Age at first marriage among women in Lesotho: Multilevel survival analysis- insight from 2023-24 demographic and health survey data

Background: 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. Methods: 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. Results: 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