Absenteeism

School absenteeism is a problem that can be caused by several different factors, such as difficulties within the family, problems in the school environment, or mental health difficulties. Absenteeism can, in turn, lead to negative consequences such as poorer mental health, social isolation, and long-term difficulties later in life. For children, school absenteeism has negative consequences for their education, social relationships, and important daily routines-routines that can otherwise serve as a protective factor against, among other things, mental health difficulties, particularly for children in vulnerable environments (Selman, 2023). It is therefore important that problems are identified at an early stage and that schools, parents, and pupils work together to reduce absenteeism (Kearney, 2008; Gren-Landell, 2021). About EAGLE EAGLE (Earle Absenteeism Guide for Lifelong Education) is a collaborative model between schools and families aimed at preventing school absenteeism at an early stage, before absenteeism becomes extensive and therefore more difficult to address. Primary schools are organisations with limited resources and a need for simple, practically oriented working methods. EAGLE therefore has a simple basic structure, with the aim of being implemented quickly when pupils begin to show problematic absenteeism. Here, problematic absenteeism refers to absenteeism that is caused by something in the child's life that is not functioning well or needs to change-for example, difficulties at school, at home, or in everyday life-and not by a straightforward cause such as a common cold. The target group is children in the early and middle years of primary school. An important component is to strengthen collaboration between parents and school staff, as well as to provide parents with guidance on parenting in relation to the child's difficulties attending school. The Gradual Development of Absenteeism Absenteeism does not begin from one day to the next; rather, it develops gradually. Unfortunately, it is common for interventions to be introduced only when absenteeism has become extensive, by which point it is more difficult to reverse. EAGLE, on the other hand, is implemented earlier, increasing the possibility of, so to speak, turning the ship in the right direction and helping children and parents establish a positive experience of school attendance. In brief, EAGLE consists of three collaborative meetings between the school and the child's parent(s)/guardian(s), two sessions providing psychological guidance to the parents, and two shorter conversations with the child to obtain their perspective. The basic principle is that, when it comes to school absenteeism among young children under the age of 12, adults-both at school and at home-should collaborate and drive the change, rather than placing this responsibility on the child. Nevertheless, the child's perspective must be taken into account throughout the entire process. School absenteeism is often described as a complex phenomenon involving an interaction between different factors that mutually influence one another (Swedish National Agency for Education, 2021). These factors may vary, but they generally concern three main areas: 1) school-related factors, 2) individual-related factors, and 3) family-related factors. The EAGLE working model provides a method for mapping these three areas and subsequently implementing appropriate interventions. Considerable time is devoted to establishing good collaboration between the school and the family and to helping parents manage the difficulties that arise when a child does not want to attend school. Aim The research project aims to: Evaluate the effectiveness of the EAGLE intervention. Understand which factors influence children's absenteeism, including factors related to both parents and pupils. Materials and Methods The research project will use both qualitative and quantitative data. The primary outcome measure will be school attendance. We will also investigate factors in the child's life that may influence absenteeism, such as symptoms of anxiety and depression, as well as their parents' attitudes towards school based on their own experiences as children.

Karamoja, in north-eastern Uganda, is among the most water-insecure regions in sub-Saharan Africa. Only 24 per cent of households can access the WHO-recommended 20 litres of water per person per day. Only 11.7 per cent have access to improved sanitation. A rapid vulnerability assessment covered all 182 operational primary schools in the sub-region between October and November 2025. It identified 53 schools as severely water insecure and a further 37 as moderately water insecure. Together, these schools serve an estimated 196,000 learners. The assessment also found that 89 schools lacked enough latrines to meet the national pupil-to-latrine ratio. Seventy-eight schools had no functional menstrual health management facilities. This study is a three-arm, phase-in cluster-randomised controlled trial. It evaluates the causal effects of a climate-resilient school WASH package on children's health and school attendance. It also examines adolescent girls' menstrual health self-efficacy. The study covers 60 primary schools that were found to be water-insecure across Karamoja's nine districts. The schools were stratified into three geographic zones. The researchers then used covariate-constrained randomisation to assign schools to three study arms. Phase 1 includes 30 schools receiving the intervention early. Phase 2 includes 20 schools receiving it later. The remaining 10 schools form the pure control group. The intervention combines climate-resilient WASH infrastructure with capacity-building and social and behaviour change activities. The infrastructure includes motorised boreholes, sex-disaggregated latrines and handwashing stations built to national standards. A subset of the boreholes will have data loggers for remote monitoring. The package also provides dedicated menstrual health facilities. These include enclosed changing areas and hygienic waste-disposal systems. Community water access points will be installed next to each school. Capacity-building activities will involve School Management Committees, Parent-Teacher Associations, teachers, District Water Officers and School Health Clubs. Data will be collected through three repeated cross-sectional rounds. The baseline will take place in the fourth quarter of 2026. The midline will take place in the first quarter of 2028, and the endline in the first quarter of 2030. Seven instruments will be used. These include pupil and matched caregiver surveys, school WASH facility and classroom roll-call observations, and head teacher and teacher surveys. The study will also digitise school enrolment, attendance and examination records. Community leaders will be interviewed separately. In each round, the sample will include 20 post-menarche girls and 20 general pupils per school. The study will interview one caregiver for each sampled pupil. The study will also interview six teachers, the head teacher and four community leaders in each school catchment. The study has three co-primary outcomes. The first is the pupil absence rate, measured using digitised attendance registers. The second is the seven-day prevalence of diarrhoea among pupils. The third is menstrual health self-efficacy among post-menarche girls. We will measure this using the 26-item Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26). The primary analysis will estimate the intent-to-treat effect of assignment to Phase 1. At midline, Phase 1 schools will be compared with Phase 2 and pure control schools. We will conduct two comparisons at endline. First, we will compare all treated schools with the pure control group. Second, Phase 1 schools will be compared with Phase 2 schools to test whether effects differ by exposure duration.

This prospective multicenter cohort study evaluates the predictive value of the Adaptive Load Index (ICA), a composite indicator derived from the WB6Dim well-being instrument, on long-duration sick leave (≥ 30 days) in French companies at a 6-month horizon. In France, 7% of sick leave episodes (those exceeding 6 months) account for 45% of total sickness benefit expenditure (Cour des Comptes 2024). Group disability insurance charges rose +24.4% in 2024 (France Assureurs 2025). Critically, a substantial proportion of long-duration sick leave occurs without prior escalation in administrative absence data - the 'cliff effect' - where presenteeism masks progressive deterioration (Gustafsson \& Marklund 2011). Prediction models based solely on absence history plateau at AUC 0.65 for cumulative days (Roelen 2013), while composite psychometric instruments reach C-index 0.73-0.74 (Airaksinen et al. 2018, SJWEH). The WB6Dim is a validated 28-item psychometric tool measuring 9 dimensions of workplace well-being (NCT07301879, NCT07433764; test-retest ICA .904). The ICA classifies respondents into 4 adaptive load levels. Aggregated at the company level, the ICA distribution may detect deterioration during the presenteeism window, before costly sick leave materializes. The study collects 4 WB6Dim assessments over 6 months alongside company-level absence data stratified by duration (2024-2026) and individual self-reported absence data (duration and episode count). Six pre-registered hypotheses test whether ICA predicts long-duration leave, including an exploratory hypothesis targeting companies with no prior absence signal but degraded well-being scores.