African Journal of Public Health and Health Systems | 02 October 2003
Evaluating the Effectiveness of a Cash-Plus-Psychosocial Intervention on Mental Health Outcomes for Orphaned and Vulnerable Children in Rural Uganda
N, a, k, a, t, o, N, a, l, w, a, d, d, a
Abstract
Orphaned and vulnerable children in sub-Saharan Africa face an increased risk of poor mental health due to poverty, trauma, and inadequate support systems. While integrated interventions that combine economic and psychological support are advised, robust evidence for their effectiveness in rural, low-resource contexts remains scarce. This study aimed to evaluate the effectiveness of an integrated cash transfer and psychosocial support intervention on symptoms of depression and anxiety among orphaned and vulnerable children in rural Uganda. A cluster-randomised controlled trial was implemented. Villages were randomised to an intervention arm (15 villages) or a wait-list control arm (15 villages). The 12-month intervention provided caregivers with unconditional quarterly cash transfers while children received structured, group-based psychosocial sessions. We enrolled 300 children aged 10–15 years. Primary outcomes were child-reported depression and anxiety symptoms, measured using validated scales at baseline and endline. Data were analysed using intention-to-treat principles with mixed-effects regression models. Children in the intervention arm demonstrated a statistically significant reduction in depression and anxiety symptom scores compared to those in the control arm. The proportion of children meeting the clinical threshold for depression decreased by 18 percentage points in the intervention group, compared to a 3 percentage point decrease in the control group. Qualitative feedback indicated perceived improvements in hope and social connectedness among participants. The integrated cash-plus-psychosocial intervention proved effective in reducing mental health symptoms among orphaned and vulnerable children in rural Uganda. This approach successfully addresses concurrent material deprivation and psychological distress. Child protection programmes should prioritise integrated economic and psychosocial components. National social protection and child welfare policies should consider scaling up evidence-based, multi-component interventions. Future research should investigate the long-term effects and cost-effectiveness of such models. orphaned and vulnerable children, mental health, cash transfer, psychosocial support, Uganda, cluster-randomised trial This study provides empirical evidence from a rigorous trial on the effectiveness of a combined economic and psychosocial intervention for improving mental health outcomes among a high-risk paediatric population in a low-resource setting.