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Backhaus S, Blackwell A, Gardner F. The effectiveness of parenting interventions in reducing violence against children in humanitarian settings in low- and middle-income countries: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2024:106850. [PMID: 38880688 DOI: 10.1016/j.chiabu.2024.106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/23/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Violence against children is a global phenomenon, yet children living in humanitarian settings are at elevated risk of experiencing violent parenting. Parenting interventions are a recommended prevention strategy. OBJECTIVE To conduct a systematic review and meta-analysis on the effectiveness of parenting interventions in preventing violence against children and related parent and child outcomes. PARTICIPANTS AND SETTING Primary caregivers in humanitarian settings in low- and middle-income countries (LMICs). METHODS A highly sensitive multi-language systematic search in electronic and grey-literature database. Studies were appraised for risk of bias, summary effects by certainty of effect, and effect estimates pooled using robust variance estimation. RESULTS Twenty-three randomized trials were meta-analyzed finding a small effect on physical and psychological violence (n = 14, k = 21, d = -0.36, 95 % CI [-0.69, -0.04]), positive parenting (n = 16, k = 43, d = 0.48, 95 % CI [0.29, 0.67]), negative parenting (n = 17, k = 37, d = -0.42, 95 % CI [-0.67, -0.16]), parental poor mental health (n = 9, k = 15, d = -0.34, 95 % CI [-0.66, -0.02]), and internalizing behaviors (n = 11, k = 29, d = -0.38, 95 % CI [-0.70, -0.05]); a non-significant effect on externalizing child behaviors (n = 9, k = 17, d = -0.12, 95 % CI [-0.50, 0.27]). Too few studies reported intimate partner violence, sexual violence, and parenting stress outcomes. CONCLUSIONS Our findings suggest that parenting interventions in humanitarian settings in LMICs may be an effective strategy to reduce physical and psychological violence, and numerous related parent and child outcomes. However, findings need to be interpreted in light of the limited number of available studies and imprecise statistical significance for selected outcomes.
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Affiliation(s)
- Sophia Backhaus
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Research Institute Child Development and Education, University of Amsterdam, the Netherlands.
| | - Alexandra Blackwell
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
| | - Frances Gardner
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
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Harrison S, Chenhall RD, Block K, Rashid SF, Vaughan C. The impact of humanitarian emergencies on adolescent boys: Findings from the Rohingya refugee crisis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003278. [PMID: 38833449 PMCID: PMC11149876 DOI: 10.1371/journal.pgph.0003278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/05/2024] [Indexed: 06/06/2024]
Abstract
Adolescent boys (age 9-19) are impacted differently by humanitarian emergencies. However, academic research on adolescent health and child protection has tended to focus on the direct impacts of an emergency rather than indirect impacts that may arise after a crisis. We sought to identify child protection concerns affecting adolescent boys in emergency settings and boys who are more vulnerable to harm through a case study of the humanitarian response to the 2017 Rohingya refugee crisis. We collected data in the Rohingya refugee crisis in Cox's Bazar, Bangladesh between 2018-2019. This included six months of participant observation, 23 semi-structured interviews and 12 informal ethnographic interviews with humanitarian staff working in the crisis, and 10 focus group discussions with a total of 52 child protection caseworkers from four child protection organisations. Our results showed that adolescent Rohingya boys were exposed to numerous protection concerns, including child labour, drug trafficking, substance abuse, family violence, and neglect. We classified these into three main typologies: community-related violence, income-related violence, and life-stage vulnerabilities. We found that adolescent boys who were unaccompanied or separated from their caregivers, adolescent boys who were members of vulnerable households, and adolescent boys with a disability were at more risk of harm. Our findings indicate that adolescent boys are exposed to an array of impactful child protection concerns in humanitarian emergencies and that this has implications for the delivery of public health and child protection interventions. We believe that humanitarian actors should improve recognition of the complexity of adolescent boys' lives and their exposure to gender and age-based harm as a critical matter for addressing adolescent health equity.
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Affiliation(s)
- Shane Harrison
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Dean Chenhall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Block
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Falb KL, Blackwell A, Hategekimana JDD, Sifat M, Roth D, O'Connor M. Co-Occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Influence of Early Life Experiences of Abuse. Violence Against Women 2024; 30:873-889. [PMID: 36579814 DOI: 10.1177/10778012221145302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Little is known about co-occurring intimate partner violence (IPV) against women and child abuse within families in humanitarian settings. Baseline data from 203 couples in eastern Democratic Republic of Congo were analyzed to assess associations between childhood experiences of abuse with present co-occurring violence. Over half of women (56.1%) and men (50.5%) reported co-occurring violence. Adjusted models demonstrate experiencing physical abuse as a child was associated with greatest odds of recent co-occurring violence while witnessing parental IPV had mixed influence. Programmatic approaches focused on reducing early childhood violence may be promising to prevent both IPV and child abuse.
