Buruli ulcer (BU) belongs to the group of neglected tropical diseases and constitutes a public health problem in many rural communities in Côte d’Ivoire. The transmission patterns of this skin infection are poorly defined, hence the current study aimed to contribute to the understanding, perceptions and interpretations of its mode of transmission using a socio-environmental approach. Social and environmental risk factors that may expose people to infection, and the dynamics of local transfer of knowledge and practices related to BU, were assessed in two endemic locations in southern Côte d’Ivoire, i.e. Taabo and Daloa. Data were generated by the administration of a household questionnaire (N=500) between February and June 2012 to assess how the population perceived transmission of BU, focus group discussions with local communities (N=8) to analyse ideologies regarding transmission patterns and semi-structured interviews with patients or their parents, former BU patients and traditional healers (N=30). The interviewees’ empirical knowledge of the disease was found to be close to its biomedical description. Their aetiological perception of the disease was linked to natural (e.g. dirty water, insects) and supernatural (e.g. witchcraft, fate) causes. Some informants attributed the spread of the disease to recently immigrated neighbouring communities whose arrival coincided with an increase in reported BU cases. However, the general consensus seemed to be that the main mode of transmission was contact with infested soil or ulcerated wounds. The participants were aware that BU was a socio-environmental problem in these endemic areas, offering a good starting point for educational campaigns for at-risk communities. Buruli ulcer control programmes should therefore include educational campaigns and Water, Sanitation and Hygiene (WASH) interventions for those at risk in affected communities.

Although young people in South Africa are growing up in an era where their socioeconomic circumstances are seemingly better than those of their parents’ generation, they face greater risks in their trajectory to adulthood. This is mainly because the environment in which they are making sexual decisions is also rapidly evolving. Currently, South Africa has the highest prevalence of HIV and AIDS in the world among young people aged 15–24. This study examined the effect of sexual behaviours initiated in adolescence on enrolment in post-secondary education. The analysis was conducted using data from the longitudinal Cape Area Panel Study (CAPS, Waves 1–5) conducted in 2002–2009, which focused on young people’s sexual behaviours in Cape Town, South Africa. The sample was restricted to 3213 individuals who reported sexual debut during adolescence. Using logistic regression models fitted separately for males and females, the results revealed that several factors acted as either hindrances or protective factors to enrolment in post-secondary education. Early sexual debut (by age 17) was negatively associated with participation in tertiary education. Other variables that had a negative effect included not using contraception at first sex, parenthood, engaging in risky behaviours such as illegal substance use, cigarette smoking and drinking alcohol and neglect of school homework (doing less than an hour a day). Higher levels of parental education (except for paternal education in the female model), urban residence and higher aspirations and analogous behaviours (studying) acted as protective factors and were positively associated with post-secondary education initiation. The paper also points to the relationship between early sexual debut and persistent socioeconomic inequality and provides empirical evidence for re-thinking policy development and implementation around schooling and sex education.

Despite the significant health benefits of breastfeeding for the mother and the infant, economic class and race disparities in breastfeeding rates persist. Support for breastfeeding from the father of the infant is associated with higher rates of breastfeeding initiation. However, little is known about the factors that may promote or deter father support of breastfeeding, especially in fathers exposed to contextual adversity such as poverty and violence. Using a mixed methods approach, the primary aims of the current work were to (1) elicit, using qualitative methodology, the worries, barriers and promotive factors for breastfeeding that expectant mothers and fathers identify as they prepare to parent a new infant, and (2) to examine factors that influence the parental breastfeeding intentions of both mothers and fathers using quantitative methodology. A sample (N=95) of expectant, third trimester mothers and fathers living in a low-income, urban environment in Midwestern USA, were interviewed from October 2013 to February 2015 about their infant feeding intentions. Compared with fathers, mothers more often identified the benefits of breastfeeding for the infant’s health and the economic advantage of breastfeeding. Mothers also identified more personal and community breastfeeding support resources. Fathers viewed their own support of breastfeeding as important but expressed a lack of knowledge about the breastfeeding process and often excluded themselves from discussions about infant feeding. The results point to important targets for interventions that aim to increase breastfeeding initiation rates in vulnerable populations in the US by increasing father support for breastfeeding.

