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Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers’ schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi, The PROMOTE, ENDLINE

Malawi, Burkina Faso, 2024
Health and Well-Being (HaW)
Caroline Kabiru
Last modified October 02, 2025 Page views 18318 Documentation in PDF Metadata DDI/XML JSON

Identification

IDNO
DDI-BFA-MWI-APHRC-PROMOTE-ENDLINE-2024-V1.0
Title
Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers’ schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi, The PROMOTE, ENDLINE
Subtitle
The PROMOTE, ENDLINE
Country
Name Country code
Malawi MWI
Burkina Faso BFA
Abstract
Introduction: In Burkina Faso and Malawi, as in many countries in sub-Saharan Africa, girls' and women's health as well as social and economic wellbeing were often negatively impacted by early childbearing. A vast majority of adolescent girls who got pregnant dropped out of school, which resulted in widening gender inequalities in schooling and economic participation. Our gender transformative research aimed to generate rigorous evidence that would provide insights on how policy makers and program implementers could support parenting adolescents. We estimated the incremental effect of three interventions aimed at facilitating adolescent mothers' (re)entry into school or vocation training in Ouagadougou (Burkina Faso) and Blantyre (Malawi). We also examined the effect of the intervention on sexual and reproductive health outcomes and mental health. The three interventions we assessed were: a cash transfer conditioned on (re)enrolment into school or vocational training; subsidized childcare; and life skills training that covered nurturing childcare, sexual and reproductive health, and financial literacy.

Study Design: A randomized trial was used to compare the effectiveness of the three interventions. We evaluated the interventions using data from surveys conducted before the start of the program and at the end of 12 months. Following the baseline, adolescent mothers (N=270) aged 10 - 19 years with a child aged 1 - 3 years were randomized into one of three study arms. Arm one received life skills training through adolescent mothers' clubs. The adolescent mothers' clubs were facilitated by community health workers (CHWs). Given their role as a bridge between the community and the health sector, working with CHWs was also critical in facilitating access to SRH and child health services for adolescent mothers and their children. The second arm received the life skills training and subsidized childcare. The third arm incorporated all three interventions. Comparing the first (mothers' clubs only) and second (mothers' clubs + subsidized childcare) allowed us to test the additional benefit of the childcare subsidy. Comparing the second and third arms (mothers' clubs + subsidized childcare + cash transfer) also allowed us to test the additional benefit of the cash transfer. Comparing the first and third arms allowed us to test the combined benefit of the subsidized childcare and cash transfers. At the endline, we assessed the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training enrolment and retention, contraceptive use, and mental health at baseline and endline. To complement the quantitative data, we conducted a qualitative process evaluation which adopted an ethnographic approach combining participant observation and repeat IDIs with adolescent mothers, and key informant interviews (KIIs) with partners, teachers, parents and childcare center managers. This approach helped gather contextual subjective knowledge about adolescent mothers, their daily interactions with key actors in their lives (including their parents, partners, teachers, etc.) and their behavioral responses to different stimuli.

Dissemination: We aimed to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings using a variety of knowledge products, including online news articles, peer-review journal publications, policy briefs, and conference abstracts, tailored to diverse groups of end-users.

Trial registration number: AEARCTR-0009115

Budget: USD 782,746 over three years

Version

Version Date
2025-08-08
Version Notes
N/A

Coverage

Geographic Coverage
Urban areas of Malawi and Burkina Faso.
Unit of Analysis
Parenting Adolescent girls.
Universe
Parenting Adolescent mothers aged 10-19 years with at least one biological child aged 1-3 years, living in urban areas of Ouagadougou (Burkina Faso) and Blantyre (Malawi).

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Caroline Kabiru African Population and Health Research Center (APHRC), Nairobi, Kenya
Producers
Name Affiliation Role
Anthony Idowu Ajayi African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Ramatou Ouedraogo African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Beatrice Maina African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator and Project Manager
Anne Khisa African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Catherine Asego African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Grace Kimemia African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Michelle Mbuthia African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Jane Mangwana African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Patrick Ilboudo African Population and Health Research Center (APHRC), Nairobi, Kenya Co-investigator
Alister Munthali Centre for Social Research (CSR) Co-Principal Investigator
Chrissie Kantukule Centre for Social Research (CSR) Co-investigator
Nathalie Sawadogo Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo Co-Principal Investigator
Alexandra Tapsoba Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo Co-investigator
Abdoul Tarnagda Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo Co-investigator
Abdoul Kader Ilboudo Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo Co-investigator
Carole Compaoré Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo Co-investigator
Funding Agency/Sponsor
Name Abbreviation Role
International Development Research Centre IDRC Provided primary funding
Swedish International Development Cooperation Agency SIDA Co-funder supporting
Other Identifications/Acknowledgments
Name Affiliation Role
Kelvin Kamau Maina APHRC Data documentation specialist
Bonface Butichi Ingumba APHRC Data Governance Officer

