Sexual violence against children in South Africa: A nationally representative cross-sectional study of prevalence and correlates

Background We could identify no nationally representative South African studies of sexual violence against children. Methods A multistage sampling frame, stratified by province, urban/rural and race group, selected households. Within households, children aged 15-17 years were interviewed after obtaining parental consent. The final sample was 5,631 (94.6% participation rate). Findings 9.99% (95%CI 8.65-11.47) of boys and 14.61% (95%CI 12.83-16.56) of girls reported some lifetime sexual victimisation. Physical abuse, emotional abuse, neglect, family violence, and other victimisations, were all strongly associated with sexual victimisation. The following were associated with greater risk of sexual abuse (adjusted OR); school enrolment (OR 2.12; 95%CI 1.29-3.48); urban dwelling (OR 0.59; 95%CI 0.43-0.80); having a flush toilet (OR 1.43; 95%CI 1.04-1.96); having a substance-misusing parent ( OR 2.37; 95%CI 1.67-3.36); being disabled (OR 1.42; 95%CI 1.10-1.82); female but not male caregivers’ poorer knowledge of the child’s whereabouts, friends and activities (OR 1.07; 95%CI 0.75-1.53) and poorer quality of the relationship with the child (OR 1.20; 95%CI 0.55-2.60). Respondents’ own substance misuse (OR 4.72; 95%CI 3.73-5.98) and high-risk sexual behaviour (OR 3.71; 95%CI 2.99-4.61) were the behaviours most frequently associated with sexual abuse, with mental health conditions far less prevalent but nonetheless strongly associated with sexual victimisation (PTSD OR 2.81, 95%CI 1.65-4.78; depression OR 3.43, 95% CI 2.26-5.19; anxiety OR 2.48, 95%CI 1.61-3.81). Interpretation Sexual violence is widespread among both girls and boys, and is associated with serious health problems. Associated factors require multi-sectoral responses to prevent sexual violence or mitigate consequences

Pediatrics

CONTEXT:Evidence confirms associations between childhood violence and major causes of mortality in adulthood. A synthesis of data on past-year prevalence of violence against children will help advance the United Nations\u2019 call to end all violence against children.OBJECTIVES:Investigators systematically reviewed population-based surveys on the prevalence of past-year violence against children and synthesized the best available evidence to generate minimum regional and global estimates.DATA SOURCES:We searched Medline, PubMed, Global Health, NBASE, CINAHL, and the World Wide Web for reports of representative surveys estimating prevalences of violence against children.STUDY SELECTION:Two investigators independently assessed surveys against inclusion criteria and rated those included on indicators of quality.DATA EXTRACTION:Investigators extracted data on past-year prevalences of violent victimization by country, age group, and type (physical, sexual, emotional, or multiple types). We used a triangulation approach which synthesized data to generate minimum regional prevalences, derived from population-weighted averages of the country-specific prevalences.RESULTS:Thirty-eight reports provided quality data for 96 countries on past-year prevalences of violence against children. Base case estimates showed a minimum of 50% or more of children in Asia, Africa, and Northern America experienced past-year violence, and that globally over half of all children\u20141 billion children, ages 2\u201317 years\u2014experienced such violence.LIMITATIONS:Due to variations in timing and types of violence reported, triangulation could only be used to generate minimum prevalence estimates.CONCLUSIONS:Expanded population-based surveillance of violence against children is essential to target prevention and drive the urgent investment in action endorsed in the United Nations 2030 Sustainable Development Agenda.CC999999/Intramural CDC HHS/United States2019-05-02T00:00:00Z26810785PMC64969586242vault:3205

The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial.

BACKGROUND: School-based violence prevention interventions offer enormous potential to reduce children's experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. METHODS AND FINDINGS: We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January-March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students' self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool-Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test-retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation. CONCLUSIONS: There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings. TRIAL REGISTRATION: clinicaltrials.gov (NCT03745573)

Hidden in plain sight. A statistical analysis of violence against children

This report was created to help document the true nature and extent of violence against children across the world. Foreword Violence against children occurs every day, everywhere: the slaps of an upset parent to control an ‘unruly’ child, the sexual victimization of a teenager by a peer or a neighbour, the bullying of one child by another in the schoolyard, the emotional degradation of a child bride by her spouse. Too many children worldwide are affected by such violence, yet it is rarely acknowledged, in part because it is so commonplace. The repercussions are not inconsequential, with ripple effects throughout society as well as future generations. Everyday violence may be pervasive, but it is not inevitable. The first step in curbing all forms of violence against children is bringing the issue to light – in all its complexity. Despite the difficulties in measuring violence against children, and considerable gaps, an unprecedented volume of data on the subject has become available over the last two decades that is providing the evidence countries need to develop effective policies, legislation and programmes to address violence. Solid data and research are essential in bringing the issue out of the shadows. They are also important in revealing hidden attitudes and social norms that may perpetuate violence against children and factors that may place certain children at higher risk. The Convention on the Rights of the Child guarantees that children everywhere should live free from all forms of violence. For this to happen, the true nature and extent of the problem must be documented. It is to that end that this report is dedicated

