Improving Child Protective and Child-Wellbeing Outcomes Among Ultra-Poor Families in Burkina Faso: Results of a Cluster Randomized Controlled Trial

Introduction:Extreme poverty heightens children’s risk of being exposed to violence and exploitation. Approximately 1.25 million children in Burkina Faso are working to augment family income. In search of better opportunities, parents send their children away for work in gold mines, cotton fields or cacao plantations in neighboring countries. Girls are at risk for transactional sex and sexual abuse, when working as domestic servants or maids. In addition, girls are often faced with early and forced marriage to reduce financial burden on the family. There is limited evidence about interventions aimed at improving child wellbeing outcomes among children in developing countries, especially in Francophone West Africa. This study tests the effects of innovative economic empowerment intervention, alone and in combination with child protection component, on wellbeing outcomes among children living in ultra-poverty in rural Burkina Faso.

Methods: This evaluation study uses a 3-arm cluster randomized control design to evaluate the effect of women’s economic empowerment intervention and the additive effect of a locally-developed child protection sensitization program on child protective outcomes. The study takes place in the Nord Region of Burkina Faso, characterized by extreme poverty and an ongoing food and nutrition crisis due to cyclical droughts. To recruit participants, 12 impoverished villages were selected based on comparable socio-demographic characteristics (e.g., poverty ranking, food insecurity, population). Within each village, families living in ultra-poverty were identified using a Participatory Wealth Ranking exercise. Each selected household included a female primary caregiver with a child between the ages of 10-15. In total, 360 women and 360 children participated in baseline assessment. To minimize cross-arm contamination, randomization occurred at the village level to assign households to three study arms: Trickle Up (economic intervention only), Trickle Up Plus (economic empowerment plus child protection sensitization component) or the waitlist condition. This paper examines outcomes at one-year follow-up.

Results: The study demonstrated that compared to the wait-list condition, children assigned to the Trickle Up+ arm demonstrated significant improvement in well-being indicators (reduced level of depression b=-2.63, p=0.002 and improved level of self-esteem b=0.94, p=0.04). Furthermore, mothers to the Trickle Up+ arm reported reduction in the use of harsh disciplining practices (b=-1.27, p=.001) and improved support for child protective beliefs such as importance of education over child labor or marriage (b=.53, p=0.004). Fewer girls were promised in marriage in the TU+ condition. To our knowledge, this is the first randomized clinical trial showing the positive effects of integrated economic and psychosocial intervention improving emotional well-being of children in the context of ultra-poverty in Burkina Faso.

Conclusions: This study suggests that linking economic strengthening strategies with child protection interventions may be critical and feasible in the contexts of humanitarian crisis to stabilize families during high-risk periods and prevent family separation, child labor and child abuse. Integrating psychosocial intervention involving all family members with economic empowerment strategies may be an innovative approach for improving wellbeing outcomes children living in severe adversity. The study suggests that the child sensitization component deepens protective effects that may result from the economic intervention alone.