PROJECT ABSTRACT
Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. A recent
systematic review estimated that 1 in 7 children in SSA struggle with a serious mental health issue. The World
Health Organization estimates prevalence rates may be even higher (20%). Across SSA, high rates of poverty,
HIV/AIDS, food insecurity, stigma and an inadequate health safety net system exacerbate serious childhood
behavioral health (CBH) needs and impede an effective response. Disruptive behavioral disorders (DBDs) are
particularly concerning as they persist through adolescence and adulthood. DBDs are also highly related to poor
physical health and interpersonal challenges in adulthood. Hence, addressing the context-specific social
influences on CBH is critical given that children in SSA comprise more than half of the total regional population.
If children’s needs are to be met in SSA, then: 1) implementing interventions designed and tested in SSA, and
which mobilize resources within existing child-focused institutions is critical; 2) combined interventions that
simultaneously target SSA-specific influences on CBH and can be delivered in collaboration with child/family-
serving community settings are necessary; and 3) group, community and population approaches to CBH are
needed to drive scalable solutions. Guided by Social Action, Asset, and Family Systems theories, the proposed
study will examine the mechanisms by which EE and FS interventions targeting social, familial and context-
specific drivers affect the mental health of 900 Ugandan children in mid-upper primary school (10 to 14 years).
The study uses an experimental, longitudinal design across 30 cluster randomized primary schools to compare
single and combination intervention options; influences of EE and FS on economic, perceptual and functioning
mediators; and context-specific moderators. The three study conditions are: 1) EE only, 2) MFG-based FS only,
3) combined EE+MFG-based FS. The interventions will be provided for 12 months; and assessments will occur
at baseline, 12, 24 and 36 months. The specific aims are: Aim 1: Examine the impact of EE only, MFG-based
FS only, and combined EE+MFG-based FS on children’s DBD symptoms and behavioral functioning; Aim 2:
Test the influence of EE only, MFG-based FS only, and combined EE+MFG-based FS on family financial stability
(e.g., food and housing stability, material assets, savings), parenting and protective family processes (e.g., family
organization, caregiver/child interaction, cohesion, support) and perceptions related to help seeking (e.g.,
stigma) on CBH and functioning; and assess whether these change mechanism mediate intervention effects on
DBD symptoms and behavioral functioning, and explore moderation by context-specific moderators of
intervention effects; and Aim 3: Qualitatively examine participants’ experiences with each intervention arm. The
investigative team will leverage their long-term partnerships in SSA to maximize the public health impact of the
research findings and to shorten the time gap from new knowledge to system and population-level improvement.
