Testing the impact of family-based intervention to improve developmental and health outcomes for female adolescents: study protocol for a cluster-randomized clinical trial in Ghana.

BACKGROUND: The International Labor Organization estimates that 9.6% of children (ages 5 to 17) across the globe are child laborers and draws attention to migrant child laborers as an underreported and highly vulnerable group, a significant portion of which are female with no education. Poverty has been identified as the main driver of child labor, with family context also being a critical contributing factor. Sub-Saharan Africa has the highest rates of child labor (24%), with Ghana -the focus of this study- registering one of the highest child labor prevalence at 22%, including unaccompanied child migrant laborers. In Ghana, unaccompanied adolescent girls migrate from the Northern region to urban centers in the south to work in the informal economy. Load carrying is the most common type of labor for this population and exposes migrant girls to multiple developmental and health risks. Hence, theory-informed evidence-based interventions are needed to prevent the unaccompanied migration of adolescent girls for labor. METHODS: A two-arm cluster randomized clinical trial will be conducted among 960 adolescent girls (age 11 to 14 years) at risk of school dropout nested within 32 public junior high schools in the Northern region of Ghana and their caregivers. The schools will be randomly assigned to one of two study conditions: 1) ANZANSI combination intervention and 2) bolstered usual care. The intervention will be delivered for 12 months, with assessments conducted at baseline and at 12-, 24-, and 36-month follow-ups post-intervention initiation. DISCUSSION: By evaluating a rigorously designed combination intervention, this study aims to generate robust evidence on approaches that can more effectively reduce migration risk and associated child labor. Ultimately, this research has the potential to provide meaningful, actionable guidance for policies and programs seeking to reduce adolescent girls' vulnerability to labor migration, strengthen families' financial stability, and improve long-term educational and developmental outcomes. Given that many developing countries in Africa and other low-resource settings continue to grapple with persistent child labor challenges, the study findings may inform scalable, multi-level strategies to prevent adolescent girls' migration for child labor. TRIAL REGISTRATION: Clinicaltrials.gov: NCT07278934, registered 12/06/2025.