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Picchetti V, Stamatakis C, Annor FB, Massetti GM, Hegle J. Association between lifetime sexual violence victimization and selected health conditions and risk behaviors among 13-24-year-olds in Lesotho: Results from the Violence Against Children and Youth Survey (VACS), 2018. CHILD ABUSE & NEGLECT 2022; 134:105916. [PMID: 36215756 PMCID: PMC9691579 DOI: 10.1016/j.chiabu.2022.105916] [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] [Received: 03/02/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sexual violence is a serious public health concern worldwide. In Lesotho, one in seven women and one in twenty men aged 18 years and older experienced sexual violence during childhood. Sexual violence victimization may lead to long-term mental and physical health issues among victims, regardless of gender. OBJECTIVE To estimate the prevalence of lifetime sexual violence victimization (SV) among 13-24-year-olds in Lesotho and assess its association with selected health conditions and risk behaviors. PARTICIPANTS AND SETTING Data from 13 to 24-year-old participants (n = 8568) of the 2018 Lesotho Violence Against Children and Youth Survey were analyzed. METHODS SV was defined as reporting one or more types of sexual violence at any age. Logistic regression analyses measured associations between SV and selected health conditions (suicidal thoughts, self-harm behaviors, mental distress, STIs, and HIV), and risk behaviors (binge drinking in the past 30 days, drug use in the past 30 days, infrequent condom use in the past 12 months, multiple sex partners in the past 12 months, and transactional sex in the past 12 months). RESULTS After controlling for study covariates, SV was significantly associated with self-harm behaviors, suicidal thoughts, ever having an STI, binge drinking in the past 30 days, infrequent condom use in the past 12 months, and multiple sex partners in the past 12 months for both males and females; and mental distress and transactional sex in the past 12 months for females. CONCLUSIONS Preventing SV against children and youth in Lesotho may improve their health and wellbeing.
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Affiliation(s)
- Viani Picchetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
| | - Caroline Stamatakis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Greta M Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jennifer Hegle
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Velloza J, Davies LD, Ensminger AL, Theofelus FM, Andjamba H, Kamuingona R, Masseti G, Coomer R, Forster N, O’Malley G. Cycles of Violence Among Young Women in Namibia: Exploring the Links Between Childhood Violence and Adult Intimate Partner Violence From the Violence Against Children and Youth Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22992-NP23014. [PMID: 35156448 PMCID: PMC9661872 DOI: 10.1177/08862605211073107] [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: 06/14/2023]
Abstract
Background: Violence against children is a global public health crisis and is associated with poor mental and physical health outcomes. Childhood violence may also increase the risk of subsequent violence revictimization by an intimate partner. We aimed to understand cycles of violence among adolescent girls and young women in Namibia to inform violence prevention and treatment interventions. Methods: The 2019 Namibia Violence Against Children and Youth Survey (VACS) examined the prevalence of childhood violence and intimate partner violence among 18-24 year old adolescent girls and young women (N = 2434). Using the data, we assessed the prevalence of childhood violence, defined as any physical, sexual, or emotional violence victimization prior to age 18, and estimated the prevalence of intimate partner violence (IPV) after age 18. We used a weighted logistic regression to assess whether childhood violence exposure was associated with subsequent experience of IPV after age 18. Results: Adolescent girls and young women in Namibia had a statistically significant higher odds of experiencing IPV if they had experienced any childhood violence including physical, sexual, and/or emotional violence (adjusted odds ratio [aOR]: 2.93; 95% Confidence Interval [95% CI: 1.64-5.23). IPV was also significantly associated with childhood physical (aOR: 1.81; 95% CI: 1.07-3.05), sexual (aOR: 3.79; 95% CI: 2.54-5.67), or emotional (aOR: 2.39; 95% CI: 1.18-4.86) violence when each were considered separately. We also observed a dose-response relationship between the number of types of childhood violence and IPV experience as a young adult. Conclusions: Childhood violence is a significant predictor of subsequent violence revictimization by an intimate partner. This analysis provides unique insights on cycles of violence among adolescent girls and young women in Namibia and points to the need for interventions during childhood to prevent violence against children and break this cycle among young women in sub-Saharan Africa.
