The aim of this paper was to report on fidelity in the preconception phase of the Healthy Life Trajectories Initiative Bukhali randomised controlled trial with young women in Soweto, South Africa, covering fidelity of content, dose and delivery, as well as barriers to fidelity, and opportunities and solutions to overcome these barriers. This mixed methods, descriptive study collected qualitative data from sessions with staff delivering the intervention component of the trial (referred to as ‘Health Helpers’) to report on content and delivery, and an open-ended survey about a key component of intervention delivery, Healthy Conversation Skills. Quantitative data on dose were collected from dosage data, structured observations (also providing data on delivery), and staff records. Health Helpers were generally positive about the relevance and relatability of the intervention materials, and highlighted the importance of simplifying, translating, contextualising and tailoring the content for participants. Adaptations to the dose and delivery of the intervention included shifting to individual sessions (versus groups), and increasing the number of telephonic compared to in-person sessions at the research site. Dosage data indicated a high level of fidelity in terms of sessions delivered for intervention and control arms, and regarding the delivery of multi-micronutrient supplements to intervention participants. Results from the structured observations also evidenced good fidelity, although challenges were noted with some aspects of the delivery of Healthy Conversation Skills. These findings provide actionable strategies for designing, delivering, and scaling complex interventions that remain both rigorous and responsive to local realities.

BackgroundMotherhood is a crucial yet understudied aspect of maternal health, especially in sub-Saharan Africa, where inequalities and focus on clinical outcomes impact care. The concept of maternal subjectivities and matrescence, has limited exploration in South African public health. This article uses qualitative longitudinal data from the Bukhali trial to examine the social dynamics that shape maternal identities among young women.MethodsSixty women, mostly single, aged 22–34, participated in multiple interviews from 2023 to 2025. Using Neale's (2021) approach, we created case profiles and selected four for detailed analysis. Data were analysed with inductive coding and longitudinal strategies.ResultsWomen's experiences of motherhood revolve around four interconnected themes. The first involves the emotional rollercoaster of matrescence and motherhood, described as intense and unpredictable, with love, exhaustion, pride, and self-doubt happening simultaneously. The second theme highlights financial struggles and economic instability, common among those facing unemployment, informal work, or limited social grants. The third theme emphasises the necessity of sacrifice and re-evaluating personal ambitions, an everyday part of motherhood rather than an exception, requiring balance between personal goals and children's immediate needs. The fourth stresses the crucial role of social support: its presence is vital, while its absence can lead to feelings of isolation, postnatal depression, and parenting difficulties for single mothers.ConclusionMotherhood in Soweto is complex and influenced by structural constraints and change. The caregiver-earner dual burden reflects post-apartheid gendered labour, while kinship support varies, challenging assumptions of female solidarity. Participants valued health education related to trials but reported no support for motherhood transition. The study recommends maternal-centered programs that address women’s psychosocial needs, personal experiences, and combine emotional and peer support with medical care.

This special issue aimed to help address the bias against Majority World countries in published methodological research in the field of developmental psychology. The 21 articles included in this issue present a diverse range of methodological articles from over 20 Majority World countries. This introductory article presents an overview of these articles, as well as the rationale for this special issue, and insights from the submission, review, and publication process. We have also collected some feedback from contributing authors, which provides insights into the experiences of the review and publication process for a special issue aimed at platforming research from Majority World countries. Finally, we make recommendations for the field of developmental psychology and child development more generally on future directions to advance methodological research in Majority World countries. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Abstract Background Current methods for assessing the healthfulness of 24-hour movement behaviours (sleep, sedentary time, light physical activity, moderate-to-vigorous physical activity) use binary classifications that fail to capture their continuous and compositional nature. This study introduces a percentile-based scoring and visualization approach to evaluate the healthfulness of movement behaviour time-use compositions, using social-emotional development in early childhood as an example. Methods This cross-sectional study includes 560 children aged 1.2–2.9 years and 1,500 children aged 3.0-4.9 years from Sleep and Activity Database for the Early Years (SADEY), an international accelerometer repository of young children’s movement behaviours. Sedentary time, light physical activity, and moderate-to-vigorous physical activity were measured using accelerometers. Sleep duration was parent-reported. Social-emotional development was assessed using age- and sex-normalized scores from the Strengths and Difficulties Questionnaire. Linear regression models with compositional covariates were used to model associations between movement behaviours and Strengths and Difficulties Questionnaire scores. Representative grids containing all possible time-use compositions (in 5 min/d increments) of sleep, sedentary time, light physical activity, and moderate-to-vigorous physical activity were developed. The regression models were applied to each time-use composition in the grid, and the predicted scores were ranked to create percentile scores for different movement behaviour time-use compositions. Results The 24-hour movement behaviour composition was associated with all five Strengths and Difficulties Questionnaire scores in both age groups (p ≤ 0.01). The grids contained 17,577 and 16,535 possible time-use compositions for 1–2 and 3–4-year-olds, respectively. Time-use compositions ranked at the 0th percentile had the least sleep and highest sedentary time, while those ranked at the 100th percentile had the most sleep and least sedentary time. Across the central range of the percentile score distribution (e.g., rankings between the 25th to 75th percentiles), some very different time-use compositions had the same percentile score. Interactive visualization tools were presented to enable real-time exploration of percentile scores for various movement behaviour time-use compositions. Conclusions This study introduces a novel approach to evaluate the health benefits of movement behaviours. This approach moves beyond traditional binary cutoffs to recognize the gradual improvements in health that occur with small changes in behaviours, and that there are multiple pathways to achieving the same health benefits.

