Violence against primary school children with disabilities in Uganda: a cross-sectional study

Prevalence of school related violence in seven countries: A cross-sectional survey

Violence against children in schools harms the affected children, limits their learning and educational attainment, and extends its harms to families and the broader communities. However, to date, comparable cross-country data on violence against children in schools has not been available. We utilize the Violence Against Children and Youth Surveys (VACS) to estimate school-related violence against children in seven countries (Honduras, Kenya, Malawi, Nigeria, Tanzania, Uganda, and Zambia). Leveraging the unique comparability of the surveys, we are able to estimate both physical and sexual violence experienced in childhood and adolescence among youth aged 13-24. Where possible, we also disaggregate by gender and perpetrator type. Overall, within our sample seven countries, we find that 12.11-44.63% of females and 14.28-53.85% of males experienced at least one form of violence. Males experience higher levels of school-related violence and a significant portion of this is due to experiencing physical violence perpetrated by male classmates.

Prevalence of functional difficulty among school-aged children and effect on school enrolment in rural southern India: A cross-sectional analysis

Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.

"If he has education, there will not be any problem": Factors affecting access to education for children with disabilities in Tamil Nadu, India

This study explores factors affecting children with disabilities' enrolment and experience in school in Tamil Nadu, India. In-depth interviews were conducted with 40 caregivers and 20 children with disabilities. Children were purposively selected to maximise heterogeneity by gender, impairment type and enrolment status, using data from a previous survey. Overall, caregivers recognised the importance of school for their children's future livelihoods or at least as a means of socialisation. However, some questioned the value of school, particularly for children with intellectual or sensory impairments. Other barriers to school enrolment and regular attendance included poor availability and affordability of transport, safety concerns or school staffs' concerns about children's behaviour being disruptive. While in school, many children's learning was limited by the lack of teacher training and resources for inclusive education. Poor physical accessibility of schools, as well as negative or overly protective attitudes from teachers and peers, often limited children's social inclusion while in school. These findings carry implications for the implementation of inclusive education in India and elsewhere, as they indicate that despite legislative progress, significant gaps in attendance, learning and social inclusion remain for children with disabilities, which may not be captured in traditional metrics on education access.

Child-led resistance in the streets of the global south: Decolonial perspectives of violence against children outside of family care

BACKGROUND

Violence against children (VAC) remains an urgent global dilemma and researchers and policymakers alike continue to work tirelessly to devise strategies aiming to end VAC. However, the perspectives and expertise of children themselves remain underrepresented in the drafting and implementation of these strategies against VAC. This paper draws attention to the marginalization of children living outside of family care and centers their perspective.

OBJECTIVE

This study aimed to characterize the forms of violence experienced by children living outside the family setting in Uganda, from the perspective of children themselves. The paper seeks to position the voicing of this perspective as a form of resistance against VAC from a decolonial perspective.

PARTICIPANTS AND SETTING

The participatory research process included a total of 94 participants in various urban study sites in Kampala, Uganda.

METHODS

The research team completed this qualitative study within a youth-driven participatory action research (YPAR) framework. Data collection techniques included interviews, focus groups, participatory visual methods and social cartography.

RESULTS

Children living outside of family care experience grave forms of emotional, physical and sexual violence. Child participants present survival strategies that can inform future research and policies on violence prevention practice.

CONCLUSIONS

The illustration of explicit violence outlined in this study represents a form of resistance children take against their perpetrators. The participatory youth researcher team urges future research and policy addressing VAC in Uganda to center these perspectives and expertise of children and adolescents in both programmatic and research initiatives aiming to end violence against children.

Increasing disclosure of school-related gender-based violence: lessons from a systematic review of data collection methods and existing survey research

BACKGROUND

School-related gender-based violence (SRGBV) includes sexual, physical or psychological violence occurring in and around schools often perpetrated by teachers or peers. In this review, we focus on studies comparing how data collection methodologies affect children's disclosures of SRGBV.

METHODS

We conducted a systematic review, searching nine databases for studies from high, middle and low-income countries using search terms related to violence, disclosure and data collection methodology. Records were initially screened by abstract and then full-texts were retrieved and data from eligible reports extracted. In this paper, we draw on results from this larger systematic review highlighting studies conducted with children which either collected data in schools or asked about violence in schools. We also describe methods compared and results of studies that were not conducted in schools, but that included children and young people. Finally, we describe how multi-country nationally representative surveys conducted in at least one low and middle-income country measure children's experiences of SRGBV.

