Violence and maltreatment in Tanzanian families-Findings from a nationally representative sample of secondary school students and their parents

The prevalence of emotional abuse in children living in Sub-Saharan Africa - A systematic review

OBJECTIVES

This study is meant to put a focus on the prevalence of emotional abuse in low-income states like the Sub-Saharan region.

METHODOLOGY

Searching PubMed, Google scholar, and web of science during February and April 2021 a total of 2264 articles were identified, 27 met the inclusion criteria. We added the results of 13 VAC (Violence Against Children and Youth) studies, conducted by UNICEF capturing information about experienced sexual, physical, or emotional violence in 13-24-year-olds, as well as 56 MIC (Multiple Indicator Cluster) studies, conducted by the CDC to research the disciplinary methods used with children aged 1-14 years in the past month by older household members. Finally, in a meta-analytic approach, we aimed to calculate a pooled estimate of the prevalence.

RESULTS

The included studies depicted a wide range in prevalence rates across countries. For example, while the VAC study in Lesotho in 2018 showed low incidence rates of emotional violence (6.9 % Females, 3.8 % Males), the average prevalence recorded by the MIC study was as high as 57.8 % for females and 59.2 % for males. On average, the MIC studies displayed a higher incidence and the discrepancy of prevalence of emotional abuse between females and males was small. Calculating a pooled estimate of the prevalence was not possible, due to the heterogeneity of the data.

CONCLUSIONS

In general countries displayed a high prevalence. A standardized use of a uniform definition of emotional abuse might help to display a more homogenous data set in the future, giving the opportunity for pooled estimates of prevalence.

Externalizing problems mediate the relation between teacher and peer violence and lower school performance

BACKGROUND

The association between children's exposure to family violence and poor academic outcomes is well-established. Less is known about how exposure to violence in the school context, i.e., by teachers and by peers, affects academic functioning. Moreover, the role of children's mental health problems in this link has hardly been examined.

OBJECTIVES

We examined direct and indirect associations between children's experiences of violence by teachers and peers and children's mental health and school functioning while controlling for children's experiences of parental violence.

PARTICIPANTS

Using a multistage random sampling approach, we obtained a representative sample of 914 students (50.5 % girls, M_age = 12.58 years) from 12 primary schools in Tanzania.

METHODS

In structured interviews, students' experiences of violence and mental health problems were assessed. Students' academic performance and absenteeism were documented using school records. Associations were examined using structural equation modeling.

RESULTS

Experiences of more teacher and peer violence were each significantly associated with higher externalizing problems (teachers: β = 0.27 [95 %-CI: 0.12, 0.47]; peers: β = 0.17, [95 %-CI: 0.07, 0.32]). Higher externalizing problems were significantly associated with poorer academic performance (β = -0.13, [95 %-CI: -0.23, -0.02]), implying significant indirect associations between students' experiences of teacher violence (β = -0.04, [95 %-CI: -0.08, -0.01]) and peer violence (β = -0.02, [95 %-CI: -0.05, -0.01]) and their academic performance via externalizing problems.

CONCLUSION

Exposure to violence at school may impair children's academic performance indirectly by increasing attention and behaviour problems. Further investigations in longitudinal studies and implementation of interventions to reduce violence in schools are indicated.

Factors Contributing to Violent Discipline in the Classroom: Findings From a Representative Sample of Primary School Teachers in Tanzania

