Violence against children in humanitarian settings: A literature review of population-based approaches

Climate change impacts on child and adolescent health and well-being: A narrative review

Background

Worldwide, the climate is changing and affecting the health and well-being of children in many ways. In this review, we provided an overview of how climate change-related events may affect child and adolescent health and well-being, including children's mental and physical health, nutrition, safety and security, learning opportunities, and family caregiving and connectedness.

Methods

In this narrative review, we highlighted and discussed peer-reviewed evidence from 2012-23, primarily from meta-analyses and systematic reviews. The search strategy used a large and varied number of search terms across three academic databases to identify relevant literature.

Results

There was consistent evidence across systematic reviews of impact on four themes. Climate-related events are associated with a) increases in posttraumatic stress and other mental health disorders in children and adolescents, b) increases in asthma, respiratory illnesses, diarrheal diseases and vector-borne diseases, c) increases in malnutrition and reduced growth and d) disruptions to responsive caregiving and family functioning, which can be linked to poor caregiver mental health, stress and loss of resources. Evidence of violence against children in climate-related disaster contexts is inconclusive. There is a lack of systematic review evidence on the associations between climate change and children's learning outcomes.

Conclusions

Systematic review evidence consistently points to negative associations between climate change and children's physical and mental health, well-being, and family functioning. Yet, much remains unknown about the causal pathways linking climate-change-related events and mental and physical health, responsive relationships and connectedness, nutrition, and learning in children and adolescents. This evidence is urgently needed so that adverse health and other impacts from climate change can be prevented or minimised through well-timed and appropriate action.

Conceptualising and challenging child neglect in humanitarian action: Protecting displaced children in Jordan and Palestine

BACKGROUND

Humanitarian organisations commonly identify neglect as a specific form of harm from which children should be protected. However, lack of debate about the aetiology of child neglect has left intact a tendency to assume that it is due to a failure of caregivers. Obscured by this assumption are the role of the humanitarian system in supporting or, indeed, undermining the efforts of primary caregivers.

OBJECTIVE

To bring together insights from the literature on child neglect in humanitarian settings with findings from empirical research in the Middle East.

PARTICIPANTS AND SETTING

Fieldwork involved 38 'peer researchers' from five refugee communities: Sudanese, Somali, Iraqi, Syrian (in Jordan) and Palestinian (in Gaza). These researchers undertook enquiry with a total of around 300 people across their respective communities.

METHODS

RESULTS: Fieldwork revealed neglect in three distinct areas: educational participation, access to healthcare, and physical safety. This neglect can be related to the humanitarian system, (including humanitarian agencies, host government, donors, etc.), that is both directly neglectful and undermining of caregivers' efforts.

CONCLUSION

Caregivers in our study illustrated the impossibility of exercising constant vigilance over children within conditions of extreme social and economic marginalisation. Thoroughgoing debate about child neglect is needed to address this situation and ensure that caregivers receive adequate support to meet their children's needs. Such support should be offered in a manner that upholds the dignity of displaced people - adults and children alike.

Prevalence of and factors associated with peer emotional and physical violence among youth ages 13-17 in Cote d'Ivoire

BACKGROUND

Peer violence during childhood is associated with negative outcomes. Data are limited on its associated factors in sub-Saharan Africa.

OBJECTIVE

This study assesses the prevalence and factors associated with peer emotional and physical violence among children and adolescents aged 13-17years in Côte d'Ivoire.

PARTICIPANTS AND SETTING

Data from the 2018 Côte d'Ivoire Violence Against Children and Youth Survey (VACS) were used to examine peer emotional and physical violence victimization. VACS is a national cross-sectional household survey of females and males aged 13-24years.

METHODS

Data included physical, emotional, and sexual violence and socioeconomic, demographic, and relationship factors. We computed the adjusted odds ratios (AOR) and confidence interval (CI) for associated factors adjusted for food insecurity and rural or urban setting.

RESULTS

Thirty-one percent of females and 46.7 % of males experienced lifetime peer physical violence and 36.8 % of females and 40.2 % of males experienced peer emotional violence in the past 12 months. Witnessing violence in the home towards the mother (female AOR 1.2, CI 1.0-1.3); male AOR 1.4, CI 1.2-1.6) and witnessing violence in the home towards a sibling (female AOR 1.2, CI 1.1-1.3; male AOR 1.3, CI 1.12-1.4) increased the odds of ever experiencing peer physical violence. In males, not living with their biological mother (AOR 1.2, CI 1.0, 1.4) or biological father (AOR 1.2, CI 1.1-1.3) was associated with ever experiencing peer physical violence.

CONCLUSION

Interventions for children and adolescents living without parents and programming focused on education and skills-building may help to reduce peer violence against children in Côte d'Ivoire.

A film-based intervention to reduce child maltreatment among migrant and displaced families from Myanmar: Protocol of a pragmatic cluster randomized controlled trial

BACKGROUND

Child maltreatment is a global public health crisis with negative consequences for physical and mental health. Children in low- and middle-income countries (LMIC)-particularly those affected by poverty, armed conflict, and forced migration-may be at increased risk of maltreatment due to heightened parental distress and disruptions to social support networks. Parenting interventions have been shown to reduce the risk of child maltreatment as well as improve a range of caregiver and child outcomes, yet large-scale implementation remains limited in low-resource displacement settings. This study will examine the impact of an entertainment-education narrative film intervention on reducing physical and emotional abuse and increasing positive parenting among migrant and displaced families from Myanmar living in Thailand.

METHOD

The study is a pragmatic, superiority cluster randomized controlled trial with approximately 40 communities randomized to the intervention or treatment as usual arms in a 1:1 ratio. Participating families in the intervention arm will be invited to attend a community screening of the film intervention and a post-screening discussion, as well as receive a poster depicting key messages from the film. Primary outcomes are changes in physical abuse, emotional abuse, and positive parenting behaviour. Secondary outcomes include caregiver knowledge of positive parenting, caregiver attitudes towards harsh punishment, caregiver psychological distress, and family functioning. Outcomes will be assessed at 3 time points: baseline, 4 weeks post-intervention, and 4-month follow up. A mixed methods process evaluation will be embedded within the trial to assess intervention delivery, acceptability, perceived impacts, and potential mechanisms of change.

DISCUSSION

To our knowledge, this study will be the first randomized controlled trial evaluation of a film-based intervention to reduce child maltreatment among migrant and displaced families in a LMIC. An integrated knowledge translation approach will inform uptake of study findings and application to potential scale up pending evaluation results.

TRIAL REGISTRATION

The study was prospectively registered with the Thai Clinical Trials Registry on 22 February 2023 (TCTR20230222005).

