Prevalence and associated risk factors of violence against conflict-affected female adolescents:A multi-country, cross-sectional study

Over half of displaced civilians in humanitarian emergencies are children, and these settings pose unique threats to children's safety with long-lasting consequences. Our study broadens the limited evidence on violence against adolescent girls in emergencies by estimating prevalence and predictors of violence among adolescent girls aged 13-14 in South Kivu, Democratic Republic of the Congo (DRC), and aged 13-19 in refugee camps in the Benishangul-Gumuz region of Ethiopia.Survey data were collected from a sample of 1296 adolescent girls using Computer-Assisted Personal Interview and Audio Computer-Assisted Self-Interview programming. Predictors of violence were modeled using multivariable logistic regression.The majority of adolescent girls (51.62%) reported experiencing at least one form of violence victimization in the previous 12 months: 31.78% reported being hit or beaten, 36.79% reported being screamed at loudly or aggressively, and 26.67% experienced unwanted sexual touching, forced sex, and/or sexual coercion. Across both countries, ever having a boyfriend and living with an intimate partner were strong predictors of violence. Fewer years of education completed in DRC, and young age in Ethiopia, were also associated with reported victimization.Prevalence of violence against adolescent girls is high in these two conflict-affected contexts. Findings indicate a need for programs targeting younger populations, broader efforts to address different forms of victimization, and increased recognition of intimate partners and caregivers as perpetrators of violence in conflict-affected settings

Disclosure bias for group versus individual reporting of violence amongst conflict-affected adolescent girls in DRC and Ethiopia

Methodologies to measure gender-based violence (GBV) have received inadequate attention, especially in humanitarian contexts where vulnerabilities to violence are exacerbated. This paper compares the results from individual audio computer-assisted self-administered (ACASI) survey interviews with results from participatory social mapping activities, employed with the same sample in two different post-conflict contexts. Eighty-seven internally displaced adolescent girls from the Democratic Republic of the Congo and 78 Sudanese girls living in Ethiopian refugee camps were interviewed using the two methodologies. Results revealed that the group-based qualitative method elicited narratives of violence focusing on events perpetrated by strangers or members of the community more distantly connected to girls. In contrast, ACASI interviews revealed violence predominantly perpetrated by family members and intimate partners. These findings suggest that group-based methods of information gathering frequently used in the field may be more susceptible to socially accepted narratives. Specifically, our findings suggest group-based methods may produce results showing that sexual violence perpetrated by strangers (e.g., from armed groups in the conflict) is more prevalent than violence perpetrated by family and intimate partners. To the extent this finding is true, it may lead to a skewed perception that adolescent GBV involving strangers is a more pressing issue than intimate partner and family-based sexual violence, when in fact, both are of great concern

Preventing violence against refugee adolescent girls:Findings from a cluster randomised controlled trial in Ethiopia

Introduction Interpersonal violence is a critical public health concern in humanitarian contexts, but evidence of effective violence prevention programmes targeting adolescent girls is lacking. We investigated the efficacy of a life skills and safe spaces programme to reduce adolescent girls’ experiences of interpersonal violence in a refugee setting.Methods In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 919 Sudanese and South Sudanese girls ages 13–19 years residing in refugee camps in Ethiopia. Girls were divided into 31 clusters, with 457 and 462 participants assigned to the intervention and control arms, respectively. Intervention clusters received 30 life skills sessions delivered in safe spaces and 8 complementary sessions for caregivers. The primary outcome was exposure to sexual violence in the previous 12 months. Secondary outcomes included disaggregated forms of sexual violence, physical violence, emotional violence, transactional sex, child marriage, feelings of safety, attitudes around rites of passage and perceptions of social support. Intent-to-treat analysis was used.Results At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (adjusted OR =0.96, 95%  CI 0.59 to 1.57), other forms of violence, transactional sex or feelings of safety. The intervention was associated with improvements in attitudes around rites of passage and identified social supports. Additionally, the intervention showed a decrease in reported child marriage among girls who were married at baseline.Conclusion While the intervention impacted key markers along the causal pathway to violence reduction, further research and programmatic adaptations are needed to prevent violence towards adolescents in humanitarian contexts.Trial registration NCT02506543