Hypertension prevalence is on the rise in low- and middle-income countries (LMICs) like South Africa, and migration and its concomitant urbanization are often considered to be associated with this rise. However, relatively little is known about the relationship between blood pressure (BP) and internal migration – a highly prevalent population process in LMICs. This study employed data for a group of 194 adult men and women from an original pilot dataset drawn from the Agincourt Health and Demographic Surveillance System in north-east South Africa conducted in 2012. Migrants in the sample were identified, tracked and interviewed. The relationship between BP and migration distance and the number of months an individual spent away from his/her home village was estimated using robust OLS regression, controlling for a series of socioeconomic, health and behavioural characteristics. It was found that migrants who moved a longer distance and for longer durations had significantly higher systolic and diastolic blood pressures compared with shorter-term migrants and those who remained nearby or in their home village. These associations remained robust and statistically significant when adjusting for measures of socioeconomic conditions, as well as body mass index and the number of meals consumed per day. Migration, both in terms of distance and time away, explained significant variation in the blood pressure of migrants in this typical South African context. The findings suggest the need for further studies of the nutritional and psycho-social factors associated with geographic mobility that may be important to understand rising hypertension levels in LMICs.

A woman’s decision to continue or terminate an unplanned pregnancy is affected by a broad range of contextual and cognitive factors. The identification of women’s perceptions of unplanned pregnancy is crucial for health care providers to be able to offer supportive care and counselling. The aim of this study was to develop an instrument to accurately measure women’s perceptions of unplanned pregnancy: the Women’s Perceptions of Unplanned Pregnancy Questionnaire. The instrument was developed using a methodological framework guided by Waltz et al. (2010). A conceptual model of the designed instrument emerged from the qualitative study using a content analysis approach conducted in Tabriz, Iran. Participants were recruited using convenience sampling method between June 2016 and July 2017. Participants were a sample of married Iranian women between the ages of 15 and 49 who had experienced an unplanned pregnancy, either unwanted or mistimed, within the last 3 months. Women with an established diagnosis of a psychological disorder were excluded from the study. The psychometric properties of the instrument were assessed using face, content, concurrent and construct validations. To evaluate face validity, qualitative and quantitative (item impact score) methods were used. The content validity was assessed by fifteen panel experts. In addition, concurrent validity of the designed instrument was tested using the Persian version of the Cambridge Worry Scale and the Spielberger State-Trait Anxiety Inventory. The construct validity was calculated by using the exploratory factor analysis method. Data were collected from questionnaires completed by 310 eligible women. Analysis of the data using exploratory factor analysis yielded 31 items in a unique six-factor structure. The instrument was found to have high internal consistency (Cronbach’s α=0.88) and adequate reliability (Intraclass Correlation Coefficient=0.89). A clearer understanding of women’s perceptions of unplanned pregnancy may enhance reproductive services and interventions.

The aim of this cross-sectional study was to investigate beliefs, attitudes and reproductive behaviours in relation to consanguinity in a population living in the backlands of north-eastern Brazil. Data were collected by face-to-face interview from 147 high school students aged 13–20 years and from 532 elderly individuals aged 60 years and over from Brejo dos Santos in the state of Paraíba in 2017. The frequency of consanguineous marriage was found to have increased over the generations, being 15.9% in the parents of the elderly participants, 17.1% in the elderly participants themselves and 20.5% in their descendants. Although 258 (50.9%) of the elderly interviewees opposed consanguineous union, 341 (65.3%) would approve of the marriage of their children with relatives. Both the young (n=108 or 78.3%) and elderly (n=398 or 80.4%) interviewees believed that consanguineous marriages were no more durable than non-consanguineous marriages (p=0.578). Additionally, 408 (82.4%) of the elderly individuals and 108 (80.6%) of the students recognized that spouses in consanguineous unions experience conflicts, just like other couples do (p=0.625). In both groups, the majority of the participants did not believe that consanguinity increased the risk of having children with disabilities. The regression of the two continuous variables ‘age’ and ‘positive attitudes score’ showed a significant correlation, suggesting that younger individuals are more susceptible to the influence of cultural factors contributing to consanguinity, such as the opinions of their parents and grandparents. The belief that consanguineous unions are more durable showed a significant difference between elderly individuals in consanguineous and non-consanguineous unions (p=0.001); the former were 2.42 more likely to believe that marriages between relatives contributes to marriage durability.