Understanding why EmpaTeach did not reduce teachers' use of violence in Nyarugusu Refugee Camp: A quantitative process evaluation of a school-based violence prevention intervention

EmpaTeach was the first intervention to address teacher violence to be tested in a humanitarian setting and the first to focus on reducing impulsive use of violence, but a cluster randomised trial found no evidence that the intervention was effective in reducing physical and emotional violence from teachers. We aimed to understand why. We conducted a quantitative process evaluation to describe the intervention implementation process (what was implemented and how); examine teachers' adoption of positive teaching practices (was the content of the intervention taken up by participants), and test mechanisms of impact underlying the program theory (how the intervention was supposed to produce change). Despite participation in the intervention activities and adoption of intervention-recommended strategies (classroom management and positive disciplinary methods), we show that teachers who used more positive discipline did not appear to use less violence; and teachers in intervention schools did not experience gains in intermediate outcomes such as empathy, growth mindset, self-efficacy or social support. Our findings suggest that the intervention did not work due to the failure of some key hypothesised mechanisms, rather than because of implementation challenges.

Navigating the Tension between Fatherhood Ideals and Realities of a Post-Conflict Setting: A Phenomenological Study of Former Child Soldiers in Sierra Leone

The concept of "fatherhood" in many African countries has traditionally been understood in terms of instrumental support to one's family, most notably, financial provision. However, in Sierra Leone and elsewhere, this narrow understanding of fatherhood is changing as a result of shifting demographic trends and responses to recent crises such as the Ebola pandemic and the aftermath of a civil war. Very little is understood about how male former children associated with armed forces and armed groups (CAAFAG) are navigating fatherhood and understanding their roles as fathers, particularly as many have grown up without fathers or parents themselves and experienced violence. Our study builds upon previous ethnographic research in Sierra Leone, and uses a phenomenological approach to understand 1) the meaning and importance of fatherhood to former child soldiers in Sierra Leone, 2) what fatherhood looks like normatively and ideally, with attention to norms about nurturing care as well as violence, and 3) how ideals of fatherhood may or may not be in tension with socioeconomic circumstances. We find that CAAFAG fathers in Sierra Leone are committed to providing emotional support, encouragement, and a loving upbringing in addition to striving to provide financially. CAAFAG fathers experienced the greatest tension between their ideals of fatherhood and their socio-economic circumstances in terms of financial support, such as paying school fees. In other words, fathers felt inhibited in becoming the types of fathers they hoped to be due to their experiences in a post-conflict, resource-constrained environment.

The effect of the COVID-19 pandemic on community violence in Connecticut

INTRODUCTION

Natural disasters may lead to increases in community violence due to broad social disruption, economic hardship, and large-scale morbidity and mortality. The effect of the COVID-19 pandemic on community violence is unknown.

METHODS

Using trauma registry data on all violence-related patient presentations in Connecticut from 2018 to 2021, we compared the pattern of violence-related trauma from pre-COVID and COVID pandemic using an interrupted time series linear regression model.

RESULTS

There was a 55% increase in violence-related trauma in the COVID period compared with the pre-COVID period (IRR: 1.55; 95%CI: 1.34-1.80; p-value<0.001) driven largely by penetrating injuries. This increase disproportionately impacted Black/Latinx communities (IRR: 1.61; 95%CI: 1.36-1.90; p-value<0.001).

CONCLUSION

Violence-related trauma increased during the COVID-19 pandemic. Increased community violence is a significant and underappreciated negative health and social consequence of the COVID-19 pandemic, and one that excessively burdens communities already at increased risk from systemic health and social inequities.

Mixed-methods findings from the Ngutulu Kagwero (agents of change) participatory comic pilot study on post-rape clinical care and sexual violence prevention with refugee youth in a humanitarian setting in Uganda

There is a dearth of evidence-based post-rape clinical care interventions tailored for refugee adolescents and youth in low-income humanitarian settings. Comics, a low-cost, low-literacy and youth-friendly method, integrate visual images with text to spark emotion and share health-promoting information. We evaluated a participatory comic intervention to increase post-exposure prophylaxis (PEP) knowledge and acceptance, and prevent sexual and gender-based violence, in Bidi Bidi refugee settlement, Uganda. Following a formative qualitative phase, we conducted a pre-test post-test pilot study with refugee youth (aged 16-24 years) (n = 120). Surveys were conducted before (t0), after (t1), and two-months following (t2) workshops. Among participants (mean age: 19.7 years, standard deviation: 2.4; n = 60 men, n = 60 women), we found significant increases from t0 to t1, and from t0 to t2 in: (a) PEP knowledge and acceptance, (b) bystander efficacy, and (c) resilient coping. We also found significant decreases from t0 to t1, and from t0 to t2 in sexual violence stigma and depression. Qualitative feedback revealed knowledge and skills acquisition to engage with post-rape care and violence prevention, and increased empathy to support survivors. Survivor-informed participatory comic books are a promising approach to advance HIV prevention through increased PEP acceptance and reduced sexual violence stigma with refugee youth.Trial registration: ClinicalTrials.gov identifier: NCT04656522.

Risk factors of adolescent exposure to violence in Burkina Faso

BACKGROUND

Globally violence against children and adolescents is a significant public health problem. Since children rely on family for early learning and socialization, evidence of the factors associated with exposure to violence within households may inform the development of policies and measures to prevent violence and aid the victims of violence. This study examines the risk and protective factors associated with adolescents' exposure to violence at home and how these differ by gender and age in four regions of Burkina Faso.

MATERIALS AND METHODS

We used data from the baseline survey of the Child-Sensitive Social Protection Programme (CSSPP) conducted in four regions of Burkina Faso. The CSSPP is a cash transfer programme accompanied by complimentary nutrition, and water and sanitation interventions to address multidimensional child poverty. We employed bivariate and multivariable regression analysis on a sample of 2222 adolescents aged 10-19 to explore the risk and protective factors associated with exposure to violence.

RESULTS

Results show that exposure to psychological violence (22.7%) was more common within the households when compared to physical violence (9.1%). Adolescent girls reported more exposure to physical violence while boys reported more exposure to psychological violence. Significant risk factors associated with the likelihood of exposure to violence among girls are orphanhood, living in a household receiving safety nets and living in a Muslim-majority community. Among boys, age, school attendance, disability, a household receiving safety nets, sharing a household with a depressed individual, and living in a Muslim-majority community, were associated with exposure to violence.