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Affiliation(s)
- Jennifer Velloza
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Luke D. Davies
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Alison L. Ensminger
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | | | - Helena Andjamba
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Rahimisa Kamuingona
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Greta Masseti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Norbert Forster
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
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Nace A, Maternowska C, Fernandez B, Cravero K. The Violence Against Children Surveys (VACS): Using VACS data to drive programmes and policies. Glob Public Health 2022; 17:2807-2825. [PMID: 34905473 DOI: 10.1080/17441692.2021.2010116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Violence Against Children Surveys (VACS) are nationally representative surveys of males and females aged 13-24 years, designed to measure the burden of sexual, physical, and emotional violence experienced in childhood, adolescence and early adulthood. As of 2020, 22 countries implemented or are implementing a VACS. Since the first article using VACS data was published in 2009, several peer-reviewed articles have been published on the VACS. However, no publications have analysed the breadth of the work and how the data are represented in the literature. We conducted a review of the peer-reviewed research which used VACS data or mentioned the VACS. Between 2009 and July 2020, 50 peer-reviewed articles with data from 11 countries were published. Two studies (2/50; 4.0%) focused on boys, while 14 studies (14/50; 28.0%) focused on violence against girls. Fourteen articles focused on sexual violence (14/50; 28.0%), compared to three on emotional violence (3/50; 6.0%), and two on physical violence (2/50; 4.0%). Lastly, 52% of the articles (26 of the 50) were first authored by someone at the U.S. Centers for Disease Control and Prevention. We identified the need to support local authors, and additional research on violence against boys, and physical and emotional violence.
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Affiliation(s)
- Amanda Nace
- University Research Co., Chevy Chase, MD, USA
| | | | | | - Kathleen Cravero
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
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Mlyakado BP, Li JCM. Explaining the Help-Seeking Intentions of Adolescents Subject to Sexual Exploitation in Tanzania: An Application of the Theory of Planned Behavior. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16084-NP16106. [PMID: 34107823 DOI: 10.1177/08862605211023494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The sexual exploitation (SE) of children and adolescents is a universal concern. Numerous empirical studies have examined the prevalence and consequences of this phenomenon worldwide, but there is little information on the factors that determine the help-seeking intentions of adolescents subject to SE in Tanzania. We drew on the theory of planned behavior (TPB) to address this knowledge gap. The study had two main objectives. First, we examined four TPB variables (attitudes toward seeking help, perceived social support, perceived social stigma, and generalized self-efficacy) as determinants of the Tanzanian adolescents' help-seeking intentions. Second, we explored the moderating effects of social stigma on the relationship between the examined TPB factors and the adolescents' help-seeking intentions. A cross-sectional survey design was used to collect data from a stratified random sample of 1,116 secondary school adolescents aged 13-17 (M = 15.66; SD = 1.09). The participants were recruited from two regions in the east and northwest of Tanzania and data were analyzed using hierarchical multiple regression. The results indicate that the TPB variables of attitude toward seeking help, perceived social support, and generalized self-efficacy were positively associated with the help-seeking intentions of adolescents subject to SE, but not social stigma. Through moderation analyses, we found that social stigma significantly weakened the explanatory power of the attitude toward seeking help. The findings of this study in the context of Tanzania were discussed and implications for policy, practice, and future research were suggested.