Acute respiratory infection (ARI) is a major cause of mortality among children under the age of five in developing countries. This paper examines Demographic and Health Survey (DHS) data on maternal recall of episodes of ARI in the contrasting settings of Bangladesh and Nigeria, where about 11.1% and 3.3% of under-5 children, respectively, are reported to have symptoms of ARI. The surveys found that about 25.6% of married Bangladeshi women and 15.4% of married Nigerian women reported experiencing spousal violence in the past year. To test the proposition that women’s experience of intimate partner violence (IPV) is associated with adversity in their children, the study examined the relationship between spousal violence in the past year and childhood ARI in the past 2 weeks among children under the age of five in Bangladesh and Nigeria. Data were taken from a nationally representative sample of mothers aged 15–49 years obtained from the 2007 Bangladesh DHS and 2008 Nigeria DHS. Random-effects multiple logistic regression models were estimated to assess the association of maternal exposure to IPV with the incidence of ARI in the past 2 weeks among under-5 children after controlling for the potentially confounding effects of maternal social and demographic characteristics. Results from Nigeria suggest that the odds of ARI incidence among children of mothers who were IPV victims were almost two times higher than among their counterparts whose mothers had not experienced IPV (OR = 1.78; 95% CI: 1.45–2.19; p <0.001). Similarly, the odds for the children of Bangladeshi IPV victims were elevated one and half times (OR = 1.61; 95% CI: 1.21–2.14; p <0.001). The findings suggest that under-5 children suffer indirect health consequences of gender-based violence.

Global estimates suggest that over a billion people live with a disability that is significant enough to affect their daily lives. According to the 2011 Indian Census, India alone has about 26.8 million people with disabilities. Research suggests that persons with disabilities (PwDs) in India are among the most neglected, stigmatized, poor and least educated of the world’s population, and women with disabilities in India are the most marginalized, both socially and economically. They bear the triple burden of being discriminated against through being ‘women’ (socially marginal beings), ‘disabled’ (incapacitated, inefficient and undesirable) and ‘women with disabilities’ (the weakest of the weak), often becoming socially invisible. Although there has been a general recognition over the years that the educational and employment opportunities of PwDs in India need to be improved, their sexual needs and aspirations, sexuality concerns and sexual and reproductive health and rights have been largely ignored. The objective of this paper is to highlight the paucity of research on the sexual and reproductive health concerns of PwDs, particularly women, in the Indian context using existing literature on India, and to identify the possible reasons of this neglect. The study describes the obstacles faced by PwDs, particularly women, to acquiring good sexual and reproductive information and services, based on the results of empirical studies. Given the lack of research on this in India, the evidence largely comes from studies conducted elsewhere in the world. Lack of information and education about sexual health concerns, physical and/or infrastructural inaccessibility, judgemental provider attitudes, limited provider knowledge about disability issues and individual factors, including inhibitions about seeking health care and financial barriers, are identified as factors inhibiting the sexual and reproductive rights of people with disabilities in India.

There has been a secular decline in age at menarche since the 19th century. Early-maturing women are more likely to have their sexual debut at a younger age, which in turn gives rise to a host of reproductive health and social problems. This study used data from five waves of National Demographic and Health Surveys conducted in the Philippines between 1993 and 2013 to examine the trends and socioeconomic differentials in age at menarche and sexual debut. The changing trend in age at menarche and sexual debut was examined across birth cohorts, and logistic regressions were used to identify the determinants of early sexual debut. In the Philippines, the mean and median ages at menarche declined from 13.2 years and 12.6 years, respectively, among young women born in 1973–1977, to 12.9 years and 12.3 years, respectively, among those born in 1993–1997. The proportion who had their sexual debut by age 20 increased from 41.2% for the 1968–1972 birth cohort to 53.4% for the 1988–1992 birth cohort. Filipino women with low education, from poor families and living in rural areas were more likely to have earlier sexual debut despite attaining menarche at a later age as compared with their higher educated counterparts, and those from wealthier families and urban areas. Logistic regression analysis showed that, besides marital status, women’s education and age at menarche were important determinants of early sexual debut. However, ethnicity, place of residence and family wealth had no significant effects on age at menarche. An increasing proportion of young women were found to be having unprotected sexual debut and at a younger age, with health and social ramifications. Hence, apart from increasing the enrolment of girls in schools and discouraging teenage marriage, there is a need for social and health agencies to implement appropriate adolescent sexual and reproductive health programmes such as counselling and educational campaigns, as well as support services, to address sexual problems among the youth.

