Stop Violence Against Girls in School : A cross country analysis of baseline research from Ghana, Kenya and Mozambique

This report presents findings from baseline studies carried out in three districts in Kenya, Ghana and Mozambique for Stop Violence Against Girls in School, a five year project (2008-2013) led by ActionAid. The study aimed to provide a baseline with which to measure and evaluate change over the course of the project, as well as building in depth knowledge of gender, violence and education in the project areas in order to inform decision making about community intervention, advocacy and research priorities in the project, and contributing to the international literature on gender violence in schools. Data was collected in 2009 in 13 primary schools and communities in Ghana, 16 in Kenya and 15 in Mozambique. A total of 2757 respondents participated in the baseline study, including girls and boys, teachers and head teachers, parents, SMC members, community leaders and women’s group leaders, District Education Officers, District Health Officers and Police. The studies combined quantitative and qualitative methods, and a desk review of the legal and policy frameworks. The baseline study confirmed that primary schoolgirls in the project areas experience multiple forms of violence in their schools, homes and communities. Gender violence is closely linked to poverty, with forms of punishment, early marriage, and transactional sex related to the demands on girls to provide support for their families in a context of economic hardship. Across the three project sites, we see disconnects between legal and policy change and local implementation. While Education For All messages are clearly impacting at local levels with increasing access and reducing gender gaps at school, attitudes to and action on gender and violence seem harder to shift. There is some evidence of change (possibly related to recent NGO work in the areas), but apparent changes in awareness or knowledge are often not matched by changes in behaviour. For example, teachers condemning corporal punishment in Kenya and Mozambique, and girls speaking out against female genital cutting and other forms of violence against girls in Kenya may be influenced by policies and interventions, yet these seem to be having little impact on changing practice. Whilst girls being able to openly condemn violence, at least with each other, is an important step in challenging violence in schools and communities, without wider change girls may be placed at increased risk of violence by speaking out in an unsupportive environment. Opportunities for reflection on deeply ingrained beliefs about gender and violence and on how these beliefs relate to practice, as well as opening spaces for different groups at different levels to come together in dialogue and action is likely to be needed to effect wider change

Childrens engagements with violence : a study in a South African school

This thesis is an account of a qualitative study which set out to explore the meanings for\ud children of living with violence. Using a social constructionist epistemology, I examine\ud how, through social relationships, children (co-)construct beliefs, values and practices in\ud relation to violence, and consider the implications for violence prevention.\ud Set in the changing context of post-apartheid South Africa, the study was located in a\ud primary school in a township of Cape Town, where gangsterism, criminal and domestic\ud violence were rife. With 36 children (aged 8, 10 and 13 years), I carried out a series of\ud semi-structured interviews and group sessions, using participatory data-gathering\ud techniques to explore themes of relationships, conflict and violence. Further\ud ethnographic data was gathered through playground observation, working as a\ud classroom assistant, and parent and teacher interviews. Forms of discourse analysis,\ud blending frameworks from developmental psychology, social psychology and\ud sociology, were used to analyse children's talk, thus creating a fine-grained analysis\ud which is sensitive to children's creative engagement with multi-layered social relations.\ud This emphasis on children's active construction of meaning differs from much of the\ud social science literature, which assumes a uni-directional relationship and casts children\ud as passive victims, sometimes caught up in a 'cycle' of violence.\ud The study reveals some of the complex, contradictory and shifting ways in which\ud children engaged with violence in the social fields of the neighbourhood, peer relations\ud and in adult-child relations. Three psycho-social processes were central to these\ud engagements: control (agency), connection (inclusion) and coherence (sense making).\ud But striving for control, connection and coherence generated tensions and conflicts. In\ud managing these tensions, children sometimes colluded with and perpetuated forms of\ud violence, but they also found ways to contest violent social relations. I construct a\ud framework to illustrate these relationships, and consider how interventions, using this\ud framework, can work with children to reduce the possibility of violence

How do Climate Change and Environmental Degradation contribute to Violence against Children?

This scoping review of the literature explores the interlinkages between two pressing crises: violence against children (VAC) and climate change (CC) together with environmental degradation (ED). Only recently have research and policy begun to shine a light on the magnifying effect of CC on children’s exposure to violence, exploitation, and abuse, with the role of ED remaining under-explored. To spur academic and political movement in this area, our research aims to help establish the magnitude, direction, and pathways of the relationship between CC, ED, and VAC. We showcase the complexity of that relationship and illustrate, in the form of case studies, why context-specific approaches and more research are needed. Doing so, we cover five thematic areas: 1) Hazards and Disaster Risk Reduction, 2) Gender, 3) Im/mobility, 4) Child Labour and 5) Health. Taking all five thematic areas together, structural violence against children emerged as a cross-cutting theme, creating and reinforcing the conditions for multiple forms of VAC in the context of CC and ED

