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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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Siu G, Nsubuga RN, Lachman JM, Namutebi C, Sekiwunga R, Zalwango F, Riddell J, Wight D. The impact of the parenting for respectability programme on violent parenting and intimate partner relationships in Uganda: A pre-post study. PLoS One 2024; 19:e0299927. [PMID: 38787892 PMCID: PMC11125497 DOI: 10.1371/journal.pone.0299927] [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: 06/15/2023] [Accepted: 01/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND There is a growing need for interventions that reduce both violence against children and intimate partner violence in low- and middle-income countries. However, few parenting interventions deliberately address this link. We tested the feasibility of a 16-session group-based parenting programme, Parenting for Respectability, in semi-rural Ugandan communities. METHODS This was a pre-post study with parents and their children (N = 484 parents; 212 children). RESULTS Pre-post comparisons found large effects for parent-reported reduced harsh parenting (Cohen's f2 = 0.41 overall; f2 = 0.47 (among session attendees); with an overall reduction of 26% for harsh parenting. Session attendees reported higher reductions than non-attendees (p = 0.014), and male caregivers reported higher reductions than female caregivers (p<0.001). Children also reported reduced harsh parenting by attending fathers (f2 = 0.64 overall; f2 = 0.60) and attending mothers (f2 = 0.56 overall; f2 = 0.51); with reduction in harsh parenting ranging between 27% to 29% in the various categories. Overall, spousal violence reduced by 27% (f2 = 0.19 overall; f2 = 0.26 (among session attendees). Both parents and children reported reduced dysfunctional parent relationships; parents: f2 = 0.19 overall; f2 = 0.26 (among session attendees); and children: f2 = 0.35 overall; f2 = 0.32 (for attending parents); with reductions ranging between 22% to 28%. Parents who attended more than 50% of the program reported greater effects on reduced dysfunctional relationships than those who attended less than half of the program (B = -0.74, p = 0.013). All secondary outcomes were improved with f2 ranging between 0.08 and 0.39; and improvements ranging between 6% and 28%. CONCLUSION Results suggest the importance of more rigorous testing to determine program effectiveness.
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Affiliation(s)
- Godfrey Siu
- Child Health and Development Centre, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health, LSHTM, London, United Kingdom
| | | | - Jamie M. Lachman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- University of Cape Town, Cape Town, South Africa
| | - Carol Namutebi
- Child Health and Development Centre, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Sekiwunga
- Child Health and Development Centre, School of Medicine Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Julie Riddell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
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Stark L, Meinhart M, Hermosilla S, Kajungu R, Cohen F, Agaba GS, Obalim G, Knox J, Onyango Mangen P. Improving psychosocial well-being and parenting practices among refugees in Uganda: Results of the journey of life effectiveness trial. Glob Ment Health (Camb) 2024; 11:e42. [PMID: 38628157 PMCID: PMC11018555 DOI: 10.1017/gmh.2024.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Caregivers play a critical role in mediating the impacts of forced displacement on children; however, humanitarian programming remains hampered by a lack of evidence-based programming. We present findings from an evaluation of a group-based curriculum delivered over the course of 12 sessions, journey of life (JoL). A waitlist-control quasi-experimental design was implemented in the Kiryandongo refugee settlement (intervention n = 631, control n = 676). Caregiver mental distress, measured using the Kessler-6, was the primary outcome. Secondary outcomes included (a) functioning, (b) social support and (c) caregiving attitudes and behaviors. Propensity score matching (PSM) and Cohen's d estimates were used to examine the intervention effects. According to our primary PSM analysis, JoL led to significant improvements in mental distress (coef.: 2.33; p < 0.001), social support (coef.: 1.45; p < 0.001), functioning (coef.: 2.64; p < 0.001), parental warmth/affection (coef.: 2.48; p < 0.001), parental undifferentiated rejection (coef.: 0.49; p < 0.001) and attitudes around violence against children (VAC) (coef.: 1.98; p < 0.001). Evidence from Cohen's d analysis underscored the value of the intervention's effect on parental warmth/affection (0.74), mental distress (0.70) and VAC attitudes (0.68). This trial adds to the evidence on holistic parenting programming to improve the mental health and parenting outcomes among refugee caregivers.