The aim of this study was to examine the gender differential effects of eating habits and physical activity on overweight and obesity among school-aged adolescents in Bangladesh. Nationally representative data extracted from the 2014 Global School-based Student Health Survey (GSHS) were utilized. The survey collected information related to physical and mental health from 2989 school-aged adolescents in Bangladesh. An exploratory data analysis and multivariate logistic regression model were employed in this study. Female adolescents were at a lower risk of being overweight or obese (AOR=0.573) than males, with a prevalence of 7.4% (males: 9.9%). The results showed that high consumption of vegetables (both: AOR=0.454; males: AOR=0.504; females: AOR=0.432), high soft drink consumption (both: AOR=2.357; males: AOR=2.929; females: AOR=1.677), high fast food consumption (both: AOR=2.777; males: AOR=6.064; females: AOR=1.695), sleep disturbance (both: AOR=0.675; males: AOR=0.590; females: AOR=0.555) and regular walking or cycling to school (both: AOR=0.472; males: AOR=0.430; females: AOR=0.557) were vital influencing factors for being overweight or obese among adolescents for both sexes. Sedentary activities during leisure time were also identified as significant predictors of being overweight or obese for males. Regular fruit and vegetable consumption, the avoidance of soft drinks and fast food, an increase in vigorous physical activity, regular attendance at physical education classes and fewer sedentary leisure time activities could all help reduce the risk of being overweight or obese for both sexes.

Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse. This article advances the syndemics scholarship by examining health conditions that cluster together with TB in the Russian Federation, by eliciting a set of social processes that precipitate this clustering and exacerbate health outcomes, and by analysing interactions between these health conditions and social processes. To provide an account of this complexity, the article takes a qualitative approach and draws on the perspectives and experiences of people with TB. The results demonstrate emergence of a syndemic of stress, substance abuse, TB and HIV that is sustained by poverty, occupational insecurity, marginalization and isolation. Frictions between the narrow focus of the health care system on TB and the wider syndemic processes in which the lives of many persons with TB are embedded, contribute to poorer health outcomes and increase the risks of developing drug resistance. Finally, the article argues that the large-scale and impersonal forces become embodied as individual pathology through the crucial interface of the ways in which persons experience and make sense of these forces and pathologies. Qualitative research is needed for the adequate analysis of this biosocial complexity in order to provide a solid basis for responses to TB-centred syndemics in various settings.

The aim of this study was to test whether Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) vary in relation to social class at birth and adulthood, educational level and region of residence, and also with inter-generational social, educational and regional mobility/migration. The study used 5702 adults (2894 males and 2718 females) from the longitudinal British National Child Development Study (all children born in England, Scotland and Wales during the first week in March 1958 with follow-up throughout childhood and adulthood, most recently at 55 years of age). In both sexes BMI and waist circumference tended to increase from social classes I+II to IV+V and higher social class was associated with higher mean FEV1 and PEF. Better-educated adults tended to have lower BMI and waist circumference, and higher mean FEV1 and PEF. Women from Wales had the highest mean BMI and waist circumference but the lowest mean PEF, while women in Scotland had the highest mean systolic blood pressure and the lowest mean FEV1. For men only, FEV1 and PEF showed regional variation and the lowest mean FEV1 was in Wales and the lowest PEF in Yorkshire & Humberside. Inter-generational social mobility was not found to be associated with any of the biomarkers, while educational mobility was related only to FEV1 and PEF. In both sexes, in unadjusted regression analysis regional migrant cohort members tended to have a lower mean BMI than sedentes. Regional male migrants also tended to have a lower waist circumference and a higher FEV1 and PEF than sedentes.

Worldwide, adolescents and young adults (aged 15–25 years) account for the highest proportion of new HIV infections, yet the uptake of HIV testing among this cohort is sub-optimal. Understanding factors that predict the uptake of HIV testing among adolescents and young adults is critical for designing effective and relevant interventions to increase testing. Drawing from the psychosocial constructs of the Health Belief Model, the study examined the effects of HIV risk perception, discussion of HIV with partners and knowing partners’ HIV status on HIV testing uptake among adolescents and young adults in two Nigerian universities. The study was conducted in 2018 and was cross-sectional in design, with a final sample of 784 male and female students selected using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the effect of HIV risk perception, discussion of HIV with partners and knowing partners’ HIV status on HIV testing uptake. Only 50.6% of participants had ever tested for HIV with 30.7% being tested in the last year, with no significant differences by sex. After controlling for other covariates (age, sex and being sexually active), knowing partners’ HIV status, having discussed HIV with partners and being very concerned about contracting HIV were found to be significantly associated with ever being tested for HIV and recent HIV testing uptake. Uptake of HIV testing was found to be low in the study setting and fell short of the first ‘90%’ UNAIDS target. Age-appropriate strategies, targeting open communication on HIV/STIs and disclosure of sero-status between sexual partners are required to promote uptake of HIV testing among young adults and adolescents in Nigeria.