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Velloza J, Davies L, Ensminger A, Theofelus FM, Andjamba H, Kamuingona R, Nakuta J, Uiras W, Massetti G, Coomer R, Wolkon A, Forster N, O'Malley G. Disclosure and help-seeking behaviors related to sexual and physical violence in childhood and adolescence: Results from the Namibia Violence Against Children and Youth Survey. CHILD ABUSE & NEGLECT 2022; 128:105624. [PMID: 35381545 PMCID: PMC9119951 DOI: 10.1016/j.chiabu.2022.105624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND Violence disclosure and help-seeking can mitigate adverse health effects associated with childhood violence, but little is known about facilitators and barriers of disclosure and help-seeking behaviors in sub-Saharan Africa. OBJECTIVE To understand factors associated with disclosure and help-seeking to inform care. PARTICIPANTS AND SETTING Participants aged 13-24 years old in the 2019 Namibia Violence Against Children and Youth Survey (VACS). METHODS We assessed the prevalence of victimization, disclosure, and help-seeking and examined factors associated with violence disclosure and help-seeking, separately, by gender. RESULTS 4211 girls and 980 boys participated in the Namibia VACS. The prevalence of childhood sexual violence differed significantly by gender (15.7% among girls, 9.8% among boys), but physical violence prevalence did not differ by gender. Among victims of sexual violence, 57.3% of girls disclosed and 10.4% sought help, compared with only 30.7% and 3.2% of boys. Among victims of physical violence, 61.1% of girls and 53.4% of boys disclosed, and 16.9% of girls and 17.7% of boys sought help. Older age, social support, and experiencing more types of violence were associated with sexual violence disclosure among boys, but none of these factors were associated with sexual violence disclosure among girls. Lower education, perpetrator type, and witnessing violence were associated with physical violence disclosure among girls, while peer support and perpetrator type were associated with physical violence disclosure among boys. CONCLUSIONS Factors associated with childhood violence differed by gender and violence type in Namibia, highlighting a need for gender-specific violence services to facilitate violence disclosure and help-seeking.
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Affiliation(s)
- Jennifer Velloza
- University of Washington, Department of Global Health, Seattle, WA, USA.
| | - Luke Davies
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Alison Ensminger
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | | | - Helena Andjamba
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Rahimisa Kamuingona
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Joyce Nakuta
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Wilhencia Uiras
- Ministry of Gender Equality, Poverty Eradication and Social Welfare (formerly Ministry of Gender Equality and Child Welfare), Government of Namibia, Windhoek, Namibia
| | - Greta Massetti
- Centers of Disease Control and Prevention, Division of Violence Prevention, Atlanta, GA, United States of America
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Division of Global HIV & Tuberculosis, Windhoek, Namibia
| | - Adam Wolkon
- Centers for Disease Control and Prevention, Division of Global HIV & Tuberculosis, Windhoek, Namibia
| | - Norbert Forster
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O'Malley
- University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
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Prencipe L, Houweling TAJ, van Lenthe FJ, Kajula L, Palermo T. Effects of Adolescent-Focused Integrated Social Protection on Depression: A Pragmatic Cluster-Randomized Controlled Trial of Tanzania's Cash Plus Intervention. Am J Epidemiol 2022; 191:1601-1613. [PMID: 35581169 PMCID: PMC9437816 DOI: 10.1093/aje/kwac093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 01/29/2023] Open
Abstract
We assessed the impacts of Tanzania's adolescent-focused Cash Plus intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to an intervention or control arm (1:1). Youth aged 14-19 years living in households receiving governmental cash transfers were invited to participate. The intervention included an intensive period (a 12-session course) and an aftercare period (9 months of mentoring, productive grants, and strengthened health services). We examined intervention impacts on a depressive symptoms scale (10-item Center for Epidemiologic Studies Depression Scale score (range, 0-30)) and rates of depressive symptomatology (score ≥10 points on the scale), recorded at study baseline (April-June 2017), midline (May-July 2018), and endline (June-August 2019). Using intention-to-treat methodology, we employed logistic and generalized linear models to estimate effects for binary and continuous outcomes, respectively. Quantile regression was used to estimate effects across the scale. From 2,458 baseline participants, 941 intervention and 992 control adolescents were reinterviewed at both follow-ups. At endline, the intervention reduced the odds of depressive symptomatology (adjusted odds ratio = 0.67, 95% confidence interval: 0.52, 0.86), with an undetectable mean scale difference (risk difference = -0.36, 95% confidence interval: -0.84, 0.11). Quantile regression results demonstrated an intervention effect along the upper distribution of the scale. Integration of multisectoral initiatives within existing social protection systems shows potential to improve mental health among youth in low-resource settings.