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Affiliation(s)
- Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Melissa Meinhart
- National Coalition of Independent Scholars, Battleboro, Vermont, USA
| | - Sabrina Hermosilla
- Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Rehema Kajungu
- Transcultural Psychosocial Organization (TPO) Uganda, Kampala, Uganda
| | - Flora Cohen
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Gary S. Agaba
- Transcultural Psychosocial Organization (TPO) Uganda, Kampala, Uganda
| | - Grace Obalim
- Transcultural Psychosocial Organization (TPO) Uganda, Kampala, Uganda
| | - Justin Knox
- Department of Psychiatry, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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Desmond C, Watt K, Rudgard WE, Sherr L, Cluver L. Whole of government approaches to accelerate adolescent success: efficiency and financing considerations. Health Policy Plan 2024; 39:168-177. [PMID: 38048303 PMCID: PMC11020293 DOI: 10.1093/heapol/czad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/10/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
The multiple domains of development covered by the Sustainable Development Goals (SDGs) present a practical challenge for governments. This is particularly acute in highly resource-constrained settings which use a sector-by-sector approach to structure financing and prioritization. One potentially under-prioritized solution is to implement interventions with the potential to simultaneously improve multiple outcomes across sectors, what United Nations Development Programme refer to as development 'accelerators'. An increasing number of accelerators are being identified in the literature. There are, however, challenges associated with the evaluation and implementation of accelerators. First, as accelerators have multiple benefits, possibly in different sectors, they will be undervalued if the priority setting is conducted sector-by-sector. Second, even if their value is recognized, accelerators may not be adopted if doing so clashes with any of the multiple competing interests policymakers consider, of which efficiency/social desirability is but one. To illustrate the first challenge, and outline a possible solution, we conduct a cost-effectiveness analysis comparing the implementation of three sector-specific interventions to an accelerator, first using a sector-by-sector planning perspective, then a whole of government approach. The case study demonstrates how evaluating the cost-effectiveness of interventions sector-by-sector can lead to suboptimal efficiency rankings and overlook interventions that are efficient from a whole of government perspective. We then examine why recommendations based on a whole of government approach to evaluation are unlikely to be heeded. To overcome this second challenge, we outline a menu of existing and novel financing mechanisms that aim to address the mismatch between political incentives and logistical constraints in the priority setting and the economic evaluation evidence for cost-effective accelerators. These approaches to financing accelerators have the potential to improve efficiency, and in doing so, progress towards the SDGs, by aligning political incentives more closely with recommendations based on efficiency rankings.
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Affiliation(s)
- Chris Desmond
- School of Economics and Finance, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, Gauteng 2000, South Africa
- Centre for Rural Health, University of KwaZulu-Natal, 238 Masizi Kunene Road, Durban, KwaZulu-Natal 4041, South Africa
| | - Kathryn Watt
- Centre for Rural Health, University of KwaZulu-Natal, 238 Masizi Kunene Road, Durban, KwaZulu-Natal 4041, South Africa
| | - William E Rudgard
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford OX1 2ER, United Kingdom
- Centre for Social Science Research, University of Cape Town, Robert Leslie Social Science Building 12 University Avenue South, University of Rondebosch, Cape Town 7700, South Africa
| | - Lorraine Sherr
- Health Psychology Unit, Institute of Global Health, University College London, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford OX1 2ER, United Kingdom
- UK Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road, 1st floor, Neuroscience Institute, Groote Schuur Hospital, Observatory, Cape Town, Western Cape 7925, South Africa
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Edwards KM, Kumar M, Waterman EA, Mullet N, Madeghe B, Musindo O. Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:593-612. [PMID: 36964686 DOI: 10.1177/15248380231160742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Violence against children-which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence-continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent-child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.
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Karimli L, Nabunya P, Ssewamala FM, Dvalishvili D. Combining Asset Accumulation and Multifamily Group Intervention to Improve Mental Health for Adolescent Girls: A Cluster-Randomized Trial in Uganda. J Adolesc Health 2024; 74:78-88. [PMID: 37715767 PMCID: PMC10840800 DOI: 10.1016/j.jadohealth.2023.08.012] [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: 02/17/2023] [Revised: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE The aim of this study is to expand the current knowledge on the relationship between poverty, family functioning, and the mental health of adolescent girls in families affected by poverty and HIV/AIDS in southern Uganda. The study investigates the association between family functioning and mental health and examines whether family functioning moderates the intervention effect on adolescent mental health. METHODS Longitudinal data were collected over the course of 24 months in a cluster randomized controlled trial conducted among N=1,260 girls aged 14-17 years in Uganda. Participants were randomized into control group (n=408 girls from n=16 schools), matched youth development accounts treatment, YDA (n=471 girls from n=16 schools), and integrated intervention combining YDA with multiple family group component (n=381 girls from n=15 schools). RESULTS We found a significant positive association between family functioning and mental health of adolescent girls in our sample. Moderator analyses suggests that effect of the intervention on Beck Hopelessness Scale was significantly moderated by family cohesion (χ2 (4) =21.43; p = .000), frequency of family communication (χ2 (4) =9.65; p = .047), and quality of child-caregiver relationship (χ2 (4) =11.12; p = .025). Additionally, the intervention effect on depression was moderated by the comfort of family communication (χ2 (4) =10.2; p = .037). DISCUSSION The study findings highlight the importance of family functioning when examining the link from poverty to adolescent mental health. The study contributes to the scarce evidence suggesting that asset-accumulation opportunities combined with a family strengthening component may improve parenting practices and adolescent mental health in poor households.