The need for intervention strategies aiming to reduce teachers' use of violent discipline methods has been expressed repeatedly, especially for countries where this practice is socially and legally accepted. Nevertheless, initial targets for interventions are not clearly identified, as factors contributing to teachers' use of violence are still understudied. In the present study, we examined the interplay between teachers' own experiences of violence, their attitudes, current stress, and their use of violent discipline in a representative sample of 173 Tanzanian primary school teachers (53.7% female, M_age = 38.1 years, SD_age = 10) using structural equation modeling. Our model showed good model fit (χ² [48, n = 173] = 78.058 (p = .004), CFI = .962, TLI = .948, RMSEA = .060 [90% CI [.034, .084], PCLOSE = .233], SRMR = .048). Results indicated direct associations between positive attitudes toward violent discipline (β = .41), stress (β = .23), and teachers' own experiences of violence (β = .21) with teachers' use of violence. Teachers' own experiences of violence were significantly associated with positive attitudes (β = .39), and these significantly mediated the association between teachers' own experiences of violence and their use of violent discipline (β =.23). Our findings underscore the relevance of past experiences, societal norms, and current working conditions in understanding teachers' violence against students. Interventions aiming to reduce teachers' use of violent discipline may focus on stress management, societal norms, personal beliefs on violent discipline, and how teachers' own previous experiences of violence may influence teacher's disciplining behavior.

Factors Contributing to Violence Against Children: Insights From a Multi-informant Study Among Family-Triads From Three East-African Refugee Camps

Parental violence poses a considerable, yet mitigable risk for the mental health and well-being of refugee children living in resource-poor refugee camps. However, little is known about potential risk factors for parental violence in these settings. Using an ecological systems perspective and a multi-informant approach, we investigated ontogenic (parental childhood experiences of violence), microsystem (parents' and children's psychopathology) and exosystem (families' monthly household income) risk factors for child-directed parental violence in a sample of 226 Burundian families living in refugee camps in Tanzania. Data were collected through individual structured clinical interviews with mothers, fathers, and children. In the child-report path model [χ² (6) = 7.752, p = .257, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.036 (p = .562)], children's posttraumatic stress disorder (PTSD) symptoms, externalizing symptoms and paternal PTSD symptoms were positively associated with violence by both parents. Maternal psychosocial impairment was positively associated with child-reported paternal violence. In the parent-report path model [χ² (6) = 7.789, p = .254, CFI = 0.97, RMSEA = 0.036 (p = .535)], children's externalizing problems as well as a lower monthly household income were positively related to maternal violence. Each parent's childhood victimization was positively linked to their use of violence against children. Maternal psychosocial impairment and paternal alcohol abuse were positively associated with paternal violence. Child and paternal psychopathology, maternal psychosocial impairment, parents' childhood victimization, and families' socioeconomic status may be important targets for prevention and intervention approaches aiming to reduce parental violence against refugee children living in camps.

Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda

Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda.

METHODS

In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 - Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables.

RESULTS

In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19-1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34-5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26-223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108-1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36-23.1, p = .001) and being female (OR = .054, 95% CI: 0.30-1.00, p = .005).

CONCLUSION

Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children's mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children.

Sustainability of effects and secondary long-term outcomes: One-year follow-up of a cluster-randomized controlled trial to prevent maltreatment in institutional care

BACKGROUND

Many orphans in East Africa are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. We report on the extension of a cluster-randomized controlled trial aiming to replicate and show sustainability of previous found effects and to discover long-term effects of the intervention Interaction Competencies with Children-for Caregivers (ICC-C) 12-months after the intervention's conclusion.

METHODS

Conducting a robust 2x3 analysis of variance, we investigated the changes over time in the waitlist orphanages (n = 75, 62.7% female, Mage = 37.63 years, SDage = 11.81), which participated in the intervention after first follow-up and in the initial intervention orphanages (n = 81, 61.7% female, Mage = 38.73 years, SDage = 11.94).

RESULTS

The caregivers in the waitlist orphanages reported less reported levels of maltreatment (d = -0.09), fewer positive attitudes towards violent discipline (d = -0.44) and increased childcare knowledge (d = 1.26) three months after intervention, replicating our findings of the initial intervention condition. In addition, these effects were maintained in the intervention orphanages 12 months post intervention. Furthermore, we found long-term improvements in negative caregiver-child relationship (d = -0.83), caregivers' stress level (d = -0.98) and their mental health problems (d = -0.61).