An Exploratory Study of Child Sexual Abuse in Tanzania

There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse and the contextual issues exacerbating the problem of CSA were explored. The research questions explored were as follows: 1. At what rate do university students in Tanzania report experiences of child sexual abuse? 2. What is the nature of child sexual abuse in Tanzania? 3. Who perpetrates child sexual abuse in Tanzania? 4. What are the effects/consequences of child sexual abuse in Tanzania? 5. What are the causes of child sexual abuse in Tanzania? An ecological framework will be employed in this research. An ecological prism is useful for investigating CSA in Tanzania because it recognises that individuals are inseparable from the context in which they live and that this context has significant influences on them. Participants (N= 487) from a university in Tanzania completed a questionnaire, which assessed abusive childhood sexual experiences, gathering information about age of victim, duration of abuse, perpetrators, amount of force or persuasion involved, and potential causes of child sexual abuse. A number of individuals were also interviewed about their experiences. Two focus groups and a review of case files also added to the research. The overall prevalence rate for child sexual abuse was 27.7%, with rates being higher for females than for males. The average age of the victim when abuse occurred was 13.8 years. Perpetrators were generally unidentified by respondents; nonetheless, a surprisingly high proportion of female perpetrators was noted. Poverty was the primary explanation given for child sexual abuse. Contextual factors exacerbating the problem of CSA were identified such as the patriarchal nature of society, the transactional nature of sexual relations, the low status of children, and the avoidance of HIV. The findings of this study suggest that child sexual abuse exists in Tanzania at similar levels to those reported throughout the world and that some of this abuse is a product of a need for economic support and survival. It is suggested that poverty feeds the “sugar daddy/mammy” phenomenon, which aggravates the problem of CSA. The avoidance of HIV is another potential factor fueling the sexual abuse of children in the region. It is argued that CSA is occuring in a patriarchial cultural context, making women and children particularly vulnerable to sexual abuse. A strong incest taboo and the higher rates of sexual abuse of boys need further investigation in the Tanzanian context. This thesis has particular relevance to students, researchers, and academics undertaking research projects focusing on child protection in SSA

The use of evidence for improving the delivery of post-rape care in South Africa

A thesis completed by published work, Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy JOHANNESBURG, SOUTH AFRICA 19 November 2015Rape is a human rights violation and has significant health and social impact. South Africa, with its historical background seeped in violence has high levels of crime including a high prevalence of rape. As such, the South African government has made some efforts to improve the health and criminal justice response to rape, but in general these have been slow, disrupted or reversed. A review of the literature on post-rape health care has indicated that there are areas in the delivery of service where sufficient evidence is lacking, and where research is available, high quality work has predominantly been undertaken in high-income countries. The aim of this thesis was to strengthen the evidence base for post-rape care service in South Africa by addressing some of the gaps in the literature. Methodology For the thesis, data from three studies are presented in three published and one unpublished article. The first study consists of a systematic review of articles published between 1990 and 2014 that evaluated the effect of health system models of care on survivors of rape or IPV in terms of health outcomes, rape or IPV recurrence, provision of related services, and referrals. The second study was related to a national post-rape care training programme. Baseline knowledge and confidence were assessed and multivariable analyses were done to test for factors associated with higher knowledge and confidence levels. The change in knowledge and confidence was also calculated from baseline to post-training, and factors associated with these changes were tested through two logistic models. The final study comprised of a review of a random sample of rape cases that were reported in Gauteng province in 2003. In the second publication, descriptive analyses were done to present the pattern of genito-anal injuries. In addition, logistic regression was done to test for survivor, rape and examination characteristics that were associated with the absence of genito-anal injuries in all survivors and those who had no previous sexual experience. Findings In the first study, no model of post-rape or IPV care could be recommended in relation to the tested outcomes due to the lack of studies on that evaluated the effect of a post-rape model of care on the specific outcomes, and due to the lack of high quality studies on IPV models of care. In the second study, it was found that the knowledge of health care providers was low although confidence was high. Higher baseline knowledge was associated with rank, having an appropriate attitude towards rape, and having served less time at the current facility, while higher confidence levels were associated with having a crisis centre in the facility and being involved in care of survivors. Significant improvements in knowledge and confidence levels were noted after the training, and providers with lower levels of empathy were found to have greater changes in knowledge. The facility level and baseline knowledge and confidence levels were associated with change in confidence. An earlier publication from the final study, for which I was a co-author, showed a strong association between the documentation of injuries and case progression in the justice system, so it was considered important to test for the factors associated with the absence of injuries in this study population. Here it was noted that there was a significantly greater odds of having injuries in survivors who were virgins, if multiple perpetrators had raped survivors, and if doctors with additional qualifications had examined survivors. Conclusion The findings of this thesis have implications for post-rape health care services in three broad focus areas: the organisation of services, the selection and capacitation of providers, and the interpretation of medico-legal evidence in term of genito-anal injuries. Proposals are suggested regarding potential improvements that could be made to post-rape care services in South Africa. The findings provide evidence for some of the principles in the South African National Sexual Assault Policy and raises important questions for future research work such as the need to critically evaluate the Thuthuzela one stop model that is being implemented in South Africa