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Sim A, Jirapramukpitak T, Eagling-Peche S, Lwin KZ, Melendez-Torres GJ, Gonzalez A, Oo NN, Castello Mitjans I, Soan M, Punpuing S, Lee C, Chuenglertsiri P, Moo T, Puffer E. A film-based intervention to reduce child maltreatment among migrant and displaced families from Myanmar: Protocol of a pragmatic cluster randomized controlled trial. PLoS One 2023; 18:e0293623. [PMID: 37903143 PMCID: PMC10615270 DOI: 10.1371/journal.pone.0293623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
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).
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Affiliation(s)
- Amanda Sim
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Khaing Zar Lwin
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | | | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Mary Soan
- Sermpanya Foundation, Mae Sot, Tak, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Catherine Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Th’Blay Moo
- Inclusive Education Foundation, Mae Sot, Tak, Thailand
| | - Eve Puffer
- Department of Psychology & Neuroscience, Duke Global Health Institute, Duke University, Durham, NC, United States of America
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Bakari M, Shayo EH, Barongo V, Kiwale Z, Fabbri C, Turner E, Eldred E, Mubyazi GM, Rodrigues K, Devries K. Qualitative process evaluation of the EmpaTeach intervention to reduce teacher violence in schools in Nyarugusu Refugee Camp, Tanzania. BMJ Open 2023; 13:e069993. [PMID: 37734883 PMCID: PMC10514605 DOI: 10.1136/bmjopen-2022-069993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/07/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE We explored the experiences and perceptions of school staff and students with the EmpaTeach intervention to prevent teachers' violence against school students. DESIGN This qualitative study involved in-depth interviews with 58 and 39 participants at midline and endline, respectively, with Burundian and Congolese intervention schools in Nyarugusu refugee camp. They comprised three education coordinators of primary and secondary schools, 29 EmpaTeach intervention coordinators, 14 stakeholders including headteachers and discipline teachers, 25 classroom teachers and 26 students. Thematic analysis was used to develop codes by examining the content of quotes to capture key themes in line with the key elements of the programme theory. RESULTS Coordinators and teachers widely reported positive experiences with the EmpaTeach programme. The intervention sessions enabled teachers to reflect on their own values and experiences of corporal punishment and equipped them with useful and acceptable classroom management and alternative discipline strategies. Teachers adopted the use of counselling, praise and reward, and joint discussions with students and parents. On the other hand, several teachers reported persistent use of corporal punishment which they attributed to children's (mis)behaviours and strong beliefs that beating was a positive approach to disciplining students. CONCLUSION The majority of coordinators and teachers widely accepted the EmpaTeach intervention as it offered useful and relevant knowledge and skills on alternative disciplinary methods. Students noticed some positive changes on the way they were being disciplined by teachers, where non-violent methods were used. Further research is needed to understand how violence prevention interventions can successfully lead to reductions in violence in fragile settings. TRIAL REGISTRATION NUMBER NCT03745573.
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Affiliation(s)
- Mtumwa Bakari
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Elizabeth H Shayo
- Health Systems, Policy and Translational Research Section, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Vivien Barongo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Zenais Kiwale
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Camilla Fabbri
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ellen Turner
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Eldred
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Katherine Rodrigues
- Research and Innovation Department, International Rescue Committee, New York, New York, USA
| | - Karen Devries
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Falb KL, Asghar K, Blackwell A, Baseme S, Nyanguba M, Roth D, Hategekimana JDD. Improving family functioning and reducing violence in the home in North Kivu, Democratic Republic of Congo: a pilot cluster-randomised controlled trial of Safe at Home. BMJ Open 2023; 13:e065759. [PMID: 36878658 PMCID: PMC10016303 DOI: 10.1136/bmjopen-2022-065759] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/01/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To test the effectiveness of the Safe at Home programme which was developed to improve family well-being and prevent multiple forms of violence in the home. DESIGN Waitlisted pilot cluster randomised controlled trial. SETTING North Kivu, Democratic Republic of Congo. PARTICIPANTS 202 heterosexual couples. INTERVENTION The Safe at Home programme. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was family functioning, with secondary outcomes of past-3 month co-occurring violence, intimate partner violence (IPV) and harsh discipline. Pathway mechanisms assessed included attitudes related to acceptance of harsh discipline, gender equitable attitudes, positive parenting skills and power sharing within the couple. RESULTS No significant improvements in family functioning were documented for women (β=1.49; 95% CI: -2.75 to 5.74; p=0.49) and men (β=1.09; 95% CI: -3.13 to 4.74; p=0.69). However, women in Safe at Home reported a OR=0.15 (p=0.000), OR=0.23 (p=0.001) and OR=0.29 (p=0.013) change in co-occurring IPV and harsh discipline; physical/sexual/emotional IPV by their partner and use of physical and/or emotional harsh discipline against their child, respectively, as compared with women in the waitlisted group. Men participating in Safe at Home reported a OR=0.23 (p=0.005) change in perpetration of co-occurring violence, OR=0.26 (p=0.003) change in any form of IPV perpetration and OR=0.56 (p=0.19) change in use of harsh discipline against their child as compared with the waitlist arm. Positive changes were also noted in pathway variables around attitudes, skills and behaviours within couples. CONCLUSION This pilot trial demonstrated the Safe at Home programme to be highly effective in preventing multiple forms of violence in the home and improving equitable attitudes and skills in couples. Future research should assess longitudinal impact and implementation at scale. TRIAL REGISTRATION NUMBER NCT04163549.
