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Despite the high prevalence of mental health difficulties in young refugees and asylum seekers, evidence suggests that they underutilise mental health services. It is important that we understand their use of, and access to, mental health services.
Aims
To examine quantitative evidence on mental health service utilisation and access among young refugees and asylum seekers.
Method
We searched MEDLINE, PsycINFO, Embase, Global Health and The International Bibliography of the Social Sciences. Searches were supplemented by reference list screening and forward-and-backward citation tracking of included studies. Results were synthesised narratively. Our review was pre-registered on PROSPERO (no. CRD42024540885) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Twenty-two studies were included. We found an overall pattern of underutilisation of services by young refugees in comparison with majority population peers, particularly for out-patient services and psychotropic medication. In contrast, there was evidence of increased emergency service use. Service use was particularly decreased for those from low- and middle-income countries, and increased in unaccompanied minors. Service use for trauma-related disorders and schizophrenia was most common, and less likely for neurodevelopmental disorders. Only one study contained data on access-related factors, which identified language as a potential barrier.
Conclusions
There is a disparity between the mental health needs and service use of young refugees, suggesting a need for greater efforts to increase access and use in this population. Future research should explore barriers and facilitators, and build on primary research examining service use in asylum seekers and unaccompanied minors, because both remain underrepresented within the literature.
Recent decades have seen a steady increase in antidepressant prescribing, but little is known about prescribing trends during and following the COVID-19 pandemic.
Aims
This preregistered systematic review, following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, aimed to investigate antidepressant prescribing trends for adults in the UK and Republic of Ireland during and after the pandemic. It also compared prescriptions by drug and location.
Method
We searched six databases: APA PsycInfo, CINAHL, MEDLINE, Scopus, medRxiv and Preprints.org. The review included primary research articles reporting trends in antidepressant prescriptions, including at least one time point after March 2020 in the UK and Republic of Ireland. This review has been preregistered on PROSPERO (ID: CRD42024498503).
Results
We identified 7,320 studies, of which ten met the search criteria for the review. Studies were grouped on the basis of time period (2020: n = 5; 2021: n = 3; 2022: n = 2), location (England, Scotland, Northern Ireland, Republic of Ireland, UK) and drug type (serotonin–noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors, tricyclics, and others (e.g. monoamine oxidase inhibitors)). Most studies (eight of ten) demonstrated increased antidepressant prescribing over time. Two studies highlighted a decrease between March and May 2020. Demographic variables reflected higher rates of prescribing for women, and the modal group receiving antidepressants comprised middle-aged adults.
Conclusions
The commonly reported increase in antidepressant prescribing corroborates pre-pandemic trends and may suggest further, increased demands for mental health support to meet the unique challenges of the pandemic. Future research is required to evaluate the appropriateness of treatment decisions and to explore psychosocial factors that influence individual prescribing choices.
Smallholder farmers in developing economies are key suppliers in agri-food value chains, yet often lack capabilities to meet quality, reliability, and sustainability expectations. This paper presents a systematic literature review of empirical studies on farmer development, conceptualised as supplier development at the farm gate to examine who builds farmers’ capabilities, which initiatives are implemented, and with what sustainability outcomes. Searches of a multidisciplinary library discovery service and Scopus identified 15 studies reporting implemented farmer development initiatives and farmer-level outcomes in developing economies. The synthesis shows that capability building is dominated by government and non-governmental organisation-led programmes, typically bundling training, extension, input provision, and financial support, while buyer-led initiatives are rare and performance is measured mainly in economic terms, with social and environmental dimensions under-specified. The review positions smallholder capability building within supply chain management and argues that building smallholder capabilities is both a development imperative and a strategic supply chain task.
To compare the clinical efficacy and prognosis of Ozaki procedure and Ross procedure in the treatment of paediatric aortic valve disease.
Methods:
According to the predetermined inclusion and exclusion criteria, relevant clinical studies were comprehensively searched in three databases, and relevant data were extracted for analysis and comparison.