Mental health disorders affect millions worldwide, with socially vulnerable youth in urban environments disproportionately affected. South Africa (SA) remains one of the most inequitable countries, and specific pathways linking poverty to mental health remains unclear. This cross-sectional study analysed baseline data from the Bukhali trial in Soweto, SA part of the global Healthy Life Trajectories Initiative (HeLTI). Young women (n = 7735) completed surveys with physical assessments covering sociodemographic, household-level and behavioural-level factors, and mental health. Among the women, 12.6% reported anxiety, 15.8% reported depression, and 9.7% experienced both. Hazardous alcohol use (20.0%) and poor sleep (55.5%) were commonly reportedly behavioural factors among these women. Being in a committed relationship reduced the odds of reporting anxiety and depression (OR ≥0.66), while childhood adversity, hazardous alcohol use, and poor sleep increased the odds (OR ≥1.29). Moderate to severe anxiety greatly increased the risk of depression (OR 32.20). In the comorbid model, while being in a committed relationship remained protective (OR 0.67), childhood adversity and poor sleep quality was associated with substantial risk (OR ≥1.31) of this co-morbidity. In a gSEM constructed a priori, significant direct associations were found for poverty (measured by household socioeconomic status) on alcohol use (p = 0.015), childhood adversity on mental health (p < 0.001), and committed relationship on anxiety (p < 0.001). Mediation analysis revealed that poverty affected anxiety partially through poor sleep (54.2%), and fully via depression (86.9%), and affected depression fully via sleep (43.7%). Childhood adversity associated with depression partially via anxiety (79.4%), sleep (31.3%), and alcohol use (14.2%), and anxiety through depression (88.6%) and sleep (42.2%). In conclusion, childhood adversity, poverty and behavioural factors co-occur, and are collectively associated with elevated symptoms of anxiety and depression among young women in urban-poor settings. While tackling structural inequalities is critical, strengthening mental health support networks in these settings could aid women.

Existing adult-report survey measures provide crucial information about children's executive function (EF) development across contexts, but lack cultural relevance and ecological validity. To address these limitations, we introduce the Executive Function from Observation and Reflection Tool (EFFORT), a publicly available, open-source item bank designed for cross-cultural adaptation that includes 32 parallel items for caregivers and teachers across six EF domains: sustained attention, response inhibition, interference suppression, working memory, cognitive flexibility, and planning/organization. EFFORT additionally includes 10 assessor report items intended for use following a structured, standardized assessment session. This study presents the first validation of the tool within seven countries (Argentina, Australia, Bangladesh, Haiti, South Africa, Sri Lanka, United States) leveraging caregiver, teacher, and assessor observations of 1738 children (aged 3-11 years). Findings revealed acceptable fit for a six-factor structure for caregiver and teacher reports that were not empirically distinct, but yielded highly reliable composites. We further validated a 12-item short form for caregivers and teachers that demonstrated strong unidimensionality, gender invariance, and age-related increases. We demonstrated significant convergence of a short-form caregiver and teacher composite with the assessor-reported measures, as well as convergence of all three adult reports with direct assessments of children's EF skills. This new tool holds promise to advance the science of how children develop and apply EFs to accomplish everyday goals across different cultural settings and in understudied populations.