CONCLUSIONS

The replication and maintenance of the intervention effects and first hints to additional long-term effects substantiates the effectiveness of ICC-C. As long as alternative care cannot be provided for all children in need, brief caregiver trainings can make an important contribution to enlarge the opportunities for many children.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03594617. Registered on 20 July 2018.

Psychopathology mediates between maltreatment and memory functioning in Burundian refugee youth

BACKGROUND

The detrimental impact of child maltreatment on children and adolescents' academic achievement and later socioeconomic wellbeing is well known. However, it is still unclear (1) whether maltreatment is actually linked to youth's long- and short-term memory deficits and (2) whether potential impairments are due to maltreatment per se or related psychopathology.

OBJECTIVE

Based on the Attentional Control Theory, we investigated a mediational model in which maltreatment would be related to psychopathology (internalizing symptoms, posttraumatic stress symptoms, posttraumatic cognitions), which would in turn be related to impaired memory functioning.

PARTICIPANTS AND SETTING

We drew on a sample of 155 Burundian refugee youth (aged 11 to 15) currently living in refugee camps in Tanzania and at high risk of experiencing ongoing maltreatment by parents.

METHODS

Youth reported on their experiences of maltreatment and psychopathology in structured clinical interviews and completed visuospatial memory tasks involving a short-term and a working memory component (Corsi Block Tapping Test) and delayed recall from long-term memory (Rey-Osterrieth Complex Figure).

RESULTS

Structural equation modeling showed that psychopathology mediated the association between increased maltreatment and reduced working memory capacity (β = -0.07, p = .02), with a trend towards mediation for short-term memory (β = -0.05, p = .06). Higher levels of maltreatment, but not psychopathology, were directly linked to long-term memory deficits (β = -0.20, p = .02).

CONCLUSIONS

Preventive efforts targeting maltreatment and interventions focusing on related psychopathology are needed to counter memory deficits and their potential negative implications for academic and socioeconomic outcomes.

Child disciplinary practices, abuse, and neglect: Findings from a formative study in Chitungwiza, Zimbabwe

BACKGROUND

Zimbabwe has a high prevalence of children who have experienced abuse according to national data.

OBJECTIVE

To understand how parents/caregivers and children describe child discipline, abuse, and neglect and what factors influence each, in order to inform the adaptation of a positive parenting/caregiving intervention in Chitungwiza, Zimbabwe.

PARTICIPANTS

A total of eight focus groups were conducted, four with parents/caregivers (N = 40) and four with their children ages 10-14 (N = 40), separately, between June-July 2016.

SETTING

Chitungwiza, Zimbabwe.

METHODS

We used an inductive and deductive analytic approach to analyze focus group transcripts, using MAXQDA 12.

RESULTS

There were similar themes across focus groups of children and parents/caregivers. Findings suggest that parents/caregivers and children may be somewhat aware of the differences between discipline and abuse, but they are not completely clear about what the definitions of discipline and abuse are, and where the boundaries between discipline and abuse lie. The use of both non-physical and physical forms of discipline were described in the community, however physical discipline was a reoccurring theme in the focus groups of both parents/caregivers and their children. There were several factors that influenced discipline and/or abuse of children in the community, including the child's gender and theseverity of the child's misbehavior/actions. Parents/caregivers shared that orphan/non-biological children were particularly vulnerable to forms of abuse and neglect committed by parents/caregivers in the community, for example, withholding food and overworking a child.

CONCLUSIONS

Understanding the differences between discipline, abuse and neglect, as well as factors that influence occurrences of abuse/neglect and/or severity of abuse/neglect, need to be considered when assessing the vulnerability of children, in order to develop and refine parenting/caregiving interventions for the Zimbabwean context.