Research on twinning in developed countries is well documented, but little is known about twinning in less-developed countries due to a lack of data or data limitations. This study examined the level of, trends in and determinants of twin births and their survival under age five in Jordan, using the 2012 Jordan Population and Family Health Survey (JPFHS) data. The birth history of 11,352 women included in the JPFHS provided information on 9859 live births that occurred within five years of the survey date, and these constituted the study subjects. Descriptive statistics, and bivariate and multivariate multilevel logistic regression models were used for data analysis. About 3.5% of the total live births were twins, which is one of the highest rates in developing countries. The twinning rate showed an increasing trend in Jordan, increasing by 45% from 2.4% in 1990 to 3.5% in 2012. Higher maternal age at child birth, higher parity, poor and richer economic status, contraceptive use status, secondary and above level of education of mothers and non-consanguinity were found to be associated with a higher rate of twin births in Jordan. Twins were observed to have a higher risk of low birth weight, being smaller in physical size at birth and at more than four times higher risk of neonatal death compared with singletons. To reduce the risk adverse outcomes of twin pregnancies and further improve maternal and child health, antenatal, delivery and postnatal care should be tailored towards the special needs of twin pregnancies and twin births in Jordan Twin pregnancies should be detected at the early stage of pregnancy so that perinatal outcomes can be improved by frequent prenatal visits, health education, counselling and proper management of peripartum complications.

In 1893, Frederick Jackson Turner proposed that America’s Western frontier was an economic ‘safety-valve’ – a place where settlers could migrate when conditions in eastern states and Europe crystallized against their upward economic mobility. However, recent studies suggest the Western frontier’s material conditions may not have been as advantageous as Jackson proposed because settlers lacked the knowledge and human capital to succeed on the Plains and Far Western frontier. Using stature, BMI and weight from five late 19th and early 20th century prisons, this study uses 61,276 observations for men between ages 15 and 79 to illustrate that current and cumulative net nutrition on the Great Plains did not deteriorate during the late 19th and early 20th centuries, indicating that recent challenges to the Turner Hypothesis are not well supported by net nutrition studies.

Despite the ongoing problems of undernutrition and infectious disease, obesity and overweight have become a major problem in developing countries, including Bangladesh. This cross-sectional study was undertaken to determine the prevalence of obesity, overweight and underweight among school children aged 6–12 years in Bangladesh. The study was conducted from June 2012 to May 2013 and the study sample comprised 1768 children (980 boys; 788 girls) from eight purposively selected schools in different areas of Dhaka city. Students were interviewed about their diet and physical activity, and anthropometric measurements were made, including height, weight, mid-upper-arm circumference (MUAC), waist circumference, hip circumference and body mass index (BMI). Undernutrition, overweight and obesity were defined using internationally accepted BMI cut-off points. Mean height, weight, BMI, MUAC, waist circumference and hip circumference values were found to be higher in boys than in girls, except at age 12 when these were found to be significantly higher in girls than in boys (p<0.05). The mean prevalence of overweight was 10.0% (boys 10.2%; girls 9.8%), and that of obesity 5.0% (boys 4.3%; girls 5.8%). The prevalence of underweight was 16.3% in boys and 12.7% in girls. The prevalence of underweight was significantly higher in poor than in rich children (22.1% vs 11.2%) and that of obesity was higher in rich than in poor children (9.9% vs 1.3%; p<0.001). A family history of obesity and hypertension emerged as a significant predictor of developing overweight and obesity (p<0.001). The data suggest that underweight and obesity co-exist in urban areas of Bangladesh, posing a challenge for the nutritional health of Bangladeshi children.