RESULTS

We screened 28,780 records, of which fourteen are included in this article. Only four studies compared data collection methodologies in schools or about violence in schools. These showed a 0 to more than 500-percent variation in the prevalence of violence measured using different data collection methodologies. An additional ten studies which were not conducted in schools, examined disclosure of violence in children and young people that was not specifically school-related. We assessed five multi-country national surveys that measured SRGBV. This limited evidence suggests that methods allowing increased anonymity (e.g. audio computer assisted self-interview, online surveys) may result in higher disclosure of violence, including SRGBV, than face-to-face interviewing. No studies included reported on safety, experiences of young people, or the costs of different methods. Multi-country national surveys used self-completion methods if completed in schools or face-to-face interviewing if completed in households, to measure SRGBV.

CONCLUSION

Evidence on the impact of data collection method on SRGBV disclosure is limited, however current prevalence of SRGBV in international surveys used to monitor SDG progress may be underestimated due to data collection methods used. Further research on SRGBV should aim to test the effects of data collection methodology on the disclosure of violence. Efforts to improve the measurement of SRGBV is central to understanding the epidemiology, monitoring changes, and developing school and community-based programs as well as policies to prevent and respond to SRGBV.

Sexual Violence Against Persons With Disabilities: A Meta-Analysis

A growing number of large-scale studies suggest that people with disabilities are at greater risk of sexual victimization than nondisabled individuals. However, certain results are inconsistent and whether potential moderators explain this variability in previous findings remain to be considered. This meta-analysis aimed to determine the magnitude of the difference in risk of being sexually victimized based on the presence of a disability. An additional objective was to evaluate the relative influence of gender, age, type of disability, type of sexual violence, and relationship with the perpetrator on the association between the presence of a disability and sexual victimization. Studies were searched using pertinent databases and retained if they included a group with a disability, provided data that quantify the occurrence of abuse, indicated the type of sexual violence, and was published between 1970 and 2018 in French or English. A total of 68 studies, allowing 84 independent samples and 12,427 participants, were included. Individuals with disabilities were at significantly higher risk of sexual victimization than persons without disabilities (odds ratio = 2.27). The risk of sexual victimization among individuals with a disability was significantly higher in adult participants compared with the risk in minor participants. Sensory impairment was the type of disability associated with the highest risk of sexual victimization. Odds of sexual victimization among individuals with a disability were significantly higher in African countries compared with all others, and odds in Western Europe were significantly lower than in the United States. No significant differences emerged across eras.

The prevalence of sexual violence against female children: A systematic review and meta-analysis

BACKGROUND

Sexual violence against female children is considered an important public health problem. However, there are currently no clear prevalence rates across the globe on which to base measures to protect these children. The objective of this study is to systematically summarize the prevalence of sexual violence against female children.

METHODS

We conducted a comprehensive search of the PubMed, Embase and Web of Science databases from their inception through April 2021 for pertinent studies reporting the prevalence of sexual violence against female children. The prevalence rate was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I² statistic. Differences by study-level characteristics were estimated through subgroup analysis and meta-regression.

RESULTS

A total of 28 cross-sectional studies were included (a total of 30,524 participants). The pooled sexual violence rate against female children was 0.24 (95 % CI = 0.20-0.27). Groups comparisons revealed that sexual violence rates obtained from 1981 to 2000 (0.28, 95 % CI = 0.21-0.36) were higher than those obtained from 2001 to 2020 (0.21, 95 % CI = 0.16-0.25), that rates were higher for female children from developed countries (0.25, 95 % CI = 0.20-0.29) than for those from developing countries (0.21, 95 % CI = 0.14-0.27), the rates for surveyed adults (0.22, 95 % CI = 0.17-0.28) than for surveyed female children (0.18, 95 % CI = 0.10-0.26), and that rates for those ≤15 years of age (0.10, 95 % CI = 0.01-0.20) were much lower than those for older children.

CONCLUSIONS

Nearly a quarter (24 %) of female children have been victims of sexual violence. Prevention strategies should be developed urgently to protect female children from aggression.

Prevalence and factors associated with the occurrence of sexual violence among people with disabilities in Burkina Faso

A person with a disability regardless of the gender has an increased risk of sexual coercion and violence in various ways. This study aimed to analyze the prevalence and the risk factors associated with lifetime sexual violence among people with disabilities (PWDs) in Burkina Faso. We conducted a secondary analysis of a cross-sectional study carried out in Central, Central-East, Central-West and "Hauts Bassins" regions of Burkina Faso. PWDs were selected during a household survey through a two-stage random sampling technique. The prevalence of sexual violence in people disabilities was 7.4% (95%: CI 5.8-9.4). Females with disabilities were more likely than males with disabilities to report lifetime sexual violence (8.9% vs. 4.9%). The place where the person usually spends time and the disability duration were significantly associated with the occurrence of sexual violence among females with disability. There is no association between the other demographic characteristics and sexual violence among people with disability.

