Background Despite an understanding of the circumstances of child marriage, including how it limits agency and erodes childhood support systems, not much is known about the relationship between child marriage and mental health of child brides, especially in the sub-Saharan African context. To address this gap, we use large-scale population-based data from ever-married women aged 18–45 in Niger ( n = 2764) and Ethiopia ( n = 4149) to examine the association of child marriage with overall psychological well-being and its sub-domains: depression, anxiety, positive well-being, vitality, self-control and general health. We complement this with qualitative data from Ethiopia to further contextualize the psychological well-being of child brides. Methods Multivariate linear regressions were conducted to estimate the association between child marriage and overall psychological well-being and its sub-domains. Thematic qualitative analysis was conducted to further understand the lives of child brides. Results Our regression analysis found significant negative associations between very early marriage (marriage at 15 years or earlier) and overall psychological well-being in both Niger and Ethiopia. With the exception of self-control, all sub-domains of psychological well-being – depression, anxiety, positive well-being, vitality and general health – were negatively associated with very early marriage. In addition, in the qualitative analysis, Ethiopian child brides reported suffering emotional distress and depression induced by the burden of handling marital responsibilities at an early age. Conclusion The study highlights that even in settings where child marriage is normative, marrying very early is associated with negative outcomes. Further research is needed to understand the mechanisms that make those married during early adolescence particularly vulnerable to psychological distress, so that programs can address those vulnerabilities. Electronic supplementary material The online version of this article (10.1186/s12889-019-7314-z) contains supplementary material, which is available to authorized users.

IntroductionThis systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs.MethodsThis systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand journal searches identified the studies. This current review of the literature addresses the question of whether laparoscopic simulation translates the acquisition of surgical skills to the operating room (OR).ResultsThis systematic review of simulation-based training and laparoscopic surgery found that specific skills could be translatable to the OR. Twenty-one studies reported learning outcomes measured in five behavioral categories: economy of movement (8 studies); suturing (3 studies); performance time (13 studies); error rates (7 studies), and global rating (7 studies).ConclusionSimulation-based training can lead to demonstrable benefits of surgical skills in the OR environment. This review suggests that simulation-based training is an effective way to teach laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become apart of surgical curriculum.

Despite expansive scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services in Kenya over the last decade, Kenya remains one of the countries contributing to high numbers of children living with HIV globally and is among the 22 PMTCT global plan priority countries. Using structured and in-depth interviews this study examined enabling factors that enhance utilization of and adherence to PMTCT services in an urban setting in Kenya. HIV-positive birthmothers (N = 55) whose infants were HIV-negative at the time of the study completed a structured interview and a subset (n = 15) participated in in-depth interviews. The majority of the mothers (98 %) delivered at a health facility and 91 % exclusively breastfed. Further, 91 % attended clinic appointments regularly and 69.1 % strictly adhered to prescribed medication dosage and schedules. However, 18 % had not disclosed their HIV status to anybody, 27 % did not use condom during sex, 95 % did not participate in AIDS support groups and 53 % of their male partners were not involved in PMTCT. Four key themes facilitating PMTCT success emerged from the qualitative data: supportive counseling, striving for motherhood, assurance of confidentiality; and confirmation, affirmation and admiration. HIV/AIDS related stigma and gender imbalances create many missed opportunities for HIV-positive mothers to reach out for support from family and community, apply acquired knowledge and access more affordable care. To be successful, PMTCT programs should be aware of these factors and ensure that mothers are provided with culturally competent care.

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Child marriage is prevalent in Africa, with almost 40% of girls being married before age 18. Although child marriage is linked to a range of adverse outcomes, including intimate partner violence, little is known about the quality of these marriages in terms of the levels of communication, trust, equality, intimacy, conflict, marital satisfaction or happiness. We used both quantitative and qualitative data to examine how exact age at first marriage influenced multiple domains of relationship quality in Ethiopia. Our analysis was based on household survey data from 3396 currently married or recently divorced women aged 18–45, 32 in-depth interviews and 8 participatory focus groups in two regions. The regression results show a strong negative effect of marriage at or before age 12 on relationship quality across multiple domains. The qualitative data suggest a more pervasive effect on marital quality, with the lack of ability to choose whom they married and reduced agency emerging as particularly important factors influencing marital quality. This relationship may be direct or indirect, potentially mediated by factors such as intimate partner violence. Interventions intending to mitigate the effects of child marriage should include components that aim to improve the quality of spousal relationships, particularly in terms of communication and negotiation skills.