Child maltreatment, cognitive functions and the mediating role of mental health problems among maltreated children and adolescents in Uganda

BACKGROUND

Child maltreatment poses high risks to the mental health and cognitive functioning of children not only in childhood but also in later life. However, it remains unclear whether child maltreatment is directly associated with impaired cognitive functioning or whether this link is mediated by mental health problems. Our study aimed at examining this research question among children and adolescents in Uganda.

METHODS

A sample of 232 school-going children and adolescents with a mean age of 14.03 (SD = 3.25) was assessed on multiple forms of maltreatment using the Maltreatment and Abuse Chronology Exposure-Pediatric Version (pediMACE). Executive functions were assessed by the Tower of London task and working memory by the Corsi Block Tapping task, while mental health problems were assessed using the Child PTSD Symptom Scale for PTSD and the Center for Epidemiological Studies Depression Scale for Children (CES-DC).

RESULTS

In total, 232 (100%) of the participant reported to have experienced at least one type of maltreatment in their lifetime including emotional, physical, and sexual violence as well as neglect. We found a negative association between child maltreatment and executive functions (β = - 0.487, p < 0.001) and working memory (β = - 0.242, p = 0.001). Mental health problems did not mediate this relationship.

CONCLUSIONS

Child maltreatment seems to be related to lower working memory and executive functioning of affected children and adolescents even after controlling for potential cofounders. Our study indicates that child maltreatment the affects children's cognitive functionality beyond health and well-being.

Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol

BACKGROUND

Following a finding of alcohol use among children aged 5-8 years old in Mbale, Uganda, this project investigates the magnitude of alcohol and substance use among children ged 6-13 years old and related household, community, school, health system and clinical factors.

METHODS

The project includes four larger work packages (WPs). WP1 comprises management, WP2 and 3 include the scientific components and WP4 includes integration of results, dissemination, policy and implementation advice. This protocol presents the planned research work in WP 2 and 3. WP2 comprises the adaptation and validation of the alcohol use screening tool Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) to the age group and setting. WP3 comprises four substudies (SS). SS1 is a cross-sectional community household survey with an estimated sample size of 3500 children aged 6-13 years and their caregivers. We apply cluster sampling and systematic sampling within the clusters. Data collection includes a structured questionnaire for caregiver and child, measuring social and demographic factors, mental health status, alcohol and substance use, nutrition history and anthropometry. Urine samples from children will be collected to measure ethyl glucuronide (EtG), a biological marker of alcohol intake. Further, facilitators, barriers and response mechanisms in the health system (SS2) and the school system (SS3) is explored with surveys and qualitative assessments. SS4 includes qualitative interviews with children. Analysis will apply descriptive statistics for the primary outcome of establishing the magnitude of alcohol drinking and substance use, and associated factors will be assessed using appropriate regression models. The substudies will be analysed independently, as well as inform each other through mixed methods strategies at the stages of design, analysis, and dissemination.

ETHICS AND DISSEMINATION

Data protection and ethical approvals have been obtained in Uganda and Norway, and referral procedures developed. Dissemination comprises peer-reviewed, open access research papers, policy recommendations and intersectoral dialogues.Trial registration numberClinicaltrials.gov 29.10.2020 (NCT04743024).

A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps

Children and adolescents' mental health risk and resilience arise from a complex interplay of factors on several socio-ecological levels. However, little is known about the factors that shape the mental health of refugee youth living in refugee camps close to ongoing conflict. We conducted a cross-sectional study with a representative sample of 217 Burundian refugee children aged 7-15 and their mothers residing in refugee camps in Tanzania to investigate associations between risk, protective and promotive factors from various ecological levels (individual, microsystem, exosystem), and children's post-traumatic stress disorder (PTSD) symptoms, internalizing and externalizing problems, and prosocial behavior. Data were collected using structured clinical interviews and analyzed using multiple regression models. Exposure to violence across all contexts and engagement coping were risk factors for PTSD symptoms and internalizing problems, while only violence by mothers seemed to increase children's vulnerability for externalizing problems. A differential impact of violence exposures on prosocial behavior was observed. Higher-quality friendships appeared to protect youth from PTSD symptoms and externalizing problems, while they also promoted children's prosocial behavior, just as mothers' social support networks. Prevention and intervention approaches should integrate risk, protective and promotive factors for refugee youth's mental health across multiple ecological contexts and take into account context-specific and adaptive responses to war and displacement.