Prevalence and factors associated to the occurrence of sexual violence among people with disabilities in Burkina Faso

A person with a disability regardless of the gender has an increased risk of sexual coercion and violence in various ways. This study aimed to analyze the prevalence and the risk factors associated with lifetime sexual violence among people with disabilities (PWDs) in Burkina Faso. We conducted a secondary analysis of a cross-sectional study carried out in four regions (Central, Central-East, Central-West and 'Hauts Bassins' regions) of Burkina Faso. PWDs were selected during a household survey through a two-stage random sampling technique. The prevalence of sexual violence in people disabilities was 7.4% (95%: CI 5.8-9.4). Females with disabilities were more likely than males with disabilities to report lifetime sexual violence (8.9% vs 4.9%). The place where the person usually spends time and the disability duration were significantly associated with the occurrence of sexual violence among female with disability. No significant association was found between different and sexual violence among people with disabilities. Sexual violence is frequent among PWDs in Burkina Faso. Specific policy to protect PWDs particularly women with disabilities from sexual violence is urgently needed.

Disability status and multi-dimensional personal well-being among adolescents in the Southern Highlands Region of Tanzania: results of a cross-sectional study

OBJECTIVE

Examine how disability status among adolescents is associated with the following domains of personal well-being: schooling, livelihoods, health, violence and psychosocial well-being. It is hypothesised that adolescents with a disability will have greater deficits in these areas of well-being compared with their healthier counterparts.

DESIGN

Cross-sectional data from 2018 were obtained from the second round of an on-going study of adolescents living in poor households in two regions of the Southern Highlands of Tanzania (Iringa and Mbeya). We use the Washington Group (WG) Short Set indicators to measure disability and undertook logistic and linear multivariate regressions to understand the association between disability and the outcomes of interest.

PARTICIPANTS

The sample included 2274 participants aged 15-20 years living in households participating in a government social protection programme targeted to households living in extreme poverty.

RESULTS

Overall, 310 participants (14%) were classified as having disabilities. Outcomes not associated with disability status included literacy, schooling, livelihoods and self-efficacy. Adolescents with disabilities were less likely to report good or very good health (adjusted OR (aOR)=0.39, 95% CI 0.29 to 0.52) and had increased odds of reporting depressive symptoms in (aOR=1.46, 95% CI 1.11 to 1.90), emotional violence (aOR=2.18, 95% CI 1.49 to 3.20) and physical violence (aOR=1.71, 95% CI 1.13 to 2.59), compared with those without disabilities. Reports of depression were higher among men, and violence was more prevalent among women. Patterns of association were generally similar between men and women, although the association of disability with markers of well-being reached statistical significance more often among men.

CONCLUSION

This study highlights areas where adolescents with disabilities are falling behind their peers in terms of personal well-being. These findings suggest that interventions may be needed to mainstream disability in programmes and policies aiming to improve well-being, mental health and violence prevention among adolescents.

TRIAL REGISTRATION NUMBER

Pan African Clinical Trial Registry (PACTR201804003008116).

Creating Learning Environments Free of Violence in Special Education Through the Dialogic Model of Prevention and Resolution of Conflicts

Violence suffered by children is a violation of human rights and a global health problem. Children with disabilities are especially vulnerable to violence in the school environment, which has a negative impact on their well-being and health. Students with disabilities educated in special schools have, in addition, more reduced experiences of interaction that may reduce both their opportunities for learning and for building protective social networks of support. This study analyses the transference of evidence-based actions to prevent violence in schools - the dialogic model of prevention and resolution of conflicts (DMPRC) - in the context of a special school, and its impact on the reduction of violence, the creation of egalitarian relationships, and the prevention of bullying. A case study with a communicative approach was conducted including in-depth interviews and communicative focus groups with the diverse participants to analyze the process of transformation carried out in the school and the main actions that give students a voice in the management and creation of egalitarian non-violent relationships. The results show that the inclusion of the students' voices in the resolution and prevention of conflicts reduces violence, empowers special education students, strengthens friendship relationships, caring behavior, and active positioning among the community. The positive impact of the transference of the DMPRC to special schools contributes to students' well-being and healthy development by offering safe and protective educational spaces and quality emotional education, also contributing to the achievement of the Sustainable Development Goals related to the elimination of all forms of violence in childhood.

