Child friendly spaces impact across five humanitarian settings: A meta-analysis
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Date
2019-05-15Author
Hermosilla, Sabrina
Metzler, Janna
Savage, Kevin
Musa, Miriam
Ager, Alastair
Metadata
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Hermosilla, S., Metzler, J., Savage, K., Musa, M. and Ager, A. (2019) ‘Child friendly spaces impact across five humanitarian settings: a meta-analysis’, BMC Public Health, 19(1), p. 576. Available at: https://doi.org/10.1186/s12889-019-6939-2.
Abstract
Background: Humanitarian crises present major threats to the wellbeing of children. These threats include risks of
violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts
frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak
evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces
(CFS), one such commonly implemented intervention after humanitarian emergencies. Methods: We completed baseline and endline (three-six months post-baseline) assessments regarding protection
concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and
1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and
Nepal. We estimated intervention effect-sizes with Cohen’s d for difference in mean difference scores between
attenders and non-attenders – who proved comparable on baseline measures – by site. We then pooled findings for a
meta-analysis summarizing overall impacts across domains. Results: Amongst children aged 6–11, significant intervention impacts were observed through site-level analysis for
protection concerns (Ethiopia, Cohen’s d = 0.48, 95% CI 0.08–0.88), psychosocial wellbeing (Ethiopia, d = 0.51,
95% CI 0.10–0.91; and Uganda, d = 0.21, 95% CI 0.02–0.40), and developmental assets (Uganda, d = 0.37, 95%
CI 0.15–0.59; and Iraq, d = 0.86, 95% CI 0.18–1.54). Pooled analyses for this age group found impacts of intervention to
be significant only for psychosocial wellbeing (d = 0.18, 95% CI 0.03–0.33). Among children aged 12–17, site-level
analysis indicated intervention impact for protection concerns in one site (Iraq, d = 0.58, 95% CI 0.07–1.09), with pooled
analysis indicating no significant impacts. Conclusion: CFS can provide – albeit inconsistently - a protective and promotive environment for younger children.
CFS show no impact with older children and in connecting children and carers with wider community resources. A
major reappraisal of programming approaches and quality assurance mechanisms is required.