Disclosure bias for group versus individual reporting of violence amongst conflict-affected adolescent girls in DRC and Ethiopia

Methodologies to measure gender-based violence (GBV) have received inadequate attention, especially in humanitarian contexts where vulnerabilities to violence are exacerbated. This paper compares the results from individual audio computer-assisted self-administered (ACASI) survey interviews with results from participatory social mapping activities, employed with the same sample in two different post-conflict contexts. Eighty-seven internally displaced adolescent girls from the Democratic Republic of the Congo and 78 Sudanese girls living in Ethiopian refugee camps were interviewed using the two methodologies. Results revealed that the group-based qualitative method elicited narratives of violence focusing on events perpetrated by strangers or members of the community more distantly connected to girls. In contrast, ACASI interviews revealed violence predominantly perpetrated by family members and intimate partners. These findings suggest that group-based methods of information gathering frequently used in the field may be more susceptible to socially accepted narratives. Specifically, our findings suggest group-based methods may produce results showing that sexual violence perpetrated by strangers (e.g., from armed groups in the conflict) is more prevalent than violence perpetrated by family and intimate partners. To the extent this finding is true, it may lead to a skewed perception that adolescent GBV involving strangers is a more pressing issue than intimate partner and family-based sexual violence, when in fact, both are of great concern

Preventing violence against conflict-affected adolescent girls: findings from Ethiopia, Democratic Republic of Congo, and Pakistan

Background: Interpersonal violence is a major public health concern in humanitarian contexts, and adolescent girls are uniquely vulnerable. There is little evidence on effective violence prevention programmes targeting this population. We investigated the efficacy, feasibility, and acceptability of a life skills and safe spaces programme to reduce violence exposure for conflict-affected adolescent girls. Methods: Evaluations were conducted in Ethiopia, the Democratic Republic of Congo (DRC), and Pakistan. In Ethiopia and DRC, the programme was evaluated via cluster-randomised controlled trials in refugee camps. In Ethiopia, girls aged 13–19 were enrolled. Girls and their caregivers in the treatment group received the intervention and the control group was waitlisted. In DRC, girls aged 10–14 and their caregivers were enrolled. All girls received the intervention and treatment was randomised for caregivers. In both Ethiopia and DRC, the primary outcome was girls’ exposure to sexual violence. In Pakistan, a mixed-methods evaluation design focused on feasibility and acceptability. A single-group within-participants pre-post test was administered to 78 internally displaced and host community girls aged 12–19 enrolled in the programme. Qualitative in-depth interviews were conducted with a subset of 15 girls at endline. Primary outcomes included perceptions of programme content and changes in freedom of movement, safety, self-esteem, and hope. Findings: In Ethiopia, 919 girls were enrolled, 457 in the intervention group and 462 in the wait-list group. At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (aOR=0·96, 95% CI 0·59–1·57). In DRC, 869 girls ages 10–14 and 764 caregivers were enrolled. 389 caregivers received the intervention and 375 were wait-listed. At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (aOR=0·95, 95% CI 0·65–1·37). In Pakistan, programme content was perceived as acceptable and freedom of movement, safety, self-esteem, and hope increased over time. Interpretation: The intervention was feasible and acceptable in Pakistan, but further research and programmatic adaptations are needed to prevent adolescent violence in humanitarian contexts. Funding: UK Department for International Development

Prevalence and perpetrators of past year violence^a, reported via ACASI.

<p>Prevalence and perpetrators of past year violence<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0174741#t002fn001" target="_blank">^a</a>, reported via ACASI.</p

Demographics of study population.

<p>Demographics of study population.</p