Peer victimization and experiences of violence at school and at home among school age children with disabilities in Pakistan and Afghanistan

Background: Children with disabilities are more likely to experience violence or injury at school and at home, but there is little evidence from Central Asia. Objective: To describe the prevalence of disability and associations with peer violence perpetration and victimization, depression, corporal punishment, school performance and school attendance, among middle school children in Pakistan and Afghanistan. Method: This is a secondary analysis of data gathered in the course of evaluations of interventions to prevent peer violence conducted in Pakistan and Afghanistan as part of the 'What Works to Prevent Violence against Women and Girls Global Programme'. In Pakistan, the research was conducted in 40 schools, and disability was assessed at midline in 1516 interviews with Grade 7s. In Afghanistan, the data were from the baseline study conducted in 11 schools with 770 children. Generalized Linear Mixed Modeling was used to assess associations with disability. Results: In Afghanistan, the prevalence of disability was much higher for girls (22.1%) than boys (12.9%), while in Pakistan 6.0% of boys and girls reported a disability. Peer violence victimization was strongly associated with disability in Afghanistan and marginally associated in Pakistan. In Pakistan, perpetration of peer violence was associated with disability. In both countries, disability was significantly associated with higher depression scores. Food insecurity was strongly associated with disability in Afghanistan. Conclusion: Disability is highly prevalent in Afghanistan and Pakistan schools and this is associated with a greater risk of experiencing and perpetrating peer violence. It is important to ensure that all children can benefit from school-based prevention interventions.

No One Left Behind? Comparing Poverty and Deprivation between People with and without Disabilities in the Maldives

The 2030 Sustainable Development Goals call for the disaggregation of all indicators by disability and other characteristics so as to “leave no one behind” from development progress. Data on disability, however, is acknowledged to be lacking, which is essential for informing policy and planning. Consequently, this study estimates the prevalence of disability in the Maldives and compares indicators of poverty and living conditions between people with and without disabilities, using nationally-representative, population-based data (n = 5363). The prevalence of disability was estimated at 6.8%. Overall, this research finds that people with disabilities are at risk of being left behind from progress across multiple Sustainable Development Goal domains, including in combatting income poverty, food insecurity and exclusion from health, education, work and social participation, and vulnerability to violence. Further, amongst people with disabilities, people with cognitive and mental health impairments, people living outside the capital, Male’, and children and working-age adults tend to face the highest levels of deprivation.

Perceived barriers and supports to accessing community-based services for Uganda's pediatric post-surgical population

BACKGROUND

Access to pediatric surgical intervention in low-income countries is expanding, but investments in post-surgical care have received less attention. This study explored the barriers and supports for school-aged children to access post-surgical, community-based follow-up care in Uganda as perceived by community stakeholders.

MATERIALS AND METHODS

This qualitative exploratory case study used in-depth, semi-structured interviews and in-country site visits among Ugandan organizations providing follow-up care to school-aged children in Uganda after surgery. Data from eight interviews and eight site visits were coded, analyzed, and cross-tabulated with a modified grounded theory approach.

RESULTS

Four key barriers to community-based follow-up care were identified: discrimination, financial barriers, geographical barriers (including transportation), and caregiver limitations to support recovery. Three key supports to successful access to and participation in community-based post-surgical recovery were identified: disability awareness, the provision of sustained follow-up care, and caregiver supports for reintegration.

CONCLUSIONS

Increasing awareness of disability across local Ugandan communities, educating caregivers with accessible and culturally aware approaches, and funding sustainable follow-up care programming provide promising avenues for pediatric post-surgical recovery and community reintegration in contemporary Uganda.Implications for rehabilitationMultiple, intersecting factors prevent or promote access to post-surgical community-based services among school-aged children in Uganda.The most prominent barriers to pediatric community reintegration in Uganda include discrimination, lack of financial resources, geographical factors, and caregiver limitations.Community and interprofessional alliances must address disability awareness and sources of stigma in local contexts to promote optimal recovery and reintegration after surgery.Collaborative efforts are needed to develop sustainable funding for community-based care programs that specifically support pediatric post-surgical recovery and reintegration.Efforts to provide appropriate and empowering caregiver education are critical, particularly in geographical regions where ongoing access to rehabilitation professionals is minimal.

Exploration of the Relationship between Severe and Complex Disabilities and Child Sexual Abuse: A Call for Relevant Research

Despite the awareness that children with severe and complex difficulties experience child sexual abuse (CSA), the development of research in this area is still in its infancy. This call for relevant research seeks to identify the main gaps in knowledge in order to inform future debate, potential research questions, and raise issues for practice. Themes are identified relevant to researchers and practitioners globally. These include the complexity and duality of definition: recognition of CSA; barriers to communication with children and between services; diversity of segregated and inclusive settings; interaction of age and gender; adult and peer abuse in institutions; sexuality and disability; and intrusive care and medical practices. Recommendations for future research and practice in creating safe environments are provided.

How to conduct good quality research on violence against children with disabilities: key ethical, measurement, and research principles

Background

Approximately one billion children experience violence every year. Violence against children is an urgent global public health concern and violation of children’s rights. It is also a risk factor for serious negative health and social outcomes and is therefore addressed within the Sustainable Development Goals (SDGs). Children with disabilities, who make up one in 20 children worldwide, are particularly vulnerable to violence although good quality data are lacking on causes and means of prevention of violence against children with disabilities. Key challenges exist in the measurement of disability and violence, which in part explains the dearth in evidence.