Existing adult-report survey measures provide crucial information about children’s executive function (EF) development across contexts, but lack cultural relevance and ecological validity. To address these limitations, we introduce the Executive Function From Observation and Reflection Tool (EFFORT), a publicly available, open-source item bank designed for cross-cultural adaptation that includes 32 parallel items for caregivers and teachers across six EF domains: sustained attention, response inhibition, interference suppression, working memory, cognitive flexibility, and planning/organization. EFFORT additionally includes 10 assessor-report items intended for use following a structured, standardized assessment session. This study presents the first multinational validation of the tool across seven countries (Argentina, Australia, Bangladesh, Haiti, South Africa, Sri Lanka, United States) leveraging caregiver, teacher, and assessor observations of 1,738 children (aged 3–11 years). Findings revealed acceptable fit for a six-factor structure for caregiver and teacher reports that were not empirically distinct, but yielded highly reliable composites. We further validated a 12-item short form for caregiver and teacher that demonstrated strong unidimensionality, gender invariance, and age-related increases. We demonstrated significant convergence of a short-form caregiver and teachers composite with the assessor-reported measures, as well as convergence of all three adult reports with direct assessments of children’s EF skills. This new tool holds promise to advance the science of how children develop and apply EFs to accomplish everyday goals across different cultural settings and in understudied populations.

Background The preconception phase of the Healthy Life Trajectories Initiative Bukhali randomised controlled trial has been completed with young women in Soweto, South Africa. Given the gap in preconception care and interventions in low- and middle-income countries, and low levels of awareness about preconception health as a concept, it is important to understand participants’ perceptions of this phase of the trial. Objectives The aim of this study was to report on trial participants’ perceptions of the preconception phase of the trial, with a focus on its acceptability. Design This qualitative, descriptive study formed part of the Bukhali process evaluation. Methods Participants were purposively selected from the intervention (n=22) and control (n=17) arms of the Bukhali trial. Eight semi-structured focus groups were conducted with participants (two rounds of focus groups with same participants, including some replacements). A codebook thematic approach was taken to the descriptive process of data analysis. Results The main themes identified were perceptions of preconception and pregnancy planning, perceived impact of the trial, motivation for staying involved in the trial, agency, and suggestions for preconception services. The trial was viewed as acceptable by women participating in both the intervention and control arms of the trial, but preconception remains an unfamiliar term. Terms such as pregnancy planning, family planning, and ‘preventing’ added to the confusion around the framing of health promotion for young women who are not pregnant. Participants preferred a longer intervention or service, and wanted this service to be delivered in a similar way to the Bukhali trial, not in clinics by nurses. Conclusion Addressing preconception health with young women in Soweto should be done in a way that is contextually relevant, and that over time, contributes to their learning and development, benefitting their physical and mental health, irrespective of their pregnancy plans or intentions.

The Bukhali trial is being implemented with young women (18-28 years) in Soweto, South Africa. A qualitative longitudinal study was conducted to explore Bukhali trial participants’ perceptions of health and their health behaviours over time and in the context of their life circumstances. This article reports an interpretation of interview data from a sub-sample of 11 of 35 participants who participated in four interviews conducted over 12 months. A longitudinal case analysis approach was applied, and four themes were developed: life circumstances, perceptions of health, health behaviours and changes, and experiences of the trial. Participants experienced largely challenging life circumstances characterised by instability and lack of security in terms of employment and education. Their health and health behaviour trajectories also lacked stability and were fragile within the Soweto context. Data were also interpreted through the lens of a concept previously explored in Soweto and introduced in the final interview: ukuphumelela (‘flourishing’). This concept provided a useful framework for understanding the dominance of external or structural (versus internal or personal) factors and social dynamics influencing the health behaviour and life trajectories of participants, particularly in terms of success in the face of difficulty. Participants’ experiences of the trial highlighted the critical role of support provided by and trust established with trial staff. This longitudinal qualitative approach provides unique perspectives about the Bukhali trial over time, the importance of contextualising health behaviour change, and the variable instability impacting the participants, outcomes and implementation of Bukhali in Soweto, a vulnerable setting.