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Affiliation(s)
- Leah Prencipe
- Correspondence to Leah Prencipe, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail: )
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Stamatakis CE, Sumner SA, Massetti G, Kress H, Basile KC, Marcelin LH, Cela T, Wadonda-Kabondo N, Onotu D, Ogbanufe O, Chipimo PJ, Conkling M, Apondi R, Aluzimbi G. Sexual Violence Prevalence and Related Pregnancy Among Girls and Young Women: A Multicountry Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2428-NP2441. [PMID: 32618217 DOI: 10.1177/0886260520936366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to quantify the prevalence of forced sex, pressured sex, and related pregnancy among adolescent girls and young women in five low- and middle-income countries. Nationally representative, cross-sectional household surveys were conducted in Haiti, Malawi, Nigeria, Zambia, and Uganda among girls and young women aged 13 to 24 years. A stratified three-stage cluster sample design was used. Respondents were interviewed to assess prevalence of sexual violence, pregnancy related to the first or most recent experience of forced or pressured sex, relationship to perpetrator, mean age at sexual debut, mean age at pregnancy related to forced or pressured sex, and prevalence of forced/coerced sexual debut. Frequencies, weighted percentages, and weighted means are presented. The lifetime prevalence of forced or pressured sex ranged from 10.4% to 18.0%. Among these adolescent girls and young women, the percentage who experienced pregnancy related to their first or most recent experience of forced or pressured sex ranged from 13.2% to 36.6%. In three countries, the most common perpetrator associated with the first pregnancy related to forced or pressured sex was a current or previous intimate partner. Mean age at pregnancy related to forced or pressured sex was similar to mean age at sexual debut in all countries. Preventing sexual violence against girls and young women will prevent a significant proportion of adverse effects on health, including unintended pregnancy. Implementation of strategies to prevent and respond to sexual violence against adolescent girls and young women is urgently needed.
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Affiliation(s)
| | - Steven A Sumner
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Greta Massetti
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard Kress
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Louis Herns Marcelin
- Interuniversity Institute for Research and Development, Port-au-Prince, Haiti
- University of Miami, Coral Gables, FL, USA
| | - Toni Cela
- Interuniversity Institute for Research and Development, Port-au-Prince, Haiti
- University of Miami, Coral Gables, FL, USA
| | | | - Dennis Onotu
- Centers for Disease Control and Prevention, Abuja, Nigeria
| | | | | | | | - Rose Apondi
- Centers for Disease Control and Prevention, Kampala, Uganda
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Weber AM, Gupta R, Abdalla S, Cislaghi B, Meausoone V, Darmstadt GL. Gender-related data missingness, imbalance and bias in global health surveys. BMJ Glob Health 2021; 6:e007405. [PMID: 34836912 PMCID: PMC8628344 DOI: 10.1136/bmjgh-2021-007405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022] Open
Abstract
Global surveys have built-in gender-related biases associated with data missingness across the gender dimensions of people's lives, imbalanced or incomplete representation of population groups, and biased ways in which gender information is elicited and used. While increasing focus is being placed on the integration of sex-disaggregated statistics into national programmes and on understanding effects of gender-based disparities on the health of all people, the data necessary for elucidating underlying causes of gender disparities and designing effective intervention programmes continue to be lacking. Approaches exist, however, that can reasonably address some shortcomings, such as separating questions of gender identification from biological sex. Qualitative research can elucidate ways to rephrase questions and translate gendered terms to avoid perpetuating historical gender biases and prompting biased responses. Non-health disciplines may offer lessons in collecting gender-related data. Ultimately, multidisciplinary global collaborations are needed to advance this evolving field and to set standards for how we measure gender in all its forms.
