Results In all the three countries, this study finds health expenditure to be the predominant out of pocket cost incurred by women experiencing violence. Women who experience violence also have statistically significant higher depression, disability and acute illness scores, and thus indicate the broader health impacts of VAWG. These health impacts affect the overall productivity of women experiencing violence. Approximately 80 million productivity work days in Pakistan, 65 million productivity work days in Ghana, and 8.5 million productivity work days in scaled population of South Sudan are lost due to women experiencing any violence. The productivity loss indicates the significant impact VAWG has on the overall economy. ConclusionThe results of this study on the socioeconomic cost of VAWG highlight the need for crucial action by a wide range of actors, from local authorities and community leaders to national government. Moreover, the results suggest the potential burden that VAWG places on the health sector in the countries studied. The health and economic impacts outlined in this study together build a strong economic case for investment by government and donors in the prevention of VAWG.

Results Social and cultural engagement were both independently associated with a lower risk of developing dementia in older age in fully-adjusted models. Using time-to-event analyses, socialising once a week was associated with a 29% lower risk OR=0.71 95%CI 0.52-0.97 and cultural engagement every few months or more was associated with a 42% lower risk OR=0.58 95%CI 0.41-0.80. Using competing risk models, socialising OR=0.80 95%CI 0.59-1.08 and cultural engagement OR=0.65 95%CI 0.47-0.90. Using modified Fine and Gray Subdistribution hazards models, socialising OR=0.66 95%CI 0.53-0.82 and cultural engagement OR=0.42 95%CI 0.32-0.56. Community group activities were only associated with dementia in minimally-adjusted models. Results were robust to sensitivity analyses considering moderators, reverse causality, over-adjustment, and baseline cognitive function. ConclusionThe results presented here suggest that social and cultural engagement are independent risk-reducing factor for the development of dementia in older age. Even for those who lack contact with friends and family or who socialise infrequently, engagement with cultural venues, even on a less frequent basis, could be protective against the incidence of dementia. These findings align with broader findings relating to cognitive reserve and support the development of multimodal community-based interventions to promote healthy cognitive ageing amongst older adults.