Addressing silences in research on girls’ experiences of teacher sexual violence: insights from Uganda

Growing evidence from multiple countries in Africa documents sexual violence in schools. However, when that violence is committed by teachers it is shrouded in secrecy. This article identifies disconnects between quantitative and qualitative research, policy and practice, which have contributed to these silences. We address some of these silences through a dialogical analysis of mixed methods data from the Contexts of Violence in Adolescence Cohort study (CoVAC) with young people in Uganda. The analysis illuminates girls’ experiences of sexual violence by school staff, and patterns of discrimination and inequality that increase vulnerabilities. The data reveal how schools vary in their institutional responses and, in the absence of institutional support, girls develop strategies to resist sexual coercion. Overall, our analysis exposes significant disconnects between policies and practices of sexual exploitation in schools. We conclude that dialogical, mixed methods research approaches have strong potential to better understand and address silences in policy and practice on highly sensitive topics

Does the Good Schools Toolkit Reduce Physical, Sexual and Emotional Violence, and Injuries, in Girls and Boys equally? A Cluster-Randomised Controlled Trial.

We aimed to investigate whether the Good School Toolkit reduced emotional violence, severe physical violence, sexual violence and injuries from school staff to students, as well as emotional, physical and sexual violence between peers, in Ugandan primary schools. We performed a two-arm cluster randomised controlled trial with parallel assignment. Forty-two schools in one district were allocated to intervention (n = 21) or wait-list control (n = 21) arms in 2012. We did cross-sectional baseline and endline surveys in 2012 and 2014, and the Good School Toolkit intervention was implemented for 18 months between surveys. Analyses were by intention to treat and are adjusted for clustering within schools and for baseline school-level proportions of outcomes. The Toolkit was associated with an overall reduction in any form of violence from staff and/or peers in the past week towards both male (aOR = 0.34, 95%CI 0.22-0.53) and female students (aOR = 0.55, 95%CI 0.36-0.84). Injuries as a result of violence from school staff were also lower in male (aOR = 0.36, 95%CI 0.20-0.65) and female students (aOR = 0.51, 95%CI 0.29-0.90). Although the Toolkit seems to be effective at reducing violence in both sexes, there is some suggestion that the Toolkit may have stronger effects in boys than girls. The Toolkit is a promising intervention to reduce a wide range of different forms of violence from school staff and between peers in schools, and should be urgently considered for scale-up. Further research is needed to investigate how the intervention could engage more successfully with girls

Young-onset dementia: scoping review of key pointers to diagnostic accuracy

Background Routine psychiatric assessments tailored to older patients are often insufficient to identify the complexity of presentation in younger patients with dementia. Significant overlap between psychiatric disorders and neurodegenerative disease means that high rates of prior incorrect psychiatric diagnosis are common. Long delays to diagnosis, misdiagnosis and lack of knowledge from professionals are key concerns. No specific practice guidelines exist for diagnosis of young onset dementia (YOD). Aim The review evaluates the current evidence about best practice in diagnosis to guide thorough assessment of the complex presentations of YOD with a view to upskilling professionals in the field. Method A comprehensive search of the literature adopting a scoping review methodology was conducted regarding essential elements of diagnosis in YOD, over and above those in current diagnostic criteria for disease subtypes. This methodology was chosen because research in this area is sparse and not amenable to a traditional systematic review. Results The quality of evidence identified is variable with the majority provided from expert opinion and evidence is lacking on some topics. Evidence appears weighted towards diagnosis in fronto-temporal dementia (FTD) and its subtypes and young onset Alzheimer’s disease (AD). Conclusion The literature demonstrates that a clinically rigorous and systematic approach is necessary in order to avoid mis- or under-diagnosis for younger people. The advent of new disease modifying treatments necessitates clinicians in the field to improve knowledge of new imaging techniques and genetics, with the goal of improving training and practice, and highlights the need for quality indicators and alignment of diagnostic procedures across clinical settings

Context of Violence in Adolescence Cohort (CoVAC) study: protocol for a mixed methods longitudinal study in Uganda.

