorgbor SK (2022). Parental involvement in the academic performance of students in Ghana: Socio-economic status. Open Journal of Educational Research, 2(3), 114–125. 10.31586/ojer.2022.305 [DOI] [Google Scholar]
  26. Lee JA, & Hudson RE (2011). Empowerment approach to social work practice (Vol. 5). Oxford University Press. [Google Scholar]
  27. Maynard PE, & Olson DH (1987). Circumplex model of family systems: A treatment tool in family counseling. Journal of Counseling & Development, 65(9), 502–504. 10.1002/j.1556-6676.1987.tb00766.x [DOI] [Google Scholar]
  28. McKay MM, Gonzales JJ, Stone S, Ryland D, & Kohner K (1995). Multiple family therapy groups: A responsive intervention model for inner city families. Social Work with Groups, 18(4), 41–56. 10.1300/J009v18n04_04 [DOI] [Google Scholar]
  29. Michalopoulos S, & Papaioannou E (2016). The long-run effects of the scramble for Africa. American Economic Review, 106(7), 1802–1848. 10.1257/aer.20131311 [DOI] [Google Scholar]
  30. Miller AB, Esposito-Smythers C, & Leichtweis RN (2015). Role of social support in adolescent suicidal ideation and suicide attempts. Journal of Adolescent Health, 56(3), 286–292. 10.1016/j.jadohealth.2014.10.265 [DOI] [PubMed] [Google Scholar]
  31. Moeller K (2013). Proving “The Girl Effect”: Corporate knowledge production and educational intervention. International Journal of Educational Development, 33(6), 612–621. 10.1016/j.ijedudev.2013.08.001 [DOI] [Google Scholar]
  32. Molini V, & Paci P (2015). Poverty reduction in Ghana: Progress and challenges (World Bank publications reports 22733). https://ideas.repec.org/s/wbk/wboper.html [Google Scholar]
  33. Moos RH (1994). Family environment scale manual: Development, applications, research. Consulting Psychologists Press. [Google Scholar]
  34. Murphy-Graham E (2024). From girls’ education to gender-transformative education: Lessons from different nations. Dædalus, 153(4), 267–285. 10.1162/daed_a_02115 [DOI] [Google Scholar]
  35. Mussa EC, Mirzabaev A, Admassie A, Nshakira-Rukundo E, & von Braun J (2019). Does childhood work impede long-term human capital accumulation? Empirical evidence from rural Ethiopia. International Journal of Educational Development, 66, 234–246. 10.1016/j.ijedudev.2018.09.001 [DOI] [Google Scholar]
  36. Nartey P, Bahar OS, & Nabunya P (2023). A review of the cultural gender norms contributing to gender inequality in Ghana: An ecological systems perspective. Journal of International Women’s Studies, 25(7), Article 14. https://vc.bridgew.edu/jiws/vol25/iss7/14 [PMC free article] [PubMed] [Google Scholar]
  37. Nunn N (2008). The long-term effects of Africa's slave trades. The Quarterly Journal of Economics, 123(1), 139–176. 10.1162/qjec.2008.123.1.139 [DOI] [Google Scholar]
  38. Offrey LD, & Rinaldi CM (2017). Parent–child communication and adolescents’ problem-solving strategies in hypothetical bullying situations. International Journal of Adolescence and Youth, 22(3), 251–267. 10.1080/02673843.2014.884006 [DOI] [Google Scholar]
  39. Olson DH, Waldvogel L, & Schlieff M (2019). Circumplex model of marital and family systems: An update. Journal of Family Theory & Review, 11(2), 199–211. 10.1111/jftr.12331 [DOI] [Google Scholar]
  40. Olsson J, Höjer S, Nyström L, & Emmelin M (2017). Orphanhood and mistreatment drive children to leave home: A study from early AIDS-affected Kagera region, Tanzania. International Social Work, 60(5), 1218–1232. 10.1177/0020872816641751 [DOI] [Google Scholar]
  41. Osuji HL, Nabunya P, Byansi W, Parchment TM, Ssewamala F, McKay MM, & Huang K-Y (2018). Social support and school outcomes of adolescents orphaned and made vulnerable by HIV/AIDS living in South Western Uganda. Vulnerable Children and Youth Studies, 13(3), 228–238. 10.1080/17450128.2018.1439211 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Pierre J (2020). The racial vernaculars of development: A view from West Africa. American Anthropologist, 122(1), 86–98. 10.1111/aman.13352 [DOI] [Google Scholar]
  43. Reiss F (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24–31. 10.1016/j.socscimed.2013.04.026 [DOI] [PubMed] [Google Scholar]
  44. Roessler P, Pengl Y, Marty R, Titlow K, & Van de Walle N (2020). The cash crop revolution, colonialism and legacies of spatial inequality: evidence from Africa. https://ora.ox.ac.uk/objects/uuid:f1ca642c-0f89-43c2-ac2c-09d2b3b5b393/files/s2f75r864g [Google Scholar]
  45. Rothwell DW, & Han CK (2010). Exploring the relationship between assets and family stress among low-income families. Family Relations, 59(4), 396–407. 10.1111/j.1741-3729.2010.00611.x [DOI] [Google Scholar]