CONCLUSIONS

These gender-specific findings highlight the importance of family background characteristics and can be used to inform and strengthen the targeting of vulnerable children and adolescents in interventions aimed at reducing exposure to violence against children.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

School violence, depression symptoms, and school climate: a cross-sectional study of Congolese and Burundian refugee children

Forcibly displaced children are at increased risk of violence and mental health disorders. In refugee contexts, schools are generally perceived as protective environments where children can build a sense of belonging and recover from trauma. Evidence shows that positive school climates can support student skills development and socio-emotional wellbeing and protect them against a host of adverse outcomes. However, schools are also places where children may experience violence, from both teachers and peers. Prevalence estimates of violence against children in humanitarian settings are scarce and evidence on the relationship between school climate and student outcomes in these contexts is non-existent. The aim of the study is to estimate the prevalence of school-based violence against children and to explore the association between perceptions of school climate and students' experiences and use of violence and their depression symptoms. We relied on data from a cross-sectional survey of students and teachers in all primary and secondary schools in Nyarugusu Refugee Camp in Tanzania, conducted as part of a cluster randomised controlled trial, to compute prevalence estimates and used mixed logistic regression analysis to assess the association between school climate and students' outcomes. We found that students in Nyarugusu experienced high levels of violence from both peers and teachers in both primary and secondary schools in the camp, with little difference between boys and girls. Nearly one in ten students screened positive for symptoms of depression. We found that opportunities for students and teachers to be involved in decision-making were associated with higher odds of violent discipline and teachers' self-efficacy was a significant protective factor against student depression symptoms. However, generally, school-level perceptions of school climate were not associated with student outcomes after adjusting for potential confounders. Our findings suggest that interventions to prevent and respond to teacher and peer violence in schools and to support students' mental health are urgently needed. Our results challenge the assumption that education environments are inherently protective for children and call for further investigation of norms around violence among students and teachers to better understand the role of school climate in refugee settings.

Risk and Refuge: Adolescent Boys' Experiences of Violence in "Post-Conflict" Colombia

Increasingly, researchers and practitioners are examining connections between public and private cycles of violence. In complex emergency settings, these cycles of violence often intersect with conflicting norms and values as societies work toward sustainable peace. Gender norms, particularly norms of masculinity, are not often highlighted in transdisciplinary violence studies. Furthermore, few studies on either subject capture the perspectives and experiences of adolescent boys. This study seeks to explore adolescent boys' (13-17 years) experiences with violence at home and in the community in "post-conflict" Colombia. Thematic qualitative analysis of 20 interview transcripts from 14 Colombian boys in Cundinamarca (n = 5) and Córdoba (n = 9) revealed themes of conflict avoidance, hegemonic masculinity, and opportunities for change in the form of positive coping habits. Further research into social and emotional coping behaviors and linkages to perpetuating violence between adolescence and adulthood is needed.

Ngutulu Kagwero (agents of change): study design of a participatory comic pilot study on sexual violence prevention and post-rape clinical care with refugee youth in a humanitarian setting in Uganda

With over 1.4 million refugees, Uganda is Sub-Saharan Africa’s largest refugee-hosting nation. Bidi Bidi, Uganda’s largest refugee settlement, hosts over 230,000 residents. There is a dearth of evidence-based sexual violence prevention and post-rape clinical care interventions in low- and middle-income humanitarian contexts tailored for refugee youth. Graphic medicine refers to juxtaposing images and narratives, often through using comics, to convey health promotion messaging. Comics can offer youth-friendly, low-cost, scalable approaches for sexual violence prevention and care. Yet there is limited empirical evaluation of comic interventions for sexual violence prevention and post-rape clinical care. This paper details the study design used to develop and pilot test a participatory comic intervention focused on sexual violence prevention through increasing bystander practices, reducing sexual violence stigma, and increasing post exposure prophylaxis (PEP) knowledge with youth aged 16–24 and healthcare providers in Bidi Bidi. Participants took part in a single-session peer-facilitated workshop that explored social, sexual, and psychological dimensions of sexual violence, bystander interventions, and post-rape clinical care. In the workshop, participants completed a participatory comic book based on narratives from qualitative data conducted with refugee youth sexual violence survivors. This pilot study employed a one-group pre-test/post-test design to assess feasibility outcomes and preliminary evidence of the intervention’s efficacy. Challenges included community lockdowns due to COVID-19 which resulted in study implementation delays, political instability, and attrition of participants during follow-up surveys. Lessons learned included the important role of youth facilitation in youth-centred interventions and the promise of participatory comics for youth and healthcare provider engagement for developing solutions and reducing stigma regarding SGBV. The Ngutulu Kagwero (Agents of change) project produced a contextually and age-tailored comic intervention that can be implemented in future fully powered randomized controlled trials to determine effectiveness in advancing sexual violence prevention and care with youth in humanitarian contexts.

Afghan Women's Use of Violence against Their Children and Associations with IPV, Adverse Childhood Experiences and Poverty: A Cross-Sectional and Structural Equation Modelling Analysis

Children who experience violence from a parent are more likely to experience and perpetrate intimate partner violence (IPV) later in life. Drawing on cross-sectional data among married women enrolled in the baseline of a randomized control trial in Afghanistan, we assess risk factors for women's use of violence against their children, focused on women's own adverse childhood experiences and experiences of IPV, poverty, poor mental health and gender attitudes. Analysis uses logistic regression and structural equation modelling (SEM). In total 744 married women reported on their use of violence against a child, with 71.8% (n = 534) reporting this in the past month. In regression models, their own experiences of witnessing their mother being physically abused, poverty during childhood, current food insecurity, their husband using corporal punishment on their child, current IPV experience, and other violence in the home were all associated with increased likelihood of women reporting corporal punishment. In the SEM, three pathways emerged linking women's childhood trauma and poverty to use of corporal punishment. One pathway was mediated by poor mental health, a second was mediated by wider use of violence in the home and a third from food insecurity mediated by having more gender inequitable attitudes. Addressing the culture of violence in the home is critical to reducing violence against children, as well as enabling treatment of parental mental health problems and generally addressing gender equity.

The pathways between natural disasters and violence against children: a systematic review

Background

Natural disasters are increasingly affecting a larger segment of the world’s population. These highly disruptive events have the potential to produce negative changes in social dynamics and the environment which increase violence against children. We do not currently have a comprehensive understanding of how natural disasters lead to violence against children despite the growing threat to human populations and the importance of violence as a public health issue. The mapping of pathways to violence is critical in designing targeted and evidence-based prevention services for children. We systematically reviewed peer-reviewed articles and grey literature to document the pathways between natural disasters and violence against children and to suggest how this information could be used in the design of future programming.

Methods

We searched 15 bibliographic databases and six grey literature repositories from the earliest date of publication to May 16, 2018. In addition, we solicited grey literature from humanitarian agencies globally that implement child-focused programming after natural disasters. Peer-reviewed articles and grey literature that presented original quantitative or qualitative evidence on how natural disasters led to violence against children were included. The authors synthesized the evidence narratively and used thematic analysis with a constant comparative method to articulate pathways to violence.

Results

We identified 6276 unduplicated publications. Nine peer-reviewed articles and 17 grey literature publications met the inclusion criteria. The literature outlined five pathways between natural disasters and violence, including: (i) environmentally induced changes in supervision, accompaniment, and child separation; (ii) transgression of social norms in post-disaster behavior; (iii) economic stress; (iv) negative coping with stress; and (v) insecure shelter and living conditions.