Objectives The Healthy Life Trajectories Initiative (HeLTI) is an international multistudy consortium that supports the development and integration of four randomised controlled trials (RCTs) conducted in South Africa, India, China and Canada. HeLTI aims to evaluate interventions to improve the health and well-being of mothers and children, starting from preconception through pregnancy and early childhood until age 5 years. This paper describes the process by which we prospectively harmonised the participating studies and provides a descriptive analysis of the study-specific harmonisation potential.Design Prospective harmonisation of four international RCTs.Methods A list of core variables to be collected across ten waves of data collection was defined. Taking this list into consideration, investigators developed country-specific questionnaires that were then assessed and adjusted to optimise the harmonisation potential across countries. As questionnaires were not identical, where required, processing scripts were generated to help transform the collected data into the core variable format.Setting The four RCTs are conducted in Canada, China, India and South Africa. The prospective harmonisation was led by the Maelstrom Research team in Canada.Participants Between 4500 and 6000 women planning to get pregnant are recruited in each RCT. Women remain in the study if they become pregnant inside the planned interval of 1–3 years, depending on the country.Results A total of 1962 variables from questionnaires, physical measurements and biospecimen analyses were defined across 10 timepoints of data collection and 3 subpopulations (mothers, partners and children). These variables cover 47 different domains of information. For the preconception phase, following the development of questionnaires and their implementation in the data collection software, 77.2% of the core variables defined can be created across the four studies.Conclusion The HeLTI harmonisation process was successful, and the datasets generated represent a valuable resource allowing researchers to address a wide range of research questions on the impact of behaviour change interventions on maternal and child health indicators in different populations.

Study Objectives To examine (1) multidimensional sleep profiles in preschoolers (3-6 years) across geocultural regions and (2) differences in sleep characteristics and family practices between Majority World regions (Pacific Islands, Sub-Saharan Africa, Eastern Europe, Northeast Asia, Southeast Asia, South Asia, the Middle East and North Africa, and Latin America) and the Minority World (the Western world).Methods Participants were 3507 preschoolers from 37 countries. Nighttime sleep characteristics and nap duration (accelerometer: n = 1950) and family practices (parental questionnaire) were measured. Mixed models were used to estimate the marginal means of sleep characteristics by region and examine the differences.Results Geocultural region explained up to 30% of variance in sleep characteristics. A pattern of short nighttime sleep duration, low sleep efficiency, and long nap duration was observed in Eastern Europe, Northeast Asia, and Southeast Asia. The second pattern, with later sleep midpoints and greater night-to-night sleep variability, was observed in South Asia, the Middle East and North Africa, and Latin America. Compared to the Minority World, less optimal sleep characteristics were observed in several Majority World regions, with medium-to-large effect sizes (divided by d divided by=0.48-2.35). Several Majority World regions reported more frequent parental smartphone use during bedtime routines (Northeast Asia, Southeast Asia: 0.77-0.99 units) and were more likely to have electronic devices in children's bedroom (Eastern Europe, Latin America, South Asia: OR = 5.97-16.57) and co-sleeping arrangement (Asia, Latin America: OR = 7.05-49.86), compared to the Minority World.Conclusions Preschoolers' sleep profiles and related family practices vary across geocultural regions, which should be considered in sleep health promotion initiatives and policies.

Background The actions required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours (physical activity, sedentary behaviour including screen time, sleep) are unclear. Objective To identify how to improve surveillance of movement behaviours, from the perspective of experts. Methods This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from 'extremely' to 'not at all' important. Consensus was defined as > 70% rating of 'extremely' or 'very' important. Results We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research. Conclusions This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally.

INTRODUCTION:There is limited research on applying theory to retention in complex intervention trials. To address this gap, this study aimed to qualitatively examine retention in the Bukhali randomised controlled trial, from the perspective of trial participants and staff, through the lens of self-determination theory (SDT). The Bukhali trial is part of the Healthy Life Trajectories Initiative in Soweto, South Africa, with young women. METHODS:Nine focus group discussions were used to generate data from Bukhali trial staff (n=45, 23-64 years), and participants, including those currently enrolled (n=16, 25-31 years) and those who had withdrawn from the trial (n=20, 24-32 years). A codebook thematic approach was taken to data analysis; SDT was used to develop a conceptual model to analyse the data in context. The main themes identified were external influences on the trial, trial implementing environment, controlled motivation and intrinsic autonomous motivation. RESULTS:Our findings highlighted the contextual issues influencing the trial, including participants' socioeconomic circumstances, and the presence or absence of social support, the trial complexity and participant burden. Issues related to controlled motivation comprised challenges of staying in contact, financial incentives and food, health services provided and other incentives. We also identified aspects of the trial supporting participants' psychological needs of autonomy, competence and relatedness, which in turn contributed to their intrinsic autonomous motivation. These included participants' interest in the trial and its relevance to them; participants' sense of agency, meaning and purpose through their involvement; the building of their knowledge and awareness about their health; relating to other participants and the relationships built with staff and being treated well. CONCLUSION:SDT provides a helpful frame for a contextualised understanding of the complexity of retention of Bukhali trial participants (longitudinal study and intervention). These findings have relevance for trials in under-resourced settings.