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Affiliation(s)
- Kathryn L Falb
- International Rescue Committee, Airbel Impact Lab, Washington, DC, USA
| | - Khudejha Asghar
- International Rescue Committee, Violence Prevention and Reponse, Washington, DC, USA
| | | | - Simon Baseme
- International Rescue Committee, Women's Protection and Empowerment, Goma, Congo (the Democratic Republic of the)
| | - Martin Nyanguba
- International Rescue Committee, Child Protection, Goma, Congo (the Democratic Republic of the)
| | - Danielle Roth
- International Rescue Committee, Violence Prevention and Response, New York, New York, USA
| | - Jean de Dieu Hategekimana
- International Rescue Committee, Women's Protection and Empowerment, Goma, Congo (the Democratic Republic of the)
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Blackwell AH, de Dieu Hategekimana J, Bauma D, Roth D, Thivillier P, O'Connor M, Falb K. Violent Discipline in North Kivu, Democratic Republic of Congo: The Role of Child Gender and Disability Status in Cross-sectional Analysis. Matern Child Health J 2023; 27:861-872. [PMID: 36853372 PMCID: PMC10115712 DOI: 10.1007/s10995-023-03598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Violence is used to punish or educate children across the world, with detrimental effects on their physical, emotional, and social health that persist into their adulthood. This study aimed to understand the use of violent discipline by caregivers in conflict-affected communities and how it varied by the child's gender and disability level. METHODS Using cross-sectional data collected from 394 respondents (196 men and 198 women) in North Kivu, Democratic Republic of Congo, logistic generalized estimating equations stratified by gender assessed the association between past-three-month perpetration of violent discipline, caregiver demographics, conflict experiences, and disability attitudes, as well as child demographics of age, gender, disability level, and the interaction of gender and disability. RESULTS Compared to women with boy children with no disability, odds of perpetration of violent discipline were higher among those with girl children with no disability (aOR: 2.24; 95%CI: 1.11-4.51) and boy children with moderate or severe disability (aOR: 2.91; 95%CI: 1.14-7.33), and the interaction of girl children with a moderate or severe disability showed a 7.80 increase in odds of perpetration; however, association with women's discriminatory disability attitudes was not significant. In contrast, the interaction of child gender and disability level were not significantly associated with perpetration of violent discipline for men, but disability attitudes were significantly associated (aOR: 1.07; 95%CI: 1.00-1.15). DISCUSSION Results suggest that levels of violence in conflict-affected households in North Kivu, DRC are high, with women reporting higher levels of violent discipline overall, and amplified use of violence against girl children with disabilities. More research and programs with an intersectional lens are needed in conflict settings to better understand and address the use of violent discipline and underlying discriminatory norms around gender and disability.
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Affiliation(s)
- Alexandra H Blackwell
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA. .,Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom.
| | - Jean de Dieu Hategekimana
- International Rescue Committee Democratic Republic of Congo, 8 Avenue des Citronniers, Q. Croiz-Rouge, Kinshasa/Gombe, RD Congo, BP, 8119, South Africa
| | - Daddy Bauma
- International Rescue Committee Democratic Republic of Congo, 8 Avenue des Citronniers, Q. Croiz-Rouge, Kinshasa/Gombe, RD Congo, BP, 8119, South Africa
| | - Danielle Roth
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | | | - Meghan O'Connor
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | - Kathryn Falb
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
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Fabbri C, Powell-Jackson T, Leurent B, Rodrigues K, Shayo E, Barongo V, Devries KM. School violence, depression symptoms, and school climate: a cross-sectional study of Congolese and Burundian refugee children. Confl Health 2022; 16:42. [PMID: 35870935 PMCID: PMC9308201 DOI: 10.1186/s13031-022-00475-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Camilla Fabbri
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.
| | - Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
| | - Baptiste Leurent
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
- University College London, London, UK
| | | | - Elizabeth Shayo
- National Institute for Medical Research, 3 Barack Obama Dr, P.O. Box 9653, 11101, Dar es Salaam, Tanzania
| | - Vivien Barongo
- National Institute for Medical Research, 3 Barack Obama Dr, P.O. Box 9653, 11101, Dar es Salaam, Tanzania
| | - Karen M Devries
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
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Caron F, Tourneux P, Tchidjou HK, Taleb A, Gouron R, Panuel M, Klein C. Incidence of child abuse with subdural hemorrhage during the first year of the COVID-19 pandemic: a nationwide study in France. Eur J Pediatr 2022; 181:2433-2438. [PMID: 35302178 PMCID: PMC8929282 DOI: 10.1007/s00431-022-04387-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED The global COVID-19 pandemic prompted governments to impose unprecedented sanitary measures, such as social distancing, curfews, and lockdowns. In France and other countries, the first COVID-19 lockdown raised concerns about an increased risk of child abuse. Abusive head trauma (AHT) is one of the most serious forms of child abuse in children aged 0-24 months and constitutes the leading cause of death in children under 2 years of age. Subdural hemorrhage (SDH) is present in 89% of cases of AHT and constitutes one of the most specific, objective clinical presentations in the diagnosis of child abuse. In a French nationwide study, we sought to evaluate the potential impact of the first year of the COVID-19 pandemic on the incidence of hospital admissions for child abuse with SDH, relative to the two previous years. We conducted a nationwide, retrospective study of data in the French national hospital discharge summary database by applying the International Classification of Diseases (10th Revision) codes for SDH and for child abuse. After including children aged up to 24 months with a diagnosis of child abuse and/or SDH following hospital admission anywhere in France between January 1, 2018, and December 31, 2020, we compared the incidence of child abuse, the incidence of SDH + child abuse, and the demographic data for 2020 with the corresponding values for 2018 and 2019. There were no significant differences in the number of hospital admissions due to child abuse or SDH + child abuse between 2020 and the 2018/2019 control years. The incidence of SDH + child abuse was higher among boys than among girls. There were significantly fewer hospital admissions in May 2020 (p = 0.01) and significantly more in December 2020 (p = 0.03), relative to the same months in the two preceding years. There was a nonsignificant trend toward a lower incidence of hospital admission for child abuse in 2020, relative to 2019 (decrease: 6.4%) and 2018 (decrease: 7.6%). CONCLUSION When considering children under the age of 24 months in France, the incidence of hospital admission for SDH in the context of child abuse was not significantly higher in 2020 than in the two previous years. WHAT IS KNOWN • The impact of COVID-19 lockdown on child abuse and more specifically on subdural hemorrhage remains unknown. WHAT IS NEW • There was no increase in hospitalizations for child abuse and AHT. • We found that boys are more often victims of child abuse and subdural hemorrhage among children aged less than 12 months.
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Affiliation(s)
- Fiorella Caron
- Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - Pierre Tourneux
- Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
- PériTox Laboratory UMR_I 01, UFR de Medicine, University of Picardie Jules Verne, Amiens, France
| | | | - Ariski Taleb
- Department of Medical Information, Montreuil-sur-Mer Medical Center, Montreuil-sur-Mer, France
| | - Richard Gouron
- Department of Pediatric Orthopedics, University of Picardie Jules Verne and Amiens Picardie University Medical Center, Amiens, France
| | - Michel Panuel
- Department of Medical Imaging Hôpital Nord, Hôpitaux de Marseille, Assistance Publique, Marseille, France
| | - Céline Klein
- Department of Pediatric Orthopedics, University of Picardie Jules Verne and Amiens Picardie University Medical Center, Amiens, France
- Service d’Orthopédie Pédiatrique, CHU Amiens-Picardie, 1 rue du Professeur Cabrol, 80054 Amiens Cedex 1, France
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10
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Woldetsadik D, Llorent-Martínez EJ, Gebrezgabher S, Njenga M, Mendum R, Castillo-López R, Fernández-de Córdova ML, Hailu H, Evans CT, Madani N, Mafika TP, Fleming DEB. Okra ( Abelmoschus esculentus) in a refugee context in East Africa: Kitchen gardening helps with mineral provision. SN APPLIED SCIENCES 2021; 4:32. [PMID: 34957376 PMCID: PMC8689287 DOI: 10.1007/s42452-021-04898-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Kitchen gardening is considered a way to reconnect with agriculture and complement the cereal-based relief food offered to refugees in East Africa. This work aimed at profiling mineral content of okra in four refugee camps and settlements located in Ethiopia and Uganda and its contribution to adequate intake (AIs) or recommended dietary allowances (RDAs) for young children and pregnant and lactating women (PLW). The study also evaluated the applicability of portable X-ray fluorescence (PXRF) as compared with inductively coupled plasma mass spectrometry (ICP-MS) for mineral profiling of okra powder samples. The contents of minerals (mg kg-1) from the ICP-MS readings were in the following ranges: K (14,385-33,294), Ca (2610-14,090), P (3178-13,248), Mg (3896-7986), Cu (3.81-19.3), Fe (75.7-1243), Zn (33-141) and Mn (23.1-261). Regardless of geographic origin, at low-end consumption probability (17 g day-1 for young children and 68 g day-1 for PLW), okra could contribute ˂ 15% (2.7-12.9%) AI for macro-minerals (K and Ca). In addition, the contributions to RDA values for Fe and Zn, elements of known public health interest, ranged from 4.5 to 34.7% for young children. Interestingly, regression lines revealed strong agreement between ICP-MS and PXRF readings for Mn and Zn, with R2 values > 0.91. This information is useful in support of nutrition-sensitive kitchen gardening programs through scaling culturally important crops in refugee settings. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s42452-021-04898-6.