Improving research on violence against children with disabilities

This paper provides guidance on how to conduct good quality, ethical, and inclusive research on violence against children with disabilities, particularly in low-income settings. The lack of an international agreed ‘gold standard’ frustrates efforts to measure violence across settings and time. Careful consideration must be given to the design of survey tools. Qualitative and participatory research methods also offer important opportunities to explore children’s subjective understanding and experiences of violence. Challenges also exist around the measurement of disability. Disability may be measured by asking directly about disability, through self-reported functioning, or through the presence of impairments or health conditions. These approaches have strengths and limitations and should build on what children are able to do and include appropriate adaptations for specific impairments where necessary. Ethical research also requires adherence to ethical guidelines and approvals, obtaining informed consent, appropriate child protection responses, and careful consideration of interviewer-related issues including their selection, training, and welfare. Key methodological gaps remain - how to include children with severe communication challenges in research; how to respond in instances of weak child protection systems; designing sampling procedures that adequately represent children with disabilities in large-scale violence surveys; and determining how best to ask about violence safely in large-scale surveys and monitoring data. This paper further advocates for the dissemination of research results in inclusive and accessible formats.

Conclusion

With careful planning, challenges in collecting data on disability and violence can be overcome to generate evidence in this neglected area.

Positive Youth Development Programs in Low- and Middle-Income Countries: A Conceptual Framework and Systematic Review of Efficacy

PURPOSE

Positive youth development (PYD) has served as a framework for youth programs in high-income countries since the 1990s and has demonstrated broad behavioral health and developmental benefits. PYD programs build skills, assets, and competencies; foster youth agency; build healthy relationships; strengthen the environment; and transform systems to prepare youth for successful adulthood. The goal of this article was to systematically review the impact of PYD programs in low- and middle-income countries (LMICs).

METHODS

Targeted searches of knowledge repository Web sites and keyword searches of Scopus and PubMed identified over 21,500 articles and over 3,700 evaluation reports published between 1990 and mid-2016. Ninety-four PYD programs with evaluations in LMICs were identified, of which 35 had at least one experimental or rigorous quasi-experimental evaluation.

RESULTS

Sixty percent of the 35 programs with rigorous evaluations demonstrated positive effects on behaviors, including substance use and risky sexual activity, and/or more distal developmental outcomes, such as employment and health indicators.

CONCLUSIONS

There is promising evidence that PYD programs can be effective in LMICs; however, more rigorous examination with long-term follow-up is required to establish if these programs offer benefits similar to those seen in higher income countries.

Physical, psychological and social impact of school violence on children

Violence against children includes all forms of violence against people under 18 years old whether perpetrated by parents or other caregivers, peers, partners, teacher or strangers. This is a public health, human rights, and social problem: levels of violence against children are frightfully high and it is estimated that up to 1 billion children aged 2–17 years, have experienced a type of violence. Very few studies provided physical violence perpetrated at school but it can have a physical impact, causing psychological distress, permanent physical disability and long-term physical or mental ill-health. Children who experienced any type of violence at school may develop reactive attachment disorder, modest physical inactivity, overweight or obesity, diabetes, smoking habits, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease and other negative outcomes. Evidence from international studies clearly shows that nonviolent, positive discipline delivers better results, while any type of violence is associated with many negative one.

"A child who is hidden has no rights": Responses to violence against children with disabilities

BACKGROUND

There is an urgent need to understand how best to prevent and respond to violence against children with disabilities as they are at a high risk for violence because they are marginalized, isolated, and targeted and have little power within their communities.

OBJECTIVE

Guided by social-ecological theory, this study explores responses to violence against children with disabilities, including preventative measures and treatment of victims in the West African countries of Guinea, Niger, Sierra Leone, and Togo.

PARTICIPANTS

Participants were recruited using purposive and snowball sampling from the following three groups: disability stakeholders including representatives from local, national, and international organizations and governments; community members including parents, teachers, and leaders; and children with disabilities.

METHODS

A qualitative study design guided data generation, that included document analysis, semi-structured interviews, and focus groups across the four countries. In total, 419 people participated. Of those participants, 191 took part in an interview and the rest participated in one of 55 focus groups.

FINDINGS

Responses to disability-based violence are driven at the mesosystem and exosystem levels. Prevailing views indicated that national level policies and laws are not always considered part of solutions, communities are leading responses to violence, and children with disabilities are hidden at home or in institutions for both their own and their family's safety. Conclusions The findings can inform development of prevention and intervention programs that will protect children with disabilities from violence in contexts with high levels of disability stigma, social conflict, violence, and poverty.