Background: Valid, reliable, and easy-to-administer scales are crucial for identifying mental health conditions, especially in LMICs where such scales tend not to be validated. This study aims to address this gap by investigating the psychometric properties and factorial structure of the PHQ-9 and GAD-7 in a sample of young women in Soweto, South Africa. Methods: The PHQ-9 and GAD-7 were administered to 6028 women aged 18-28 years old. Cronbach's alpha, Mokken scale analysis, and Confirmatory Factor Analysis were used to provide support for the internal consistency and construct validity of these scales. Results: Both scales demonstrated good internal consistency (alpha = 0.81 for PHQ-9 and alpha = 0.84 for GAD-7). Internal consistency reliability was further supported by positive inter-item correlations and item-by-scale correlations for all items on both measures. CFA of the PHQ-9 and GAD-7 showed a reasonable fit for the 1-factor model and 2-factor models (depression and anxiety with somatic and cognitive subtypes). Limitations: This study was limited to young African women in urban Soweto who were proficient in English, which may affect generalizability. Differences in language or cultural context may impact the accuracy and applicability of these scales to other African populations. Conclusion: The PHQ-9 and GAD-7 are valid and reliable for identifying psychological distress in the studied population. Despite showing good psychometric properties, further diagnostic assessment is needed to confirm clinical diagnoses. The scales are useful for identifying those at risk but not a substitute for comprehensive diagnostic evaluations.

This qualitative study explored how mature defence mechanisms support positive deviance in health and wellbeing among young women facing adversity in Soweto, South Africa. Drawing from the Bukhali randomized controlled trial in Soweto, which targets improved health trajectories for young women, this study focused on a group of participants who exhibited positive deviance in the trial by being employed or studying, engaging actively in the trial, and showing favourable physical and mental health indicators despite living in a context marked by poverty, inequality, and trauma. Eight in-depth interviews were conducted with participants who met selection criteria, and data were analysed using a codebook thematic approach, incorporating a psychoanalytic framework of defensive functioning. Participants demonstrated frequent use of high adaptive defences, such as anticipation, self-observation, sublimation, and self-assertion, which enabled emotional regulation, agency, and healthy coping. Self-isolation and low affiliation, often seen as withdrawal, were reframed as protective strategies when balanced with meaningful social connections. These findings offer a psychologically rich understanding of how young women in challenging environments navigate complex social landscapes. By integrating positive deviance with defensive functioning, the study extends psychoanalytic theory to marginalized contexts, revealing how mature defence mechanisms contribute to resilience. The insights have implications for designing strength-based mental health interventions tailored to the realities and psychological capacities of marginalized populations.

Background: The South African response to the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was swift and assertive, although it came with economic and social costs. An understanding of the pandemic experiences of different population groups is integral to enhancing disease control.Aim: The aim of this study was to identify behavioural responses and public perceptions relating to the coronavirus disease 2019 (COVID-19) pandemic.Setting: The study was conducted in South Africa.Methods: In June 2022, a national online survey (N = 3018) was conducted among adults ( 18 years). Logistic regression was used to examine the factors associated with adherence to government measures and vaccination. Structural equation modelling (SEM) was applied to examine the direct and indirect relationship of socioeconomic status (SES) with protective behaviours.Results: Data showed no direct association between SES and vaccination uptake, but SES was indirectly and positively associated with vaccination uptake. Socioeconomic status was also indirectly and positively associated with adherence to government measures through pathways mediated by access to the Internet, access to local news, government trust and positive government experiences.Conclusion: This study highlights the complexity of government measures and vaccination adoption and the socioeconomic barriers affecting these.Contribution: Results from this study should be used to inform future pandemic preparedness plans. In particular, policymakers should consider the importance of providing scientific information through channels accessible to each socioeconomic group to promote positive behavioural changes, as well as the need to adapt pandemic responses to different socioeconomic groups.