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Affiliation(s)
- Desta Woldetsadik
- Department of Soil and Water Resources Management, Wollo University, Dessie, Ethiopia
| | - Eulogio J. Llorent-Martínez
- Department of Physical and Analytical Chemistry, Faculty of Experimental Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain
| | | | - Mary Njenga
- World Agroforestry (ICRAF), Nairobi, Kenya
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya
| | - Ruth Mendum
- Office of International Programs, College of Agricultural Sciences, Pennsylvania State University, State College, USA
| | - Roxana Castillo-López
- Department of Physical and Analytical Chemistry, Faculty of Experimental Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain
| | - Maria L. Fernández-de Córdova
- Department of Physical and Analytical Chemistry, Faculty of Experimental Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain
| | - Hillette Hailu
- Department of Soil and Water Resources Management, Wollo University, Dessie, Ethiopia
| | - Colby T. Evans
- Physics Department, Mount Allison University, Sackville, NB Canada
| | - Nelly Madani
- Physics Department, Mount Allison University, Sackville, NB Canada
| | - Tamlyn P. Mafika
- Physics Department, Mount Allison University, Sackville, NB Canada
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11
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Natukunda HPM, Mubiri P, Cluver LD, Ddumba-Nyanzi I, Bukenya B, Walakira EJ. Which Factors Are Associated With Adolescent Reports of Experiencing Various Forms of Abuse at the Family Level in Post-Conflict Northern Uganda? JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12067-NP12096. [PMID: 31789094 DOI: 10.1177/0886260519888526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research assessing familial violence against adolescents, using caregiver-adolescent dyads, is limited in post-conflict settings. This study aimed to determine the prevalence and factors associated with adolescent-reported familial abuse in post-conflict northern Uganda. It also assessed the relationship between abuse subtypes and (a) beliefs supporting aggression and (b) adolescent well-being and life satisfaction. A randomly selected community-based sample of 10- to 17-year-old adolescents (54% girls) and their caregivers (N = 427 dyads) in two northern Uganda districts was used. Abuse outcomes were adolescent reported. All measures used standardized tools that have been adapted for research in resource-limited settings. Analyses used multivariable linear regressions in Stata 14/IC. Overall, physical, emotional, and sexual abuse rates were 70% (confidence interval [CI] = [65.7, 74.4]), 72% (CI = [67.4, 76.0]), and 18.0% (CI = [14.0, 21.2]), respectively. Polyvictimization was 61% (CI = [55.4, 64.7]). There were no gender differences regarding adolescent reports of physical and emotional abuse, but adolescent girls were more likely to report sexual abuse and polyvictimization than adolescent boys. All forms of adolescent-reported abuse (except sexual abuse) were associated with caregiver reports of harsh disciplinary practices. In addition, emotional abuse was associated with physical and sexual abuse. Physical abuse was associated with being an orphan and emotional abuse. Sexual abuse was associated with being a girl, older adolescent age, living in a larger household, and emotional abuse. Polyvictimization was positively associated with being an orphan, younger caregiver age, caregiver-reported poor monitoring and supervision, and higher household socioeconomic status, but negatively associated with lower parental role satisfaction. Physical and emotional (but not sexual) abuse and polyvictimization were associated with beliefs supporting aggression among adolescents. All abuse subtypes were associated with lower levels of perceived well-being and life satisfaction among adolescents in this study. Child abuse prevention programs have the potential to improve adolescent-caregiver interaction and interrupt the violence transmission cycle in this setting.
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Affiliation(s)
- Helen P M Natukunda
- Makerere University, Kampala, Uganda
- MRC Harwell Institute, UK Research and Innovation, Oxfordshire, UK
- University of Oxford, UK
| | | | - Lucie D Cluver
- University of Oxford, UK
- University of Cape Town, South Africa
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12
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Fabbri C, Rodrigues K, Leurent B, Allen E, Qiu M, Zuakulu M, Nombo D, Kaemingk M, De Filippo A, Torrats-Espinosa G, Shayo E, Barongo V, Greco G, Tol W, Devries KM. The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial. PLoS Med 2021; 18:e1003808. [PMID: 34606500 PMCID: PMC8489723 DOI: 10.1371/journal.pmed.1003808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
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).
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Affiliation(s)
- Camilla Fabbri
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine Rodrigues
- International Rescue Committee, New York, New York, United States of America
| | - Baptiste Leurent
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary Qiu
- Innovations for Poverty Action, Dar es Salaam, Tanzania
| | | | - Dennis Nombo
- International Rescue Committee, New York, New York, United States of America
| | - Michael Kaemingk
- Behavioral Insights Team, New York, New York, United States of America
| | | | | | - Elizabeth Shayo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Vivien Barongo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Giulia Greco
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wietse Tol
- University of Copenhagen, Copenhagen, Denmark
| | - Karen M. Devries
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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13
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Ndungu J, Jewkes R, Ngcobo-Sithole M, Chirwa E, Gibbs A. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7923. [PMID: 34360216 PMCID: PMC8345444 DOI: 10.3390/ijerph18157923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Jane Ndungu
- Office of Engagement and Transformation, Nelson Mandela University, Port Elizabeth 6001, South Africa
| | - Rachel Jewkes
- Office of the Executive Scientist, South African Medical Research Council, Pretoria 0001, South Africa;
| | | | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (E.C.); (A.G.)
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (E.C.); (A.G.)
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14
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Miller KE, Jordans MJD, Tol WA, Galappatti A. A call for greater conceptual clarity in the field of mental health and psychosocial support in humanitarian settings. Epidemiol Psychiatr Sci 2021; 30:e5. [PMID: 33413736 PMCID: PMC8057504 DOI: 10.1017/s2045796020001110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions. METHODS We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied. RESULTS Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology. CONCLUSIONS Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.
