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Assim A, Kaminer D, Hogarth L, Magner-Parsons B, Seedat S. Coping motives as a mediator of the relationship between child maltreatment and substance use problems in south African adolescents. CHILD ABUSE & NEGLECT 2024; 154:106885. [PMID: 38850749 DOI: 10.1016/j.chiabu.2024.106885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Evidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by 'coping motives': maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts. OBJECTIVE The present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents. PARTICIPANTS AND SETTING A sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey. METHODS Participants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems. RESULTS CM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives. CONCLUSIONS The findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.
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Affiliation(s)
- Ayesha Assim
- Department of Psychology, University of Cape Town, Private Bag X3, Rondebosch, 7701 Cape Town, South Africa
| | - Debra Kaminer
- Department of Psychology, University of Cape Town, Private Bag X3, Rondebosch, 7701 Cape Town, South Africa.
| | - Lee Hogarth
- School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter EX4 4QG, United Kingdom
| | - Bella Magner-Parsons
- School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter EX4 4QG, United Kingdom
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Faculty of Medicine and Health Sciences, 241, Cape Town, South Africa
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Ambrosio MDG, Lachman JM, Zinzer P, Gwebu H, Vyas S, Vallance I, Calderon F, Gardner F, Markle L, Stern D, Facciola C, Schley A, Danisa N, Brukwe K, Melendez-Torres GJ. A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial. JMIR Res Protoc 2024; 13:e52145. [PMID: 38700935 PMCID: PMC11102037 DOI: 10.2196/52145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programs are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programs within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation. OBJECTIVE This study aims to investigate the most effective and cost-effective combination of external components to optimize user engagement with ParentText, an open-source chatbot-led parenting intervention to prevent VAC in Mpumalanga, South Africa. METHODS This study will use a mixed methods design incorporating a 2 × 2 factorial cluster-randomized controlled trial and qualitative interviews. Parents of adolescent girls (32 clusters, 120 participants [60 parents and 60 girls aged 10 to 17 years] per cluster; N=3840 total participants) will be recruited from the Ehlanzeni and Nkangala districts of Mpumalanga. Clusters will be randomly assigned to receive 1 of the 4 engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pretest-posttest parent- and adolescent-reported surveys, facilitator-reported implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semistructured interviews and used to expand the interpretation and understanding of the quantitative findings. RESULTS Recruitment and data collection started in August 2023 and were finalized in November 2023. The total number of participants enrolled in the study is 1009, with 744 caregivers having completed onboarding to the chatbot-led intervention. Female participants represent 92.96% (938/1009) of the sample population, whereas male participants represent 7.03% (71/1009). The average participant age is 43 (SD 9) years. CONCLUSIONS The ParentText Optimisation Trial is the first study to rigorously test engagement with a chatbot-led parenting intervention in a low- or middle-income country. The results of this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomized controlled trial in 2024. TRIAL REGISTRATION Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/WFXNE. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52145.
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Affiliation(s)
| | - Jamie M Lachman
- University of Oxford, Oxford, United Kingdom
- Parenting for Lifelong Health, Oxford, United Kingdom
- University of Cape Town, Cape Town, South Africa
| | | | | | - Seema Vyas
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - Laurie Markle
- Parenting for Lifelong Health, Oxford, United Kingdom
| | - David Stern
- Innovations in Development, Education and the Mathematical Sciences International, Reading, United Kingdom
| | - Chiara Facciola
- Innovations in Development, Education and the Mathematical Sciences International, Reading, United Kingdom
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Cao X, Wang Z, Chen Y, Zhu J. Childhood maltreatment and resting-state network connectivity: The risk-buffering role of positive parenting. Dev Psychopathol 2024:1-12. [PMID: 38561986 DOI: 10.1017/s0954579424000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Unraveling the neurobiological foundations of childhood maltreatment is important due to the persistent associations with adverse mental health outcomes. However, the mechanisms through which abuse and neglect disturb resting-state network connectivity remain elusive. Moreover, it remains unclear if positive parenting can mitigate the negative impact of childhood maltreatment on network connectivity. We analyzed a cohort of 194 adolescents and young adults (aged 14-25, 47.42% female) from the Neuroscience in Psychiatry Network (NSPN) to investigate the impact of childhood abuse and neglect on resting-state network connectivity. Specifically, we examined the SAN, DMN, FPN, DAN, and VAN over time. We also explored the moderating role of positive parenting. The results showed that childhood abuse was linked to stronger connectivity within the SAN and VAN, as well as between the DMN-DAN, DMN-VAN, DMN-SAN, SAN-DAN, FPN-DAN, SAN-VAN, and VAN-DAN networks about 18 months later. Positive parenting during childhood buffered the negative impact of childhood abuse on network connectivity. To our knowledge, this is the first study to demonstrate the protective effect of positive parenting on network connectivity following childhood abuse. These findings not only highlight the importance of positive parenting but also lead to a better understanding of the neurobiology and resilience mechanisms of childhood maltreatment.
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Affiliation(s)
- Xinyu Cao
- Center for Early Environment and Brain Development, School of Education, Guangzhou University, Guangzhou, China
- Center for Cognition and Brain Disorders of Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
| | - Zhengxinyue Wang
- Center for Early Environment and Brain Development, School of Education, Guangzhou University, Guangzhou, China
- Center for Cognition and Brain Disorders of Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
| | - Yuanyuan Chen
- Center for Early Environment and Brain Development, School of Education, Guangzhou University, Guangzhou, China
- Department of Psychology, Guangzhou University; Guangzhou, China
| | - Jianjun Zhu
- Center for Early Environment and Brain Development, School of Education, Guangzhou University, Guangzhou, China
- Department of Psychology, Guangzhou University; Guangzhou, China
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Franchino-Olsen H, Orkin M, Meinck F. Toward a Contextually Sensitive Understanding of Polyvictimization: A Latent Class Analysis of Violence, Risks, and Protections Among South African Adolescents From Highly Deprived Settings. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241233273. [PMID: 38407004 DOI: 10.1177/08862605241233273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
South African adolescents experience a high prevalence of violence victimization alongside the health and economic burdens of HIV/AIDS and poverty. Polyvictimization is a useful theory and framework that allows for a nuanced understanding of lived adolescent experience patterns. Polyvictimization examinations are further enriched by person-centered analytical approaches. This study used latent class analysis to differentiate a sample of South African adolescents from highly deprived communities by their polyvictimization profiles and contextual violence risk and protective factors. Adolescents were sampled twice (2010/2011; 2011/2012), and data reflected their lifetime (sexual abuse) or recent (all other forms of assessed abuse/violence) violence victimizations, as well as individual, household, and community characteristics. Model fit indices supported a seven-class model with adolescents in high, moderate, and low polyvictimization classes. Adolescents in the high polyvictimization classes experienced a heavy burden of poverty and multiple forms of violence across contexts and were distinguished by HIV/AIDS and disability. Adolescents in the low polyvictimization class experienced relatively little violence, despite living in violent communities, and low household and individual burdens of HIV/AIDS and disability. Findings emphasize the importance of considering adolescent violence through a contextually sensitive polyvictimization lens to understand the complex web of violence that adolescents experience. This work supports previous research in low-resource South African settings highlighting the interconnected nature of violence, poverty, disability, and HIV/AIDS. Future research should explore these complex violence patterns and their effects, while program and policy actions must target and prevent adolescent violence especially for those impacted by poverty, disability, and HIV/AIDS.
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Affiliation(s)
| | - Mark Orkin
- University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Franziska Meinck
- University of Edinburgh, UK
- University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- North-West University, Vanderbijlpark, South Africa
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5
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Mihret AM, Heinrichs N. Intergenerational effects of child maltreatment on adolescents' anxiety and depression in Ethiopia: the important mediating and moderating roles of current psychological distress. BMC Psychiatry 2024; 24:126. [PMID: 38360563 PMCID: PMC10870629 DOI: 10.1186/s12888-024-05586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Child abuse is widespread around the world, and one continent with particularly high rates is Africa. Research in high- and middle-income countries shows the cascading effect of parental history of child abuse and neglect on adolescents' maltreatment and, in turn, on mental health problems. This cascade has been reported in young children but has rarely been studied in parent-adolescent dyads or in low-income countries (LICs). The goal of this study was to test intergenerational associations of child abuse and neglect and to examine how these experiences are in turn associated with youth anxiety and depression in an LIC. METHODS A total of 231 adolescents (age: 13-21 years) and 185 of their parents (n = 90 fathers and n = 95 mothers) were recruited from secondary schools in Addis Abeba, Ethiopia. Using a cross-sectional design, participants completed a set of questionnaires assessing child maltreatment (in adolescence and own past history in parents), parental psychological distress, youth depression and anxiety, and sociodemographic factors. RESULTS The frequencies of child maltreatment exposure were 68% for adolescents and 65% for their parents (when they were a child). Fifty-one percent and 42% of adolescents had borderline to clinical levels of anxiety and depression symptoms, respectively. Adolescents of parents with a history of child abuse and neglect also reported higher exposure to maltreatment themselves (p < 0.001). Current paternal, but not maternal, psychological distress mediated this intergenerational association of maltreatment experiences (95% CI [1.164, 9.467]). We further found parents' psychological distress to be a significant moderator of the indirect pathways of the intergenerational effect of child maltreatment on adolescents' anxiety and depression (95% CI [- 0.770, - 0.012]). CONCLUSIONS We found child maltreatment to be intergenerationally associated, and this effect subsequently affected adolescents' anxiety and depression through different pathways supporting the cascading effects across generations. Intervention plans may be effective through an array of possible indirect pathways and encourage the implementation of multiple access points to facilitate change in the lives of affected youth in Africa.
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Affiliation(s)
- Amare Misganaw Mihret
- Clinical Psychology and Psychotherapy, Universität Bremen, Grazer Straße 6, 28359, Bremen, Germany.
- Department of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Bielefeld University Universität Bielefeld, Universität Straße 25, 33615, Bielefeld, Germany.
| | - Nina Heinrichs
- Clinical Psychology and Psychotherapy, Universität Bremen, Grazer Straße 6, 28359, Bremen, Germany
- Department of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Bielefeld University Universität Bielefeld, Universität Straße 25, 33615, Bielefeld, Germany
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Woollett N, Christofides N, Franchino-Olsen H, Silima M, Fouche A, Meinck F. "Children Are Like Vuvuzelas Always Ready to Blow": Exploring How to Engage Young Children in Violence Research. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241230088. [PMID: 38334107 DOI: 10.1177/08862605241230088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Children's participation and inclusion in violence research, particularly in low- and middle-income country (LMIC) contexts, is scant and not well understood. To assess how young children can be engaged in violence research, 4- to 7-year-old children were recruited into our pilot study in a rural area of South Africa. Six interviewers, recruited from the community, were trained to complete cognitive interviews (n = 24), interviewer-administered questionnaires (n = 21), and qualitative interviews (n = 18) with young children. Three focus group discussions (FGDs) were conducted with interviewers. Findings from FGDs and assessment of interview performance highlighted that young children could feasibly and meaningfully appraise violence they experience and articulate their view in a research context. Art- and play-based approaches offered participants an easier and developmentally appropriate platform for communication, expression, and engagement, and asking directly about violence was acceptable. The ease with which children participated was determined both by their level of development and the sensitivity of the interviewers; thus, intensive training and mentorship were required over time to assist interviewers in understanding child development and mental health and increase recognition of these issues and their presentation. Interviewers critically engaged with personal values regarding children's rights and voice in research, reflecting that some of the stories were difficult to listen to. They were able to use and value novel methods to facilitate the ethical involvement of young children to yield rich data. Without young children's involvement and dynamic participation in violence research, the field will not have the evidence to build best practices, respond appropriately to the needs of this vulnerable population, and interrupt the intergenerational transmission of violence that develops in these formative years. Our study adds to the burgeoning evidence that young participants are vital to the research process and are valuable active contributors to understanding violence in LMICs.