Fuel to the fire: The escalating interplay of attachment and maltreatment in the transgenerational transmission of psychopathology in families living in refugee camps

Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent–child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.

Reducing violent discipline by teachers using Interaction Competencies with Children for Teachers (ICC-T): study protocol for a matched cluster randomized controlled trial in Tanzanian public primary schools

Background

Despite the existing national and international plans of action to end violent discipline strategies used by teachers in schools, they still prevail in Tanzanian schools. This underlines the need to implement school-based interventions that aim at reducing violent discipline by teachers. In this study, we will evaluate the feasibility and effectiveness of the preventative intervention Interaction Competencies with Children – for Teachers (ICC-T) in Tanzanian primary schools. Following its success in secondary schools, we hypothesize that the intervention will reduce teachers’ positive attitudes towards and their use of violent discipline at school.

Methods/design

The study will be conducted in six randomly selected regions in Tanzania. We have already randomly selected two schools in each region (12 in total) that fulfill our inclusion criteria. From each region, one school will be randomly assigned to the intervention and the other to the monitoring group (no intervention). Eighty students between the ages of 9 to 12 years (N = 960) and 20 teachers from each school (N = 240) will be included in the trial. We will collect data directly before the intervention (t1) and 6 months after the intervention (t2) both at intervention and monitoring schools. Using guided questionnaire assessments, we will measure violence by teachers using students’ reports on their exposure to and teachers’ reports on their use of violence using the Conflict Tactics Scale. Furthermore, we will assess teachers’ positive attitudes towards violent discipline using a modified version of the Conflict Tactic Scale. The feasibility of the intervention will be evaluated using purpose-built measures assessing the demand, applicability, acceptability, and integration of core elements into daily work in the participating schools.

Discussion

The proposed study will allow us to test the feasibility and effectiveness of an intervention aiming to reduce positive attitudes towards and the use of violent discipline by teachers in school settings. With the reduction of violent discipline by teachers, this study contributes to national and international efforts towards ending violence against children as well as the attainment of the United Nations’ Sustainable Development Goals that also aim to prevent all types of maltreatment of children.

Trial registration

ClinicalTrials.gov, NCT03893851. Registered on 28 March 2019.

Prevalence of family violence and mental health and their relation to peer victimization: A representative study of adolescent students in Southwestern Uganda

BACKGROUND

Despite global efforts to end violence against children in all settings, reports reveal that violence against children is still highly prevalent, especially in low-and middle- income countries. Violence in childhood is associated with a host of negative outcomes, and exposure in one setting can easily spill over to other contexts. For instance, exposure to family violence was not only related to mental health problems but also seems to be a risk factor for peer victimization.

OBJECTIVES

The present study aimed to examine the prevalence of maltreatment within the family and adolescents' mental health problems and their relation to peer victimization. We also aimed to gain new insights into the perceptions of adolescents concerning maltreatment within their families.

METHODS

Data were collected from April to November 2017 in a representative sample of 702 students from 12 public secondary schools in Southwestern Uganda who responded to self-administered questionnaires.

RESULTS

Overall, 95% of the students experienced at least one type of family violence in the past month. Students (81.3%) had endorsed some level of acceptance of violent discipline as a valid strategy in response to any misbehavior. Maltreatment within the family was related to peer victimization (β = .47) and this relation was mediated by mental health problems (0.002, 95%-CI: 0.001-0.004).

