Absence of conflict of interest.
Citation
Karimli, L., Rost, L., & Ismayilova, L. (2018). Integrating economic strengthening and family coaching to reduce work-related health hazards among children of poor households: Burkina Faso. Journal of Adolescent Health, 62, S6-S14.
Highlights
- The study’s objective was to examine the impact of the Trickle Up and Trickle Up Plus programs on children’s exposure to work-related hazards and abuse, and children’s work-related health outcomes. This summary focuses on the comparison between the Trickle Up Plus intervention group and the control group.
- The study was a randomized controlled trial in the Nord Region of Burkina Faso, West Africa. Using three waves of survey data administered to children and adults separately, the authors conducted statistical models to compare the outcomes of treatment and control group members.
- The study found that Trickle Up Plus program participation was significantly related to a reduction of hazardous work and abuse, compared with the control group. However, the study found no statistically significant relationship between the Trickle Up program and work-related health outcomes.
- The quality of causal evidence presented in this report is low because it was a randomized controlled trial with unknown attrition and the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to the Trickle Up Plus program; other factors are likely to have contributed.
Intervention Examined
Trickle Up Plus Program
Features of the Intervention
Trickle Up is a nonprofit agency that has been working in Burkina Faso, West Africa, for more than 10 years. Women participating in the Trickle Up Plus program received: 1) access to a newly formed women's savings group; 2) training in livelihood planning and household management for women in the savings group; 3) the equivalent of $100 to start or expand livelihood activities; 4) one-on-one mentoring offered by trained field workers; and 5) family coaching to increase awareness about hazardous child work, labor-related child separation, and early/forced marriage. These coaching components were developed by the Burkina Faso Ministry of Social Action and implemented by a community-based organization Aide au Enfants et aux Families Démunies. Coaches received three days of training from the Ministry of Social Action. Families received monthly sessions, each lasting 35 to 45 minutes (the authors do not indicate how many months of coaching were provided). Women were enrolled in the program for 24 months.
Trickle Up implemented the program, which targeted females in poor households in the Nord Region of Burkina Faso that cared for a child 10 to 15 years old. The authors did not provide information about how often the savings group met, how training was provided, or how often one-on-one mentoring was provided.
Features of the Study
The study was a randomized controlled trial at the village level. Study participants were selected in three stages. First, 12 villages in the Nord Region were selected. Researchers selected the villages based on comparability of population, size, ethnic makeup, distance from an urban center, and socioeconomic status, although all residents in the area were considered extremely poor. Villages were then randomly assigned to one of two treatment groups; four were assigned to Trickle Up, four were assigned to Trickle Up Plus, and four were assigned to the control group. Second, 30 of the poorest households were selected in each village based on the Participatory Wealth Ranking developed by Trickle Up. This resulted in 120 households in each group. In the last stage, a female that cared for a child 10 to 15 years of age, and one child (aged 10 to 15 years old), were enrolled in the study. After these three stages of selection, 120 females and 120 children were in each group, resulting in a total sample of 720 people. Households in the control condition did not receive anything; however, they were placed on a waiting list and were to receive the intervention in 2017 after the study ended. Data were obtained from surveys conducted at baseline before the program started, 12 months after the intervention started, and 24 months after the intervention started (at program end). The authors used statistical models to compare the outcomes of treatment and control group members.
Findings
Employment/Child labor
- After 24 months of participating in the Trickle Up Plus program, children were significantly less likely to have used machinery or heavy equipment that could lead to a serious injury (40% less likely than children in the control group), significantly less likely to have been exposed to dust fumes, insufficient ventilation, chemicals, or explosives (30% less likely); and significantly less likely to have been shouted at or repeatedly insulted (10% less likely).
- After 24 months of participating in the Trickle Up Plus program, children were significantly less likely to have experienced any hazardous working conditions or abuse while collecting water (30% less likely), collecting wood (30% less likely), cooking (40% less likely), cleaning dishes or the house (50% less likely), or washing clothes (40% less likely).
Health and Safety
- There was not a statistically significant relationship between participation in the Trickle Up Plus program and work-related health outcomes in either the first or second wave of follow-up.
Considerations for Interpreting the Findings
The study was a randomized controlled trial with unknown attrition in each group. In cases of high or unknown attrition, a study can receive a moderate causal evidence rating if the analysis controls for possible differences in background characteristics of the treatment and control groups. However, the authors did not account for preexisting differences between the groups before program participation on all required characteristics. Specifically, the authors noted large dissimilarities between the two groups on exposure to dust, fumes, insufficient ventilation, chemicals, or explosives; exposure to hazards or abuse when collecting wood; and exposure to hazards or abuse when washing clothes. Therefore, preexisting differences between the groups—and not the program itself—could explain the observed differences in outcomes.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because it was a randomized controlled trial with unknown attrition and the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to the Trickle Up Plus program; other factors are likely to have contributed.