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Affiliation(s)
- Nataly Woollett
- University of the Witwatersrand, Johannesburg, South Africa
- University of Johannesburg, Johannesburg, South Africa
| | | | | | - Mpho Silima
- University of the Witwatersrand, Johannesburg, South Africa
| | - Ansie Fouche
- North-West University, Vanderbijlpark, South Africa
- United Arab Emirates University, A1 Ain, UAE
| | - Franziska Meinck
- University of the Witwatersrand, Johannesburg, South Africa
- University of Edinburgh, Scotland, UK
- North-West University, Vanderbijlpark, South Africa
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Dietrich JJ, Hornschuh S, Madi P, Ramsammy CW, Tsotetsi L, Tshabalala G, Nkala-Dlamini B, Violari A, Kidman R. Implementing ecological momentary assessments to measure violence and adolescent HIV transmission risk: Lessons from Johannesburg, South Africa. PLOS DIGITAL HEALTH 2024; 3:e0000283. [PMID: 38306387 PMCID: PMC10836659 DOI: 10.1371/journal.pdig.0000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/04/2023] [Indexed: 02/04/2024]
Abstract
Ecological Momentary Assessment (EMA) is an important methodology to understand risky behaviour and holds promise for HIV research. EMA is still novel in sub-Saharan Africa. We describe challenges and lessons learned on a novel study implementing mobile phone EMAs with adolescent boys in South Africa. The Tsamaisano study was a longitudinal study from 2020-2023 to recruit adolescent boys aged 15-19 years; including those without HIV and those perinatally infected and living with HIV. Participants were prompted to complete 52 weekly mobile phone survey on emotional state, exposure to and perpetration of violence, and sexual risk behaviour. Surveys were delivered using a random algorithm to choose the day. We incorporated mechanisms to assess challenges and optimize survey completion: weekly team meetings with youth representation and real-time data monitoring. Additionally, 20 frequent vs infrequent survey submitters participated in qualitative interviews about barriers and recommendations. Real-time monitoring indicated low (defined as <50%) survey completion in the first months of study implementation. To ensure that both the adolescent participant and their caregiver understood the commitment required for successful EMA, we created and implemented a guided discussion around mobile phone access during the enrolment visit. We identified a need for increased and ongoing technical support; addressed by creating technical guides, implementing a standard two-week check-in call after enrolment, adding an automated request button for call-back assistance, creating a WhatsApp messaging stream, and reaching out to all participants failing to submit two sequential surveys. Entry-level smartphones, including those initially distributed by the study, did not have capacity for certain updates and had to be replaced with more expensive models. Participants struggled with randomly allocated survey days; completion improved with set completion days and targeted reminder messages. Together, these steps improved survey completion from 40% in December 2020 to 65% in April 2022. We describe key lessons learned to inform future study designs with mobile phone EMAs, drawing on our experience implementing such among adolescent boys, including persons living with HIV, in a low-and-middle income setting. The key lessons learned through the Tsamaisano study are important to inform future study designs with EMA utilizing mobile phone, electronic data collection among adolescent boys in low-and-middle-income settings.
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Affiliation(s)
- Janan Janine Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), a division of the Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Phumla Madi
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice W. Ramsammy
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lerato Tsotetsi
- African Social Sciences Unit of Research and Evaluation (ASSURE), a division of the Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Gugulethu Tshabalala
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busisiwe Nkala-Dlamini
- Department of Social Work, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Kidman
- Program in Public Health, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Department of Family, Population and Preventive Medicine, State University of New York at Stony Brook, Stony Brook, New York, United States of America
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Edwards KM, Kumar M, Waterman EA, Mullet N, Madeghe B, Musindo O. Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:593-612. [PMID: 36964686 DOI: 10.1177/15248380231160742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Violence against children-which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence-continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent-child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.
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Naidoo L, Rasool S, Van Hout MC. Non-offending caregivers reflections on the use of a film encompassing child sexual abuse perpetrator's testimonies for potential child protection initiatives in South Africa. CHILD ABUSE & NEGLECT 2023; 146:106485. [PMID: 37844457 DOI: 10.1016/j.chiabu.2023.106485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Child sexual abuse (CSA) remains a challenge in South Africa, despite various legislative developments to address child abuse. Despite non-offending caregivers (NOC) playing a critical role in child safeguarding, and supporting disclosure and recovery, very little research has focused on understanding what works in assisting them in supporting child victims in South Africa. OBJECTIVES The study examines the exposure of NOC who watched a short film based on the testimonies of four CSA perpetrators in therapy, with a view to exploring whether this film could be useful for CSA prevention, disclosure and support initiatives. PARTICIPANTS AND SETTING A convenience sample of eight NOC attending a community support service in KwaZulu-Natal, South Africa. METHODS After viewing the film, the NOC completed a questionnaire, and were asked to discuss usefulness of film content based on perpetrator testimonials in sensitizing NOC around disclosure of sexual abuse and support of the child. Thematic data analysis combined their perceptions of sexual abuse experienced by their children/grandchildren and the effect that content of the film had on their perceptions. RESULTS Five themes emerged; Awareness of CSA and available child protection programs; Views toward CSA disclosure; Emotive responses; Lessons learnt for identification of CSA and child protection; and Recommendations for future programs. CONCLUSIONS The process of viewing and discussing the film stimulated a shift for NOC to identify risk, facilitate disclosure of CSA, and become more supportive toward child victims. The study highlights the potential of using film to guide NOC targeted child protection and safeguarding initiatives.
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Affiliation(s)
- Linda Naidoo
- School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Shahana Rasool
- Department of Social Work, University of Johannesburg, South Africa.
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Hartmann M, Giovenco D, Zeebari Z, Itzikowitz G, Ekström AM, Nielsen A, Pettifor A, Bekker LG, Kågesten AE. Associations between psychosocial wellbeing and experience of gender-based violence at community, household, and intimate-partner levels among a cross-sectional cohort of young people living with and without HIV during COVID-19 in Cape Town, South Africa. BMC Public Health 2023; 23:2115. [PMID: 37891509 PMCID: PMC10612288 DOI: 10.1186/s12889-023-16945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Growing evidence indicates that gender-based violence (GBV) increased during COVID-19. We investigated self-reported impact of the pandemic on GBV at community, household and intimate partner (IPV) levels among young people and its associations with psychosocial wellbeing, i.e., COVID-related stressors and mental health. METHODS Cross-sectional data were drawn from a survey with young people ages 13-24 (N = 536) living with HIV (YPLWH) and without HIV (YPLWoH), in peri-urban Cape Town, South Africa. The survey, conducted February-October 2021, examined the impact of the initial lockdown on experience and perceived changes in GBV at each level, and pandemic-related psychosocial wellbeing. Descriptive statistics and binomial and multinomial regression analyses were conducted to illustrate exposure and perceived changes in GBV since lockdown, and their association with COVID-related stress factors (e.g., social isolation, anxiety about COVID), mental health (e.g., depression, anxiety), and other risk factors (e.g., age, gender, socioeconomic status) by HIV status. RESULTS Participants were 70% women with mean age 19 years; 40% were living with HIV. Since lockdown, YPLWoH were significantly more likely than YPLWH to perceive community violence as increasing (45% vs. 28%, p < 0.001), and to report household violence (37% vs. 23%, p = 0.006) and perceive it as increasing (56% vs. 27%, p = 0.002) (ref: decreasing violence). YPLWoH were also more likely to report IPV experience (19% vs. 15%, p = 0.41) and perception of IPV increasing (15% vs. 8%, p = 0.92). In adjusted models, COVID-related stressors and common mental health disorders were only associated with household violence. However, indicators of economic status such as living in informal housing (RRR = 2.07; 95% CI = 1.12-3.83) and food insecurity (Community violence: RRR = 1.79; 95% CI = 1.00-3.20; Household violence: RRR = 1.72; 95% CI = 1.15-2.60) emerged as significant risk factors for exposure to increased GBV particularly among YPLWoH. CONCLUSIONS Findings suggest that for young people in this setting, GBV at community and household levels was more prevalent during COVID-19 compared to IPV, especially for YPLWoH. While we found limited associations between COVID-related stressors and GBV, the perceived increases in GBV since lockdown in a setting where GBV is endemic, and the association of household violence with mental health, is a concern for future pandemic responses and should be longitudinally assessed.
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Affiliation(s)
- Miriam Hartmann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Women's Global Health Imperative, RTI International, Berkely, CA, USA.
| | - Danielle Giovenco
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Zangin Zeebari
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
| | - Gina Itzikowitz
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital, Stockholm, Sweden
| | - Anna Nielsen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Ouma S, Abbo C, Natala N, McCoy M, Kroupina M. Victimization among adolescents of female sex workers: findings from the children of at-risk parents (CARP) study in Uganda. BMC Pediatr 2023; 23:311. [PMID: 37340336 DOI: 10.1186/s12887-023-04131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/14/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Female sex workers (FSWs) live and work in high-risk environments, experience high levels of adversity, and have multigenerational trauma that can negatively affect their children. Yet not much is known about the prevalence of victimization (i.e., exposure to maltreatment and trauma) among children of FSWs. This study compared the prevalence of lifetime victimization among adolescents of FSWs and adolescents of non-FSWs in Gulu City, Northern Uganda. METHODS A comparative cross-sectional study was conducted among adolescents (10-17 years) enrolled in the Children of At-Risk Parents (CARP) study. This study included 147 adolescents of FSWs and 147 adolescents of non-FSWs selected for comparison in Gulu City, Northern Uganda. The adolescents of FSWs were identified through their mothers using respondent-driven sampling. Data on the residence of FSWs guided a proportionate stratified sampling of adolescents of non-FSWs. Using the Juvenile Victimization Questionnaire, we screened for 34 different types of victimization during participants' lifetimes. Percentage point differences within groups of adolescents and comparison between adolescents of FSWs and non-FSWs were calculated using STATA version 14.1. Statistical significance was set to p < 0.05. RESULTS 99.3% of the participants experienced at least one form of lifetime victimization. The median number of lifetime victimizations was 12.4. Overall, lifetime victimization was higher among adolescents of FSWs than non-FSWs (13.4 vs. 11.5), male vs. female adolescents (13.4 vs. 11.9), and older [14-17 years] vs. younger (10-13 years) adolescents (14.0 vs. 11.7). Further, more adolescents of FSWs experienced lifetime victimization in the following domains and subdomains, all of which were statistically significant: kidnap (15.8% vs. 4.8%), emotional abuse (65.8% vs. 50.0%), emotional neglect (37.4% vs. 21.1%), physical intimidation (10.2% vs. 4.1%), relational aggression (36.4% vs. 18.4%), verbal aggression (68.7% vs. 46.9%), sexual victimization (31.3% vs. 17.7%), verbal sexual harassment (20.4% vs. 5.4%), exposure to murder scene (42.9% vs. 26.5%), witness to domestic violence (39.5% vs. 26.5%), and witness to the murder of relatives (31.3% vs. 21.1%). Conversely, more adolescents of non-FSWs experienced caregiver victimization than the adolescents of FSWs (98.0 vs. 92.5; p < 0.05). CONCLUSIONS Childhood victimization is highly prevalent in Northern Uganda and disproportionately affects the adolescents of FSWs. Therefore, government and development partners should urgently develop policies and interventions targeting prevention, early detection, and timely management of victimization in this vulnerable population.
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Affiliation(s)
- Simple Ouma
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
- Department of Research, The AIDS Support Organization (TASO), Kampala, Uganda.