Conclusions

Service providers would benefit from systematic documentation to a high-quality standard of all possible pathways to violence in tailoring programming after natural disasters. The identified pathways in this review provide a foundation for designing targeted prevention services. In addition, the positive coping strategies within certain affected families and communities can be leveraged in implementing strength-based approaches to violence prevention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11252-3.

PROTOCOL: Impact of social protection on gender equality in low- and middle-income countries: A systematic review of reviews

This is the protocol for a Campbell review. The review aims to systematically collect, appraise, map and synthesise the evidence from systematic reviews on the differential gender impacts of social protection programmes in Low- and Middle-Income Countries (LMICs). Therefore, it will answer the following questions: (1) What is known from systematic reviews on the gender-differentiated impacts of social protection programmes in LMICs? (2) What is known from systematic reviews about the factors that determine these gender-differentiated impacts? (3) What is known from existing systematic reviews about design and implementation features of social protection programmes and their association with gender outcomes?

Child Abuse in Natural Disasters and Conflicts: A Systematic Review

Violence against children affects a significant portion of youth around the world. Emergencies and natural disasters escalate the risk due to weakened child protection systems and disruption of preventative mechanisms. In this systematic review, 692 related papers were searched in various databases in the initial search. After review, 11 papers were finally selected for full review. These papers were selected based on publication date, relevance to emergencies, their geographical area type of violence, age of subjects, and their gender. Most families affected by natural disasters, especially those in lower socioeconomic status, face greater social and economic pressures. The families that are more vulnerable to loss of food and shelter commit violence against children more frequently. On the other hand, while the rate of violence increases in emergencies, the reported rate of violence is less than the actual rate due to lack of required infrastructure and reporting mechanisms. The emergency housing increased risk of some types of child abuse. The history of exposure to violence, parental substance abuse, poverty, and child labor were predictors of increased violence against children in emergency situations. Sexual violence against girls after conflicts and physical violence against boys after emergencies are common forms of violence. Poverty as another predictor exposes children to more violence due to limited family economic resources and support. Given the identified predictors of violence, humanitarian organizations can come closer to providing appropriate plans to reduce the risk during and postdisaster.

Gender-based violence against adolescent girls in humanitarian settings: a review of the evidence

Adolescent girls face elevated risks of gender-based violence in humanitarian settings because of the intersectionality of age and gender, and the additional and exacerbated risk factors relevant to emergencies. Because there is no clear division of labour between the gender-based violence and child protection sectors, adolescent girls are often neglected by both groups, and violence against this subpopulation goes unaddressed. This Review presents an adapted ecological framework for gender-based violence risks facing adolescent girls in emergencies, synthesises the scant evidence for gender-based violence prevention and response, and identifies barriers to effective and ethical measurement and evaluation of programme effectiveness. Although nascent evidence highlights promising interventions for transforming girls' attitudes about violence and gender inequity and improving psychosocial and mental wellbeing, little evidence supports the ability of existing approaches to reduce gender-based violence incidence. A more explicit focus on adolescent girls is needed when designing and evaluating interventions to ensure global efforts to end gender-based violence are inclusive of this population. TRANSLATIONS: For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

Assault and care characteristics of victims of sexual violence in eleven Médecins Sans Frontières programs in Africa. What about men and boys?

BACKGROUND

Often neglected, male-directed sexual violence (SV) has recently gained recognition as a significant issue. However, documentation of male SV patients, assaults and characteristics of presentation for care remains poor. Médecins Sans Frontières (MSF) systematically documented these in all victims admitted to eleven SV clinics in seven African countries between 2011 and 2017, providing a unique opportunity to describe SV patterns in male cases compared to females, according to age categories and contexts, thereby improving their access to SV care.

METHODS AND FINDINGS

This was a multi-centric, cross-sectional study using routine program data. The study included 13550 SV cases, including 1009 males (7.5%). Proportions of males varied between programs and contexts, with the highest being recorded in migratory contexts (12.7%). Children (<13yrs) represented 34.3% of males. Different SV patterns appeared between younger and older males; while male children and adolescents were more often assaulted by known civilians, without physical violence, adult males more often endured violent assault, perpetrated by authority figures. Male patients presented more frequently to clinics providing integrated care (medical and psychological) for victims of violence (odds ratio 3.3, 95%CI 2.4-4.6), as compared to other types of clinics where SV disclosure upon admission was necessary. Males, particularly adults, were disproportionately more likely to suffer being compelled to rape (odds ratio 12.9, 95%CI 7.6-21.8).Retention in SV care was similar for males and females.

CONCLUSIONS

Patterns of male-directed SV varied considerably according to contexts and age categories. A key finding was the importance of the clinic setup; integrated medical and SV clinics, where initial disclosure was not necessary to access care, appeared more likely to meet males' needs, while accommodating females' ones. All victims' needs should be considered when planning SV services, with an emphasis on appropriately trained and trauma-informed medical staff, health promotion activities and increased psychosocial support.

Understanding the link between child maltreatment and adolescent future expectations in Northern Uganda: A serial mediation analysis

BACKGROUND

Recent research has identified high levels of child maltreatment and harsh parenting in post-war societies which have had detrimental effects on children's development. Future expectations are an important aspect of adolescents' development particularly in the challenging contexts of post-war societies where social instabilities and violence are prevalent. To date, however, the link between child maltreatment and adolescent future expectations remains understudied.

OBJECTIVE

By applying a socio-ecological perspective, this study aimed to investigate risk (internalizing symptoms) and protective factors (community integration) linking experiences of harsh parenting with adolescents' future expectations.

PARTICIPANTS AND SETTING

Data was collected from N = 199 northern Ugandan adolescents (40.2 % females, M_age = 14.56 years) with structured interviews.

METHODS

Serial mediation analyses were calculated with child maltreatment as the predictor, future expectations as the outcome, and internalizing symptoms as well as community integration as mediating variables.

RESULTS

Results of the mediation model (R² = .22, F(5193) = 10.54, p <  .001, total effect (b = -0.28, p < .005) revealed a direct effect of child maltreatment on future expectations (effect size: -.20, 95 % bootstrap CI = -0.40, -.01) as well as an indirect effect of child maltreatment via internalizing symptoms and community integration on future expectations (effect size of -.07 (95 % bootstrap CI = -0.14, -0.01).

CONCLUSION

Child maltreatment was found to be linked to negative future expectations among Northern Ugandan adolescents, and both internalizing symptoms as well as community integration played mediating roles in the associations. Interventions should take psychopathology and community factors into account.