Results:
This meta-analysis included four retrospective cohort studies with a total of 243 patients (117 undergoing Ozaki procedure and 126 undergoing Ross procedure). There were no significant difference in the in-hospital all-cause mortality [odds ratio = 1.38; 95% confidence interval: 0.38, 5.07, p = 0.63] and all-cause mortality during the follow-up period [odds ratio = 1.85; 95% confidence interval: 0.54, 6.32, p = 0.32] between Ozaki procedure and Ross procedure. The reoperation on the aortic valve [odds ratio = 10.48; 95% confidence interval: 2.22, 49.40, p = 0.003] was higher in the Ozaki procedure than in the Ross procedure. There were no patients who underwent pulmonary valve reoperation after Ozaki procedure [odds ratio = 0.21; 95% confidence interval: 0.03, 1.23, p = 0.08]. The cumulative reoperation rate after Ozaki procedure [odds ratio = 2.29; 95% confidence interval: 0.93, 5.66, p = 0.07] was higher than that of Ross procedure, but the difference was not statistically significant. The cardiopulmonary bypass time after Ozaki procedure [odds ratio = −32.09; 95% confidence interval:−45.05, −19.14, p < 0.00001] was shorter than that of Ross procedure. The incidence of postoperative complications [odds ratio = 0.24; 95% confidence interval: 0.04, 1.62, p = 0.14], aortic cross-clamping time [odds ratio = −20.39; 95% confidence interval: −43.68, 2.90, p = 0.09], ventilator assistance time [odds ratio = 1.71; 95% confidence interval: −42.70, 46.13, p = 0.94], and ICU time [odds ratio = −0.38; 95% confidence interval: −0.93, 0.16, p = 0.17] in Ozaki procedure was not statistically significant compared to Ross procedure.
Conclusions:
In the treatment of children with aortic valve disease, there is no statistically significant difference between the Ozaki procedure and the Ross procedure in terms of freedom from reoperation and all-cause mortality.
Science is invariably based on some sort of data collection and further treatment of the data gathered. Data can come from pure observations, from structured observations (‘natural experiments’) or from experiments. The central importance of models in science is mentioned. It is discussed how the choice of statistics reflects the philosophy of science adopted by the scientist. Different research programmes use different statistics, in particular, depending on when and how they deal with variation. The relationship between falsificationism and the rejection of null hypotheses as a workaround for the Duhem-Quine thesis is discussed, as well as the role of significance thresholds and their associated problems. It is argued that predicted results are more reliable than chance findings. The pros and cons of having alternative hypotheses are discussed, and a short introduction to Bayesian statistics as an alternative to frequentist approaches is given. Systematic reviews and metaanalyses of data from several studies are introduced, and an example is given on how different types of evidence from many studies are combined to form the current consensus of rational opinion regarding a particular hypothesis.
The aim of this review is to quantify the strength of evidence for the efficacy of exogenous enzymes (EE) in dairy calf rearing, by systematically identifying, consolidating and discussing existing research on the subject. This review identified 17 articles that measured the effect of EE alone or in combination with another treatment on indicator variables for calf performance, behaviour, health or environmental output; 15 studies realised a positive effect of enzyme supplementation on at least one variable, and one study realised a negative effect of treatment on body parameters. Inconsistent results were noted for effects of EE on growth and feed efficiency. Studies that combined EE with another treatment, did not tend to find performance improvements compared to stand-alone treatments. However, several studies were underpowered which could have limited their ability to detect effects on primary response variables. All papers that measured digestibility found an increase in fibre digestibility from enzyme treatment; however, this did not always result in improved feed efficiency or growth. Reductions in non-nutritive oral behaviour, increased resting time and rumination, were observed in studies measuring calf behaviour, as were enhanced rumen development and reduced cost of calf rearing; suggesting that EE could enhance calf health and welfare, whilst having additional advantages for rearing economics. Future research into the efficacy of EE in dairy calves is worth pursuing. However, a targeted and evidence-based approach to experimental design is required, with due consideration given to enzyme actions and interactions, as well as robust power analysis for sample size.