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nakita Natala
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minnesota, USA
| | - Molly McCoy
- Department of Pediatrics, University of Minnesota, Minnesota, USA
| | - Maria Kroupina
- Department of Pediatrics, University of Minnesota, Minnesota, USA
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Nyandwi A, Munyanshongore C, Nyirazinyoye L, Ndola P, Perren-Klingler G. Correlates of emotional violence against children in Rwanda: Findings from a cross-sectional national survey. PLoS One 2023; 18:e0286788. [PMID: 37310951 DOI: 10.1371/journal.pone.0286788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 05/06/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION National data on children affected by violence are critical in preventing violence against children. Rwanda conducted its first cross-sectional national survey on violence against children in 2015. This study used data from the Rwanda Survey to describe the profile of children affected by emotional violence (EV) and to assess factors associated with it in Rwanda. METHODS A sample of 1,110 children (618 boys and 492 girls) aged 13-17 from the Rwanda Survey was analysed. Weighted descriptive statistics were applied to describe the prevalence of EV and the profile of children affected by it. In addition, factors associated with EV were investigated using logistic regression. RESULTS Male children were more likely to experience EV than female children. Nine percent (8.87%, 95% CI [6.95-11.25]) of male children versus five percent (5.17%, 95% CI [3.79-7.03]) of female children reported having experienced EV in their lifetime. Seven percent (6.77%, 95% CI [5.15-8.84]) of male children versus four percent of female children (3.97%, 95% CI [2.83-5.54]) reported having experienced EV in the last twelve months before the survey. Fathers and mothers were the top two perpetrators of EV against children. Seventeen percent of male children (17.09%, 95% CI [11.06-25.47]) and 12 percent of female children (11.89%, 95% CI [6.97,19.55]) reported EV by their fathers. Mothers were responsible for nineteen percent (19.25%, 95% CI [12.94-27.65]) of EV reported by male children and eleven percent (10.78%, 95% CI [5.77-19.25]) of EV reported by female children. Female children (OR = 0.48, 95% CI [0.31-0.76]) and children with some trust in people from their communities (OR = 0.47, 95% CI [0.23-0.93]) were less likely to report EV. Factors associated with risk for EV were not attending school (OR = 1.80, 95% CI [1.10-2.92]), living with father only (OR = 2.96, 95% CI [1.21-7.85]), not feeling close to biological parents (OR = 7.18, 95% CI [2.12-24.37]), living in a larger household (OR = 1.81, 95% CI [1.03-3.19]), not having a friend (OR = 2.08, 95% CI [1.02-4.11]), and not feeling safe in the community (OR = 2.56, 95% CI [1.03-6.38]). CONCLUSION EV against children was pervasive in Rwanda, with parents topping the list of its perpetrators. Children from unsupportive socioeconomic family environments, i.e., children without a close relationship with biological parents, children not attending school, children living with their fathers only, children from larger households of five people and more, children without a friend, and children who reported not feeling safe in their communities, were identified as groups of children vulnerable to emotional violence in Rwanda. A family-centred approach, focusing on positive parenting and protecting vulnerable children, is needed to reduce emotional violence against children and the risk factors associated with it in Rwanda.
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Affiliation(s)
| | | | | | - Prata Ndola
- School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
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13
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Kurtz M, Kawka H, Horstick O, Brenner S, Deckert A, Louis VR, Winkler V, Lowery Wilson M, Bärnighausen T, Dambach P. The prevalence of emotional abuse in children living in Sub-Saharan Africa - A systematic review. CHILD ABUSE & NEGLECT 2023; 140:106155. [PMID: 37004459 DOI: 10.1016/j.chiabu.2023.106155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 05/06/2023]
Abstract
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.
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Affiliation(s)
- M Kurtz
- University Heidelberg, Germany.
| | - H Kawka
- University Heidelberg, Germany
| | - O Horstick
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - S Brenner
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - A Deckert
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - V R Louis
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - V Winkler
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - M Lowery Wilson
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - T Bärnighausen
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - P Dambach
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
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Kutywayo A, Frade S, Chidumwa G, Mahuma T, Naidoo NP, Mullick S. Experiences of violence among female and male grade eight learners: baseline findings from the Girls Achieve Power (GAP Year) trial across three South African townships. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.13276.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Background: South African adolescents experience disproportionally high rates of violence, with lifelong health, social and economic impacts. Few papers present risk factors associated with experiences of adolescent violence. Methods: A baseline cross-sectional survey was done (April 2017 – Sept 2018) with 3432 grade 8 learners in the Girls Achieve Power (GAP Year) trial from 26 high schools in three townships (Soweto and Tembisa, Gauteng and Khayelitsha, Western Cape). Collected data on lifetime experiences of different types of violence, perpetrators, and place of violence. Descriptive statistics and logistic regression were used to enumerate experiences of, and factors associated with violence. Results: A total of 2383 respondents are included. Most (63.1%) were girls, 81.5% aged 12-14. In total 25.9% had ever experienced violence, higher among boys (p=<0.001). Physical violence was most common (35.7%), then psychological (21.8%), sexual (13.1%), neglect (10.6%), cyberbullying (7.6%), corporal punishment (6.5%) and economic abuse (4.8%). Boys experienced more physical violence (36.0%); girls experienced more psychological violence (22.2%). Gauteng had double the reports of sexual violence (18.4% vs 7.6%, p<0.001). Violence happened most at school (27.4%), followed by the park (19.8%) or their friends’ home (12.9%). Multivariate analysis showed that boys (aOR 1.68; 95% CV 1.32-2.14; p<0.001), those aged 15-17 years (aOR 1.41; 95% CV 1.04-1.89; p=0.025), those who ever used substances (aOR 1.90; 95% CI 1.9-2.28; p<0.001), and those who sometimes feel worthless (aOR 1.33; 95% CI 1.09-1.63, p=0.005) were at higher odds of ever experiencing violence. Those who had ever had sex were more likely to have ever experienced violence (aOR 1.42; 95% CI 1.10-1.83; p=0.008). Conclusion: Urgently need wider adoption, scaling, and sustaining of evidence-based primary violence prevention and structural interventions are required to reduce the high burden of adolescent violence. Stakeholders across the ecological model are needed to tackle harmful cultural norms that perpetuate violence.
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Meinck F, Woollett N, Franchino-Olsen H, Silima M, Thurston C, Fouché A, Monaisa K, Christofides N. Interrupting the intergenerational cycle of violence: protocol for a three-generational longitudinal mixed-methods study in South Africa (INTERRUPT_VIOLENCE). BMC Public Health 2023; 23:395. [PMID: 36849941 PMCID: PMC9969039 DOI: 10.1186/s12889-023-15168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/31/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Violence is a global social and human rights issue with serious public health implications across the life-course. Interpersonal violence is transmitted across generations and there is an urgent need to understand the mechanisms of this transmission to identify and inform interventions and policies for prevention and response. We lack an evidence-base for understanding the underlying mechanisms of the intra- and intergenerational transmission of violence as well as potential for intervention, particularly in regions with high rates of interpersonal violence such as sub-Saharan Africa. The study has three aims: 1) to identify mechanisms of violence transmission across generations and by gender through quantitative and qualitative methods; 2) to examine the effect of multiple violence experience on health outcomes, victimisation and perpetration; 3) to investigate the effect of structural risk factors on violence transmission; and 4) to examine protective interventions and policies to reduce violence and improve health outcomes. METHODS INTERRUPT_VIOLENCE is a mixed-methods three-generational longitudinal study. It builds on a two-wave existing cohort study of 1665 adolescents in South Africa interviewed in 2010/11 and 2011/12. For wave three and possible future waves, the original participants (now young adults), their oldest child (aged 6+), and their former primary caregiver will be recruited. Quantitative surveys will be carried out followed by qualitative in-depth interviews with a subset of 30 survey families. Adults will provide informed consent, while children will be invited to assent following adult consent for child participation. Stringent distress and referral protocols will be in place for the study. Triangulation will be used to deepen interpretation of findings. Qualitative data will be analysed thematically, quantitative data using advanced longitudinal modelling. Ethical approval was granted by the University of Edinburgh, University of the Witwatersrand, North-West University, and the Provincial Department of Health Mpumalanga. Results will be published in peer-reviewed journals, policy briefs, and at scientific meetings. DISCUSSION The proposed study represents a major scientific advance in understanding the transmission and prevention of violence and associated health outcomes and will impact a critically important societal and public health challenge of our time.
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Affiliation(s)
- Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD, UK. .,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. .,OPTENTIA, North-West University, Vanderbijlpark, South Africa.
| | - Nataly Woollett
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Visual Arts, University of Johannesburg, Johannesburg, South Africa
| | - Hannabeth Franchino-Olsen
- School of Social and Political Sciences, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD, UK
| | - Mpho Silima
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Thurston
- School of Social and Political Sciences, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD, UK
| | - Ansie Fouché
- Department of Social Wellbeing, United Arab Emirates University, Al Ain, UAE.,Compres, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Kopano Monaisa
- OPTENTIA, North-West University, Vanderbijlpark, South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Velloza J, Davies LD, Ensminger AL, Theofelus FM, Andjamba H, Kamuingona R, Masseti G, Coomer R, Forster N, O’Malley G. Cycles of Violence Among Young Women in Namibia: Exploring the Links Between Childhood Violence and Adult Intimate Partner Violence From the Violence Against Children and Youth Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22992-NP23014. [PMID: 35156448 PMCID: PMC9661872 DOI: 10.1177/08862605211073107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Violence against children is a global public health crisis and is associated with poor mental and physical health outcomes. Childhood violence may also increase the risk of subsequent violence revictimization by an intimate partner. We aimed to understand cycles of violence among adolescent girls and young women in Namibia to inform violence prevention and treatment interventions. Methods: The 2019 Namibia Violence Against Children and Youth Survey (VACS) examined the prevalence of childhood violence and intimate partner violence among 18-24 year old adolescent girls and young women (N = 2434). Using the data, we assessed the prevalence of childhood violence, defined as any physical, sexual, or emotional violence victimization prior to age 18, and estimated the prevalence of intimate partner violence (IPV) after age 18. We used a weighted logistic regression to assess whether childhood violence exposure was associated with subsequent experience of IPV after age 18. Results: Adolescent girls and young women in Namibia had a statistically significant higher odds of experiencing IPV if they had experienced any childhood violence including physical, sexual, and/or emotional violence (adjusted odds ratio [aOR]: 2.93; 95% Confidence Interval [95% CI: 1.64-5.23). IPV was also significantly associated with childhood physical (aOR: 1.81; 95% CI: 1.07-3.05), sexual (aOR: 3.79; 95% CI: 2.54-5.67), or emotional (aOR: 2.39; 95% CI: 1.18-4.86) violence when each were considered separately. We also observed a dose-response relationship between the number of types of childhood violence and IPV experience as a young adult. Conclusions: Childhood violence is a significant predictor of subsequent violence revictimization by an intimate partner. This analysis provides unique insights on cycles of violence among adolescent girls and young women in Namibia and points to the need for interventions during childhood to prevent violence against children and break this cycle among young women in sub-Saharan Africa.