Child abuse in the West Bank of the occupied Palestinian territory (WB/oPt): social and political determinants

BACKGROUND

Child maltreatment is a global epidemic. It affects morbidity, mortality, social behavior, wellbeing, and quality of life of children. This study aims to assess prevalence of child abuse in the West Bank (WB) of the occupied Palestinian territory (oPt) and to determine some of its social and political associated factors.

METHODS

We analyzed secondary data obtained from a cross sectional study conducted on a sample representing Palestinian children on the West Bank and using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) tool. The ISPCAN Child Abuse Screening Tool for parents (ICAST-P) questionnaire was completed by 1107 Palestinian mothers to estimate physical and emotional child abusive practices at home for children aged 0-12 years. Univariate, bivariate, and multivariate binary logistic regression analyses were performed using the SPSS® version 20 to assess prevalence and predictors of child abuse.

RESULTS

Overall, around 34% of the West Bank-children were abused by their mothers. Results of the logistic regression analysis indicated that male children, children of younger mothers, children whose fathers were with low levels of education, children whose mothers reported low levels of parental warmth, and children whose parents were exposed to political violence were at greater risk of being abused.

CONCLUSIONS

Child abuse is highly prevalent among children of the Palestinian society in the West Bank. Policy makers need to pay more attention to this epidemic. The association between child abuse and political violence found in this study makes a just solution for Palestinians essential for improving the welfare of children and families.

Physical Violence Against Children and Adolescents in Porto: A 5-Year Study

The aim of the present study was to analyze the prevalence of physical violence against children and adolescents (PVCA) in a 5-year period in the city of Porto, Portugal. All forensic reports between 2009 and 2013 in the clinical services of the North Branch of the National Institute of Legal Medicine and forensic sciences were analyzed. Victims were classified according to sex, age, relationship with perpetrator, traumatic consequences of the event, and year of occurrence. Statistical analysis was performed using SPSS (Version 22.0). Continuous variables were described when appropriated frequencies were displayed. The association between variables was evaluated using chi-square, Fisher's exact test, or Kruskal-Wallis test, when appropriate and a logistic regression was performed. The margin of error for the statistical tests was 5.0%. A total of 2,148 occurrences were evaluated. Most subjects were male, and mean victim age was 13 years. The single most frequent perpetrator was an unknown individual, but most offenders were known to the victim. The majority site of injury was the face. The larger number of complaints of aggression maintained a similar frequency over the 5 years analyzed. A physical examination to confirm the reasons between the complaint and the type of aggression was performed and shown a high relationship. Adolescents were more susceptible to violence than younger children were. The most affected region was the face.

Child labor, sex and mental health outcomes amongst adolescent refugees

INTRODUCTION

Refugee adolescents living in camps and settlements in low and middle-income countries are a vulnerable population who face protection and psychosocial risks. This study explores prevalence of child labor amongst adolescent refugees from South Sudan in two refugee settlements in Uganda, to understand impacts of child labor on mental health outcomes, and examines the influence of sex on these impacts.

METHODS

Surveys were conducted in Adjumani and Kiryandongo refugee settlements, Uganda, with 470 adolescents between 13 and 17 interviewed between December 2014-February 2015. Univariate finite mixture modeling identified a two-cluster model of child labor. Logistic regression models assessed the association of child labor and mental health.

RESULTS

A two-cluster solution for child labor activity was determined among the 332 adolescents who self-reported engaging in any child labor (Significant child labor: n = 174, 37%; moderate child labor cluster: n = 158, 34%; no child labor cluster: n = 138, 29%. Odds of depression amongst adolescents exposed to significant vs. no child labor was 4.15 (95% CI: 2.01-8.56), in a model examining interaction of sex and child labor and controlling for socio-demographic variables. For the anxiety outcome, girls exposed to significant vs. no child labor are less likely to report higher levels of anxiety (OR: 0.29, 95% CI: 0.09-0.90).

CONCLUSIONS

Adolescents living in refugee settlements in Uganda report high levels of participation in child labor. Protection of adolescents from the risks involved with child labor in refugee contexts is an important and often over-looked area of child protection in humanitarian settings.

Predictors of Interpersonal Violence in the Household in Humanitarian Settings: A Systematic Review

Interpersonal violence against women and children has increasingly been recognized as a public health priority in humanitarian emergencies. However, because the household is generally considered a private sphere, violence between family members remains neglected. A systematic literature review was conducted to identify predictors of household violence in humanitarian emergencies. PubMed, Web of Science, and Scopus were searched from January 1, 1998, to February 16, 2016. A predictor was defined as any individual, household, or community-level exposure that increases or decreases the risk associated with physical, sexual, or emotional interpersonal violence between two or more people living together. All studies reporting on quantitative research were eligible for inclusion. Results were analyzed using qualitative synthesis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed as applicable. The search strategy resulted in 2,587 original records, of which 33 studies met inclusion criteria. Thirty-two of the 33 studies used a cross-sectional design. This was the first known systematic review of predictors of household violence in humanitarian settings. The household framework drew attention to several factors that are associated with violence against both women and children, including conflict exposure, alcohol and drug use, income/economic status, mental health/coping strategies, and limited social support. There is a need for longitudinal research and experimental designs that can better establish temporality between exposures and household violence outcomes, control for confounding, and inform practice. In the interim, programmers and policy makers should try to leverage the predictors identified by this review for integrated violence prevention and response strategies, with the important caveat that ongoing evaluation of such strategies is needed.

Social ecological factors associated with experiencing violence among urban refugee and displaced adolescent girls and young women in informal settlements in Kampala, Uganda: a cross-sectional study

BACKGROUND

Research on violence targeting urban forcibly displaced adolescent girls and young women (AGYW) is limited, particularly regarding polyvictimization (exposure to multiple forms of violence). Yet there is a global trend of refugee urbanization, and urban AGYW are at the nexus of violence disparities among adolescents, forcibly displaced persons, and slum dwellers. This study explored factors associated with young adulthood violence (> 16 years) (YAV) and intimate partner violence (IPV) among forcibly displaced AGYW in Kampala, Uganda.

METHODS

We conducted a cross-sectional survey with forcibly displaced AGYW aged 16-24 from five informal settlement (slum) communities across Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya) using peer network sampling. We assessed YAV (experienced at age 16 or above) (sexual, physical, emotional violence) and recent (past 12-month) IPV (physical, sexual, control violence). We conducted descriptive statistics, followed by multinomial logistic regression analyses to explore social ecological factors (e.g., intrapersonal: depression; interpersonal: sexual relationship power, community: food insecurity) associated with experiencing YAV and YAV polyvictimization, and IPV and IPV polyvictimization.