CONCLUSIONS

The results indicated a high prevalence of maltreatment within Ugandan families that was associated with peer victimization. This underscores the need to implement interventions aiming to reduce maltreatment and violence in order to protect children from potentially negative consequences.

Parenting and discipline in post-conflict Sierra Leone

BACKGROUND

While the literature on physical punishment concludes that it has negative effects on children, the practice remains common in many countries. In post-conflict countries with nongovernmental organizations (NGO) operating in child protection, traditional disciplinary practices may conflict with international child rights agendas. The country of Sierra Leone has a unique history of conflict, abject poverty, low literacy, and weak governance - often, NGO agents are responsible for providing social services that the government is unable to consistently provide.

OBJECTIVE

We examined how Sierra Leonean caregivers think about appropriate discipline for children, and whether they perceived any changes in their attitudes toward disciplinary practices since the end of the war.

PARTICIPANTS AND SETTING

We collected data from parents and caregivers in urban, peri-urban, and rural areas of Sierra Leone's four districts.

METHODS

We used focus groups (12 groups, n = 92) and individual interviews (n = 21) to collect data in 2013. Focus groups and interviews were conducted by research assistants fluent in Krio and English. We used a thematic content analysis approach.

RESULTS

We found that physical discipline-"beating"-was widely acceptable and common. A few parents mentioned other means of discipline, such as withholding food. Parents widely agreed that parenting had changed since the war, and reported that child rights movements supported by NGOs had made it more difficult to discipline their children in traditional ways.

CONCLUSIONS

Discipline was seen a central component of child-rearing and a means of ensuring safe and proper development. This may be a protective mechanism in the precarious, high poverty environment of post-war Sierra Leone. The negative responses of parents to NGO efforts to reduce physical punishment and other forms of child abuse suggest that grassroots approaches are needed to address this pervasive problem.

Stress and positive attitudes towards violent discipline are associated with school violence by Ugandan teachers

BACKGROUND

Globally, the use of violent discipline methods by teachers to manage child behavior is still highly prevalent despite enactment of laws that prohibit school violence. In the case of Uganda there is a dearth of accurate prevalence statistics on school violence and factors associated with the use of violence by teachers.

OBJECTIVES

Therefore, the current study examined the prevalence of and attitudes towards violence. The study also explored the association between teachers' stress, positive attitudes towards violence and the use of violent discipline management methods.

METHODS

A representative sample of 291 teachers and 702 students from 12 public secondary schools in southwestern Uganda responded to anonymous self-administered questionnaires. Data were collected from April to November 2017.

RESULTS

Findings indicated that 86.5% of the teachers reported having used violent disciplinary methods on students in the past month while 91.5% of the students reported experiencing violence by teachers. Teachers (88.3%, n = 256) endorsed positive attitudes towards violent discipline. Teachers' stress was related to higher levels of violent discipline (β = 0.20). This relation was mediated by positive attitudes towards violence (0.06, SE: 0.01, 95%-CI: 0.035-0.092).

CONCLUSIONS

Our findings indicate that teacher reported stress was associated with their use of violent behavior and positive attitudes and that positive attitudes reduced the association between teachers' stress and violent behavior. Therefore, interventions aiming to reduce violence by teachers may need to integrate effective stress management skills, in addition to nonviolent discipline strategies, and fostering attitudinal change towards the use of violent methods.

Reducing violence by teachers using the preventative intervention Interaction Competencies with Children for Teachers (ICC-T): A cluster randomized controlled trial at public secondary schools in Tanzania

The high global prevalence of school violence underlines the need for prevention. However, there are few scientifically evaluated intervention approaches that aim at preventing violence by teachers. We evaluated the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T). In a cluster randomized controlled trial we assessed attitudes towards and use of violence by teachers (self-reported and reported by students) at eight schools in four regions in Tanzania. Two regions were randomly assigned as intervention regions. Data were assessed in the months before and three months after intervention. In total, 158 teachers (58% females; age: 32.08 years, SD = 5.65) and 486 students (54% females; age: 15.61 years, SD = 0.89) participated in this study. The feasibility was very good: Participants' acceptance was high and they reported a good integration of the core elements in their working routine. The significantly stronger decrease in the use of emotional and physical violence reported both by teachers and students as well as the stronger decrease in positive attitudes of teachers towards physical and emotional violence in the intervention schools at follow-up provide initial evidence of the efficacy. However, further evidence for the sustainability of its effect is needed.