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Affiliation(s)
- Jennifer Velloza
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Luke D. Davies
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Alison L. Ensminger
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | | | - Helena Andjamba
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Rahimisa Kamuingona
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Greta Masseti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Norbert Forster
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
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Nguyen KA, Kengne AP, Abrahams N, Jewkes R, Mhlongo S, Peer N. Associations of childhood maltreatment with hypertension in South African women: a cross-sectional study. BMJ Open 2022; 12:e057436. [PMID: 36123062 PMCID: PMC9486236 DOI: 10.1136/bmjopen-2021-057436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the associations of childhood maltreatment (CM) with hypertension, and the mediating effects of hypertension risk factors on the associations in South African women, using baseline data of the Rape Impact Cohort Evaluation longitudinal study. DESIGN Cross-sectional SETTING AND PARTICIPANTS: Self-reported data on CM exposure and its severity in 18-40-year-old women living in KwaZulu-Natal province were assessed. Logistic regression models, adjusted for traditional hypertension risk factors, rape exposure, HIV-infection, other traumatic exposures, depression scores and acute stress reactions (ASR) scores were used to examine the CM-hypertension associations. RESULTS Among 1797 women, 220 (12.2%) had hypertension; CM prevalence was higher in women with hypertension than without hypertension overall (70.9% vs 57.2%) and for each abuse type: sexual abuse (20.9% vs 12.4%), physical abuse (51.8% vs 41.5%), emotional abuse (40% vs 27.6%) and parental neglect (35% vs 25.7%). Exposures to 1-2 types and 3-4 types of CM were 46.4% and 24.5%, respectively, in women with hypertension, and lower in women without (42.9% and 14.3%, respectively). Exposures to any CM (adjusted OR: 1.62; 95% CI: 1.19 to 2.25), sexual abuse (1.64; 95% CI: 1.12 to 2.37), emotional abuse (1.57; 95% CI: 1.16 to 2.13), physical abuse (1.43; 95% CI: 1.07 to 1.92) and parental neglect (1.37; 95% CI: 1.00 to 1.86) were associated with hypertension. Exposures to an increasing number of abuse types and cumulative severity of CM overall (1.13; 95% CI: 1.05 to 1.21) and for each CM type were associated with increased odds of hypertension. Alcohol use, other trauma experienced, depression and ASR partially mediated these associations. CONCLUSION CM was associated with hypertension; the effects were greater with multiple abuse types and severe abuse, and were partially mediated by alcohol use, depression, ASR and other traumatic exposures. While CM must be prevented, effective mental health interventions to curb the uptake of unhealthy behaviours and the development of hypertension in women exposed to CM are key.
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Affiliation(s)
- Kim Anh Nguyen
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa
- Department of Medicine, University of Cape Town, Observatory, Western Cape, South Africa
| | - Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Cape Town, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa
- Department of Medicine, University of Cape Town, Observatory, Western Cape, South Africa
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Longitudinal consistency of self-reports of adverse childhood experiences among adolescents in a low-income setting. SSM Popul Health 2022; 19:101205. [PMID: 36091299 PMCID: PMC9449854 DOI: 10.1016/j.ssmph.2022.101205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
A sizeable literature documents the associations between adverse childhood experiences (ACEs) and poor health in later life. By and large, ACEs are measured using retrospective self-reports. Little is known about the longitudinal consistency of these self-reports in panel data with multiple measurements. This is especially true in adolescence, as most studies using ACEs self-reports have been conducted among adults. Furthermore, very few studies have explored the consistency of ACEs self-reports in low- and middle-income countries, where the reported prevalence of ACEs tends to be higher than in high-income countries. Addressing these gaps, the current study examines the consistency of ACEs self-reports among a cohort of adolescents (N = 1,878, age 10 to 16 at survey baseline) in rural Malawi. We use data from two waves of the ACE project of the Malawi Longitudinal Study of Families and Health carried out in 2017-18 and 2021. In addition to the high prevalence of self-reported ACEs among adolescents in our sample, we document very low consistency of self-reports over time (average Kappa coefficient of 0.11). This low consistency is attributable not only to adolescents reporting more ACEs over time, which could be due to new exposures, but also to adolescents reporting fewer ACEs over time. Analyses of survey vignettes indicate that individual and sociocultural perceptions of abuse do not explain this low consistency. We find that external events (such as changes in socioeconomic status and negative economic shocks) and internal psychological states (such as depression and post-traumatic stress disorder) both predict inconsistencies in ACEs self-reports. Compared with results from prior studies, our findings indicate that the longitudinal consistency of ACEs self-reports may be lower in adolescence than in adulthood. Taken together, these findings suggest that ACEs self-reports provided by adults may be biased by key processes unfolding in adolescence. Very low consistency of ACEs self-reports in a cohort of adolescents. Individual and sociocultural perceptions of abuse do not explain low consistency. Psychological states such as depression and PTSD predict inconsistent self-reports. Consistency of ACEs self-reports may be lower in adolescence than in adulthood.
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Kutywayo A, Frade S, Mahuma T, Naidoo NP, Mullick S. Experiences of violence among female and male grade eight learners: baseline findings from the Girls Achieve Power (GAP Year) trial across three South African townships. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13276.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: South African adolescents experience disproportionally high rates of violence, with lifelong health, social and economic impacts. Few papers present risk factors associated with experiences of adolescent violence. Methods: A baseline cross-sectional survey was done (April 2017 – Sept 2018) with 3432 grade 8 learners in the Girls Achieve Power (GAP Year) trial from 26 high schools in three townships (Soweto and Tembisa, Gauteng and Khayelitsha, Western Cape). Collected data on lifetime experiences of different types of violence, perpetrators, and place of violence. Descriptive statistics and logistic regression were used to enumerate experiences of, and factors associated with violence. Results: A total of 2383 respondents are included. Most (63.1%) were girls, 81.5% aged 12-14. In total 25.9% had ever experienced violence, higher among boys (p=<0.001). Physical violence was most common (35.7%), then psychological (21.8%), sexual (13.1%), neglect (10.6%), cyberbullying (7.6%), corporal punishment (6.5%) and economic abuse (4.8%). Boys experienced more physical violence (36.0%); girls experienced more psychological violence (22.2%). Gauteng had double the reports of sexual violence (18.4% vs 7.6%, p<0.001). Violence happened most at school (27.4%), followed by the park (19.8%) or their friends’ home (12.9%). Multivariate analysis showed that boys (aOR 1.57; 95% CV 1.27-1.94; p=0.000), those aged 15-17 years (aOR 1.41; 95% CV 1.07-1.84; p=0.013), those who ever used substances (aOR 1.92; 95% CI 1.54-2.37; p=0.000), and those who sometimes feel worthless (aOR 1.35; 95% CI 1.10-1.64, p=0.003) were at higher odds of ever experiencing violence. Those who had never had sex were less likely to have ever experienced violence (aOR 0.66; 95% CI 0.51-0.83; p=0.001). Conclusion: Urgently need wider adoption, scaling, and sustaining of evidence-based primary violence prevention and structural interventions are required to reduce the high burden of adolescent violence. Stakeholders across the ecological model are needed to tackle harmful cultural norms that perpetuate violence.
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Wangamati CK, Mdala I, Ogutu B, Sokoine K, Ochieng M, Majikata S, Ochieng CB, Kelly SA. Assessment of whole school approach intervention to reduce violence affecting children in and around schools in Kenya and Tanzania: protocol for a before-and-after, mixed-methods pilot study. BMJ Open 2022; 12:e055231. [PMID: 35523488 PMCID: PMC9083418 DOI: 10.1136/bmjopen-2021-055231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION National violence against children (VAC) surveys in Tanzania and Kenya reported that approximately three-quarters of children in Tanzania experienced physical violence while 45.9% of women and 56.1% of men experienced childhood violence in Kenya. In response to VAC, Investing in Children and their Societies-Strengthening Families & Protecting Children (ICS-SP) developed the whole school approach (WSA) for reducing VAC in and around schools. Objectives of this evaluation are to: (1) determine intervention's feasibility and (2) the extent to which the WSA reduces prevalence and incidence of VAC in and around schools in Kenya and Tanzania; (3) gain insights into changes in stakeholders' knowledge, attitudes and practices in relation to VAC following intervention implementation and (4) provide evidence-based recommendations for refining intervention content, delivery and theory of change (ToC). METHODS AND ANALYSIS The study is a mixed-methods, controlled before-and-after, quasi experimental pilot designed to assess the delivery and potential changes in knowledge, attitudes, behaviours and VAC prevalence and incidence in and around schools following the WSA intervention implementation in Kenya and Tanzania. The preintervention phase will entail stakeholder enhancement of the WSA ToC and baseline cross-sectional surveys of teaching and non-teaching staff and parents (knowledge, attitude and practices), pupils (VAC incidents and school climate) and school safety audits. The WSA intervention implementation phase will include an intervention delivery process assessment and random school visits. In the postintervention phase, end-line surveys will be conducted similarly to baseline. Focus group discussions and in-depth interviews will be held with ICS-SP staff, training facilitators, teachers, parents and pupils to gain insights into acceptability, delivery and potential intervention effects. Quantitative and qualitative data will be analysed using SPSS V.25 and NVIVO V.12, respectively. ETHICS AND DISSEMINATION Ethics approvals were received from Amref Health Africa in Kenya (AMREF-ESRC P910/2020) and National Health Research Ethics Committee (NatHREC) in Tanzania (NIMR/HQ/R.8a/Vol.IX/3655). Dissemination will be through research reports.
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Affiliation(s)
| | - Ibrahimu Mdala
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Susan A Kelly
- Global Health & Childhoods, Independent Consultant, Mwanza, United Republic of Tanzania
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21
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Al-kreimeen RA, Alghafary NA, Samawi FS. The Association of Emotional Blackmail and Adjustment to College Life Among Warned Female Students at Al-Balqa University Students. Health Psychol Res 2022; 10:34109. [DOI: 10.52965/001c.34109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022] Open
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22
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Quail KR, Ward CL. Nonviolent Discipline Options for Caregivers and Teachers: A Systematic Overview of the Evidence. TRAUMA, VIOLENCE & ABUSE 2022; 23:620-638. [PMID: 33111651 DOI: 10.1177/1524838020967340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Violence against children is a widespread problem with devastating consequences, and corporal punishment is a risk factor for more serious forms of physical abuse. One reason for the persistence of corporal punishment may be the lack of awareness of positive disciplinary alternatives. Nonviolent options offered to caregivers and teachers must be effective in addressing challenging behavior, or they may be rejected in favor of a return to physical punishment. There is an urgent need to determine which discipline options are evidence-supported and what that evidence says so that robust alternatives to corporal punishment can be made available. The primary objective of this research was to find, and explore the state of the science on, individual nonviolent interventions for challenging behavior, in so doing forming a "tool kit" for use by caregivers and teachers. A systematic overview of systematic reviews was conducted. Included systematic reviews were peer-reviewed and published in English between 1999 and 2018. Screening, quality assessment using AMSTAR, and data extraction were performed independently by two reviewers. A total of 223 reviews were included, covering data from 3,921 primary studies. A wide range of evidence-supported interventions exist, many of which have been found effective with severely challenging behavior. Important positive outcomes shown suggest that the use of these tools should be promoted not only for the prevention of violence but also for optimum child development. More research is needed on the use of these methods in home situations and on de-escalation skills.
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Affiliation(s)
- Karen R Quail
- Department of Psychology, University of Cape Town, South Africa
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23
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Chen C, Ji S, Jiang J. Psychological Abuse and Social Support in Chinese Adolescents: The Mediating Effect of Self-Esteem. Front Psychol 2022; 13:852256. [PMID: 35401363 PMCID: PMC8989465 DOI: 10.3389/fpsyg.2022.852256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Although previous studies have explored relationships between psychological abuse and social support, the pathways from psychological abuse to social support are still unclear, particularly in Chinese adolescents. This cross-sectional study attempts to delineate the prevalence of psychological abuse and explore the relationships between psychological abuse, social support, and self-esteem under the Chinese cultural context. Data were obtained from 417 Chinese adolescents aged 15-18 years old. All of them completed the Child Psychological Abuse and Neglect Scale, Rosenberg Self-Esteem Scale (SES), and Multidimensional Scale of Perceived Social Support (MSPSS). Results indicated that the prevalence of psychological abuse in Chinese adolescents was 25.66%, and psychological abuse was negatively associated with self-esteem and social support, respectively. Self-esteem partially mediated the relationships between psychological abuse and social support. Findings highlight the importance of improving self-esteem in survivors of psychological abuse for decreasing the negative effects on social support. Additionally, the significance and limitations of the results were discussed.