Neurocognitive patterns in leadership shape employee behavior and organizational outcomes, offering important insights for advancing human resource management (HRM) theory and practice. Using a focused, theory-driven journal-based content analysis of ten high-ranked HRM and organizational journals, this review synthesizes neuroleadership research published between 2005 and 2025. The analysis is guided by six integrated neuroleadership themes (decision-making, emotional regulation, motivation and reward processing, social cognition, stress resilience, and attentional control) across six core HRM domains and interpreted through performance-oriented and sustainability-oriented HRM perspectives. The findings suggest that neuroleadership research predominantly emphasizes sustainability-oriented HRM, with decision-making and emotional–cognitive themes most frequently examined within learning and development, followed by employee engagement and well-being and organizational development. In contrast, performance-oriented HRM emphases, such as performance control and transactional management, receive comparatively less attention. The review highlights the need to expand research on motivation, stress resilience, and attentional control to address the demands of an increasingly digitalized workforce.
This systematic review and meta-analyses provide the first synthesis of the literature on trait mindfulness and psychotic-like experiences (PLEs). Theoretical models suggest a protective function of mindfulness and it is important to understand any potential role of mindfulness in the prevention and treatment of PLEs. We examined the following: (1) What is the relationship between trait mindfulness and PLEs in nonclinical populations?; and (2) What is the effect of mindfulness-based interventions (MBIs) on PLEs in nonclinical populations? Five databases were searched, and effect sizes were extracted for each study. Seventeen papers were included in the review. Eleven papers explored the relationship between mindfulness and PLEs, and the meta-regression found a small negative association between PLEs and mindfulness (k = 8; pooled correlation r = −0.25; 95% confidence interval [CI]: −0.37, −0.13, p < .001). Eight studies investigated the effect of MBIs on PLEs and the summary effect was not significant in the meta-analysis (k = 5; pooled standard mean difference = .09; 95% CI: −0.61, 0.79, p = 0.80). Overall, the findings suggest that higher levels of mindfulness are associated with reduced PLEs, with no evidence for the effectiveness of MBIs in reducing PLEs. Findings should be interpreted cautiously given the small number of studies and high heterogeneity in the meta-analyses. Future studies are needed to determine whether MBIs might prevent the transition to psychosis or an at-risk mental state and might usefully measure a broader range of clinically relevant outcomes.
Electroconvulsive therapy (ECT) is highly effective for major depressive disorder (MDD), but about 50% of patients relapse within 1 year. A comprehensive review of all potential relapse-prevention strategies is lacking.
Aims
This systematic review aimed to identify, summarise and critically evaluate the available evidence on pharmacological, neuromodulatory, psychological and combination strategies to prevent relapse following successful ECT for MDD.
Method
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO: no. CRD42023392575). We searched PubMed, Embase, PsychInfo and Cochrane Library up to March 2025. Eligible studies included adults (>18 years) with unipolar MDD who responded to acute ECT and were followed for ≥3 months. We included randomised controlled trials (RCTs), cohort studies and case series (over ten cases). Risk of bias and quality were assessed and a narrative synthesis conducted.
Results
A total of 28 studies (N = 11 119) were included. Lithium (alone or with antidepressants) was most consistently associated with reduced relapse in 10 studies. Continuation ECT (C-ECT), particularly when combined with pharmacotherapy, also reduced relapse in several RCTs. Evidence for psychotherapy (e.g. cognitive–behavioural therapy) is limited (two studies), warranting further studies. No studies on repetitive transcranial magnetic stimulation or ketamine were found. Study quality varied, with some being underpowered or having used inconsistent definitions of relapse.
Conclusions
Pharmacotherapy with lithium and, separately, C-ECT combined with medication, showed the strongest evidence for relapse prevention following ECT. The evidence base is limited by heterogeneity, small sample sizes and few studies on novel or psychological strategies. More robust clinical studies are needed to identify optimal long-term strategies.
The COVID-19 pandemic presented significant challenges to infectious disease management and mental health services (MHS). Service demand and delivery changed due to fear of infection, economic hardships, and the psychological effects of protective measures. This systematic review with meta-analysis aims to quantify these impacts on different mental health service settings.
Methods
Comprehensive searches were conducted in PubMed, Embase, and PsycINFO, focusing on studies published from the initial outbreak of COVID-19, starting in November 2019. Studies were included comparing the utilization of mental health inpatient, emergency department (ED), and outpatient services (including telemedicine and medication prescriptions) before and during the COVID-19 pandemic. A random-effects model was employed to estimate pooled effects, with study quality assessed using a modified Newcastle-Ottawa Scale.