RESULTS

Over half of participants (n = 333; mean age = 19.31; SD = 2.56, range = 16-24) reported YAV (n = 179; 53.7%) and 9.3% (n = 41) reported YAV polyvictimization. Most participants that were in an intimate relationship in the last 12 months (n = 200; 85.8%) reported IPV, among these, 45.5% reported one form of IPV and 54.5% reported IPV polyvictimization. In adjusted analyses, experiencing any YAV was significantly associated with: adolescent sexual and reproductive health (SRH) stigma; sexual relationship power; mobile app usage; depressive symptoms; childhood abuse; and childhood polyvictimization. In adjusted analyses YAV polyvictimization was associated with: depressive symptoms; childhood polyvictimization; sexual relationship power; and food insecurity. Recent IPV polyvictimization in adjusted analyses was associated with owning/using a mobile phone and depressive symptoms. Participants with higher sexual relationship power had lower odds of recent IPV polyvictimization.

CONCLUSION

Findings suggest that YAV and IPV polyvictimization require urgent attention among forcibly displaced AGYW in Kampala. Multi-level strategies are required to address intrapersonal e.g. (depression), interpersonal (e.g. childhood abuse, sexual relationship power) and community (e.g. adolescent SRH stigma, food insecurity) factors associated with experiencing violence. Future research can tailor approaches to advance health, agency and human rights among urban forcibly displaced AGYW.

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.

Assessing large-scale violence against children surveys in selected Southeast Asian countries: A scoping review

BACKGROUND

Violence against children (VAC) is a widespread, global issue with far-reaching social and economic consequences. In recent years, VAC has received substantial international attention, resulting in government initiatives to reduce VAC, in part, by strengthening data collection and information systems.

OBJECTIVE

This scoping review was undertaken to map survey methodologies for VAC measurement in Indonesia and other Southeast Asian countries and to identify key considerations for developing both methodologically sound and culturally appropriate VAC surveys in Indonesia and similar contexts.

METHODS

The authors conducted manual and automated searches in English and Bahasa Indonesia through PubMed, global databases, and websites, and consulted with partners from the government of Indonesia and the child protection field to identify surveys conducted from 2006 to 2016 in Indonesia and Southeast Asia. The search identified 275 records, of which 11 met all inclusion criteria.

RESULTS

The 11 surveys utilized a wide range of methodologies and employed inconsistent definitions, different age ranges for respondents, and different combinations of self-administered and face-to-face modes. A majority of the studies utilized household-based sampling, did not include a qualitative component, and used a tablet for data collection.

CONCLUSION

In developing VAC surveys, researchers should consider which groups of children are excluded from the sampling frame; how qualitative data can be used to strengthen the validity of survey results; how to maximize privacy in face-to-face interviews; and whether self-administered modes are feasible and acceptable. Researchers should also ensure that the survey and research protocol undergo rigorous ethical review.

Violence against children and natural disasters: A systematic review and meta-analysis of quantitative evidence

OBJECTIVES

Reviews of violence against children in disaster settings focus on armed conflict. Little is understood about natural disasters which has implications in planning humanitarian response. We examined the magnitude and direction of the association between exposure to natural disasters and physical, emotional, and sexual violence against children, and assessed the quality of the evidence.

METHODS

We searched 15 health and social science databases from first record until May 16, 2018. Publications describing all types of quantitative study design were eligible for inclusion. We presented study characteristics and quality in a narrative form and generated pooled estimates using a three-level random effects model. We evaluated Cochrane's Q with p-values below 0.10 and radial plots to assess heterogeneity. Planned subgroup analyses explored differential results by violence form, study design, and analysis method.

RESULTS

11 publications met inclusion criteria. The majority were cross-sectional studies examining physical or sexual violence in the United States. We found no evidence of a consistent association or directional influence between natural disasters and violence against children. Combined categorical violence outcomes had substantial heterogeneity [Q (df = 66) = 252.83, p < 0.001]. Subgroups without evidence of heterogeneity had confidence intervals that included a possible null effect. Our findings were mainly limited by inconsistencies in operational definitions of violence, a lack of representative sampling, and unclear establishment of temporal order between natural disaster exposure and violence outcomes.

CONCLUSIONS

Based on the available evidence, we cannot confidently conclude that natural disasters increase the level or severity of violence against children above non-disaster settings, however heterogeneity and study quality hamper our ability to draw firm conclusions. More nuanced and rigorous research is needed to inform practice and policy as natural disasters increasingly affect human populations.

Physical violence against children and adolescents in Recife: a 5-year retrospective study

The aim of the present study was to analyze the prevalence results of physical violence against children and adolescents in a 5-year period in Recife, Brazil. Inter-personal violence is one of the most recognizable forms of child aggression and has become as an imperative public health issue. All violence related forensic reports performed between 2009 and 2013 in the clinical services of the Institute of Legal Medicine Antônio Percivo Cunha were analyzed. Victims were classified according to sex, age, relationship with perpetrator, injuries and year of occurrence. Statistical analysis was performed using the SPSS (version 22.0). Continuous variables were described and when appropriate, frequencies were displayed and compared. The association between variables was evaluated using chi-square and Fisher's exact test. The margin of error for the statistical tests was 5.0%. A total of 9783 occurrences were evaluated, involving mainly male subjects (n=5447, 55.7%). Victims' mean age was 13.9 years, the most common perpetrators were victims' acquaintances (n=2538, 25.9%). Facial injuries were the most frequent affecting a little over a fifth of the total sample (n=3673, 20.1%). These findings support the important role dentists can play in identifying and reporting physical violence against children and adolescents.

Converging drivers of interpersonal violence: Findings from a qualitative study in post-hurricane Haiti

OBJECTIVE

Interpersonal violence affecting women and children is increasingly recognized as a public health priority in humanitarian emergencies. Yet, research and intervention efforts have been fragmented across gender-based violence and child protection sectors. Using data from the Transforming Households: Reducing Incidence of Violence in Emergencies (THRIVE) project, this study sought to qualitatively investigate the intersecting drivers of multiple forms of violence in Côteaux, Haiti, while obtaining insight on how these drivers may be influenced by a humanitarian emergency.

METHODS

This analysis used transcripts obtained using a photo elicitation approach over the course of three sessions per person. Thirty-six individuals participated in the study: eight adult females, ten adult males, eight adolescent females, ten adolescent males. Participants were given cameras to capture images related to family relationships, family safety, and changes to family dynamics due to Hurricane Matthew and its aftermath. In subsequent sessions, these photographs were used as prompts for qualitative interviews.

RESULTS

Multiple and converging drivers of interpersonal violence were identified including the accumulation of daily stressors, loss of power/control, learned behavior (intergenerational cycle of abuse), and inequitable gender norms, all of which were influenced by the humanitarian context caused by Hurricane Matthew.

CONCLUSIONS

Our findings suggest multiple and converging drivers of violence may be exacerbated in times of crises, requiring interdisciplinary responses. In order to comprehensively address the drivers of violence, practitioners and policy makers should consider the needs of individuals and their families holistically, integrating community-led, gender transformative efforts and positive parenting with basic needs provision.