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Affiliation(s)
- Chen Chen
- Center for Educational Science and Technology, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Shengkai Ji
- Teachers’ College, Jiaxing University, Jiaxing, China
| | - Juan Jiang
- Department of Preschool Education, Liaoning National Normal College, Shenyang, China
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24
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Schroeder E, Tallarico R, Bakaroudis M. The impact of adolescent initiation rites in East and Southern Africa: Implications for policies and practices. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2022. [DOI: 10.1080/02673843.2022.2052123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Renata Tallarico
- Regional Coordinator, UNFPA East and Southern Africa Regional Office, Johannesburg, South Africa
| | - Maria Bakaroudis
- Comprehensive Sexuality Education Specialist & Disability Focal Point, UNFPA East and Southern Africa Regional Office, Johannesburg, South Africa
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25
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Merrill KG, Campbell JC, Kennedy CE, Burke VM, Miti S, Frimpong C, Decker MR, Abrams EA, Mwansa JK, Denison JA. 'So hurt and broken': A qualitative study of experiences of violence and HIV outcomes among Zambian youth living with HIV. Glob Public Health 2022; 17:444-456. [PMID: 33428559 PMCID: PMC8272734 DOI: 10.1080/17441692.2020.1864749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Emerging data show associations between violence victimisation and negative HIV outcomes among youth in sub-Saharan Africa. We conducted in-depth interviews with adolescents and young adults living with HIV (aged 15-24 years) in Ndola, Zambia, to better understand this relationship. We purposively selected 41 youth (24 females, 17 males) with varied experiences of violence and virologic results. Analysis used thematic coding. Two-thirds of participants said violence affected their medication adherence, clinic attendance, and/or virologic results. They focused on the negative effects of psychological abuse from family members in homes and peers at schools, which were the most salient forms of violence raised, and sexual violence against females. In contrast, they typically depicted physical violence from caregivers and teachers as a standard discipline practice, with few impacts. Youth wanted HIV clinic settings to address verbal abuse and emotional maltreatment, alongside physical and sexual violence, including through peer mentoring. Violence - especially verbal and emotional forms - must be recognised as a potential barrier to HIV self-management among youth living with HIV in the region. Further testing of clinic, home, and school-based interventions may be critical to reducing levels of violence and improving HIV outcomes in this vulnerable but resilient population.Trial registration: ClinicalTrials.gov identifier: NCT04115813.
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Affiliation(s)
- Katherine G. Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacquelyn C. Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia M. Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A. Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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26
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Hatcher AM, Mkhize SP, Parker A, de Kadt J. Depressive symptoms and violence exposure in a population-based sample of adult women in South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001079. [PMID: 36962572 PMCID: PMC10021317 DOI: 10.1371/journal.pgph.0001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/19/2022] [Indexed: 03/26/2023]
Abstract
Depressive symptoms are a major burden of disease globally and is associated with violence and poverty. However, much of the research linking these conditions is from resource-rich settings and among smaller, clinical samples. Secondary data from a household survey in Gauteng Province of South Africa examines the cross-sectional association between adult women's elevated depressive symptoms and markers of violence. Using tablet computers, participants self-completed interview modules to screen for depressive symptoms (Patient Health Questionnaire 2-item screener), childhood exposure to physical and sexual abuse (Childhood Trauma Questionnaire 4-item index), as well as past-year exposure to sexual or intimate partner violence (SIPV; WHO Multicountry Study instrument 4-item index). Socio-economic status, food security, education, and income were self-reported. Representative data at the ward level allows for modeling of results using survey commands and mixed-level modeling. Of the 7,276 adult women participating in the household survey, 42.1% reported elevated depressive symptoms. A total of 63.9% reported childhood violence exposure and 5.3% had past-year SIPV. Multi-level modeling suggests that violence is a strong predictor of depressive symptoms. Childhood abuse alone increases the odds of high depressive symptomology, after controlling for individual-level markers of poverty and neighborhood of residence (aOR 1.31, 95%, CI 1.17-1.37). Combined exposure to childhood abuse and past-year SIPV increased odds of reporting elevated depressive symptoms (aOR 2.05, 95%, CI 1.54-2.71). Ward characteristics account for 6% of the variance in depressive symptoms, over and above the contributions of household food security and socio-economic status. Exposure to violence in childhood and past-year SIPV were associated with depressive symptoms among women. These associations persist after controlling for socio-economic markers and latent neighborhood characteristics, which also had significant association with elevated depressive symptoms. These data suggest that efforts to reduce the burden of depressive symptoms may benefit from approaches that prevent violence against women and children.
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Affiliation(s)
- Abigail M Hatcher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sthembiso Pollen Mkhize
- Gauteng City Regional Observatory, University of Johannesburg and University of the Witwatersrand, Johannesburg, South Africa
| | - Alexandra Parker
- Gauteng City Regional Observatory, University of Johannesburg and University of the Witwatersrand, Johannesburg, South Africa
| | - Julia de Kadt
- Gauteng City Regional Observatory, University of Johannesburg and University of the Witwatersrand, Johannesburg, South Africa
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Mathews B, MacMillan HL, Meinck F, Finkelhor D, Haslam D, Tonmyr L, Gonzalez A, Afifi TO, Scott JG, Pacella RE, Higgins DJ, Thomas H, Collin-Vézina D, Walsh K. The ethics of child maltreatment surveys in relation to participant distress: Implications of social science evidence, ethical guidelines, and law. CHILD ABUSE & NEGLECT 2022; 123:105424. [PMID: 34883421 DOI: 10.1016/j.chiabu.2021.105424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 06/13/2023]
Abstract
Epidemiological surveys measuring the prevalence of child maltreatment generate essential knowledge that is required to enhance human rights, promote gender equality, and reduce child abuse and neglect and its effects. Yet, evidence suggests Institutional Review Boards (IRBs) may assess the risk of these studies using higher than normal thresholds, based on a perception they may cause high distress to participants. It is essential for IRBs and researchers to have an accurate understanding of the nature and extent of participant distress associated with these studies, and of the duties of researchers towards survey participants, so that meritorious research is endorsed and duties to participants discharged. Assessment by IRBs of the ethics of such research must be appropriately informed by scientific evidence, ethical principles, and legal requirements. This article adds to knowledge by considering participant distress in child maltreatment surveys and its appropriate ethical and operational treatment. We provide an updated overview of scientific evidence of the frequency and severity of distress in studies of child maltreatment, a review of ethical requirements including a focus on beneficence and participant welfare, and a new analysis of researchers' legal duties towards participants. Our analyses demonstrate that participant distress is infrequent and transitory, that researchers can satisfy ethical requirements towards participants, and that legal liability does not extend to emotional distress. Informed by these bodies of knowledge, we distil key principles of good epidemiological practice to provide solutions to operational requirements in these surveys, which both fulfil ethical requirements to participants, and demonstrate trauma-informed practice.
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Affiliation(s)
- Ben Mathews
- Australian Centre for Health Law Research, School of Law, Queensland University of Technology (QUT), Australia; Bloomberg School of Public Health, Johns Hopkins University, USA.
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Department of Pediatrics, McMaster University, Canada
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, UK; School of Health Sciences, North-West University, South Africa
| | - David Finkelhor
- Crimes Against Children Research Center, Family Research Laboratory, Department of Sociology, University of New Hampshire, USA
| | - Divna Haslam
- Australian Centre for Health Law Research, School of Law, Queensland University of Technology (QUT), Australia; Parenting and Family Support Centre, The University of Queensland, Australia
| | - Lil Tonmyr
- Family Violence Surveillance, Public Health Agency of Canada, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Canada
| | - Tracie O Afifi
- Department of Community Health Sciences, University of Manitoba, Canada; Department of Psychiatry, University of Manitoba, Canada
| | - James G Scott
- Mental Health Programme, QIMR Berghofer Medical Research Institute, Australia; Queensland Centre for Mental Health Research, Australia
| | - Rosana E Pacella
- Institute for Lifecourse Development, Faculty of Education, Health & Human Sciences, University of Greenwich, UK
| | - Daryl J Higgins
- Institute of Child Protection Studies, Australian Catholic University, Australia
| | - Hannah Thomas
- Mental Health Programme, QIMR Berghofer Medical Research Institute, Australia; Queensland Centre for Mental Health Research, Australia
| | | | - Kerryann Walsh
- School of Early Childhood and Inclusive Education, Queensland University of Technology (QUT), Australia
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28
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Falconer NS, Casale M, Kuo C, Nyberg BJ, Hillis SD, Cluver LD. Factors That Protect Children From Community Violence: Applying the INSPIRE Model to a Sample of South African Children. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:11602-11629. [PMID: 31948335 DOI: 10.1177/0886260519898425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009-2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies-positive parenting, basic necessities, formal social support, and school structural support-and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct p < .001; adjusted odds ratio [AOR] = .57; indirect p < .01; AOR = .62), formal support (direct p < .05; AOR = .83; indirect p < .05; AOR = .73), and school support (direct p < .001; AOR = .53; indirect p < .001; AOR = .49). Combined interventions in direct and indirect community violence analyses demonstrated that children reporting a higher number of strategies were less likely to have experienced community violence. This outcome extends the results of longitudinal studies in South Africa highlighting social protection with care as a means to overcome structural deprivation strains, thereby reducing the likelihood of children's exposure to community violence. Moreover, these findings uphold the INSPIRE model as an effective cross-sectoral approach to prevent and reduce the community violence that children experience.
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Affiliation(s)
- N Suzanne Falconer
- GlobalFingerprints, Minneapolis, MN, USA
- Two Sparrows Consulting, Rockford, IL, USA
| | - Marisa Casale
- University of the Western Cape, Bellville, South Africa
- University of Oxford, UK
| | - Caroline Kuo
- Brown University School of Public Health, Providence, RI, USA
- University of Cape Town, South Africa
| | - Beverly J Nyberg
- Clemson University, SC, USA
- Common Root Consulting, Washington, DC, USA
| | - Susan D Hillis
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Natukunda HPM, Mubiri P, Cluver LD, Ddumba-Nyanzi I, Bukenya B, Walakira EJ. Which Factors Are Associated With Adolescent Reports of Experiencing Various Forms of Abuse at the Family Level in Post-Conflict Northern Uganda? JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12067-NP12096. [PMID: 31789094 DOI: 10.1177/0886260519888526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research assessing familial violence against adolescents, using caregiver-adolescent dyads, is limited in post-conflict settings. This study aimed to determine the prevalence and factors associated with adolescent-reported familial abuse in post-conflict northern Uganda. It also assessed the relationship between abuse subtypes and (a) beliefs supporting aggression and (b) adolescent well-being and life satisfaction. A randomly selected community-based sample of 10- to 17-year-old adolescents (54% girls) and their caregivers (N = 427 dyads) in two northern Uganda districts was used. Abuse outcomes were adolescent reported. All measures used standardized tools that have been adapted for research in resource-limited settings. Analyses used multivariable linear regressions in Stata 14/IC. Overall, physical, emotional, and sexual abuse rates were 70% (confidence interval [CI] = [65.7, 74.4]), 72% (CI = [67.4, 76.0]), and 18.0% (CI = [14.0, 21.2]), respectively. Polyvictimization was 61% (CI = [55.4, 64.7]). There were no gender differences regarding adolescent reports of physical and emotional abuse, but adolescent girls were more likely to report sexual abuse and polyvictimization than adolescent boys. All forms of adolescent-reported abuse (except sexual abuse) were associated with caregiver reports of harsh disciplinary practices. In addition, emotional abuse was associated with physical and sexual abuse. Physical abuse was associated with being an orphan and emotional abuse. Sexual abuse was associated with being a girl, older adolescent age, living in a larger household, and emotional abuse. Polyvictimization was positively associated with being an orphan, younger caregiver age, caregiver-reported poor monitoring and supervision, and higher household socioeconomic status, but negatively associated with lower parental role satisfaction. Physical and emotional (but not sexual) abuse and polyvictimization were associated with beliefs supporting aggression among adolescents. All abuse subtypes were associated with lower levels of perceived well-being and life satisfaction among adolescents in this study. Child abuse prevention programs have the potential to improve adolescent-caregiver interaction and interrupt the violence transmission cycle in this setting.