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Affiliation(s)
- Leyla Karimli
- Social Welfare Department, Luskin School of Public Affairs, University of California, Los Angeles (UCLA), Los Angeles, California.
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Darejan Dvalishvili
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
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Meinhart M, Mangen PO, Hermosilla S, Cohen F, Agaba GS, Kajungu R, Knox J, Obalim G, Stark L. Refugee caregivers: Associations between psychosocial wellbeing and parenting in Uganda. Stress Health 2023; 39:1014-1025. [PMID: 36812652 DOI: 10.1002/smi.3236] [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: 10/06/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Caregivers in humanitarian settings experience compounding stressors that may challenge their ability to provide quality parenting to children in their care. In recognition of this precarity, our analysis examines the linkage between psychosocial wellbeing and parenting behaviours among caregivers in Kiryandongo Settlement, Uganda. Using baseline data from an evaluation of a psychosocial intervention designed to support caregiver wellbeing and engage caregivers to support children in their communities, multi-variable ordinary least square regressions were used to estimate how various measures of psychosocial wellbeing (i.e. psychological distress, social support, and functioning) and parenting attitudes (related to violence against children) are associated with parental warmth and rejection. Profound livelihood challenges were found, as nearly half of the sample (48.20%) indicated cash from INGOs as their income source and/or reported never attending school (46.71%). Increased social support (coef. 0.11; 95% CIs: 0.08-0.15) and positive attitudes (coef. 0.21; 95% CIs: 0.14-0.29) were significantly associated with more desirable parental warmth/affection. Similarly, positive attitudes (coef. 0.16; 95% CIs 0.11-0.20), reduced distress (coef. 0.11; 95% CIs: 0.08-0.14) and increased functioning (coef. 0.03; 95% CIs: 0.01-0.04) were significantly associated with more desirable scores of parental undifferentiated rejection. While further research is needed to examine underlining mechanisms and causal pathways, our findings both link individual wellbeing characteristics with parenting behaviours and suggest further exploration into whether and how broader elements of the ecosystem may influence parenting outcomes.
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Affiliation(s)
- Melissa Meinhart
- National Coalition of Independent Scholars, Battleboro, Vermont, USA
| | | | | | - Flora Cohen
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Rehema Kajungu
- Transcultural Psychosocial Organization Uganda, Kampala, Uganda
| | - Justin Knox
- Columbia University, New York, New York, USA
| | - Grace Obalim
- Transcultural Psychosocial Organization Uganda, Kampala, Uganda
| | - Lindsay Stark
- Washington University in St. Louis, St. Louis, Missouri, USA
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Backhaus S, Leijten P, Meinck F, Gardner F. Different Instruments, Same Content? A Systematic Comparison of Child Maltreatment and Harsh Parenting Instruments. TRAUMA, VIOLENCE & ABUSE 2023; 24:3546-3563. [PMID: 36437787 PMCID: PMC10594851 DOI: 10.1177/15248380221134290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Child maltreatment and harsh parenting both include harmful actions by parents toward children that are physical (e.g., spanking, slapping) or emotional (e.g., threatening, yelling). The distinction between these two constructs, in meaning and measurement, is often unclear, leading to inconsistent research and policy. This study systematically identified, reviewed, and compared parent-reported child maltreatment (N = 7) and harsh parenting (N = 18) instruments. The overlap in parenting behaviors was 73%. All physical behaviors that were measured in harsh parenting instruments (e.g., spanking, beating up) were also measured in child maltreatment instruments. Unique physical behaviors measured in maltreatment instruments include twisting body parts and choking. All emotional behaviors in maltreatment instruments were included in harsh parenting instruments, and vice versa. Our findings suggest similar, but not identical, operationalizations of child maltreatment and harsh parenting. Our findings can help guide discussions on definitions, operationalizations, and their consequences for research on violence against children.