Persons with disabilities as experts-by experience: using personal narratives to affect community attitudes in Kilifi, Kenya

BACKGROUND

The last decade has seen improved public awareness of disability in sub-Saharan Africa. However, negative and stereotypical views of disability still persist in many communities. We conducted a study to promote awareness of disability in rural Kenya, using a process of reflection and education. This paper reports on the second aspect - education. The research question was: How can personal narratives of living with disability affect community attitudes and responses to disability?

METHODS

A qualitative phenomenological approach was adopted. Twenty community-based groups involving 249 participants took part. Each group participated in one focus group discussion at baseline, to explore the members' personal experiences and views of disability. The intervention involved three adults with disabilities sharing their personal narratives with each group. After the intervention, repeat focus group discussions were conducted with each group. Thematic analysis was carried out according to the framework method.

RESULTS

The emergent framework consisted of four main themes, organised as opposing constructs: 'burden' and 'agency', 'sub-human' and 'human'. 'Burden' focused on the perceived hopelessness of the situation. Post-intervention revealed greater support for the 'agency' of persons with disabilities, evidenced by what the person could do, rather than their inability, and the relevance of support. The 'sub-human' to 'human' construct captured dehumanising and discriminating practice towards persons with disabilities on one side, and recognition of the person and inclusion in the community on the other. Whilst support and empathy were evident at the pre-intervention stage, post-intervention revealed greater recognition of people with disabilities as fellow human beings.

CONCLUSION

This study provides a proof of concept regarding the deployment of persons with disabilities as agents for change. Exposure to experts-by-experience provided community groups with opportunities to reflect on, examine and adjust their views on disability in this rural part of Kenya. The sharing of personal narratives appeared to resonate with group members, to encourage recognition of the person and not just the disability, and to move their resolve toward ideas for collective action. Further research is needed to assess the effects of such interventions.

Reducing Physical Violence Toward Primary School Students With Disabilities

PURPOSE

We tested whether the Good School Toolkit reduces physical violence from peers and school staff toward students with and without disabilities in Ugandan primary schools.

METHODS

We conducted a cluster randomized controlled trial, with data collected via cross-sectional surveys in 2012 and 2014. Forty-two primary schools in Luwero District, Uganda, were randomly assigned to receive the Good School Toolkit for 18 months, or to a waitlisted control group. The primary outcome was past week physical violence from school staff, measured by primary 5, 6, and 7 students' (aged 11-14 years) self-reports using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional. Disability was assessed through the six Short Set Washington Group questions on functioning. Analyses were by intention to treat.

RESULTS

At endline, 53% of control group students with no functional difficulties reported violence from peers or school staff, versus 84% of students with a disability. Prevalence of past week physical violence from school staff was lower in intervention schools than in the control schools after the intervention, in students with no functional difficulties (adjusted odds ratio [aOR] = .41, 95% confidence interval [CI .26-.65]), students with some functional difficulties (aOR = .36, 95% CI .21-.63), and students with disabilities (aOR = .29, 95% CI .14-.59). The intervention also reduced violence from peers in young adolescents, with no evidence of a difference in effect by disability status.

CONCLUSIONS

The Good School Toolkit is an effective intervention to reduce violence perpetrated by peers and school staff against young adolescents with disabilities in Ugandan primary schools.

From the day they are born: a qualitative study exploring violence against children with disabilities in West Africa

Background

Despite the building evidence on violence against children globally, almost nothing is known about the violence children with disabilities in low and middle-income countries (LMICs) experience. The prevalence of violence against children with disabilities can be expected to be higher in LMICs where there are greater stigmas associated with having a child with a disability, less resources for families who have children with disabilities, and wider acceptance of the use of corporal punishment to discipline children. This study explores violence experienced by children with disabilities based on data collected from four countries in West Africa- Guinea, Niger, Sierra Leone, and Togo.

Methods

A qualitative study design guided data generation with a total of 419 children, community members, and disability stakeholders. Participants were selected using purposive sampling. Stakeholders shared their observations of or experiences of violence against children with disabilities in their community in interviews and focus groups. Thematic analysis guided data analysis and identified patterns of meaning among participants’ experiences.

Results

Results illuminate that children with disabilities experience violence more than non-disabled children, episodes of violence start at birth, and that how children with disabilities participate in their communities contributes to their different experiences of violence.

Conclusions

The study recommends policy-oriented actions and prevention programs that include children and their families in strategizing ways to address violence.

"If he could speak, he would be able to point out who does those things to him": Experiences of violence and access to child protection among children with disabilities in Uganda and Malawi

Introduction

There is growing evidence that children with disabilities face an increased risk of violence globally. While child protection mechanisms to prevent and respond to violence–including formal government systems and more informal programmes and activities run by local communities or NGOs–are slowly becoming operationalised in low- and- middle-income countries, little is known about whether existing mechanisms are disability-inclusive. The aim of this study is to provide a better understanding of children with disabilities’ experiences of violence and their access to available child protection mechanisms in low resource settings.