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Affiliation(s)
- Helen P M Natukunda
- Makerere University, Kampala, Uganda
- MRC Harwell Institute, UK Research and Innovation, Oxfordshire, UK
- University of Oxford, UK
| | | | - Lucie D Cluver
- University of Oxford, UK
- University of Cape Town, South Africa
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Myers B, Browne FA, Carney T, Kline T, Bonner CP, Wechsberg WM. The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11403. [PMID: 34769920 PMCID: PMC8582840 DOI: 10.3390/ijerph182111403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/03/2022]
Abstract
Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Felicia A Browne
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tracy Kline
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | | | - Wendee M Wechsberg
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
- Maternal and Child Health Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27529, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27703, USA
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31
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Viljoen L, Hoddinott G, Malunga S, Vanqa N, Mhlakwaphalwa T, Marthinus A, Mcimeli K, Bond V, Seeley J, Bock P, Hayes R, Reynolds L. Women's sexual scripting in the context of universal access to antiretroviral treatment-findings from the HPTN 071 (PopART) trial in South Africa. BMC Womens Health 2021; 21:370. [PMID: 34689783 PMCID: PMC8543855 DOI: 10.1186/s12905-021-01513-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND HIV treatment-based prevention modalities present new opportunities for women to make decisions around sex, intimacy, and prevention. The Universal test and treat (UTT) strategy, where widespread HIV testing is implemented and all people with HIV can access treatment, has the potential to change how sex is understood and HIV prevention incorporated into sexual relationships. We use the frame of sexual scripting to explore how women attribute meaning to sex relative to UTT in an HIV prevention trial setting. Exploring women's sexual narratives, we explored how HIV prevention feature in the sexual scripts for women who had access to UTT in South Africa (prior to treatment guideline changes) and increased HIV prevention messaging, compared to places without widespread access to HIV testing and immediate access to treatment. METHODS We employed a two-phased thematic analysis to explore longitudinal qualitative data collected from 71 women (18-35 years old) between 2016 and 2018 as part of an HIV prevention trial in the Western Cape Province, South Africa. Of the participants, 58/71 (82%) were from intervention communities while 13/71 (18%) lived in control communities without access to UTT. Twenty participants self-disclosed that they were living with HIV. RESULTS We found no narrative differences between women who had access to UTT and those who did not. HIV and HIV prevention, including treatment-based prevention modalities, were largely absent from women's thinking about sex. In their scripts, women idealised romantic sex, positioned sex as 'about relationships', and described risky sex as 'other'. When women were confronted by HIV risk (for example, when a partner disclosed his HIV-positive status) this created a point of disjuncture between this new perception of risk and their accepted relationship scripts. CONCLUSION These findings suggest that HIV-negative women did not include their partners' use of antiretroviral therapy in their sexual partnership choices. For these women, the preventive benefits of UTT are experienced passively-through community-wide viral suppression-rather than through their own behaviour change explicitly related to the availability of treatment as prevention. We propose that prevention-based modalities should be made available and supported and framed as an intervention to promote relationship well-being.
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Affiliation(s)
- Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa.
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Samantha Malunga
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tembeka Mhlakwaphalwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Arlene Marthinus
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khanyisa Mcimeli
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lindsey Reynolds
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa
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Daluxolo Ngidi N, Moletsane R, Essack Z. "Theyabduct usand rapeus": Adolescents' participatory visual reflections of their vulnerability to sexual violence in South African townships. Soc Sci Med 2021; 287:114401. [PMID: 34555745 DOI: 10.1016/j.socscimed.2021.114401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
The abduction and sexual violation of adolescents, especially in township contexts, has increasingly made headlines in South Africa. These incidents are evocative of jackrolling, a phenomenon that plagued townships during the apartheid upheavals in the late 1980s. The abduction of adolescents on their school journeys has been reported in several South African townships. In this paper, we report on a study in which we used participatory visual methods (i.e., cellphilms: short videos made with cellphones) to explore how 19 adolescent girls and boys living in the Inanda, Ntuzuma, and KwaMashu (INK) township precinct, outside Durban reflected on their vulnerability to sexual violence. Although the question was broad, our analysis of the visual data suggests that adolescents believed that their vulnerability to abduction and rape was almost inevitable. As such, in their cellphilms, they chose to portray their risk and vulnerability to abduction, rape, and even murder on their daily journeys to and from school. We found that through this methodology, adolescents were able to illustrate and/or articulate their fear of sexual violence. For them, violence was an inescapable reality that created fear and helplessness. This underscores the need for interventions, including the provision of safe scholar transport and visible policing in the community.
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Affiliation(s)
| | | | - Zaynab Essack
- Centre for Community-Based Research, Human Sciences Research Council and School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Chen IC, Duh MC, Jaw TS, Liu YC, Wu YH, Yin HL, Hsu JH. Experience with outreach services of a multidisciplinary team for child abuse identification. J Formos Med Assoc 2021; 121:1111-1116. [PMID: 34535376 DOI: 10.1016/j.jfma.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement. METHODS We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined. RESULTS Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p < 0.05) but not with any other variables. CONCLUSION Our experience indicates that an OMDT can play an important role in child protection and activating law enforcement for children with complex or critical physical abuse. We suggest that in Taiwan, OMDT services should be incorporated into child protection centers, National Health Insurance system and governmental child protection policies.
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Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chieh Duh
- School of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Twei-Shiun Jaw
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yen-Hsien Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsin-Ling Yin
- Department of Clinical Forensic Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Liu H, Li TW, Liang L, Hou WK. Trauma exposure and mental health of prisoners and ex-prisoners: A systematic review and meta-analysis. Clin Psychol Rev 2021; 89:102069. [PMID: 34454322 DOI: 10.1016/j.cpr.2021.102069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
The present meta-analytic review examined the associations between different forms of trauma and mental disorders among prisoners and ex-prisoners. Studies published from 1998 to March 31 2021 were identified by searching PsycINFO, PubMed, Medline and Web of Science. Data were meta-analyzed using a random-effect model. Moderator and mediator analyses were conducted. The protocol was registered in PROSPERO (CRD42020181587). We identified 62 studies (50 non-duplicated samples) with 15,115 (97.86%) prisoners and 330 (2.14%) ex-prisoners in 16 countries. A multi-level meta-analysis found that overall trauma was positively associated with more diagnoses or symptoms of mental disorders (Zr = 0.198, 95% CI = [0.167, 0.229], p < 0.001). Stronger effect sizes were found between childhood trauma (Zr = 0.357, 95% CI = [0.147, 0.568], p < 0.01) and sexual trauma (Zr = 0.326, 95% CI = [0.216, 0.435], p < 0.001) and stress-related disorders. Multilevel moderator analysis showed that effect size was stronger in imprisonment trauma (β = 0.247, 95% CI = [0.177, 0.316], p < 0.01), mixed trauma (β = 0.234, 95% CI = [0.196, 0.272], p < 0.001), and stress-related disorders (β = 0.261, 95% CI = [0.214, 0.307], p < 0.01). Associations between trauma and mental disorders were mediated by social support but not coping. Our findings provide an evidence base for future research on the impact of trauma and inform assessments and interventions in correctional settings.
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Affiliation(s)
- Huinan Liu
- Department of Psychology, The Education University of Hong Kong, Hong Kong, SAR, China; Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, SAR, China
| | - Tsz Wai Li
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, SAR, China
| | - Li Liang
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, SAR, China; Department of Psychology, The University of Hong Kong, Hong Kong, SAR, China
| | - Wai Kai Hou
- Department of Psychology, The Education University of Hong Kong, Hong Kong, SAR, China; Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, SAR, China.
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Beyene AS, Chojenta C, Loxton D. Gender-Based Violence Among Female Senior Secondary School Students in Eastern Ethiopia. VIOLENCE AND VICTIMS 2021; 36:509-530. [PMID: 34385281 DOI: 10.1891/vv-d-19-00183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Gender-based violence (GBV) is a major global public health issue due to its short- and long-term adverse effects on women's health. Little is known about the factors associated with physical and emotional violence among female school students in Ethiopia. We determined the magnitude and risk factors of emotional violence, physical violence, sexual violence, and any form of GBV among 1,199 female school students in eastern Ethiopia using the facilitated self-administered questionnaires. The prevalence of any form of GBV in the past 12 months was 53.04% (95% CI: 50.22-55.87). Around 52% (95% CI: 47.61-55.54) of respondents indicated they had experienced all three forms of GBV. The prevalence of emotional violence in the past 12 months was 43.04% (95% CI: 40.22-45.84), physical violence was 43.79% (95% CI: 40.94-46.59), and sexual violence was 31.44% (95% CI: 28.81-34.07). Having a boyfriend, being married, not receiving enough pocket money from family, witnessing violence as a child, using alcohol, being sexually active, and discussing reproductive health with family increased the risk of any form of GBV in the past 12 months. This suggests that early intervention and support to mitigate the long-term adverse impacts of GBV are needed.
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Affiliation(s)
- Addisu Shunu Beyene
- School of Public Health, College of Health and Medical Sciences, Harar, Oromia, Ethiopia
| | - Catherine Chojenta
- Centre for Women's Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW
| | - Deborah Loxton
- Centre for Women's Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW
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Kutywayo A, Frade S, Gordon K, Mahuma T, Naidoo NP, Mullick S. Who’s got the power? Expressions of empowerment among in-school adolescents enrolled in the Girls Achieve Power (GAP Year) trial in three peri-urban settings of South Africa. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13336.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Empowerment is when a person gains mastery of their life and environment. This paper describes three central elements of empowerment (agency, resources, and institutional structures) expressed by adolescents, discussing implications for strengthening adolescent sexual reproductive health, HIV, and violence prevention programming. Methods: A cross-sectional survey was conducted (April 2017 – May 2018) as part of the GAP Year trial among grade eight learners (12 – 18 years) from 26 lowest quintile public high schools in Khayelitsha, Soweto and Thembisa townships, South Africa. Data were on empowerment experiences using a knowledge, attitudes, and practices survey. Descriptive and chi-square test statistics were employed, assessing the association between sociodemographic and domains of empowerment. Results: A total of 2383 adolescents in 26 schools completed the baseline survey: 63.1% female, mean age 13.7 years, 96.9% Black African. Agency: Males (4.04 vs 3.94, p=0.008) and those 15 – 18 years (4.10 vs 3.95, p=0.027) expressed stronger decision-making capacity. Females (3.18 vs 2.92, p<0.001) indicated a greater sense of collective action. Females (0.77 vs 0.72, p=0.008), those aged 12 -14 years (0.76 vs 0.71, p=0.027) and those with at least one parent/guardian employed (p=0.014) had stronger leadership confidence. Resources: Those 12-14 years expressed higher self-esteem (2.18 vs 2.08, p=0.017). Males (2.24 vs 1.87, p<0.001) and those who had at least one parent/guardian employed (p=0.047) had a higher perception of freedom from gender-based violence. Males showed greater mobility (2.89 vs 2.66, p=<0.001). Institutional structures: Coloured participants showed more positive norms than their Black counterparts (5.38 vs 2.12, p=0.005). Conclusions: Males expressed greater empowerment around decision-making, gender-based violence and mobility; females expressed greater collective action and leadership. Working across the ecological model, interventions addressing sex differences, targeting adolescents of all ages, and parental unemployment may strengthen expressions of empowerment, especially adolescents’ safety, mobility, aspirations, and future hopes.