"His body is human, but he has a tiracchāna heart": An ethnographic study of the epigenesis of child abuse in Cambodia

In Cambodia, more than half of all children experience physical, emotional, or sexual abuse. This article examines how Cambodians view the causes and effects of child abuse and analyses its underlying cultural forces. Adopting a conceptual framework originally developed for the cultural context of violence against women, 110 cases of child abuse were ethnographically studied, comprising 61 cases of sexual abuse (50 girls and 11 boys), 26 cases of physical abuse (13 girls and 13 boys), and 23 cases of emotional abuse or neglect (13 girls and 10 boys). The perpetrators included fathers and other close relatives, lay Buddhist officiants and monks, and neighbors. Most informants viewed the sexual or physical abuse of children as stemming from "cultural attractors," including blighted endowment caused by deeds in a previous life, a bad character starting early in life, astrological vulnerability to abuse, preordained entanglement between the child and the abuser (they are "fated" to meet), sexual craving, "entering the road to ruin," and a moral blindness that portrays the abuser as blameless. Although these traits are similar to those identified in the explanations of violence against women, there were notable differences such as the role of the tiracchāna in explaining sexual abuse, including incest. Using these findings, this article identifies a cultural epigenesis of child sexual abuse, and provides a blueprint for developing a culturally responsive plan to prevent child abuse.

Altered social trajectories and risks of violence among young Syrian women seeking refuge in Turkey: a qualitative study

BACKGROUND

There is limited evidence regarding the ways in which displacement disrupts social norms, expectations and trajectories for adolescent girls and young women and the resulting impacts on their risks of violence. This knowledge gap is especially marked with regards to Syrian adolescent girls and young women seeking refuge in Turkey. We explored risks of gender-based violence against Syrian adolescent girls and young women in Turkey and examined how these risks were shaped by their displacement.

METHODS

Data were collected in August 2016 in Izmir, Turkey through five sex-specific focus group discussions with Syrian adolescents and young people (aged 15-25 years) and two mixed gender focus group discussions with Syrian adults (18 years and older). Group discussions covered the issues facing Syrian adolescents and young women in Turkey, and how these were influenced by their displacement. Discussions in Arabic were audio-recorded, transcribed and translated into English. Data were coded inductively, and analysed thematically.

RESULTS

Syrian adolescent girls and young women expressed an increased sense of vulnerability to violence since their displacement. Due to financial strains and limited educational opportunities, they were often encouraged by parents to work or marry, both of which they perceived to increase the risks of violence. In contrast, some adults suggested that marriage could protect adolescent girls and young women from risks of violence associated with working. Being alone outside the home was viewed as risky by all participants due to pervasive sexual, verbal and physical harassment, aggression, and even kidnapping attempts. To limit these risks, many parents reported keeping adolescent girls and young women at home, or ensuring that they were accompanied by male relatives when in public.

CONCLUSIONS

Syrian adolescent girls and young women face multiple risks of violence following displacement related to altered social trajectories. Some family-based strategies to protect young women from violence could reinforce restrictive gender norms and increase risks of violence. Interventions to address violence should include providing safe spaces, access to education and safe transport for young women, and financial support for families as well as community-based interventions to address the daily risks of sexual harassment in public spaces.

Coming of Age in the Shadow of the Taliban: Adolescents' and Parents' Views Toward Interpersonal Violence and Harmful Traditional Practices in Afghanistan

OBJECTIVES

To understand Afghan adolescents' and parents' attitudes toward interpersonal violence.

METHODS

We used a 2-stage sampling method in 6 provinces during 2016; we included 916 adolescents aged 12 to 15 years and 454 parents.

RESULTS

In the abstract, a minority of adolescents or parents endorsed violence; however, specific situations justified most violence (e.g., husbands beating wives, parents hitting children). Both adolescents (48.0%) and parents (39.0%) thought a wife hitting her husband was least justifiable. Endorsement of violence justification did not appear to vary significantly on the basis of parental education or wealth. More fathers rejected all violence rationale than did mothers, and women were more likely to justify wife beating (75.0% vs 58.6%; P < .01), beating of daughters (78.5% vs 60.6%; P < .01), and teachers hitting students (62.9% vs 51.5%; P < .01). Of all respondents, 25% approved of threatening a child if he or she speaks out against harmful traditional practices.

CONCLUSIONS

Although it may be socially unacceptable to advocate physical aggression, most Afghans still find numerous conditions that justify it. Without deliberate violence reduction strategies, education alone is unlikely to reduce the high levels of interpersonal violence in Afghanistan.

Setting global research priorities for child protection in humanitarian action: Results from an adapted CHNRI exercise

BACKGROUND

Armed conflict, natural disaster, and forced displacement affect millions of children each year. Such humanitarian crises increase the risk of family separation, erode existing support networks, and often result in economic loss, increasing children's vulnerability to violence, exploitation, neglect, and abuse. Research is needed to understand these risks and vulnerabilities and guide donor investment towards the most effective interventions for improving the well-being of children in humanitarian contexts.

METHODS

The Assessment, Measurement & Evidence (AME) Working Group of the Alliance for Child Protection in Humanitarian Action (ACPHA) identified experts to participate in a research priority setting exercise adapted from the Child Health and Nutrition Research Initiative (CHNRI). Experts individually identified key areas for research investment which were subsequently ranked by participants using a Likert scale. Research Priority Scores (RPS) and Average Expert Agreement (AEA) were calculated for each identified research topic, the top fifteen of which are presented within this paper.

RESULTS

Intervention research, which aims to rigorously evaluate the effectiveness of standard child protection activities in humanitarian settings, ranked highly. Child labor was a key area of sector research with two of the top ten priorities examining the practice. Respondents also prioritized research efforts to understand how best to bridge humanitarian and development efforts for child protection as well as identifying most effective way to build the capacity of local systems in order to sustain child protection gains after a crisis.

CONCLUSIONS

Rigorous, scientific research that assesses the scope of child protection risks, examines the effectiveness of interventions to improve child well-being, and translates evidence to practice is critical. Findings from this research priority setting exercise offer guidance for a global research agenda on child protection in humanitarian settings, encouraging cooperation among donors, implementers, and academics to pursue a coordinated approach to evidence generation.

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

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Preventing violence against children in schools: Contributions from the Be Safe program in Sri Lanka

Violence against children is a global public health issue with serious social, economic, physical, and emotional impacts. This study evaluates the effectiveness of a school-based program aimed to prevent and respond to physical, sexual, and psychological violence against children in Sri Lanka from the perspective of parents. A cross-sectional retrospective study design was used. A total of 835 parents of children who participated in the program were surveyed across seven districts in Sri Lanka. Dose-response analyses were conducted to assess for correlations between program exposure and perceived prevention of violence against children. Low to moderate correlations were found between exposure to the program and perceived child safety in schools, school policies, and in the community. The findings provide preliminary evidence of program effectiveness; however, more efforts are needed to validate and sustain outcomes. Implications for future violence prevention programming, along with the use of dose-response evaluations, are discussed.