Reducing violence against children by implementing the preventative intervention Interaction Competencies with Children for Teachers (ICC-T): study protocol for a cluster randomized controlled trial in Southwestern Uganda

BACKGROUND

An adolescent's school is often the second most important place for his development and education after the home. However, reports highlight the recurrence of the use of violent discipline in schools. There are few school-based interventions that aim at reducing violence at school that have been implemented and evaluated in sub-Saharan Africa. To reduce violent disciplinary measures used at school, we aim to implement and evaluate the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T).

METHODS/DESIGN

The study will be conducted in six randomly selected districts of the Ankole region in southwestern Uganda. We shall randomly select two mixed-day secondary schools from each district that fulfill our inclusion criteria. Schools will be randomly assigned to the intervention condition, where ICC-T will be implemented, and control schools (no intervention). Sixty students between the ages of 12 and 17 years and at least 15 teachers per school will be included in the trial. We aim to collect pre-assessment data directly before the intervention (t1) and 3 months after the intervention (t2) in both intervention and control schools. Using self-administered questionnaires, we will measure students' exposure to violence using the Conflict Tactics Scale (CTS), their psychological well-being using the Strengths and Difficulties Questionnaire (SDQ), and teachers' positive attitudes towards violent disciplining and teachers' use of violent disciplinary methods (CTS). The implementation feasibility of ICC-T in the cultural context of southwestern Uganda will be assessed with purpose-built measures that follow the guidelines for feasibility studies assessing the demand, applicability, acceptability, and integration of core elements in the daily work.

DISCUSSION

The proposed study will allow us to test the feasibility and efficacy of a preventative intervention seeking to reduce violent disciplinary measures in school settings using a scientifically rigorous design. The proposed study provides the opportunity to contribute to the attainment of goal number 16.2 of the United Nations' Sustainable Development Agenda 2015-2030, which aspires to end all forms of violence against children.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03051854 . Registered on 14 February 2017.

Mental health problems and their association to violence and maltreatment in a nationally representative sample of Tanzanian secondary school students

PURPOSE

Little is known about the prevalence of mental health problems among adolescents in Sub-Saharan Africa. Research consistently determined violence and maltreatment to be important risk factors. In this study, we examined the prevalence of mental health problems among adolescents in Tanzania, as well as the association with exposure to violence and maltreatment.

METHODS

We administered a set of questionnaires (e.g., strength and difficulties questionnaire; conflict tactic scale) to a nationally representative sample of 700 Tanzanian secondary school children (52% girls; age 14.92 years, SD = 1.02) and 333 parents or primary caregivers (53% females; age 43.47 years, SD = 9.02).

RESULTS

41% of the students reported an elevated level of mental health problems (emotional problems 40%, peer problems 63%, conduct problems 45%, hyperactivity 17%) in the past 6 months. Concordantly, 31% of parents reported observing an elevated level of mental health problems in their children (emotional problems 37%, peer problems 54%, conduct problems 35%, hyperactivity 17%). After controlling for other risk factors, we found significant associations between physical violence by parents and adolescent's mental health problems reported by students (β = 0.15) and their parents (β = 0.33).

CONCLUSIONS

Our findings suggest a high prevalence of mental health problems using screening tools among secondary school students in Tanzania as well as an association between physical violence by parents and adolescents' mental health problems. Our findings emphasize the need to inform the population at large about the potentially adverse consequences associated with violence against children and adolescents.