Results
Among 128 studies, significant decreases in utilization were observed during the initial phase of the pandemic for inpatient services (RR: 0.75, 95% CI: 0.67 to 0.85) and ED visits (RR: 0.87, 95% CI: 0.69 to 1.10). Outpatient services showed a similar decline (RR: 0.78, 95% CI: 0.66 to 0.92), while no significant change was found in psychotropic medication prescriptions (RR: 0.90, CI: 0.77 to 1.05). In contrast, telemedicine utilization increased significantly (RR: 7.57, 95% CI: 3.63 to 15.77).
Conclusions
The findings reveal substantial shifts in mental health service utilization during the pandemic, with the largest reductions in inpatient services and significant increases in telemedicine use. These results emphasize the need for flexible healthcare models. Further research is essential to evaluate the consequences of reduced MHS utilization.
Assessing hospital preparedness for nuclear and radiological threats is one of the most effective methods for evaluating the condition of hospitals in relation to such incidents. This study aimed to review the tools used to assess hospital preparedness for nuclear and radiological threats and to analyze the strengths and weaknesses of these instruments.
Materials and Methods
In this systematic review, the full texts of 98 studies identified through database searches and 7 studies identified through manual searches were reviewed. Data were extracted from studies that addressed the measurement tools for assessing hospital preparedness for nuclear and radiological threats from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The content quality of the tools was evaluated based on the World Health Organization (WHO) preparedness criteria, and the psychometric properties of the tools were examined using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) study criteria.
Results
Among the studies reviewed, only 21 met the inclusion criteria, within which 9 tools for assessing hospital preparedness were identified. Eight tools directly assessed vulnerability in terms of physical space, related equipment, and hospital personnel, while one tool used a different criterion as an indicator of hospital preparedness for nuclear and radiological threats. The findings showed that most of the tools focused solely on evaluating a hospital’s vulnerability in terms of physical space, equipment, and personnel, with insufficient attention given to other critical aspects such as protocols, triage, and other important issues.
Conclusion
Given the limitations of existing tools in terms of psychometric evaluation, the lack of theoretical models, the reliance on empirical findings for tool design, and considering the critical importance of measuring and assessing hospital preparedness for nuclear and radiological threats, there is a pressing need in the health sector for the development of scientific tools based on the experiences of process owners and hospital specialists. These tools should adhere to rigorous processes of instrument development and validation.
Systematic reviews are often characterized as being inherently replicable, but several studies have challenged this claim. The objective of the study was to investigate the variation in results following independent replication of literature searches and meta-analyses of systematic reviews. We included 10 systematic reviews of the effects of health interventions published in November 2020. Two information specialists repeated the original database search strategies. Two experienced review authors screened full-text articles, extracted data, and calculated the results for the first reported meta-analysis. All replicators were initially blinded to the results of the original review. A meta-analysis was considered not ‘fully replicable’ if the original and replicated summary estimate or confidence interval width differed by more than 10%, and meaningfully different if there was a difference in the direction or statistical significance. The difference between the number of records retrieved by the original reviewers and the information specialists exceeded 10% in 25/43 (58%) searches for the first replicator and 21/43 (49%) searches for the second. Eight meta-analyses (80%, 95% CI: 49–96) were initially classified as not fully replicable. After screening and data discrepancies were addressed, the number of meta-analyses classified as not fully replicable decreased to five (50%, 95% CI: 24–76). Differences were classified as meaningful in one blinded replication (10%, 95% CI: 1–40) and none of the unblinded replications (0%, 95% CI: 0–28). The results of systematic review processes were not always consistent when their reported methods were repeated. However, these inconsistencies seldom affected summary estimates from meta-analyses in a meaningful way.
Transcranial direct current stimulation (tDCS) shows promise for treating depression, but heterogeneous findings from randomised controlled trials (RCTs) – likely due to patient characteristics and methodological differences – limit clear conclusions about its efficacy.
Aims
This individual patient data meta-analysis (IPD-MA) aims to evaluate the efficacy of tDCS for depression and explore moderators of clinical depression improvement.