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Affiliation(s)
| | - M. J. D. Jordans
- War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - W. A. Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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15
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Seddighi H, Salmani I, Javadi MH, Seddighi S. Child Abuse in Natural Disasters and Conflicts: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:176-185. [PMID: 30866745 DOI: 10.1177/1524838019835973] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
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.
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Affiliation(s)
- Hamed Seddighi
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ibrahim Salmani
- Department of Health in Disaster and Emergency, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohhamad Hossein Javadi
- Department of Social work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Saeideh Seddighi
- Social Science Department, Allameh Tabataba'i University, Tehran, Iran
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16
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Tobin J, Cashmore J. Thirty years of the CRC: Child protection progress, challenges and opportunities. CHILD ABUSE & NEGLECT 2020; 110:104436. [PMID: 32622698 DOI: 10.1016/j.chiabu.2020.104436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/16/2020] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
The CRC has a challenging and ambitious agenda in relation to the protection of children from all forms of violence, particularly the large and increasing numbers of children affected by natural disasters, armed conflict, trafficking, poverty and increasing inequality, displacement and trafficking. In this article, we outline some of the issues in the implementation and understanding of the Convention and highlight three major international developments over the last decade: the adoption of General Comment No 13, the work of the Special Representative of the Secretary General on Violence Against Children, and the adoption of the 2030 Agenda for Sustainable Development by the UN General Assembly in 2005. We also identify four broad domains in which the Convention can and is being used to enhance efforts to ensure the protection of children based on a rights framework - advocacy and litigation, policy design, service delivery and research and monitoring methodology - rather than a welfare-based approach. The key to a rights-based approach in efforts to protect children is a focus on children's right to be involved in decision-making - and in research - that affect their lives.
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Affiliation(s)
- John Tobin
- Melbourne Law School, University of Melbourne, Australia
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17
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Gender-based violence against adolescent girls in humanitarian settings: a review of the evidence. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 5:210-222. [PMID: 33220789 DOI: 10.1016/s2352-4642(20)30245-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/23/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022]
Abstract
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.
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18
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Rumble L, Febrianto RF, Larasati MN, Hamilton C, Mathews B, Dunne MP. Childhood Sexual Violence in Indonesia: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:284-299. [PMID: 29629637 DOI: 10.1177/1524838018767932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There has been relatively little research into the prevalence of childhood sexual violence (CSV) as well as the risk and protective factors for CSV in low- and middle-income countries including Indonesia. Systematic searches conducted in English and Bahasa Indonesia in this review identified 594 records published between 2006 and 2016 in peer-reviewed journals and other literature including 299 Indonesian records. Fifteen studies, including nine prevalence studies, met the quality appraisal criteria developed for this review. The review found that CSV research is scarce: Only one study included nationally representative prevalence estimates. Varying definitions for CSV, survey methods, and sample characteristics limited the generalizability of the data. The available evidence points to significant risk of sexual violence affecting both girls and boys across many geographical and institutional settings. Married adolescent girls are vulnerable to sexual violence by partners in their homes. Children in schools are vulnerable to CSV by peers and adults. Victims seldom disclose incidents and rarely seek support. In addition, early childhood experiences of trauma were strongly associated with later perpetration of sexual violence and revictimization. Limited information is available about protective factors. This review synthesizes evidence about what is currently known about CSV in Indonesia and identifies the strengths and weaknesses of the existing research. A more robust evidence base regarding CSV is required to better inform policy and justify investment into prevention programs.
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Affiliation(s)
| | | | | | | | - Ben Mathews
- Queensland University of Technology, Queensland, Brisbane, Australia
| | - Michael P Dunne
- Queensland University of Technology, Queensland, Brisbane, Australia
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Logie CH, Okumu M, Mwima S, Hakiza R, Irungi KP, Kyambadde P, Kironde E, Narasimhan M. 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. Confl Health 2019; 13:60. [PMID: 31867053 PMCID: PMC6918605 DOI: 10.1186/s13031-019-0242-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
- Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON M5G 1N8 Canada
| | - Moses Okumu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
- School of Social Work, University of North Carolina-Chapel Hill, 325 Pittsboro ST CB#3550, Chapel Hill, NC 27599 USA
- National STI Control Unit, Mulago Hospital, Kampala, Uganda
| | - Simon Mwima
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most At Risk Population Initiative, Kampala, Uganda
| | - Robert Hakiza
- Most At Risk Population Initiative, Kampala, Uganda
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | | | - Peter Kyambadde
- National STI Control Unit, Mulago Hospital, Kampala, Uganda
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most At Risk Population Initiative, Kampala, Uganda
| | | | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, CH-1211, 27 Geneva, Switzerland
- World Health Organization, Department of Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme (HRP), Geneva, Switzerland
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20
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Mootz JJ, Stark L, Meyer E, Asghar K, Roa AH, Potts A, Poulton C, Marsh M, Ritterbusch A, Bennouna C. Examining intersections between violence against women and violence against children: perspectives of adolescents and adults in displaced Colombian communities. Confl Health 2019; 13:25. [PMID: 31198437 PMCID: PMC6558814 DOI: 10.1186/s13031-019-0200-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/30/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Research examining the interrelated drivers of household violence against women and violence against children is nascent, particularly in humanitarian settings. Gaps remain in understanding how relocation, displacement and ongoing insecurity affect families and may exacerbate household violence. METHODS Employing purposive sampling, we used photo elicitation methods to facilitate semi-structured, in-depth interviews with female and male adolescents and adults aged 13-75 (n = 73) in two districts in Colombia from May to August of 2017. Participants were displaced and/or residing in neighborhoods characterized by high levels of insecurity from armed groups. RESULTS Using inductive thematic analysis and situating the analysis within a feminist socioecological framework, we found several shared drivers of household violence. Intersections among drivers at all socioecological levels occurred among societal gender norms, substance use, attempts to regulate women's and children's behavior with violence, and daily stressors associated with numerous community problems. A central theme of relocation was of family compositions that were in continual flux and of family members confronted by economic insecurity and increased access to substances. CONCLUSIONS Findings suggest interventions that systemically consider families' struggles with relocation and violence with multifaceted attention to socioecological intersections.