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Affiliation(s)
- Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | - Ribhav Gupta
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Valerie Meausoone
- Stanford Research Computing Center, Stanford University, Stanford, California, USA
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Mkonyi E, Mwakawanga DL, Rosser BRS, Bonilla ZE, Lukumay GG, Mohammed I, Mushy SE, Mgopa LR, Ross MW, Massae AF, Trent M, Wadley J. The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania. CHILD ABUSE & NEGLECT 2021; 121:105268. [PMID: 34416472 PMCID: PMC8513504 DOI: 10.1016/j.chiabu.2021.105268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Child sexual abuse (CSA) is a significant public health problem affecting one billion children aged 2 to 17 globally. The prevalence of CSA in Tanzania is one of the highest; however, how health care providers manage CSA cases has not been studied. OBJECTIVES This study investigated how medical, nursing, and midwifery professionals in Tanzania handle cases of CSA and identified the factors that facilitate or impede the provision of quality care to CSA victims. METHODS Participants were 60 experienced healthcare professionals and 61 health students working in Dar es Salaam, Tanzania. We conducted 18 focus groups stratified by profession (midwifery, nursing, or medicine) and experience (practitioners versus students). RESULTS Three main themes emerged. First, child abuse management involved using a multi-disciplinary approach, including proper history taking, physical assessment, treatment, and referral. Second, factors that enhanced disclosure of CSA included building rapport, privacy, and confidentiality. Third, factors that impeded care included fear of harm to the child if the abuse was reported, abuse reporting being perceived as a "waste of time" for providers, loss of evidence from the victim, family resistance, poverty, corruption and cultural dynamics. CONCLUSIONS Midwives, nurses and doctors were all experienced in and reported similar challenges in addressing CSA. At a structural level, the ratio of providers to patients in health facilities inhibits quality care. These findings have implications for strengthening CSA policy/guidelines and clinical practice in Tanzania. Mandated CSA training is necessary for midwifery, nursing, and medical students as well as in continuing education courses for more experienced providers.
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Affiliation(s)
- Ever Mkonyi
- University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | - Stella E Mushy
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Tanzania
| | | | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Tanzania
| | - Maria Trent
- Johns Hopkins University, Baltimore, MD, USA
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Goessmann K, Ssenyonga J, Nkuba M, Hermenau K, Hecker T. Characterizing the prevalence and contributing factors of sexual violence: A representative cross-sectional study among school-going adolescents in two East African countries. CHILD ABUSE & NEGLECT 2020; 109:104711. [PMID: 32927296 DOI: 10.1016/j.chiabu.2020.104711] [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: 11/13/2019] [Revised: 08/20/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sexual violence against minors is a global phenomenon with wide-ranging negative consequences. Global reports suggest that it is a particularly serious issue in East African countries, although research on prevalence and characteristics of violence in these countries is scarce. OBJECTIVE The aim of this study was to assess sexual violence and its circumstances among Tanzanian and Ugandan adolescents. PARTICIPANTS AND SETTING Two representative samples of secondary school students aged 12-17 from Tanzania and Uganda (N = 1402) were included in this study. METHODS Data assessed using standardized questionnaires were analyzed to determine prevalence, characteristics, and contributing factors of sexual violence among youth. RESULTS We found high levels of sexual violence (27.2 %) exceeding global average estimates of under 20 %. Significantly more sexual violence experiences were reported by boys (29.9 %) than girls (24.6 %) and by older compared to younger adolescents (30.2 % vs. 19.6 %). Peers were the most frequent perpetrator group, named by 47.6 % of those reporting abuse. Several potential contributing factors for victimization were identified, such as rural living area, external financial support, and being in a romantic relationship. CONCLUSIONS Sexual violence is a relevant issue among East African adolescents that occurs in a variety of settings but appears to be most prevalent between peers. Comprehensive sexual education approaches may help to improve the protection of adolescents and to enhance autonomous sexual development.
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Affiliation(s)
- Katharina Goessmann
- Department of Psychology, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany.
| | - Joseph Ssenyonga
- Department of Psychology, University of Konstanz, 78567, Konstanz, Germany; Department of Educational Foundations and Psychology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Mabula Nkuba
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, 2329, Dar es salaam, Tanzania; Vivo International e.V., Postbox 5108, 78430, Konstanz, Germany.
| | - Katharin Hermenau
- Department of Psychology, University of Konstanz, 78567, Konstanz, Germany; Vivo International e.V., Postbox 5108, 78430, Konstanz, Germany.
| | - Tobias Hecker
- Department of Psychology, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany; Vivo International e.V., Postbox 5108, 78430, Konstanz, Germany.
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Kidman R, Waidler J, Palermo T. Uptake of HIV testing among adolescents and associated adolescent-friendly services. BMC Health Serv Res 2020; 20:881. [PMID: 32943066 PMCID: PMC7499858 DOI: 10.1186/s12913-020-05731-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. Methods The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents’ uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services. Results Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents. Conclusions We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.