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Affiliation(s)
| | | | - Franziska Meinck
- University of Edinburgh, United Kingdom
- University of Witwatersrand, Johannesburg, South Africa
- North-West University, Vanderbijlpark, South Africa
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Kuunibe N, Bountogo M, Ouermi L, Sié A, Bärnighausen T, Harling G. Effects of education and age on the experience of youth violence in a very low-resource setting: a fixed-effects analysis in rural Burkina Faso. BMJ Open 2023; 13:e071104. [PMID: 37852761 PMCID: PMC10603425 DOI: 10.1136/bmjopen-2022-071104] [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: 12/16/2022] [Accepted: 08/31/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE The study aimed to investigate the effects of education and age on the experience of youth violence in low-income and middle-income country settings. DESIGN Using a standardised questionnaire, our study collected two waves of longitudinal data on sociodemographics, health practices, health outcomes and risk factors. The panel fixed-effects ordinary least squares regression models were used for the analysis. SETTINGS The study was conducted in 59 villages and the town of Nouna with a population of about 100 000 individuals, 1 hospital and 13 primary health centres in Burkina Faso. PARTICIPANTS We interviewed 1644 adolescents in 2017 and 1291 respondents in 2018 who participated in both rounds. OUTCOME AND EXPOSURE MEASURES We examined the experience of physical attacks in the past 12 months and bullying in the past 30 days. Our exposures were completed years of age and educational attainment. RESULTS A substantial minority of respondents experienced violence in both waves (24.1% bullying and 12.2% physical attack), with males experiencing more violence. Bullying was positively associated with more education (β=0.12; 95% CI 0.02 to 0.22) and non-significantly with older age. Both effects were stronger in males than females, although the gender differences were not significant. Physical attacks fell with increasing age (β=-0.18; 95% CI -0.31 to -0.05) and this association was again stronger in males than females; education and physical attacks were not substantively associated. CONCLUSIONS Bullying and physical attacks are common for rural adolescent Burkinabe. The age patterns found suggest that, particularly for males, there is a need to target violence prevention at younger ages and bullying prevention at slightly older ones, particularly for those remaining in school. Nevertheless, a fuller understanding of the mechanisms behind our findings is needed to design effective interventions to protect youth in low-income settings from violence.
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Affiliation(s)
- Naasegnibe Kuunibe
- Department of Economics, Faculty of Social Science and Arts, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Mamadou Bountogo
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
- Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
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Brathwaite R, Mutumba M, Nanteza J, Filiatreau LM, Migadde H, Namatovu P, Nabisere B, Mugisha J, Mwebembezi A, Ssewamala FM. Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46486. [PMID: 37314844 PMCID: PMC10337321 DOI: 10.2196/46486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them. OBJECTIVE We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda's fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them. METHODS This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group). RESULTS Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024. CONCLUSIONS Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them. TRIAL REGISTRATION ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46486.
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Affiliation(s)
- Rachel Brathwaite
- Brown School, Washington University in St. Louis, St Louis, MO, United States
| | - Massy Mutumba
- Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Herbert Migadde
- International Center for Child Health and Development, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, Masaka, Uganda
| | - Betina Nabisere
- International Center for Child Health and Development, Masaka, Uganda
| | | | | | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St Louis, MO, United States
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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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Mutumba M, Ssewamala F, Namirembe R, Sensoy Bahar O, Nabunya P, Neilands T, Tozan Y, Namuwonge F, Nattabi J, Acayo Laker P, Mukasa B, Mwebembezi A. A Multilevel Integrated Intervention to Reduce the Impact of HIV Stigma on HIV Treatment Outcomes Among Adolescents Living With HIV in Uganda: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40101. [PMID: 36197706 PMCID: PMC9582915 DOI: 10.2196/40101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND HIV stigma remains a formidable barrier to HIV treatment adherence among school-attending adolescents living with HIV, owing to high levels of HIV stigma within schools, rigid school structures and routines, lack of adherence support, and food insecurity. Thus, this protocol paper presents an evidence-informed multilevel intervention that will simultaneously address family- and school-related barriers to HIV treatment adherence and care engagement among adolescents living with HIV attending boarding schools in Uganda. OBJECTIVE The proposed intervention-Multilevel Suubi (MSuubi)-has the following objectives: examine the impact of M-Suubi on HIV viral suppression (primary outcome) and adherence to HIV treatment, including keeping appointments, pharmacy refills, pill counts, and retention in care; examine the effect of M-Suubi on HIV stigma (internalized, anticipated, and enacted), with secondary analyses to explore hypothesized mechanisms of change (eg, depression) and intervention mediation; assess the cost and cost-effectiveness of each intervention condition; and qualitatively examine participants' experiences with HIV stigma, HIV treatment adherence, and