  46. Sensoy Bahar O, Byansi W, Ibrahim A, Boateng A, Kumbelim K, Nartey PB, Amissah F, Nabunya P, Ssewamala FM, & McKay MM (2025). Preliminary impact of a combination intervention on intention to migrate and school absence among adolescent girls: Results from a pilot cluster-randomized clinical trial in Northern Ghana. Children and Youth Services Review, 171, Article 108205. 10.1016/j.childyouth.2025.108205 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Sensoy Bahar O, Ssewamala FM, Ibrahim A, Boateng A, Nabunya P, Neilands TB, Asampong E, & McKay MM (2020). Anzansi family program: A study protocol for a combination intervention addressing developmental and health outcomes for adolescent girls at risk of unaccompanied migration. Pilot and Feasibility Studies, 6(1), 1–12. 10.1186/s40814-020-00737-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Sensoy Bahar B, Bynasi W, Ibrahim A, Boateng A, Nartey P, Nabunya P, Kumbelim K, Ssewamala F, & McKay M (2024). Short-term impact of a combination intervention on family cohesion: Results from a pilot cluster-randomized clinical trial in Northern Ghana. Journal of Research on Adolescence: The Official Journal of the Society for Research on Adolescence, 34(3), 957–968. 10.1111/jora.12977 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Sherraden M (1991). Assets and the poor: A new American welfare policy. M.E. Sharpe. [Google Scholar]
  50. Shumway R (2018). A shared legacy: Atlantic dimensions of Gold Coast (Ghana) history in the nineteenth century. Ghana Studies, 21, 41–62. 10.1353/ghs.2018.0003 [DOI] [Google Scholar]
  51. Shumway R, & Getz TR (2017). Slavery and its legacy in Ghana and the diaspora. Bloomsbury. [Google Scholar]
  52. Skinner HA, Steinhauer PD, & Santa-Barbara J (1983). The family assessment measure. Canadian Journal of Community Mental Health, 2(2), 91–103. 10.7870/cjcmh-1983-0018 [DOI] [Google Scholar]
  53. Sommer M (2010). Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania. Journal of Adolescence, 33(4), 521–529. 10.1016/j.adolescence.2009.03.008 [DOI] [PubMed] [Google Scholar]
  54. Ssewamala FM (2015). Optimizing the “demographic dividend” in young developing countries: The role of contractual savings and insurance for financing education. International Journal of Social Welfare, 24(3), 248–262. 10.1111/ijsw.12131 [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Ssewamala FM, Han C-K, & Neilands TB (2009). Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: Findings from a randomized clinical trial in rural Uganda. Social Science & Medicine, 69(2), 191–198. 10.1016/j.socscimed.2009.05.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. UNESCO. (2023). Global Education Monitoring Report 2023: Technology in education—A tool on whose terms?. https://unesdoc.unesco.org/ark:/48223/pf0000385723 [Google Scholar]
  57. United Nations Educational Scientific and Cultural Organization. (2021). Reimagining our futures together: A new social contract for education. https://www.right-to-education.org/sites/right-to-education.org/files/resource-attachments/UNESCO_Reimagining%20our%20futures%20together_social%20contract%20for%20education_Nov2021_EN.pdf
  58. Van de Waal W, Ashon MA, & Comings JP (2024). A case study of support for girls’ access to primary school in Ghana. Prospects, 54(1), 241–253. 10.1007/s11125-022-09626-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Wang MT, & Eccles JS (2012). Social support matters: Longitudinal effects of social support on three dimensions of school engagement from middle to high school. Child Development, 83(3), 877–895. 10.1111/j.1467-8624.2012.01745.x [DOI] [PubMed] [Google Scholar]
  60. Wang Y, Huebner ES, & Tian L (2021). Parent-child cohesion, self-esteem, and academic achievement: The longitudinal relations among elementary school students. Learning and Instruction, 73, Article 101467. 10.1016/j.learninstruc.2021.101467 [DOI] [Google Scholar]
  61. Waszak C, Severy LJ, Kafafi L, & Badawi I (2001). Fertility behavior and psychological stress: The mediating influence of gender norm beliefs among Egyptian women. Psychology of Women Quarterly, 25(3), 197–208. 10.1111/1471-6402.00021 [DOI] [Google Scholar]
  62. Wray W, & Ed M (2015). Parenting in poverty: Inequity through the lens of attachment and resilience. American International Journal of Social Science, 4(2), 223–232. https://www.aijssnet.com/journals/Vol_4_No_2_April_2015/20.pdf [Google Scholar]
  63. Yan Z, Yu S, & Lin W (2024). Parents’ perceived social support and children’s mental health: The chain mediating role of parental marital quality and parent‒child relationships. Current Psychology, 43(5), 4198–4210. 10.1007/s12144-023-04625-x [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix 1
NIHMS2179431-supplement-Appendix_1.doc (40KB, doc)

RESOURCES