Method
Databases (PubMed, Embase, Web of Science, Cochrane Library) were searched up to 1 February 2025 for RCTs comparing active versus sham tDCS in acute depressive episodes. The outcomes were Hedges’ g for continuous measures of depressive symptoms, odds ratio for response and remission rates and analyses of individual/methodological moderators of clinical improvement. Acceptability was assessed via dropout rates. Heterogeneity was quantified using the I² statistic. Publication and risk of bias were evaluated with Egger’s test and Cochrane Risk of Bias Tool, respectively.
Results
Of 29 eligible RCTs, 18 data-sets provided IPD, totalling 1246 included in the IPD-MA (651 active, 595 sham; mean age 43.2, 63.4% female). Most studies (90%) had low risk of bias. Active tDCS showed small but statistically significant effects on depression improvement (Hedges’ d = 0.24, 95% CI = 0.11–0.35) and response rates (odds ratio 1.33, 95% CI = 1.04–1.72), with low-to-moderate heterogeneity. No significant difference in remission rates (odds ratio 1.30, 95% CI = 0.98–1.74) and dropout rates (12.7% active, 11.3% sham) were observed between groups. Only sample size significantly moderated clinical improvement, with larger trials showing smaller between-group differences.
Conclusions
In this IPD data-set, tDCS showed modest efficacy for depression. Future research should clarify its mechanisms, considering non-specific placebo effects.
Growing demand for social care and resource constraints compel decision-makers to decide how to allocate public resources to social care. Such decisions may result in differences in access to social care between groups in society. In this study we conducted a secondary analysis of articles included in a systematic review on the underpinnings of resource allocation decisions in social care, extending that work to examine the potential consequences of such decisions. We conducted the review in accordance with the PRISMA framework. Through a thematic framework analysis of 37 of the 42 articles included in the parent review, we identified five groups in society that may be disproportionately affected by the consequences of resource allocation decisions on social care: (1) individuals with long-term social care needs (2) informal caregivers, (3) lower socio-economic groups, (4) individuals with limited health literacy skills, and (5) individuals living across different regions. Our findings highlight that allocation decisions in social care particularly affect women and individuals facing language barriers and may create local variation in provision of social care. These findings suggest potential for inequitable access to social care in society and underscore the need for decision-makers to consider the consequences of their allocation decisions.
Over the last 20 years, the political dynamics in EU legislative policy-making have fundamentally changed as trilogues have become the major forum for legislative negotiations. From this perspective, this article represents a first systematic review of the literature on trilogues by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. In doing so, it demonstrates the impact of trilogues on EU legislative politics, both intra- and inter-institutionally, as well as the normative concerns they have raised. It also shows that trilogues do not yet constitute uniform practices. Further, this article identifies the limits of our knowledge and therefore avenues for future research to improve our understanding of EU legislative politics.
This article presents a new strategy for reviewing large, multidisciplinary academic literatures: a multi-method comprehensive review (MCR). We present this approach and demonstrate its use by the NGO Knowledge Collective, which aims to aggregate knowledge on NGOs in international development. We explain the process by which scholars can identify, analyze, and synthesize a population of hundreds or thousands of articles. MCRs facilitate cross-disciplinary synthesis, systematically identify gaps in a literature, and can create data for further scholarly use. The main drawback is the significant resources needed to manage the volume of text to review, although such obstacles may be mitigated through advances in “big data” methodologies over time.
Although episodic volunteers are a critical resource for many organisations, their motives for volunteering are poorly understood. A systematic review was conducted to describe empirical evidence about motives for episodic volunteering (EV) across sectors (sport, tourism, events, health and social welfare). Identified EV motives were then categorised using core functions from the Volunteer Functions Inventory (VFI) for comparison across studies. Twelve databases (1990–December 2014) were searched. Thirty-three English language studies included results describing EV motives. Studies were predominantly cross-sectional, quantitative, event-based and originating in North America. Measurement of motives was also inconsistent. Common motives were helping others and socialising. Physical challenge and healing motives were specific to sport-based events and charity sport events, respectively. Over 80 % of motives were classified using VFI functions, particularly enhancement, values and social functions. The VFI supplemented by qualitative work may be efficacious to further identify EV motives and retention strategies.