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Affiliation(s)
- Rachel Kidman
- Department of Family, Population and Preventive Medicine, HSC Level 3, Room 79 Stony Brook University (State University of New York), Stony Brook, NY, 11794, USA
| | - Jennifer Waidler
- UNICEF Office of Research - Innocenti, Via degli Alfani 58, 50121, Florence, Italy.
| | - Tia Palermo
- Department of Epidemiology at Environmental Health, 270 Farber Hall, University at Buffalo (State University of New York), Buffalo, NY, 14214-8001, USA
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12
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A Massive Extradural Hematoma in Sickle Cell Disease and the Importance of Rapid Neuroimaging. Case Rep Hematol 2020; 2019:1742472. [PMID: 31929921 PMCID: PMC6935788 DOI: 10.1155/2019/1742472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy leading to several serious organ complications and early death. It is mostly found in equatorial countries like Tanzania. Extradural hematoma (EDH) is a rare, but serious complication to SCD and may have debilitating consequences. Hitherto, there is no report of EDH in SCD where neuroimaging has been available before, during, and after such an event. Here, we describe a young female SCD patient who developed EDH that required surgical evacuation. She had made full recovery after three months. Neuroimaging performed two years prior to this event was unremarkable except for multiple small cerebral infarcts. On admission, neuroimaging revealed a subgaleal hematoma, possibly indicating disruption of the skull cortex due to increased hematopoiesis. Three months after evacuation of the hematoma, neuroimaging showed evidence of brain atrophy and the previously reported cerebral infarcts and multifocal bone infarction, but no vasculopathy. Possibly, disruption of the skull cortex with subsequent bleeding caused the EDH. As the differential diagnoses of neurological complications in SCD are many and some complications are reversible, neuroimaging should be performed without delay.
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13
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Mutagoma M, Nyirazinyoye L, Sebuhoro D, Riedel DJ, Ntaganira J. Sexual and physical violence and associated factors among female sex workers in Rwanda: a cross-sectional survey. Int J STD AIDS 2018; 30:241-248. [PMID: 30392461 DOI: 10.1177/0956462418800848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Female sex workers (FSWs) frequently face violence in their working place. This study assessed the physical and sexual violence and associated factors among FSWs in Rwanda. A cross-sectional study was conducted among FSWs in Rwanda in 2015. Venue-Day-Time sampling method was used for recruitment. Descriptive analyses and logistic regression models were computed to assess factors associated with violence. In total, 1978 FSWs were recruited. A large proportion (18.3%) had been sexually abused outside of the family circle, and 37.8% had faced physical violence before 15 years of age. Clients were most often reported (67.0%) as perpetrators of physical violence in sex work. Being aged 25 years old and above, and having sexually transmitted infections (STIs) were positively associated with sexual violence (aOR = 2.1[95%CI: 1.80-2.39]) and (aOR = 3.0[95%CI: 1.01-2.14], respectively). Being aged 25 years old and above (aOR = 0.8[95%CI: 0.76-0.89]) and drinking alcohol every day (aOR = 0.6[95%CI: 0.42-0.87]) were negatively associated with physical violence. Sexual and physical violence was common among FSWs in Rwanda. Single FSWs are the most vulnerable to sexual violence. Alcohol consumption and having STIs are associated with violence against FSWs. Human rights and social protection as well as health promotion among FSWs is needed.