Sampling

Sampling Procedure
For the endline survey, the sample consisted of all adolescent mothers who participated in the baseline survey and were enrolled in one of the three intervention arms. A total of 407 participants, with 201 in Burkina Faso and 206 in Malawi. This was a longitudinal follow-up, with no new sampling conducted; instead, every baseline participant was traced and re-interviewed to allow intent-to-treat analysis, regardless of their level of participation in the interventions. At baseline, participants were selected through multi-stage sampling, beginning with the random selection of enumeration areas (EAs) from a primary sampling frame, followed by a household listing to identify eligible adolescent mothers aged 10-19 years with a child aged 1-3 years who had lived in the study site for at least one year. In each EA, 20 eligible households were randomly selected, and if a household had more than one eligible adolescent, one was chosen using a Kish grid. For the endline, field teams revisited the same households and communities, and any cases of dropout were documented for attrition analysis rather than being replaced.
Deviations from the Sample Design
There were no significant deviations from the original sampling design. Minor adjustments occurred at the community level to account for incomplete lists of eligible adolescent mothers, particularly in areas where formal records were lacking. In such cases, local health workers and community leaders assisted in identifying additional participants through referrals and community mapping. These adjustments ensured inclusion of all eligible participants within the targeted clusters without compromising the study’s purposive sampling framework.
Response Rate
The report does not provide formal response rates. However, a total of 407 adolescent mothers aged 10–19 were successfully interviewed across Malawi and Burkina Faso (206 in Malawi, 201 in Burkina Faso). No information was provided on refusals, ineligibility, or total eligible sample approached.
Weighting
No sampling weights were applied.

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date Cycle
2024-06-02 2024-07-31 Malawi
2024-10-01 2024-10-30 Burkina Faso
Mode of data collection
Face-to-face [f2f]
Supervision
Data collection for the PROMOTE Endline survey was supervised by trained field coordinators who oversaw enumerator teams in both Malawi and Burkina Faso. Supervisors were responsible for monitoring adherence to survey protocols, reviewing data quality in real time (facilitated by the use of tablets), and ensuring ethical conduct throughout fieldwork. Daily debriefings and data checks were conducted to address issues promptly, and local language support was provided to assist enumerators in engaging effectively with respondents.
Type of Research Instrument
The PROMOTE Endline survey adopted the same questionnaire used at baseline so that changes can be measured consistently. The structured questionnaire was administered face-to-face to adolescent mothers aged 10–19 years. The instrument was delivered digitally via tablets and covered multiple modules, including socio-demographic characteristics, education and vocational training, sexual and reproductive health, mental and physical health, financial literacy, gender attitudes, intimate partner violence (IPV), childcare and bonding, and future aspirations.

Data Processing

Cleaning Operations
Data was collected using SurveyCTO, a tablet-based platform that enabled real-time electronic entry during interviews, with automatic skip patterns and validation checks built into the forms. Completed data were securely uploaded to a central server and subsequently cleaned and processed by the research team. The cleaning process included checks for missing values, outliers, and inconsistencies. STATA software was used for data cleaning, management, and analysis, including recoding variables and generating descriptive statistics for reporting.
Other Processing
Data was collected in the field using digital tablets equipped with the SurveyCTO platform, which allowed for real-time data entry using a highly structured, pre-programmed electronic questionnaire. The system incorporated automatic skip logic, range and consistency checks, and built-in validations to prevent entry errors. Enumerators could not override these checks, ensuring high-quality data capture at the point of collection. All interviews were conducted face-to-face and recorded electronically in local languages. Upon completion of interviews each day, data were synced to a secure central server.

Each country team had dedicated data managers who supervised the uploading, monitoring, and storage of incoming data. The centralized server was maintained with restricted access and encryption protocols to ensure respondent confidentiality. After fieldwork concluded, datasets were downloaded, reviewed, and cleaned using STATA software. The cleaning process involved removing duplicates, correcting inconsistencies, managing missing values, and recoding variables based on a predefined analysis plan. Open-ended “other” responses were reviewed and, in some cases, recoded into existing categories where appropriate. Unique respondent identifiers allowed for module linkage without compromising anonymity.

Though no double data entry or manual verification was needed due to the digital collection mode, a series of consistency checks and summary statistics were generated to identify outliers or unusual patterns. Variables such as age, education level, contraceptive use, and income were grouped or transformed as needed for tabulation. Final, cleaned datasets were saved in both raw and analysis-ready formats for subsequent use in monitoring and evaluation.

Data Appraisal

Estimates of Sampling Error
N/A

Data access

Contact
Name Email
African Population and Health Research Center datarequest@aphrc.org
Conditions
APHRC data access condition

All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research.
This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:

1.Data Ownership:
The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.

2.Purpose:
The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.

3.Respondent Identifiers:
The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.

4.Confidentiality pledge:
The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.

5.Reporting of errors or inconsistencies:
The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.

6.Publications resulting from APHRC data:
The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.

7.Security:
The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.

8.Loss of privilege to use data:
In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.

9.Acknowledgement:
Any work/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:
"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City."Additionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.

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11.Change of contact details:
The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.
Citation requirement
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download

Metadata production

Document ID
DDI-BFA-MWI-APHRC-PROMOTE-ENDLINE-2024-V1.0
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC DDI Documentation
Date of Production
2025-08-27
Document version
Version 1.0(August 2025)