Telomere length is a biomarker of ageing, with shorter lengths associated with a higher risk of age-related diseases and mortality. Oxidative stress and inflammation predominantly contribute to telomere shortening. Diets rich in antioxidant and anti-inflammatory properties may help preserve telomere length. Nuts and seeds contain antioxidant and anti-inflammatory nutrients and bioactive compounds. Their consumption is recognised as protective against age-related conditions. The objective of this review is to evaluate the role of nut and seed intake on telomere length in humans. A systematic search was conducted in four databases from inception to 12 March 2024 to identify observational and interventional studies assessing nut and seed intake and measuring telomere length as an outcome in adults (aged ≥ 18 years). Data from the included articles were extracted by one reviewer and verified by another reviewer. Out of the nine observational studies included, three reported positive associations between nut and seed intake and telomere length. None of the four interventional studies included reported a significant positive effect. Meta-analysis was not performed due to high variability in reporting telomere length measurements. The evidence is insufficient to confirm a beneficial role of nut and seed intake on telomere length. Adequately powered long-term intervention studies are needed.
Several studies have been published studying association between parental low birth weight (BW) and neonatal outcomes of their children. To date no systematic review and meta-analysis (SRM) has been published to quantify the impact of maternal and paternal BW on outcomes in the next generation. The aim of this SRM was to analyse the association between parental BW and anthropometric and metabolic outcomes in their children.
Electronic databases were searched for studies documenting BW of parents and children with neonatal outcomes. Primary outcome was to evaluate impact of parental BW on occurrence of LBW in children. Secondary outcomes were to assess impact of parental BW on occurrence of macrosomia, small for gestational age (SGA), preterm labour/delivery, and burden of non-communicable disease in later life.
We screened 54,961 articles, data from 14 studies (320,515 parent–child pairs), which fulfilled all criteria, were analysed. Maternal LBW was associated with higher chances of neonatal LBW [odds ratio (OR)1.95 (95% CI:1.56–2.46); P < 0.01; I2 = 91%], neonatal SGA [OR 2.29(95% CI:1.72–3.05); P < 0.01; I2 = 37%], lower chances of neonatal macrosomia [OR 0.50 (95% CI:0.39–0.65); P < 0.01; I2 = 35%] and had no impact on preterm labour/delivery [OR1.20(95% CI:0.67–2.16); P = 0.53; I2 = 88%]. Maternal macrosomia was associated with higher neonatal macrosomia [OR 2.66 (95% CI:2.44–3.16); P < 0.01; I2 = 48%], lower SGA [OR 0.40(95% CI:0.29–0.53); P < 0.01; I2 = 0%] and preterm labour/delivery [OR 0.77 (95% CI:0.63–0.94); P < 0.01; I2 = 4%]. Paternal but not maternal LBW was predictor of metabolic syndrome and diabetes in adulthood.
Maternal LBW is an important predictor of LBW and SGA in neonates. Maternal macrosomia is an important predictor of neonatal macrosomia; is protective against SGA and preterm labour/childbirth. Neonatal size of parents is reflected in neonatal size of their children.
Cash transfer programmes have achieved widespread adoption across developing countries, yet evidence on their effectiveness in the Middle East and North Africa remains comparatively limited. This systematic review examines four central questions: whether transfer effectiveness shows threshold effects whereby modest amounts alter behaviour while substantial poverty reduction requires larger transfers; how supply-side service capacity constraints mediate the effectiveness of demand-side incentives; how conflict and displacement influence programme sustainability; and how programme design features interact with patriarchal structures to shape women’s empowerment. Database searches spanning 2000–2024 identified 270 experimental or quasi-experimental studies with quantitative outcomes. Narrative synthesis examined heterogeneity across transfer amounts, programme design, and contexts. Results indicate non-linear threshold effects: modest transfers (5–10 per cent of household income) alter behaviour through framing mechanisms, whereas meaningful poverty reduction requires transfers of 15–20 per cent or more. Demand-side incentives produce counterproductive outcomes when supply-side capacity binds. Humanitarian assistance improves consumption temporarily but effects dissipate within —four to ten months absent sustainable livelihood pathways. Financial resources alone do not guarantee women’s empowerment; complementary interventions addressing social norms and legal frameworks appear necessary. These findings suggest the imperative of calibrating transfer magnitudes to programme objectives while recognising empowerment requires interventions transcending monetary provision.