intervention and educators' attitudes toward adolescents living with HIV and experiences with group-based HIV stigma reduction for educators, and program or policy implementation after training. METHODS MSuubi is a 5-year multilevel mixed methods randomized controlled trial targeting adolescents living with HIV aged 10 to 17 years enrolled in a primary or secondary school with a boarding section. This longitudinal study will use a 3-arm cluster randomized design across 42 HIV clinics in southwestern Uganda. Participants will be randomized at the clinic level to 1 of the 3 study conditions (n=14 schools; n=280 students per study arm). These include the bolstered usual care (consisting of the literature on antiretroviral therapy adherence promotion and stigma reduction), multiple family groups for HIV stigma reduction plus family economic empowerment (MFG-HIVSR plus FEE), and Group-based HIV stigma reduction for educators (GED-HIVSR). Adolescents randomized to the GED-HIVSR treatment arm will also receive the MFG-HIVSR plus FEE treatment. MSuubi will be provided for 20 months, with assessments at baseline and 12, 24, and 36 months. RESULTS This study was funded in September 2021. Participant screening and recruitment began in April 2022, with 158 dyads enrolled as of May 2022. Dissemination of the main study findings is anticipated in 2025. CONCLUSIONS MSuubi will assess the effects of a combined intervention (family-based economic empowerment, financial literacy education, and school-based HIV stigma) on HIV stigma among adolescents living with HIV in Uganda. The results will expand our understanding of effective intervention strategies for reducing stigma among HIV-infected and noninfected populations in Uganda and improving HIV treatment outcomes among adolescents living with HIV in sub-Saharan Africa. TRIAL REGISTRATION ClinicalTrials.gov NCT05307250; https://clinicaltrials.gov/ct2/show/NCT05307250. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40101.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Fred Ssewamala
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Rashida Namirembe
- International Center for Child Health and Development, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Torsten Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Yesim Tozan
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Jennifer Nattabi
- Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Penina Acayo Laker
- Sam Fox School of Design and Visual Arts, Washington University in St Louis, St Louis, MO, United States
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13
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Dhaliwal M, Small R, Webb D, Cluver L, Ibrahim M, Bok L, Nascimento C, Wang C, Garagic A, Jensen L. Covid-19 as a long multiwave event: implications for responses to safeguard younger generations. BMJ 2022; 376:e068123. [PMID: 35086910 PMCID: PMC8792762 DOI: 10.1136/bmj-2021-068123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Mandeep Dhaliwal and colleagues call for urgent correction of the response to covid-19 to safeguard the development of children and young people
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Affiliation(s)
| | - Roy Small
- United Nations Development Programme, New York, USA
| | - Douglas Webb
- United Nations Development Programme, New York, USA
| | - Lucie Cluver
- University of Oxford. Oxford, UK
- University of Cape Town, Cape Town, South Africa
| | | | - Ludo Bok
- United Nations Development Programme, New York, USA
| | - Collin Nascimento
- OXY Occidental College, Kahane United Nations Program, Los Angeles, USA
| | - Cheng Wang
- OXY Occidental College, Kahane United Nations Program, Los Angeles, USA
| | - Aidan Garagic
- OXY Occidental College, Kahane United Nations Program, Los Angeles, USA
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Ahmed A, Hamed R, Abd Elaziz S, Agba N. Child behavior and psychological comorbidities in relation to different forms of child abuse among working children. EGYPTIAN JOURNAL OF PSYCHIATRY 2022; 43:125. [DOI: 10.4103/ejpsy.ejpsy_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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15
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Vosoghi N, Fallahi-Khoshknab M, Hosseini M, Ahmadi F. Nursing Care Challenges of Child Violence Victims: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:430-436. [PMID: 34703782 PMCID: PMC8491823 DOI: 10.4103/ijnmr.ijnmr_151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/07/2020] [Accepted: 04/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Violence against children is a serious global phenomenon. The severity of the injuries caused due to violence toward a child is sometimes so great that it sends them to the hospital. Nurses have the first contact with Child Violence Victims (CVVs). These nurses experience different challenges. This study was aimed at exploring nurses' experiences of challenges in care provision to CVVs. MATERIALS AND METHODS This conventional content analysis and qualitative study was conducted in 2018-2019. Using a purposive sampling method, 17 nurses with experience in care delivery to CVVs were recruited from among those working in Children's Medical Center, Tehran, Iran, and Bu-Ali Subspecialty Hospital, Ardabil, Iran. In-depth semi-structured interviews were conducted to collect the required data. Data were analyzed through the conventional content analysis method. RESULTS During data analysis, the 3 main categories of role conflict, lack of continuity of care, and emotional resentment and 9 subcategories were identified. Nurses experience challenges in care provision to CVVs. They do not have enough knowledge about CVVs, are unable to maintain the continuity of care, and experience role conflicts and emotional resentment. CONCLUSIONS Nurses experience some difficulties and challenges in the process of care delivery to CVVs. They tried to overcome emotional resentment, different conflicts, and concerns about the lack of continuity of care without adequate support and resources. Thus, planning to support nurses in this regard seems essential.