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Naidoo L, Van Hout MC. Child Sex Offender Mind-Set and Grooming Strategies: A Discourse Analysis of Sex Offender Narratives from South Africa. JOURNAL OF CHILD SEXUAL ABUSE 2021; 30:616-635. [PMID: 33719911 DOI: 10.1080/10538712.2021.1890296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
Violence against children, particularly sexual violence continues to threaten South African society. Whilst severely under-reported, the perpetration of child sexual abuse (CSA) against boys and girls is a significant societal concern, underpinned by adverse childhood familial instability, childhood abuse in particular sexual abuse, violence, inequality and wider structural forces. The research base is growing, despite low disclosure rates and significant barriers to access. In order to better understand unique trajectories of perpetration of CSA, particular to the South African context, we conducted an in-depth qualitative study with twelve male child sex offenders who were attending a therapeutic, rehabilitation programme. They provided open discourse on the forms of enticement, exploitation or entrapment of child victims, including threats of harm, used to elicit compliance into sexual activities. They disclosed trauma dictated fantasy, and that they felt powerful and in control, when they sexually abused their victims. Most of the offenses took place in their own home. By delving into the strategies and mind set of the offender who sexually abuse children, this study provides evidence of a distinct and deliberate, 'grooming process' used by offenders; and emphasizes the cyclic patterns of offending. Understanding these truths explores its potential for the prevention of the CSA. In its entirety, the research deconstructs the strategies of the offender and examines their actual role in the onset of sexually offending behavior against children; in order to draw out the implications of these complexities for policy, practice, crime prevention, particularly in terms of the prevention of CSA.
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Affiliation(s)
- Linda Naidoo
- University of Johannesburg, Johannesburg, South Africa
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Kutywayo A, Frade S, Mahuma T, Naidoo NP, Mullick S. Experiences of violence among female and male grade eight learners: baseline findings from the Girls Achieve Power (GAP Year) trial across three South African townships. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13276.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: South African adolescents experience disproportionally high rates of violence, with lifelong health, social and economic impacts. Few papers present risk factors associated with experiences of adolescent violence. Methods: A baseline cross-sectional survey was done (April 2017 – Sept 2018) with 3432 grade 8 learners in the Girls Achieve Power (GAP Year) trial from 26 high schools in three townships (Soweto and Tembisa, Gauteng and Khayelitsha, Western Cape). Collected data on lifetime experiences of different types of violence, perpetrators, and place of violence. Descriptive statistics and logistic regression were used to enumerate experiences of, and factors associated with violence. Results: A total of 2383 respondents are included. Most (63.1%) were girls, 81.5% aged 12-14. In total 26% had ever experienced violence, higher among boys (p=<0.001). Physical violence was most common (35.7%), then psychological (21.8%), sexual (13.1%), neglect (10.6%), cyberbullying (7.6%), corporal punishment (6.5%) and economic abuse (4.8%). Boys experienced more physical violence (36.0%); girls experienced more psychological violence (22.2%). Gauteng had double the reports of sexual violence (18.4% vs 7.6%, p<0.001). Violence happened most at school (27.4%), followed by the park (19.8%) or their friends’ home (12.9%). Multivariate analysis showed that boys (aOR 1.57; 95% CV 1.27-1.94; p=0.000), those aged 15-17 years (aOR 1.41; 95% CV 1.07-1.84; p=0.013), those who ever used substances (aOR 1.92; 95% CI 1.54-2.37; p=0.000), and those who sometimes feel worthless (aOR 1.35; 95% CI 1.10-1.64, p=0.003) were at higher odds of ever experiencing violence. Those who had never had sex were less likely to have ever experienced violence (aOR 0.66; 95% CI 0.51-0.83; p=0.001). Conclusion: Urgently need wider adoption, scaling, and sustaining of evidence-based primary violence prevention and structural interventions are required to reduce the high burden of adolescent violence. Stakeholders across the ecological model are needed to tackle harmful cultural norms that perpetuate violence.
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Merrill KG, Campbell JC, Decker MR, McGready J, Burke VM, Mwansa JK, Miti S, Frimpong C, Kennedy CE, Denison JA. Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults. AIDS Behav 2021; 25:1373-1383. [PMID: 32761474 PMCID: PMC8052241 DOI: 10.1007/s10461-020-02958-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the relationship between past-year violence victimization and viral load (VL) failure among consecutively-sampled male and female adolescents and young adults, aged 15-24, in four HIV clinics in Ndola, Zambia. Measures of past-year physical violence, psychological abuse, and forced sex were adapted from the ICAST-C and WHO Multi-Country Study. Using logistic regression, we derived associations between VL failure (≥ 1000 copies/mL) and: any victimization; cumulative victimization; and types and perpetrators of violence. Among 272 youth (59.2% female, 72.8% perinatally infected), 73.5% (n = 200) experienced past-year violence and 36.8% (n = 100) had VL failure. Higher odds of VL failure were observed for participants who reported high frequency of any violence versus no violence victimization (adjusted OR, aOR: 3.58; 95% CI 1.14-11.27), high frequency of psychological abuse versus no psychological abuse (aOR: 3.32; 95% CI 1.26-8.70), any versus no violence from a family member other than a parent/caregiver for physical violence (aOR: 2.18, 95% CI 1.05-4.54) and psychological abuse (aOR: 2.50; 95% CI 1.37-4.54), and any versus no physical violence from a friend/peer (aOR: 2.14, 95% CI 1.05-4.36). Past-year violence victimization was associated with VL failure when considering the frequency, type, and perpetrator of violence. Programs addressing violence among youth living with HIV may be critical to improving viral suppression and preventing onward transmission.
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Affiliation(s)
- Katherine G Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jacquelyn C Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia M Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
| | | | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Lim YY, Wahab S, Kumar J, Ibrahim F, Kamaluddin MR. Typologies and Psychological Profiles of Child Sexual Abusers: An Extensive Review. CHILDREN-BASEL 2021; 8:children8050333. [PMID: 33922985 PMCID: PMC8146192 DOI: 10.3390/children8050333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/20/2022]
Abstract
Child sexual abuse is a public health issue that has been associated with a variety of negative health outcomes. Child sexual abusers constitute a heterogeneous population of individuals. This review lays out an overview of the current understanding of typologies and psychological profiles of child sexual abusers. Typologies of child sexual abusers in general and online child sexual abusers are reviewed to summarise the existing knowledge. Psychological traits including personality traits, cognitive distortion, empathy, and impulsivity are examined to provide a wider perspective of the psycho-criminogenic factors of child sexual abuse. Although past research on child sexual abusers has provided insights into the organisation and classification of different types of child sexual abusers, the classification of these typologies has drawn widespread criticisms. In this review, we discuss the challenges and limitations pertaining to the existing typologies and studies related to the psychological profile of child sexual abusers.
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Affiliation(s)
- Yeong Yeong Lim
- Department of Early Childhood Studies, Faculty of Creative Industries, Universiti Tunku Abdul Rahman, Kajang 43000, Malaysia;
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia;
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Fauziah Ibrahim
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia;
| | - Mohammad Rahim Kamaluddin
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia;
- Correspondence: ; Tel.: +60-3-89213923 (ext. 8923); Fax: +60-3-8921-3541
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Ashaba S, Cooper-Vince C, Maling S, Satinsky EN, Baguma C, Akena D, Nansera D, Bajunirwe F, Tsai AC. Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100094. [PMID: 34841384 PMCID: PMC8623847 DOI: 10.1016/j.jadr.2021.100094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Childhood trauma is associated with mental health problems among adolescents living with HIV (ALHIV) in sub-Saharan Africa, but little is known about potential moderating factors. METHODS We enrolled 224 ALHIV aged 13-17 years and collected information on childhood trauma, major depressive disorder, and suicidality. We used modified multivariable Poisson regression to estimate the association between the mental health outcome variables and childhood trauma, and to assess for effect modification by social support. RESULTS Major depressive disorder had a statistically significant association with emotional abuse (adjusted relative risk [ARR] 2.57; 95% CI 1.31-5.04; P=0.006) and physical abuse (ARR 2.16; 95% CI 1.19-3.89; P=0.01). The estimated association between any abuse and major depressive disorder was statistically significant among those with a low level of social support (ARR 4.30; 95% CI 1.64-11.25; P=0.003) but not among those with a high level of social support (ARR 1.30; 95% CI 0.57-2.98; P=0.52). Suicidality also had a statistically significant association with emotional abuse (ARR 2.03; 95% CI 1.05-3.920; P=0.03) and physical abuse (ARR 3.17; 95% CI 1.60-6.25.; P=0.001), but no differences by social support were noted. LIMITATIONS Corporal punishment is used widely in schools and homes as a form of discipline in Uganda; this cultural practice could have biased reporting about physical abuse. CONCLUSIONS Childhood trauma is associated with poor mental health among ALHIV, but its effects may be moderated by social support. More research is needed to develop social support interventions for ALHIV with adverse childhood experiences for improved mental health outcomes.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | | | - Samuel Maling
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Emily N. Satinsky
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Charles Baguma
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere College of Health Sciences, Makerere, Uganda
| | - Denis Nansera
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Alexander C. Tsai
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Herrero Romero R, Hall J, Cluver L, Meinck F, Hinde E. How Does Exposure to Violence Affect School Delay and Academic Motivation for Adolescents Living in Socioeconomically Disadvantaged Communities in South Africa? JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP3661-NP3694. [PMID: 29909713 DOI: 10.1177/0886260518779597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To date, little is known about the effects of violence on the educational outcomes of adolescents in disadvantaged communities in South Africa. In response, self-report data were collected from a socioeconomically disadvantaged sample of 503 adolescents aged 10 to 18 participating in a child abuse prevention trial in the Eastern Cape. Adolescents were purposively selected in the trial. This study applies Latent Profile Analysis (LPA) to examine relationships between past-month exposure to violence, school delay, and academic motivation. About 93.8% of adolescents in the sample experienced poly-violence-exposure to at least two forms of violence in the past month. Results identified two distinct profiles in the socioeconomically disadvantaged sample: Profile 1, adolescents exposed to more frequent poly-violence, and Profile 2, adolescents exposed to less frequent poly-violence. Being exposed to more frequent poly-violence was associated with greater risk of school delay-based on age-appropriate grade in South Africa. However, being exposed to more frequent poly-violence was not associated with lower academic motivation-adolescents showed high rates of wanting to achieve. Our findings suggest that exposure to more frequent poly-violence increases risk of school delay among adolescents from disadvantaged communities, while not affecting their academic motivation. Thus, although adolescents maintained aspirations and goals to do well at school, exposure to high frequency of violence affected their capacity to fulfill these aims.
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Affiliation(s)
| | | | - Lucie Cluver
- University of Oxford, UK
- University of Cape Town, South Africa
| | - Franziska Meinck
- University of Oxford, UK
- North-West University, Vanderbijlpark, South Africa
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Makongoza M, Nduna M. Awareness and Rejection Accounts of Intimate Partner Violence by Young Women in Soweto, Johannesburg, South Africa. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7-32. [PMID: 29294878 DOI: 10.1177/0886260517726413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intimate partner violence (IPV) is the most prevalent form of interpersonal violence experienced by women in South Africa. A study conducted with young women from South Africa, aged 13 to 23 years, estimated that 42% experienced physical violence from their intimate partners. The subtle and nuanced social dynamics of IPV are less understood owing to little qualitative research on this subject. This study qualitatively explored how young women perceive and experience IPV. Participants were recruited through snowballing from townships in Soweto, outside Johannesburg. In-depth, face-to-face, and semistructured interviews were conducted with seven young women aged 15 to 20 years. The discourse analysis was implemented to understand participants' construction of IPV. Participants reported direct experiences of IPV and indirect through exposure to interparental and interpersonal violence. Findings indicate a progressive shift of perceptions from absolute tolerance of relationship violence to rejection. However, victim blaming and relegating relationship violence to the private realm still existed. Essentialisation of masculine qualities such as anger was used to construct and understand men's use of violence. Young women highlighted infidelity, pregnancy, and sex demands from their partners as reasons for them being subjected to IPV.