Methods

This study was conducted in Kasungu and Mulanje districts in Malawi and Kamuli district in Uganda between October-December 2015. In-depth, semi-structured interviews were conducted with approximately 20 purposively selected child/caregiver pairs in each country (43 pairs total). Interviews with key informants involved in the provision of child protection and disability support were also conducted. All interviews were recorded, transcribed and coded in NVivo. Thematic Analysis, complemented by constant comparison as described in Grounded Theory, was used to analyse the data.

Results

Almost all children with disabilities reported experiencing violence, with verbal abuse and bullying the most common forms. Very few of these children sought recourse through available child protection mechanisms. Some of the key factors impeding access to child protection for children with disabilities included: lack of local government disability-inclusive planning and budgeting; centralization of limited disability and social protection services; financial barriers to seeking and receiving care; and stigma and negative attitudes toward disabilities.

Conclusion

Children with disabilities face both high levels of violence and high barriers to accessing available child protection mechanisms. There is an urgent need to ensure that all efforts to prevent and respond to violence against children are more disability-inclusive. In addition, it may be appropriate to target child protection mechanisms specifically toward children with disabilities because of the different and intersecting vulnerabilities that they face.

Physical, psychological, sexual, and systemic abuse of children with disabilities in East Africa: Mapping the evidence

Children with disabilities (CWDs) are at a higher risk of being maltreated than are typical children. The evidence base on the abuse of children with disabilities living in low- and middle-income countries is extremely limited but the problem is particularly acute in East Africa. We don't know the types of evidence that exist on this topic. This problem is compounded by the fact that key indicators of disability, such as reliable prevalence rates, are not available currently. This paper addresses this serious problem by mapping the existing evidence-base to document the coverage, patterns, and gaps in existing research on the abuse of children with disabilities in East Africa. An evidence map, following systematic review guidelines, was conducted and included a systematic search, transparent and structured data extraction, and critical appraisal. Health and social science databases (Medline, EMBASE, PsychInfo, Taylor&Francis, Web of Science, and SAGE) were systematically searched for relevant studies. A substantive grey literature search was also conducted. All empirical research on the abuse of CWDs in East Africa was eligible for inclusion: Data on abuse was systematically extracted and the research evidence, following critical appraisal, mapped according to the type of abuse and disability condition, highlighting gaps and patterns in the evidence-base. 6005 studies were identified and screened, of which 177 received a full-text assessment. Of these, 41 studies matched the inclusion criteria. By mapping the available data and reports and systematically assessing their trustworthiness and relevance, we highlight significant gaps in the available evidence base. Clear patterns emerge that show a major data gap and lack of research on sexual abuse of children with disabilities and an identifiable lack of methodological quality in many relevant studies. These make the development of a concerted and targeted research effort to tackle the abuse of children with disabilities in East Africa extremely difficult. This needs to be addressed urgently if the abuse of children with disabilities is to be prioritised by the global health community.

Gender, violence and resilience among Ugandan adolescents

Resilience, commonly understood as the ability to maintain adaptive functioning in the face of adversity, has emerged as a salient entry point in the field of positive youth development. This study makes a unique contribution by exploring dimensions of resilience among adolescents in Uganda, examining associations between violence from different perpetrators and resilience, and testing whether sex moderates these relationships. Analyses are based on data from 3706 primary school students. Exploratory factor analysis (EFA) identified five factors underlying the construct of resilience: Emotional Support; Family Connectedness; School Connectedness; Social Assets; and Psychological Assets. We used regression analysis to investigate associations between these dependent variables, background characteristics, and experiences of violence (including exposure to intimate partner violence against female caregivers). Results reflect a complex relationship between violence and resilience, with patterns varying by perpetrator (e.g., teacher, peers, caregivers) and some evidence that the sex of the student moderates these dynamics. Overall, there is a consistently negative relationship between all violence measures and Psychological Assets. In addition, teacher violence is associated with lower resilience across factors and both caregiver violence and exposure to IPV are consistently associated with decreased Family Connectedness. These findings suggest that adolescents experiencing (and exposed to) violence from adults may be particularly vulnerable to internalizing and/or externalizing behaviors and withdrawal from the family. Findings point to preventing violence from teachers complemented with enhancing family relationships as promising avenues for resilience-strengthening interventions, and also emphasize the need to consider gendered strategies to ensure girls and boys benefit equally.

