BackgroundEarly marriage (< 18 years) is associated with education cessation among girls. Little research has qualitatively assessed how girls build resiliency in affected contexts. This study examines these issues in Oromia, Ethiopia and Jharkhand, India among girls and their decision-makers exposed to early marriage prevention programs.MethodsQualitative interviews were conducted with girls who received the intervention programs and subsequently either a) married prior to age 18 or b) cancelled/postponed their proposed early marriage. Girls also selected up to three marital decision-makers for inclusion in the study. Participants (N = 207) were asked about the value and enablers of, and barriers to, girls’ education and the interplay of these themes with marriage, as part of a larger in-depth interview on early marriage. Interviews were transcribed, coded, and analyzed using latent content analysis.ResultsParticipants recognized the benefits of girls’ education, including increased self-efficacy and life skills for girls and opportunity for economic development. A girl’s capacity and desire for education, as well as her self-efficacy to demand it, were key psychological assets supporting school retention. Social support from parents and teachers was also important, as was social support from in-laws and husbands to continue school subsequent to marriage. Post-marriage education was nonetheless viewed as difficult, particularly subsequent to childbirth. Other noted barriers to girls’ education included social norms against girls’ education and for early marriage, financial barriers, and poor value of education.ConclusionSocial norms of early marriage, financial burden of school fees, and minimal opportunity for girls beyond marriage affect girls’ education. Nonetheless, some girls manifest psychological resiliency in these settings and, with support from parents and teachers, are able to stay in school and delay marriage. Unfortunately, girls less academically inclined, and those who do marry early, are less supported by family and existing programs to remain in school; programmatic efforts should be expanded to include educational support for married and childbearing girls as well as options for women and girls beyond marriage.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6340-6) contains supplementary material, which is available to authorized users.

The frequency of poor-water-quality advisories issued in Milwaukee and Racine, Wisconsin, in the absence of identifiable sources of contamination brought into question the reliability of the present indicator organism, Escherichia coli. Enteroccoci have been suggested as an alternative to E. coli for freshwater monitoring due to their direct correlation to swimmer-associated gastroenteritis. The purpose of this research was threefold: (i) to explore enterococci as an alternative to E. coli for monitoring freshwater Lake Michigan beaches, (ii) to evaluate the impact of the two indicators on regulatory decisions, and (iii) to compare membrane filtration m-enterococcus agar with indoxyl-␤-D-glucoside to a chemical substrate technique (Enterolert) for the recovery of enterococci. Recreational water samples from Milwaukee (n ‫؍‬ 305) and Racine (n ‫؍‬ 153) were analyzed for the enumeration of E. coli and enterococci using IDEXX Colilert-18 and Enterolert. Correlation between the indicators was low (R 2 ‫؍‬ 0.60 and 0.69). Based on U.S. Environmental Protection Agency bacterial indicator threshold levels of risk for full body immersion, using enterococci would have resulted in 56 additional unsafe-recreational-water-quality advisories compared to the total from using E. coli and the substrate-based methods. A comparison of the two enterococcal methods (n ‫؍‬ 124) yielded similar results (R 2 ‫؍‬ 0.62). This was further confounded by the frequent inability to verify enterococci from those wells producing fluorescence by the defined substrate test using conventional microbiological methods. These results suggest that further research is necessary regarding the use of defined substrate technology interchangeably with the U.S. Environmental Protection Agency-approved membrane filtration test for the detection of enterococci from fresh surface water.

BackgroundEarly marriage of girls (marriage < 18 years) is a pervasive abuse of rights that compromises maternal and child health. The common conceptualization of this practice as an outcome undermines the nuanced and sometimes protracted decision-making process of whom and when to marry.MethodsThis paper uses qualitative data from semi-structured interviews with females aged 13–23 years who participated in child marriage prevention programs and either married early or cancelled/postponed early marriage, and their key marital decision-makers in Oromia, Ethiopia (n = 105) and Jharkhand, India (n = 100).ResultsSocial norms and the loss of a parent were stressors sustaining early marriage across contexts. Participants described three stages of early marriage: initiation, negotiation and final decision-making. Girls were infrequently involved in the initiation of early marriage proposals, though their decision-making autonomy was greater in groom-initiated proposals. The negotiation phase was most open to extra-familial influences such as early marriage prevention program staff and teachers. Across settings, fathers were the most important final decision-makers.ConclusionsThe breadth and number of individual and social influences involved in marital decision-making in these settings means that effective early marriage prevention efforts must involve girls, families and communities. While underlying norms need to be addressed, programs should also engage and enable the choice, voice and agency of girls. Empowerment was important in this sample, but generally required additional social resources and support to have impact. Girls with greater social vulnerability, such as those without a male caretaker, had more compromised voice, choice and agency with regards to early marriage. Understanding early marriage decision-making as a process, rather than an endpoint, will better equip programs and policies that aim to eliminate early marriage to address the underlying norms that perpetuate this practice, and is an important lens through which to support the health and human rights of women and girls globally.Electronic supplementary materialThe online version of this article (10.1186/s12905-018-0631-z) contains supplementary material, which is available to authorized users.

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