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Affiliation(s)
- Jennifer J. Mootz
- Department of Psychiatry, Columbia University, New York, NY USA
- New York State Psychiatric Institute, New York, USA
| | - Lindsay Stark
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, NY USA
- George Warren Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130 USA
| | - Elizabeth Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Khudejha Asghar
- Department of Population,Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Alina Potts
- UNICEF Office of Research-Innocenti, Florence, Italy
| | | | - Mendy Marsh
- The Equality Institute, Melbourne, Australia
| | - Amy Ritterbusch
- School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Cyril Bennouna
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, NY USA
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21
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Glass N, Perrin N, Marsh M, Clough A, Desgroppes A, Kaburu F, Ross B, Read-Hamilton S. Effectiveness of the Communities Care programme on change in social norms associated with gender-based violence (GBV) with residents in intervention compared with control districts in Mogadishu, Somalia. BMJ Open 2019; 9:e023819. [PMID: 30872541 PMCID: PMC6429733 DOI: 10.1136/bmjopen-2018-023819] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Determine the effectiveness of the Communities Care programme (CCP) on change in harmful social norms associated with gender-based violence (GBV) and confidence in provision of services with residents in intervention compared with control district. We hypothesised that residents in the intervention district would report a decrease in support for harmful social norms and increase in confidence in services in comparison with control district. SETTING The study was conducted in Mogadishu, Somalia. PARTICIPANTS In the intervention district, 192 community members (50% women) completed baseline surveys with 163 (84.9%) retained at endline. In the control district, 195 community members (50% women) completed baseline surveys with 167 (85.6%) retained at endline. INTERVENTION CCP uses facilitated dialogues with community members to catalyse GBV prevention actions and provides training to diverse sectors to strengthen response services for GBV survivors. RESULTS Residents in the intervention district had significantly greater improvement in change in social norms: (1) response to sexual violence (b=-0.214, p=0.041); (2) protecting family honour (b=-0.558, p<0.001); and (3) husband's right to use violence (b=-0.309, p=0.003) compared with control district participants. The greatest change was seen in the norm of 'protecting family honour' with a Cohen's d effect size (ES) of 0.70, followed by the norm 'husband's right to use violence' (ES=0.38), and then the norm of 'response to sexual violence' (ES=0.28). Residents in intervention district had a significantly greater increase in confidence in provision of GBV services across diverse sectors than the control district (b=0.318, p<0.001) with an associated effect size of 0.67. There were no significant differences between residents in intervention and control districts on change in personal beliefs on the norms. CONCLUSION The evaluation showed the promise of CCP in changing harmful social norms associated with GBV and increasing confidence in provision of services in a complex humanitarian setting.
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Affiliation(s)
- Nancy Glass
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Amber Clough
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amelie Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - Francesco Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
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Bermudez LG, Stark L, Bennouna C, Jensen C, Potts A, Kaloga IF, Tilus R, Buteau JE, Marsh M, Hoover A, Williams ML. Converging drivers of interpersonal violence: Findings from a qualitative study in post-hurricane Haiti. CHILD ABUSE & NEGLECT 2019; 89:178-191. [PMID: 30685625 DOI: 10.1016/j.chiabu.2019.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/12/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Laura Gauer Bermudez
- Columbia University School of Social Work, 1255 Amsterdam Ave., Office 1120, New York, NY, 10027, USA.
| | - Lindsay Stark
- George Warren Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA.
| | - Cyril Bennouna
- Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA.
| | - Celina Jensen
- Care and Protection of Children (CPC) Learning Network, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA.
| | - Alina Potts
- UNICEF Office of Research-Innocenti, Piazza della Santissima Annunziata, 12, 50121, Firenze, Italy.
| | | | - Ricardo Tilus
- UNICEF Haiti, 17 Rue Armond Holy, Port-au-Prince, Haiti.
| | | | - Mendy Marsh
- UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Anna Hoover
- Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA.