Violence against children in Afghanistan: Concerns and opportunities for positive change

Violence against children (VAC) in Afghanistan is a serious issue in the context of many decades of conflict and poverty. To date, limited studies have explored the extent of VAC in Afghanistan and the settings where VAC takes place. To understand (i) the extent of VAC, (ii) settings where VAC takes place, (iii) parental forms of VAC and (iv) regional differences, an interview administered cross-sectional survey was employed among a community sample of 145 children and 104 parents living within Kabul, Torkham, and Jalalabad. Demographic information was collected as well as items from the International Child Abuse Screening Tool (ICAST-CH). In this study, 71% of children reported experiencing physical violence is some form in the past year. Home was the most likely location of violence. The overwhelming majority of parents reported using physical violence as a discipline method. Parents who attained higher levels of education and had more skilled occupations used violence less as a discipline method. However, consistent with international research, children cited their parents as their preferred source of support in situations of violence. Interestingly, parents did not see violent forms of discipline as more effective than non-violent strategies. The results offer a disturbing yet 'on the ground' insight into VAC in Afghanistan from the experience of children and parents. The results have important implications for programming design and provide a focus for stopping and preventing VAC in Afghanistan and similar contexts.

Evaluating the communities care program: best practice for rigorous research to evaluate gender based violence prevention and response programs in humanitarian settings

Background

Gender-based violence (GBV) is a significant issue for women and girls in humanitarian settings. Innovative primary prevention programs are being developed and implemented with existing response programs to change harmful social norms that sustain GBV in humanitarian settings. Social norms are expectations of how women, men, girls and boys should behave, who should have power and control over behavior, and how families and communities value women and girls and support their rights and opportunities.

Methods

The United Nations Children’s Fund (UNICEF) led Communities Care program is a primary prevention and response program designed from the understanding that within the context of conflict and displacement, there is an opportunity for positive change in social norms that support gender equity, and decrease GBV. The goal is to support communities in humanitarian settings to create healthy, safe and peaceful environments with quality response services for women and girls by transforming harmful social norms that uphold violence into norms that promote dignity, equity, and non-violence.

Conclusion

This manuscript will highlight the use of best practices in GBV research to rigorously evaluate the Communities Care program in two diverse in humanitarian settings, Somalia and South Sudan.

Safety, trust, and disclosure: A qualitative examination of violence against refugee adolescents in Kiziba Camp, Rwanda

Refugee adolescents face increased vulnerability to child protection risks including abuse, neglect, violence, and exploitation. The aim of this qualitative study was to examine the nature of violence against adolescents in Kiziba Camp, Rwanda, using an ecological framework to analyze the factors that influence protection risks and abuse disclosure across multiple system levels. In order to understand these issues more comprehensively, a transgenerational inquiry sought perceptions from both adolescents and their caregivers. In April 2016, as part of a larger, comprehensive study on adolescent protection, 19 focus group discussions were conducted with a total of 70 adolescents and 68 caregivers from the Democratic Republic of Congo. A qualitative content analysis identified three salient themes. First, structural protection risks exist for adolescents in Kiziba Camp, with economic insecurity and resource constraints resulting in specific risks such as overcrowded housing and adolescents traveling for firewood collection. Second, intergenerational conflict between caregivers and adolescents was perceived to negatively influence abuse disclosure. Lastly, protection mechanisms and reporting pathways were underutilized as caregivers and adolescents expressed concern over the shame, embarrassment, and social rejection that characterized formal disclosure in Kiziba, often rooted in restrictive and inequitable gender norms. These findings suggest that efforts at child protection should be multi-faceted and address structural aspects of risk; household levels of communication and trust; and societal norms that deter abuse reporting. The study also underscores the need for further research on risk and protective factors in camp settings to better tailor interventions aiming to reduce violence against children.

School violence, perceptions of safety and school attendance: results from a cross-sectional study in Rwanda and Uganda

Background

Adolescents displaced by conflict face a number of risks, and access to education has potential to have multiple protective aspects in humanitarian settings. Yet, the impact of violence experienced at school by adolescents in humanitarian contexts is poorly understood, especially in terms of impacts on educational outcomes.

Methods

A household survey of adolescents in a refugee camp in Rwanda (n=274) and in two refugee settlements in Uganda (n=763) was conducted. Multiple logistic regression models were used to assess the influence of violence experienced at school on school attendance, feelings of fear and feelings of safety at school.

Results

In multiple logistic regression models, adjusting for socio-demographic variables, exposure to school violence was significantly associated with feelings of safety at school (adjusted odds ratio (AOR)=2.29, 95% confidence interval (CI)=1.20-4.38) and days of school missed (AOR=3.28, 95% CI=1.54-7.01) in Rwanda. In Uganda, exposure to violence was significantly associated with all outcomes: school fear (AOR=2.26, 95% CI=1.48-3.44), school safety (AOR=1.90, 95% CI=1.23-2.92) and school attendance (AOR=2.39, 95% CI=1.52-3.74). Gender-stratified analyses indicated that in both contexts exposure to school violence is significantly associated with school attendance, school fear, and school safety for girls, but the association is weaker amongst boys (with experience of violence significantly associated with school attendance for boys in Uganda, but not for other outcomes and not in Rwanda).

Conclusions

This study presents some initial and novel findings on the relationships between violence experienced at school and educational outcomes amongst adolescents displaced by conflict.

"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.

The impact of humanitarian emergencies on the prevalence of violence against children: an evidence-based ecological framework

Little is known about the patterns and mechanisms by which humanitarian emergencies may exacerbate violence against children. In this article, we propose using the ecological framework to examine the impact of humanitarian emergencies on interpersonal violence against children. We consider the literature that supports this framework and suggest future directions for research to fill identified gaps in the framework. The relationship between humanitarian emergencies and violence against children depends on risk factors at multiple levels, including a breakdown of child protection systems, displacement, threats to livelihoods, changing gender roles, changing household composition, overcrowded living conditions, early marriage, exposure to conflict or other emergency events, and alcohol abuse. The empirical evidence supporting the proposed emergency/violence framework is limited by cross-sectional study designs and a propensity to predominantly examine individual-level determinants of violence, especially exposure to conflict or emergency events. Thus, there is a pressing need to contextualize the relationship between conflict or emergency events and violence against children within the wider ecological and household dynamics that occur during humanitarian emergencies. Ultimately, this will require longitudinal observations of children, families and communities from before the emergency through recovery and improvements to ongoing global surveillance systems. More complete data will enable the humanitarian community to design effective, appropriate and well-targeted interventions.