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Affiliation(s)
- Nazila Vosoghi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Lachman J, Wamoyi J, Spreckelsen T, Wight D, Maganga J, Gardner F. Combining parenting and economic strengthening programmes to reduce violence against children: a cluster randomised controlled trial with predominantly male caregivers in rural Tanzania. BMJ Glob Health 2021; 5:bmjgh-2020-002349. [PMID: 32641291 PMCID: PMC7348478 DOI: 10.1136/bmjgh-2020-002349] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Parenting programmes may reduce the risk of violence against children and improve child well-being. However, additional economic support may be necessary in highly deprived rural communities in sub-Saharan Africa. Furthermore, delivering programmes within farmer groups may increase male caregiver recruitment and engagement. Methods A parallel cluster randomised controlled trial examined the combined and separate effects of parenting and economic strengthening programmes on reducing violence against children aged 0–18 years in farming communities in Tanzania (n=248 families; 63% male caregivers). Eight villages were randomly assigned to four conditions (2:2:2:2): (1) 12-session parenting programme (n=60); (2) agribusiness training (n=56); (3) parenting and agribusiness combined (n=72); (4) control (n=60). Parent-report, child-report and early childhood observation assessments were conducted at baseline, mid-treatment and post-treatment. Primary outcomes were child maltreatment and parenting behaviour. Secondary outcomes included corporal punishment endorsement, parenting stress, parent/child depression, child behaviour, economic well-being and child development. Results At post-treatment, parents and children receiving the combined interventions reported less maltreatment (parents: incidence rate ratio (IRR=0.40, 95% CI 0.24 to 0.65; children: IRR=0.40, 95% CI 0.17 to 0.92). Parents reported reduced endorsement of corporal punishment (Dw=−0.43, 95% CI −0.79 to 0.07) and fewer child behaviour problems (Dw=−0.41, 95% CI −0.77 to 0.05). Parents in parenting-only villages reported less abuse (IRR=0.36, 95% CI 0.21 to 0.63) and fewer child behaviour problems (Dw=−0.47, 95% CI −0.84 to 0.11). Parents in agribusiness-only villages reported fewer child behaviour problems (Dw=−0.43, 95% CI −0.77 to 0.08) and greater household wealth (Dw=0.57, 95% CI 0.08 to 1.06). However, children in agribusiness-only villages reported increased physical abuse (IRR=2.26, 95% CI 1.00 to 5.12) and less positive parenting (Dw=−0.50, 95% CI −0.91 to 0.10). There were no other adverse effects. Conclusion Parent training may be the active ingredient in reducing maltreatment in farmer groups with majority male caregivers, while agribusiness training programmes may have unintended negative consequences on children when delivered alone. Locating parenting support in existing farmer groups can engage much higher proportions of fathers than stand-alone programmes. ClinicalTrials.gov: NCT02633319
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Affiliation(s)
- Jamie Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK .,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Joyce Wamoyi
- National Institute for Medical Research Mwanza Research Centre, Mwanza, Mwanza, United Republic of Tanzania
| | - Thees Spreckelsen
- School of Social and Political Sciences, University of Glasgow, Glasgow, Glasgow, UK
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jane Maganga
- National Institute for Medical Research Mwanza Research Centre, Mwanza, Mwanza, United Republic of Tanzania
| | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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