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Bermudez LG, Williamson K, Stark L. Setting global research priorities for child protection in humanitarian action: Results from an adapted CHNRI exercise. PLoS One 2018; 13:e0202570. [PMID: 30133538 PMCID: PMC6104993 DOI: 10.1371/journal.pone.0202570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Laura Gauer Bermudez
- Columbia University School of Social Work, New York, New York, United States of America
| | | | - Lindsay Stark
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- George Warren Brown School of Social Work, Washington University in Saint Louis, St. Louis, Missouri, United States of America
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Glass N, Perrin N, Clough A, Desgroppes A, Kaburu FN, Melton J, Rink A, Read-Hamilton S, Marsh M. Evaluating the communities care program: best practice for rigorous research to evaluate gender based violence prevention and response programs in humanitarian settings. Confl Health 2018; 12:5. [PMID: 29422946 PMCID: PMC5791214 DOI: 10.1186/s13031-018-0138-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/12/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- N Glass
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - N Perrin
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - A Clough
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - A Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - F N Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | - A Rink
- UNICEF, Juba, South Sudan
| | - S Read-Hamilton
- Consultant, Gender based violence in Emergencies, Sydney, Australia
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Bermudez LG, Parks L, Meyer SR, Muhorakeye L, Stark L. Safety, trust, and disclosure: A qualitative examination of violence against refugee adolescents in Kiziba Camp, Rwanda. Soc Sci Med 2018; 200:83-91. [PMID: 29421475 DOI: 10.1016/j.socscimed.2018.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Laura Gauer Bermudez
- Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027 USA.
| | - Lauren Parks
- Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Ave B-4 Suite 432, New York, NY 10032 USA.
| | - Sarah R Meyer
- Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Ave B-4 Suite 432, New York, NY 10032 USA.
| | - Liberata Muhorakeye
- Plan International Rwanda, Plot Number 821 in Gasabo District, P.O. Box, Kigali, Rwanda.
| | - Lindsay Stark
- Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Ave B-4 Suite 432, New York, NY 10032 USA.
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Meyer SR, Yu G, Hermosilla S, Stark L. School violence, perceptions of safety and school attendance: results from a cross-sectional study in Rwanda and Uganda. JOURNAL OF GLOBAL HEALTH REPORTS 2018; 2. [PMID: 31223666 DOI: 10.29392/joghr.2.e2018020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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.
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Affiliation(s)
- Sarah R Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Gary Yu
- New York University, Rory Meyers College of Nursing, New York, New York, USA
| | | | - Lindsay Stark
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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Shiva Kumar AK, Stern V, Subrahmanian R, Sherr L, Burton P, Guerra N, Muggah R, Samms-Vaughan M, Watts C, Mehta SK. Ending violence in childhood: a global imperative. PSYCHOL HEALTH MED 2017; 22:1-16. [DOI: 10.1080/13548506.2017.1287409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | - Patrick Burton
- Centre for Justice and Crime Prevention, Cape Town, South Africa
| | - Nancy Guerra
- Department of Psychology and Social Behavior, University of California at Irvine, Irvine, CA, USA
| | | | - Maureen Samms-Vaughan
- Department of Child and Adolescent Health, University of West Indies, Kingston, Jamaica
| | - Charlotte Watts
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Latent class analysis of violence against adolescents and psychosocial outcomes in refugee settings in Uganda and Rwanda. Glob Ment Health (Camb) 2017; 4:e19. [PMID: 29230315 PMCID: PMC5719474 DOI: 10.1017/gmh.2017.17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/18/2017] [Accepted: 08/04/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known about violence against children in refugee camps and settlements, and the evidence-base concerning mental health outcomes of youth in refugee settings in low and middle-income countries is similarly small. Evidence is needed to understand patterns of violence against children in refugee camps, and associations with adverse mental health outcomes. METHODS Surveys were conducted with adolescent refugees (aged 13-17) in two refugee contexts - Kiziba Camp, Rwanda (n = 129) (refugees from Democratic Republic of Congo) and Adjumani and Kiryandongo refugee settlements, Uganda (n = 471) (refugees from South Sudan). Latent Class Analysis was utilized to identify classes of violence exposure (including exposure to witnessing household violence, verbal abuse, physical violence and sexual violence). Logistic regressions explored the association between latent class of violence exposure and symptoms of depression and anxiety. RESULTS In Rwanda, a two-class solution was identified, with Class 1 (n = 33) representing high levels of exposure to violence and Class 2 (n = 96) representing low levels of exposure. In Uganda, a three-class solution was identified: Class 1 (high violence; n = 53), Class 2 (low violence, n = 100) and Class 3 (no violence, n = 317). Logistic regression analyses indicated that latent violence class was associated with increased odds of high anxiety symptoms in Rwanda (AOR 3.56, 95% CI 1.16-0.95), and high v. no violence class was associated with depression (AOR 3.97, 95% CI 1.07-7.61) and anxiety symptoms (AOR 2.04, 95% CI 1.05-3.96) in Uganda. CONCLUSIONS The present results support the existing evidence-base concerning the association between violence and adverse mental health outcomes, while identifying differences in patterns and associations between refugee youth in two different contexts.
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