The effects of marriage between biological relatives on the incidence of childhood genetic illness and mortality are of major policy significance, as rates of consanguinity exceed 50% in various countries. Empirical research on this question is complicated by the fact that consanguinity is often correlated with poverty and other unobserved characteristics of households, which may have independent effects on mortality. This study has developed an instrumental variables empirical strategy to re-examine this question, based on the concept that the availability of unmarried cousins of the opposite gender at the time of marriage creates quasi-random variation in the propensity to marry consanguineously. Using primary data collected in Bangladesh in 2006–07 and Pakistan in 2009–10, the study found that previous estimates of the impact of consanguinity on child health were biased and falsely precise. The study also empirically investigated the social and economic causes of consanguinity (including marital quality) and concludes that marrying a cousin can have positive economic effects for one’s natal family, by allowing deferral of dowry payments until after marriage.

Spearman’s hypothesis tested at the subtest level of an IQ battery states that differences between races on the subtests of an IQ battery are a function of the g loadings of these subtests, such that there are small differences between races on subtests with low g loadings and large differences between races on subtests with high g loadings. Jensen (1998) stated that Spearman’s hypothesis is a law-like phenomenon. It has also been confirmed many times at the level of items of the Raven’s Progressive Matrices. This study hypothesizes that with concern to Spearman’s hypothesis, subtests and items function in fundamentally the same way, and tested whether Spearman’s hypothesis is confirmed at the item level for White–East Asian comparisons. A group of Korean young adults (N=205) was compared with other groups of young adults from Canada, the US, Russia, Peru and South Africa (total N=4770) who took the Advanced Progressive Matrices. Spearman’s hypothesis was strongly confirmed with a sample-size-weighted r with a value of 0.63. Computing the g loadings of the items of the Raven with either the Raven-g or the Wechsler-g led to the same conclusions. Tests of Spearman’s hypothesis yielded less-strong outcomes when the 36-item Advanced Progressive Matrices were used than when the 60-item Standard Progressive Matrices were used. There is a substantial correlation between sample size and the outcome of Spearman’s hypothesis. So, all four hypotheses were confirmed, showing that a part of the subtest-level nomological net replicates at the item level, strengthening the position that, with concern to Spearman’s hypothesis, subtests and items function fundamentally the same. It is concluded that Spearman’s hypothesis is still a law-like phenomenon. Detailed suggestions for follow-up research are made.

The question of youth sexual behaviour has been widely debated, with researchers such as Berhan and Berhan (2015) arguing that young adults aged 15–24 are more likely to engage in risky behaviours. However, research has not adequately addressed the issue of positive sexual behaviours, in particular among young people in sub-Saharan Africa. Adapting the compensatory model of risk and resiliency theory, this study examined the determinants of positive sexual behaviours among youth in sub-Saharan Africa. Using recent data from Demographic and Health Surveys of sixteen countries representative of each African region (East, West, Southern and Central), it was hypothesized that positive sexual behaviours of youth (condom use at last sex and single sexual partnership) would be most strengthened by protective factors at the individual and family levels, and that these behaviours would differ by region due to regional variation in socio-cultural practices. Delayed age at sexual debut (first sex after the age of 15) was found to be the strongest protective factor for positive sexual behaviours among males and females in sub-Saharan Africa. Certain socioeconomic variables were found to be positively associated with positive sexual behaviours and the associations differed by gender.

Age at sexual debut is known to have implications for future sexual behaviours and health outcomes, including HIV infection, early pregnancy and maternal mortality, but may also influence educational outcomes. Longitudinal data on schooling and sexual behaviour from a demographic surveillance site in Karonga district, northern Malawi, were analysed for 3153 respondents between the ages of 12 and 25 years to examine the association between sexual debut and primary school dropout, and the role of prior school performance. Time to dropout was modelled using the Fine and Gray survival model to account for the competing event of primary school completion. To deal with the time-varying nature of age at sexual debut and school performance, models were fitted using landmark analyses. Sexual debut was found to be associated with a five-fold increase in rate of subsequent dropout for girls and a two-fold increase in dropout rate for boys (adjusted hazard ratio [aHR] of 5.27, CI 4.22–6.57, and 2.19, CI 1.77–2.7, respectively). For girls who were sexually active by age 16, only 16% ultimately completed primary schooling, compared with 70% aged 18 or older at sexual debut. Prior to sexual debut, girls had primary completion levels similar to those of boys. The association between sexual debut and school dropout could not be explained by prior poor school performance: the effect of sexual debut on dropout was as strong among those who were not behind in school as among those who were overage for their school grade. Girls who were sexually active were more likely to repeat a grade, with no effect being seen for boys. Pathways to dropout are complex and may differ for boys and girls. Interventions are needed to improve school progression so children complete primary school before sexual debut, and to improve sex education and contraception provision.