Premised on the Developmental Origins of Health and Disease theory and on the limited effectiveness of antenatal interventions, interventions in the preconception period are being conducted to potentially improve intergenerational health and non-communicable disease burdens. The Healthy Life Trajectories Initiative (HeLTI) is an international health research consortium primarily investigating the intergenerational effects of behavioural interventions on obesity via a complex four-phase intervention initiated preconceptionally, through pregnancy, and into early childhood. HeLTI, in partnership with the World Health Organization, aims to generate evidence that will shape health policy focused on preconception as part of a life course approach to population health. It is necessary to ensure that a renewed public health focus on preconception prioritises justice and equity in its framing. This article presents collaborative interdisciplinary work with HeLTI-South Africa. It applies a feminist bioethics methodology, which is empirical, situated, intersectional, and fundamentally concerned with justice, to investigate what South African HeLTI community health workers, or 'Health Helpers', who deliver the complex behavioural intervention, think about preconception health and responsibility. Seven semi-structured interviews were conducted with HeLTI-SA Health Helpers, and data were analysed using reflexive thematic analysis. Our findings show that Health Helpers' perceptions of preconception health and related responsibility were significantly gendered, heteronormative, and concerned with child-bearing intentionality and desires. These themes were inflected with Health Helpers' perceptions about how attributions of responsibility are shaped by culture, demonstrating the situated nature of epistemologies. Their ideas also highlight how preconception health knowledge can distribute responsibility unjustly. Understanding the contextual impact and relevance of values around responsibility is critical to prospectively design preconception health interventions that promote equity and fairness. This understanding can then be used for effective policy translation, with the goal that public health policy is founded upon contextual responsivity and justice for the public it aims to serve.

We present a framework developed through disability and reproductive health expert consensus to guide the adaptation of interventions for healthy life trajectories to meet the needs of women with disabilities. We conducted a scoping review of support available for women with disabilities, in-depth interviews with experts from the disability and reproductive health sectors, and a group consensus-building process for framework development with expert participants from the disability and reproductive health sectors. Findings identified challenges to disability-inclusive care in reproductive health services. Recommendations include tailored actions to specific stakeholders within their scope of practice to work toward disability-inclusive health care for persons with disabilities.

BACKGROUND:Inequalities in the provision and implementation of early childhood development (ECD) interventions in Sub-Saharan Africa remain a challenge. This scoping review aimed to investigate the types and extent of ECD interventions in this region, using the Nurturing Care framework (NCF). METHODS:This review included randomised controlled trial (RCT) studies related to ECD interventions in Sub-Saharan Africa. Sources from 2019 to 2024 were included. PubMed, MEDLINE (Ebsco), Web of Science, ProQuest and PsychInfo were searched in September 2024. Abstracts and full texts were reviewed using Rayyan. RESULTS:Of 85 studies retrieved, 21 conducted across 13 countries were included in our review. Most were conducted in Eastern and Southern Africa, with Western and Central Africa notably underrepresented. Sample sizes varied from 134 to over 9000 participants. ECD interventions targeting children from 0 to 8 years old were included. Nutrition-focused interventions were the most common (n = 9) and showed the biggest positive impact on child weight and growth. Responsive caring interventions were the second most common (n = 2), resulting in fewer reports of maltreatment, reduced endorsement of corporal punishment and fewer behavioural problems in children. The remaining three NCF dimensions (i.e., early learning opportunities, safety and security, and good health) each had only one intervention focusing solely on that dimension and showed mixed results on child development. Multidimensional interventions were common, with seven studies combining multiple ECD support elements to create a holistic approach. Although these interventions showed mixed results, they were more likely to report positive outcomes across multiple NCF domains compared to single-focus interventions. CONCLUSIONS:Most interventions focus only on a couple of NCF elements. There is a need for increased focus on underrepresented regions to address local ECD needs effectively and to develop and evaluate interventions that incorporate all elements of NCF in African contexts.

There is a notable lack of engagement in reproductive and lifecourse research with and from men, with a disproportionate focus on women. While studies investigating the lack of men's engagement with services exist, there is little evidence on their engagement with reproductive and lifecourse research. This article qualitatively examines men's engagement in such research in the Bukhali trial in South Africa. Single, in-depth interviews were conducted with 19 male partners of Bukhali participants, and data were thematically analysed. Results were grouped into three domains: (i) motivators for engagement, (ii) barriers to engagement, and (iii) recommendations to improve engagement. Motivators to engage included partner support, desiring to learn and gain knowledge, and taking the opportunity to access the same perceived trial benefits as their partner. Barriers included having misconceptions around the research, fear and mistrust of hospitals and illness, gendered ideas around 'women's health issues', hesitance around sharing personal details, and lack of time and perceived (financial) benefits. To increase engagement, male partners recommended increasing awareness and creating safe research spaces for men. Each theme was inflected with male partners' sociocultural and contextual realities and provided valuable insights into obstacles and opportunities for improving men's engagement in reproductive research.