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Affiliation(s)
| | - Mzikazi Nduna
- University of the Witwatersrand, Johannesburg, South Africa
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Pascoe L. Negotiating HIV and pregnancy prevention and sexual pleasure amongst heterosexual men and women in South Africa. CULTURE, HEALTH & SEXUALITY 2021; 23:115-130. [PMID: 32124660 DOI: 10.1080/13691058.2019.1696983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Heterosexual sex, foremost its gender-power dynamics, is embedded in and informed by the socio-historical context in which it occurs. While safer sexual communication skills are well documented as key to the success of sexual and reproductive health programming and education, communication skills about the positive aspects of sexuality such as sexual pleasure are often limited if not absent. Using data from in-depth qualitative interviews with men and women aged 26-39 from a diverse set of backgrounds in Cape Town, South Africa, this study examines the ways in which gender-power dynamics manifest in negotiations of HIV and pregnancy prevention and sexual pleasure in the intimate spaces of heterosex. Findings fall under three themes: 1) condom negotiation as a replacement for other aspects of sexual communication; 2) self-efficacy in negotiating prevention and negotiating one's own sexual pleasure; and 3) the integral role men play in heterosexual encounters in the facilitation of women's sexual autonomy and women's sexual pleasure. This study contributes to research not only examining the positive and more nuanced realities of heterosex in the South African context, but also argues for the need to integrate positive aspects of sexuality into sexual and reproductive health programming in general.
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Affiliation(s)
- Laura Pascoe
- Department of Human Ecology, University of California, Davis, CA, USA
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Taylor M, Sartorius B, Naidoo S, Vries HD. Reducing Physical Aggression in High School Students in KwaZulu-Natal: A Cluster Randomized Trial. VIOLENCE AND VICTIMS 2020; 35:861-884. [PMID: 33372114 DOI: 10.1891/vv-d-18-00060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Youth violence is of public health and social concern. A South African cluster randomized trial (434 grade 10 students, 16 schools), used the Integrated Model for Behavior Change conceptual framework to implement a 20 module classroom-based intervention program. The study contributes to the literature and used a strong analytical technique since mixed effects linear regression assessed the impact of the intervention on physical violence endpoints and other socioeconomic confounders/factors. The intervention reduced students' experiencing physical violence compared to controls and social pressure for this, yet no differences were found for hitting others. Our results support findings that school programs against violence can reduce students' experience of physical violence, but translation of these findings to reduce the actual hitting of others may need further approaches and/or more time.
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Affiliation(s)
- Myra Taylor
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Benn Sartorius
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saloshni Naidoo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hein de Vries
- Department of Health Organisation, Maastricht University, Maastricht, The Netherlands
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46
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Zuma T, Seeley J, Mdluli S, Chimbindi N, Mcgrath N, Floyd S, Birdthistle I, Harling G, Sherr L, Shahmanesh M. Young people's experiences of sexual and reproductive health interventions in rural KwaZulu-Natal, South Africa. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2020; 25:1058-1075. [PMID: 34177039 PMCID: PMC8224946 DOI: 10.1080/02673843.2020.1831558] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
Despite efforts to address HIV-infection, adolescents and young peoples' (AYP) engagement in interventions remains suboptimal. Guided by a risk protection framework we describe factors that support positive and negative experiences of HIV and SRH interventions among AYP in rural KwaZulu-Natal, South Africa, using data from: community mapping; repeat semi-structured individual interviews (n= 58 in 2017, n=50 in 2018, n=37 in 2019-2020); and group discussions (n=13). AYP who had appropriate and accurate HIV-and SRH-related information were reported to use health care services. Responsive health care workers, good family and peer relationships were seen to be protective through building close connections and improving self-efficacy to access care. In contrast to cross-generational relationships with men, alcohol and drug use and early pregnancy were seen to put AYP at risk. Policies and interventions are needed that promote stable and supportive relationships with caregivers and peers, positive social norms and non-judgemental behaviour within clinical services.
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Affiliation(s)
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sakhile Mdluli
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University College London, Division of Infection and Immunity, London, UK
| | - Nuala Mcgrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of Southampton, Southampton, UK
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University College London, Institute for Global Health, London, UK
| | - Lorraine Sherr
- University College London, Institute for Global Health, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University College London, Institute for Global Health, London, UK
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Sherr L, Yakubovich AR, Skeen S, Tomlinson M, Cluver LD, Roberts KJ, Macedo A. Depressive symptoms among children attending community based support in South Africa - pathways for disrupting risk factors. Clin Child Psychol Psychiatry 2020; 25:984-1001. [PMID: 32571077 PMCID: PMC7528548 DOI: 10.1177/1359104520935502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children's resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p < .001), but this association was removed by CBO access (contrast = 0.07 [95%CI -0.28, 0.43], p = .682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p < .001), however, this association was removed by CBO access (contrast = 0.01 [95%CI -0.55, 0.56], p = .977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.
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Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, UK
| | - Alexa R Yakubovich
- Centre for Evidence-Based Intervention, Department of Social Policy & Social Intervention, University of Oxford, UK
| | - Sarah Skeen
- Department of Psychology, Stellenbosch University, South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, South Africa
| | - Lucie D Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy & Social Intervention, University of Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | | | - Ana Macedo
- Institute for Global Health, University College London, UK
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López V, García-Quiroga M, Benbenishty R, González L, Squicciarini AM, Sánchez P. Sexual harassment by peers in Chilean schools. CHILD ABUSE & NEGLECT 2020; 107:104602. [PMID: 32562963 DOI: 10.1016/j.chiabu.2020.104602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although a significant amount of literature has explored peer sexual harassment in higher education, little is known about peer sexual harassment in primary and middle school. Among existing studies, most have examined individual student characteristics that predict peer sexual harassment without considering the importance of the classroom and school context, which may prevent or promote such harassment. OBJECTIVE The purpose of this study was to identify individual and school-related factors predicting sexual harassment victimization. METHODS A sample of 17,364 Chilean students from Grades 5 through 8 in 405 schools with low socioeconomic status answered instruments concerning peer sexual harassment, other types of peer victimization and discrimination, and perceptions of classroom and school climate and norms against sexual harassment. Data were analyzed through hierarchical multivariate regression. RESULTS Experiences of being sexual harassed by other students were reported by 13.5 % of students, with higher frequencies in male students, students from Grades 5 and 6, and students with lower individual socioeconomic status. School-related experiences of being discriminated against due to sexual orientation, ethnic origin, and disability were the strongest predictors of sexual harassment victimization. CONCLUSION We discuss how peer sexual harassment might be understood as a consequence of peer social discrimination based on sexism, racism, and ableism. We also discuss the need to provide inclusive school climate policies that allow all students to feel safe and included.
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Affiliation(s)
- Verónica López
- School of Psychology, Pontificia Universidad Católica de Valparaíso, Chile; Center for Research in Inclusive Education, Chile.
| | | | - Rami Benbenishty
- Hebrew University of Jerusalem, Israel; (Emeritus) and Universidad Andres Bello, Chile.
| | | | | | - Paola Sánchez
- Junta Nacional de Auxilio Escolar y Becas JUNAEB, Chile.
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Merrill KG, Campbell JC, Decker MR, McGready J, Burke VM, Mwansa JK, Miti S, Frimpong C, Kennedy CE, Denison JA. Prevalence of physical and sexual violence and psychological abuse among adolescents and young adults living with HIV in Zambia. PLoS One 2020; 15:e0235203. [PMID: 32584889 PMCID: PMC7316234 DOI: 10.1371/journal.pone.0235203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 06/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Little is known about violence against HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. This analysis examines experiences of violence victimization, and the perpetrators of this violence, among AYA living with HIV, aged 15-24 years, in Zambia. METHODS We analyzed baseline data from 272 AYA (60.1% female, 71.0% perinatally infected) enrolled in Project YES! (Youth Engaging for Success), a randomized controlled trial conducted in four HIV clinics in Ndola, Zambia. Violence measures were adapted from the ICAST-C and the WHO Multi-Country Study on Women's Health and Domestic Violence. Youth could report up to 12 perpetrator types for past-year experiences of violence. We estimated lifetime and past-year prevalence of physical violence, psychological abuse, and forced sex, disaggregated by sex and age group. Estimates were weighted using sex and age data from the 2013-14 Zambian Demographic and Health Survey to be representative of HIV-positive AYA in Zambia. RESULTS Estimated lifetime prevalence of any violence victimization was 78.2%. Past-year prevalence was 72.0% among males and 74.5% among females. Almost half of AYA (46.1%) had ever experienced polyvictimization (2+ types of violence). Psychological abuse was most common (70.4% lifetime, 65.3% past-year), followed by physical violence (50.8% lifetime, 44.7% past-year) and forced sex (10.4% lifetime, 4.7% past-year). Among past-year victims, males experienced more violence than females from a friend/peer (74.3% vs. 45.1%, p<0.001); females experienced more violence than males from a romantic partner (33.3% vs. 5.0%, p<0.001), parent/caregiver (32.4% vs. 17.6%, p = 0.02), and stranger (19.7% vs. 5.2%, p<0.001). CONCLUSION The widespread and overlapping prevalence of multiple types of violence highlights the critical need for prevention and response efforts that are tailored to youths' sex and the perpetrator type. Future research should explore violence victimization and HIV outcomes, and the measurement of psychological abuse and sexual violence, among HIV-positive AYA in the region.
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Affiliation(s)
- Katherine G. Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Jacquelyn C. Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Virginia M. Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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50
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Russell D, Higgins D, Posso A. Preventing child sexual abuse: A systematic review of interventions and their efficacy in developing countries. CHILD ABUSE & NEGLECT 2020; 102:104395. [PMID: 32062425 DOI: 10.1016/j.chiabu.2020.104395] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Research on prevalence, risk factors, and prevention interventions for child sexual abuse has continued to focus on western and developed countries. Where country-level prevalence data or large-scale research exists, rates of child sexual abuse are consistently higher in developing and non-western countries than their western and developed counterparts. OBJECTIVE We systematically reviewed research on the nature of child sexual abuse interventions in developing countries, the settings and populations included to identify types of child sexual abuse prevention initiatives being implemented in developing countries and their effectiveness. METHODS Following PRISMA guidelines, we conducted a systematic search of six databases and identified eight studies to include in our analysis. RESULTS Most empirically evaluated interventions in developing countries have focused on preschool and primary school-aged children. Most have focused on interventions delivered in educational settings, with a lack of focus on population-level interventions to prevent child sexual abuse. Researchers have used outcomes measuring knowledge or skills for young people in self-protection and help-seeking, not deployment of those skills, actual reduction in prevalence of CSA, or improvements in conditions of safety in organizational contexts. CONCLUSIONS If the focus on school-based strategies to prevent child sexual abuse continues in developing countries, a significant gap in knowledge of the efficacy of population-level interventions outside of school contexts, and consistency across the application of interventions will remain. Evaluations are needed that address the efficacy of broader government-led or whole-of-community prevention interventions to reduce actual prevalence of child sexual abuse, or that can link increased knowledge and skill with reduced victimization.
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Affiliation(s)
- D Russell
- Institute of Child Protection Studies, Australian Catholic University, Australia.
| | - D Higgins
- Institute of Child Protection Studies, Australian Catholic University, Australia
| | - A Posso
- Royal Melbourne Institute of Technology, Australia
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