Cost-Effectiveness of an Economic Empowerment and Family Intervention on Mental Health Among School-Going Adolescent Girls in Uganda, 2017‒2022
Fred M. Ssewamala, Yesim Tozan, Rachel Brathwaite, Joshua Kiyingi, Phionah Namatovu, Ozge Sensoy Bahar, Proscovia Nabunya, Portia B. Nartey, Torsten B. NeilandsObjectives. To assess the cost-effectiveness of an economic empowerment and family intervention on mental health outcomes among school-going adolescent girls in Uganda from 2017 to 2022.
Methods. We randomized adolescent girls aged 14 to 17 years into 3 arms: (1) health and sex education (usual care; n = 408), (2) youth development accounts (YDAs; n = 471), and (3) a combination intervention (YDA plus multiple family group [MFG]; n = 381). We fitted mixed-effects models and estimated intervention costs prospectively using the microcosting approach.
Results. The combination intervention had a statistically significant impact on mental health outcomes (depressive symptoms, hopelessness, self-concept) at 12 and 24 months, except self-esteem at 24 months, relative to usual care, with incremental cost‒effectiveness ratios ranging from $51 to $100 per 0.2-SD change at 12 months, and $53 to $157 at 24 months per 0.2-SD change.
Conclusions. The combination intervention positively and significantly impacted a higher number of mental health outcomes among school-going adolescent girls compared with YDA alone. The benefits were sustained in the short and long term, with the incremental cost-per-unit effect remaining comparable. Findings support the integration of combination interventions in school settings to promote adolescent girls’ positive mental health functioning.
Trial Registration. ClinicalTrials.gov registration no. NCT03307226. ( Am J Public Health. Published online ahead of print June 26, 2025:e1–e9. https://doi.org/10.2105/AJPH.2025.308135 )