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Affiliation(s)
- Mwumvaneza Mutagoma
- 1 School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,2 Ministry of Health, Kigali, Rwanda
| | - Laetitia Nyirazinyoye
- 1 School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Dieudonné Sebuhoro
- 3 Division (HIV, AIDS, STIs, and OBBI) Rwanda Biomedical Center, Kigali, Rwanda
| | - David J Riedel
- 4 Institute of Human Virology and Division of Infectious Diseases, Baltimore, MD, USA
| | - Joseph Ntaganira
- 1 School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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14
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Papas RK, Gakinya BN, Mwaniki MM, Lee H, Kiarie SW, Martino S, Loxley MP, Keter AK, Klein DA, Sidle JE, Baliddawa JB, Maisto SA. Rates and Covariates of Recent Sexual and Physical Violence Against HIV-Infected Outpatient Drinkers in Western Kenya. AIDS Behav 2017; 21:2243-2252. [PMID: 28097617 DOI: 10.1007/s10461-017-1684-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Victimization from physical and sexual violence presents global health challenges. Partner violence is higher in Kenya than Africa. Violence against drinkers and HIV-infected individuals is typically elevated, so dual vulnerabilities may further augment risk. Understanding violence risks can improve interventions. Participants were 614 HIV-infected outpatient drinkers in western Kenya enrolled in a randomized trial to reduce alcohol use. At baseline, past 90-day partner physical and sexual violence were examined descriptively and in gender-stratified regression models. We hypothesized higher reported violence against women than men, and positive violence association with HIV stigma and alcohol use across gender. Women reported significantly more current sexual (26.3 vs. 5.7%) and physical (38.9 vs. 24.8%) victimization than men. Rates were generally higher than Kenyan lifetime national averages. In both regression models, HIV stigma and alcohol-related sexual expectations were significantly associated with violence while alcohol use was not. For women, higher violence risk was also conferred by childhood violence, past-year transactional sex, and younger age. HIV-infected Kenyan drinkers, particularly women, endorse high current violence due to multiple risk factors. Findings have implications for HIV interventions. Longitudinal research is needed to understand development of risk.
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Affiliation(s)
- Rebecca K Papas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Benson N Gakinya
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Michael M Mwaniki
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Hana Lee
- Brown University School of Public Health, Providence, RI, USA
| | | | - Steve Martino
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Alfred K Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - John E Sidle
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joyce B Baliddawa
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
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15
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Rumble L, Ramly AA, Nuryana M, Dunne MP. The Importance of Contextual Factors in Carrying Out Childhood Violence Surveys: a Case Study from Indonesia. CHILD INDICATORS RESEARCH 2017; 11:405-421. [PMID: 29527242 PMCID: PMC5838122 DOI: 10.1007/s12187-017-9457-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 05/28/2023]
Abstract
Nationally representative research into violence against children is necessary to understand the scale and complexity of such violence and to evaluate prevention efforts. To date, however, most countries do not have adequate data. In 2013, the government of Indonesia conducted a national Violence Against Children Survey (VACS). This was a cross-sectional household survey of male and female 13-to-24- year-olds designed to estimate physical, emotional, and sexual violence prevalence. The target was to interview at least 2580 individuals; but response rates were much lower than anticipated (females = 66.6%; males = 56.1%). Insufficient data was available across several variables and there were unexpected anomalies in obtained data. We conducted a retrospective analysis of the survey to understand impediments and to advise future national efforts in Indonesia and other low-to-middle-income contexts. Survey managers and implementers (n = 22) were interviewed online and in person. We also carried out secondary analysis of the child survey data to identify factors possibly associated with (non-)response and assessed field notes from interviewers. Culturally inappropriate timing of data-collection (during Ramadan) may have had a negative impact on household responsiveness and the availability of children at home. Face-toface interviews in households were considered to impede participation and disclosure. Survey field staff and managers expressed the need for deeper training and a more comprehensive pilot. Recommendations to improve privacy and anonymity include the use of self-administered questionnaires and school-based rather than at-home surveys. These and other findings from this case study may be useful in planning future surveys in Indonesia and similar social and cultural contexts.
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Affiliation(s)
- Lauren Rumble
- UNICEF Indonesia, World Trade Center 6, 10th Floor, Jl. Jenderal Surdirman Kav.31, Jakarta, 12920 Indonesia
| | - Ali Aulia Ramly
- UNICEF Indonesia, World Trade Center 6, 10th Floor, Jl. Jenderal Surdirman Kav.31, Jakarta, 12920 Indonesia
| | - Mu’man Nuryana
- Ministry of Social Affairs of the Republic of Indonesia, Jalan Salemba Ryan, No.28, Jakarta, Pusat 10430 Indonesia
| | - Michael P. Dunne
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD 4059 Australia
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