Urgently awaiting implementation: The right to be free from exploitation, violence and abuse in Article 16 of the Convention on the Rights of Persons with Disabilities (CRPD)

The Convention on the Rights of Persons with Disabilities (CRPD) enshrines the freedom from exploitation, violence and abuse, a provision, which has hitherto received little attention. Exploring the contents of Article 16, this paper seeks to unpack both the potential for violence prevention as well as the implementation challenges. It situates violence protection within related treaty provisions and touches on specific challenges in institutional care as well as the private realm.

Violence against children perpetrated by peers: A cross-sectional school-based survey in Uganda

Violence against children by peers is a global public health problem. We aimed to assess factors associated with peer violence victimization among primary school children in Uganda. We conducted multilevel multivariable logistic regression analyses of cross-sectional data from 3706 primary students in 42 Ugandan primary schools. Among primary school students, 29% and 34% had ever experienced physical and emotional violence perpetrated by their peers, respectively. Factors strongly associated with both physical and emotional violence were similar and overlapping, and included exposure to interparental violence, having an attitude supportive of violence against children from school staff, not living with biological parents, working for payment, and higher SDQ score. However, we found that younger age, sharing sleeping area with an adult and achieving a higher educational performance score, were specifically associated with physical violence. On the other hand, being female, walking to school, reporting disability and eating one meal on the previous day, were particularly associated with emotional violence. Interventions to reduce peer violence should focus on family contexts, school environments and those with poor socio-economic status may need extra support.

Primary school students' mental health in Uganda and its association with school violence, connectedness, and school characteristics: a cross-sectional study

BACKGROUND

Few studies have explored risk factors for poor mental health in Ugandan primary schools. This study investigated whether individual- and contextual-level school-related factors including violence from school staff and other students, connectedness to school and peers, as well as school size and urban/rural location, were associated with mental health difficulties in Ugandan children. We also examined whether associations between violence exposure at school and mental health were mediated by connectedness as well as whether associations were different for boys and girls.

METHODS

The analytic sample consisted of 3,565 students from 42 primary schools participating in the Good Schools Study. Data were collected through individual interviews conducted in June and July 2012. Mental health was measured using the Strengths and Difficulties Questionnaire. Multilevel logistic regression was applied to investigate factors associated with mental health difficulties.

RESULTS

Experiences of violence from school staff and other students in the past week were strongly associated with mental health difficulties (OR = 1.58, 95 % CI 1.31 to 1.90 and 1.81, 1.47 to 2.23, respectively). Children with a low school connectedness had 1.43 times (1.11 to 1.83) the odds of mental health difficulties compared to those with a high school connectedness. The OR comparing children never feeling close to other students at their school with those always feeling close was 1.86 (1.18 to 2.93). The effect of violence on mental health was not mediated through the connectedness variables. School size was not related to mental health difficulties, but attending an urban school increased the odds of mental health difficulties after accounting for other factors. We did not find evidence that the effect of one or more of the exposures on the outcome differed between boys and girls.

CONCLUSIONS

These findings suggest that violence in school and low connectedness to school and peers are independently associated with mental health difficulties and interventions should address both concurrently. Extra support may be needed for students in urban schools.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01678846 . Registered 24 August 2012.

Exposure to violence and psychological well-being over time in children affected by HIV/AIDS in South Africa and Malawi

Many of the risk factors for violence against children are particularly prevalent in families and communities affected by HIV/AIDS. Yet, in sub-Saharan Africa, where HIV rates are high, efforts to prevent or address violence against children and its long-lasting effects are hampered by a lack of evidence. We assessed the relationship between violence exposure and mental health among HIV-affected children attending community-based organisations in South Africa (n = 834) and Malawi (n = 155, total sample n = 989) at baseline and 12-15-month follow-up. Exposure to violence in the home and in the community was high. HIV-negative children who lived with an HIV-positive person experienced most violence overall, followed by HIV-positive children. Children unaffected by HIV experienced least violence (all p < .05). Interpersonal violence in the home predicted child depression (β = 0.17, p < .001), trauma symptoms (β = 0.17, p < .001), lower self-esteem (β = -0.17, p < .001), and internalising and externalising behavioural problems (β = 0.07, p < .05), while exposure to community violence predicted trauma symptoms (β = 0.16, p < .001) and behavioural problems (β = 0.07, p < .05). Harsh physical discipline predicted lower self-esteem (β = -0.18, p < .001) and behavioural problems for children (β = 0.24, p < .001). Exposure to home (OR: 1.89, 95% CI: 1.23-2.85) and community violence predicted risk behaviour (OR: 2.39, 95% CI: 1.57-3.62). Over time, there was a decrease in depressed mood and problem behaviours, and an increase in self-esteem for children experiencing different types of violence at baseline. This may have been due to ongoing participation in the community-based programme. These data highlight the burden of violence in these communities and possibilities for programmes to include violence prevention to improve psychosocial well-being in HIV-affected children.