BACKGROUND: Violence exposure in adolescence is associated with a range of poor health and social outcomes, including both the perpetration and experience of violence in later intimate relationships. However, there is little longitudinal evidence on how both individual and contextual characteristics encourage or interrupt these associations. We designed the Contexts of Violence in Adolescence Cohort study (CoVAC) to provide evidence on these pathways for Ugandan adolescents, with the aim of providing information to improve the design of violence prevention interventions for adolescents and young adults. METHODS: CoVAC is a mixed-methods prospective cohort study with three parallel strands. Between 2014 and 2022, the study comprises three waves of quantitative survey data collection; qualitative data from five time points; and a series of workshops to facilitate direct use of emerging findings by intervention developers at Uganda-based NGO Raising Voices in their ongoing work to prevent violence. 3431 adolescents participated in a survey in 2014 when the majority were aged 11-14 years, and agreed to be re-contacted for a Wave 2 survey in 2018 (aged about 15-18 years); and again in 2021 (aged 18-21 years). 36 young people from Wave 1 survey sample will be invited to participate in longitudinal qualitative data collection. Adolescents aged 18 years and over will provide informed consent; for those under age 18 years, adolescents will be invited to assent, except in cases where caregivers, following notification, have opted not to consent to their adolescent's participation. Quantitative and qualitative data will be analysed iteratively, and triangulation will be used to confirm, clarify and deepen our interpretation of findings. We will hold regular structured meetings so that emerging findings can be integrated into intervention development. DISCUSSION: This will be the first longitudinal study on the aetiology of violence over adolescence in sub-Saharan Africa which will enable examination of pathways using mixed methods at multiple time points. Quantitative mediation analysis, and annual qualitative fieldwork will provide detailed insights into how adolescents' violence-related experiences, perspectives and practices relate to their social contexts and how these change over time. Results will feed directly into intervention development to reduce violence and harmful sequelae. TRIAL REGISTRATION: This study is a long-term follow up of participants in the Good Schools Study (NCT01678846, clinicaltrials.gov). This protocol is for cohort follow-up only; we have a separate protocol paper describing an evaluation of the long-term effects of the Good School Toolkit (In preparation)

Current UK clinical practice in diagnosing dementia in younger adults: compliance with quality indicators in electronic health records from mental health trusts

To examine current UK practice in diagnosis of patients under 65 with young onset dementia, within 5 years of date of diagnosis, identified from electronic health records of 8 NHS mental health trusts. Patients diagnosed with young onset dementia were assembled from the UK-Clinical Record Interactive System, (UK-CRIS) using diagnosis of dementia as the index date. A pre-designed proforma, derived by international Delphi consensus from experts in the field in previous work, was used to assess components of the diagnostic assessment in 402 electronic health records across 8 NHS sites. Information was extracted on key aspects of clinical and physical examination according to both a minimum and gold standard. Percentage compliance rates analysed by NHS site and statement, including compliance for site for minimum standard (11 statements), the additional 20 statements required for Gold standard, and the complete Gold standard set (31 statements) show that the additional 20 statements in the Gold standard had consistently higher compliance rates for every site compared to the minimum set. Findings confirmed variation in clinical practice and identified commonly missed items in examination and enquiry compared to expert consensus. This suggests that a template proforma, which contains the key indicators for comprehensive assessment of dementia in young adults according to a quality standard could help support clinicians to improve record keeping and reduce gaps in knowledge

The Good School Toolkit for reducing physical violence from school staff to primary school students: a cluster-randomised controlled trial in Uganda

Background Violence against children from school staff is widespread in various settings, but few interventions address this. We tested whether the Good School Toolkit—a complex behavioural intervention designed by Ugandan not-forprofi t organisation Raising Voices—could reduce physical violence from school staff to Ugandan primary school children. Methods We randomly selected 42 primary schools (clusters) from 151 schools in Luwero District, Uganda, with more than 40 primary 5 students and no existing governance interventions. All schools agreed to be enrolled. All students in primary 5, 6, and 7 (approximate ages 11–14 years) and all staff members who spoke either English or Luganda and could provide informed consent were eligible for participation in cross-sectional baseline and endline surveys in June–July 2012 and 2014, respectively. We randomly assigned 21 schools to receive the Good School Toolkit and 21 to a waitlisted control group in September, 2012. The intervention was implemented from September, 2012, to April, 2014. Owing to the nature of the intervention, it was not possible to mask assignment. The primary outcome, assessed in 2014, was past week physical violence from school staff , measured by students’ self-reports using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool—Child Institutional. Analyses were by intention to treat, and are adjusted for clustering within schools and for baseline school-level means of continuous outcomes. The trial is registered at clinicaltrials.gov, NCT01678846. Findings No schools left the study. At 18-month follow-up, 3820 (92·4%) of 4138 randomly sampled students participated in a cross-sectional survey. Prevalence of past week physical violence was lower in the intervention schools (595/1921, 31·0%) than in the control schools (924/1899, 48·7%; odds ratio 0·40, 95% CI 0·26–0·64, p<0·0001). No adverse events related to the intervention were detected, but 434 children were referred to child protective services because of what they disclosed in the follow-up survey. Interpretation The Good School Toolkit is an eff ective intervention to reduce violence against children from school staff in Ugandan primary schools