Published in PLOS One on 2026-07-22, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Abdu Hailu Shibeshi, Zeytu Gashaw Asfaw, Temesgen Gebeyehu Wondmeneh, Mohammed Ahmed Ibrahim, Hana Emenew Gelaw, Zinabu Bekele Tadese, Abdulkerim Hassen Moloro, Abdulhakim Hora Hedato, Bizunesh Fantahun Kase, Emmanuel Adewuyi, Jianhong Zhou, José Antonio Ortega
Source: PLOS One • DOI 10.1371/journal.pone.0354034
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Early marriage remains a significant public health and social issue in Lesotho, with profound implications for women's health, education, and economic empowerment. Despite legal frameworks aimed at curbing the practice, a substantial proportion of women continue to marry before the age of 18, driven by sociocultural norms, economic constraints, and limited access to opportunities. This study investigates the timing and factors associated with first marriage among women in Lesotho using advanced multilevel survival analysis to inform targeted interventions.
We analyzed retrospective time-to-event data from the nationally representative, cross-sectional 2023−24 Lesotho Demographic and Health Survey (LDHS), employing a log-logistic accelerated failure time (AFT) model within a multilevel framework to account for individual, household, and community-level factors. The analysis included 6,413 women aged 15–49, with 48.76% having experienced first marriage (events) and 51.24% right-censored. Statistical computations were performed using R statistical software (version 4.4.3), incorporating survey weights to ensure representativeness.
The median age at first marriage was 24 years (95% CI: 24–25), with significant variation across socioeconomic and contextual factors. Employment (TR = 1.072, 95% CI: 1.043–1.103), middle wealth quintile (TR = 1.060, 95% CI: 1.012–1.110), low community poverty (TR = 1.094, 95% CI: 1.045–1.145), and urban residence (TR = 1.079, 95% CI: 1.033–1.126) were statistically associated with later age at first marriage (p < 0.05). In contrast, primary education (TR = 0.856, 95% CI: 0.749–0.979), younger birth cohorts (1979–2003: TR range 0.774–0.907), richest wealth quintile (TR = 0.927, 95% CI: 0.875–0.981), and rural residence (TR = 0.927, 95% CI: 0.888–0.967) were associated with earlier age at first marriage. The intraclass correlation coefficient (ICC = 0.0029) indicated that only 0.3% of the variation in age at first marriage was attributable to community-level differences. Although statistically significant, the magnitude of these associations is modest.
The findings show that employment, middle wealth status, low community poverty, and urban residence are associated with a later age at first marriage, while primary education, younger birth cohorts, richest wealth quintile, and rural residence are associated with earlier marriage. The minimal community-level variation suggests that individual and household-level factors are more important determinants of marriage timing. Policymakers could consider prioritizing multisectoral interventions, including expanded educational access, economic empowerment programs, and poverty reduction strategies, with particular attention to rural-urban disparities. Addressing these structural factors may be relevant to achieving sustainable development goals related to gender equality and women's empowerment in Lesotho.
Background
Age at first marriage refers to the chronological age at which a woman enters her first marital or cohabiting union, whether formal or informal [1–3]. In Lesotho, substantial gender disparities exist in marriage timing. Data from the 2023−24 LDHS indicate that 16% of women aged 25–49 were married by age 18 compared to only 3% of men, with median ages at first marriage of 22.5 years for women and 26.5 years for men. Currently, half of women and 41% of men aged 15–49 are in marital or cohabiting unions [4]. Early marriage often disrupts education, reduces economic prospects, and exposes young women to health risks and gender-based inequities [5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Abdu Hailu Shibeshi, Zeytu Gashaw Asfaw, Temesgen Gebeyehu Wondmeneh, Mohammed Ahmed Ibrahim, Hana Emenew Gelaw, Zinabu Bekele Tadese, Abdulkerim Hassen Moloro, Abdulhakim Hora Hedato, Bizunesh Fantahun Kase, Emmanuel Adewuyi, Jianhong Zhou, José Antonio Ortega. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Determinants of stunting among 0–59 months children in Lesotho: A multilevel analysis of 2023/24 Demographic and Health Survey
- Evidence brief: Determinants of skilled birth attendant delivery among reproductive age women in Lesotho: A multilevel analysis of demographic and health survey data
- Evidence brief: Prevalence and associated factors of intimate partner violence against reproductive-age women in Africa and Asia regions: Insights from 2022–2024 DHS datasets
