Child Domestic Work, Violence, and Health Outcomes: A Rapid Systematic Review

Prevalence of Adverse Childhood Experiences in sub-Saharan Africa: A multicountry analysis of the Violence Against Children and Youth Surveys (VACS)

BACKGROUND

Adverse Childhood Experiences are traumatic events early in life and have been associated with significant negative health outcomes.

OBJECTIVE

To estimate the prevalence of ACEs in five low- and middle-income sub-Saharan African countries.

PARTICIPANTS AND SETTING

Nationally representative data from the Cote d'Ivoire (2018), Kenya (2019), Lesotho (2018), Mozambique (2019), and Namibia (2019) Violence Against Children and Youth Surveys (VACS) were used. Analyses were restricted to youth ages 18-24 years (n = 8766 females and 2732 males).

METHODS

VACS data were analyzed to generate sex-stratified weighted prevalence of individual ACEs (including sexual, physical, and emotional violence; witnessing interparental violence and violence in the community; and orphanhood) and aggregate ACEs (total ACEs; 0, 1-2, and 3 or more), for each country and combined.

RESULTS

The most common type of ACEs among both females and males was witnessing physical violence (males: 55.0 % [95 % CI: 51.1-58.8] and females: 37.2 % [95 % CI = 34.3-40.1]) followed by experiencing physical violence (males: 49.7 % [95 % CI = 45.5-53.9] and in females: 36.5 % [95 % CI = 33.8-39.2]). Prevalence of sexual violence was significantly higher in females than in males (16.0 % [95 % CI = 13.9-18.2] vs 8.3 % [95 % CI = 7.0-9.8]; p < 0.001). About 72 % of females and 82 % of males have experienced at least one form of ACE with 20 % of females and 24.2 % of males experiencing 3 or more ACEs.

CONCLUSION

This study demonstrated that majority of the children in countries in sub-Saharan Africa have experienced multiple ACEs in their lifetime. Understanding the extent of the problem will help design early interventions to reduce childhood exposure to ACEs or mitigate against the harmful impact of ACEs.

Child labour in cocoa growing regions of Ghana and Côte d'Ivoire: an analysis of academic attainment in children engaged in hazardous labour

This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d'Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour.

Highly precarious general and sexual health conditions of young domestic servants: results from a qualitative exploratory study and perspectives for community-based research in Bamako, Mali

Most domestic servants (DS) in Mali are very young female migrants living in precarious conditions. We aimed to understand their living and working conditions in relation to their general and sexual health. Seven focus groups (53 participants) were conducted by the DS community-based organization ADDAD. Narratives were thematically analyzed using an inductive method. The dominant emerging theme was DS' strong dependence on their employers. Employers' attitudes regarding DS workload, the provision of food, water and hygiene products, housing conditions, and healthcare cover, appeared decisive for DS' physical and mental health, and the type of healthcare they used (self-medication, traditional care, healthcare facilities). Psychological, physical and sexual violence in employers' households was frequent. HIV/STI prevention knowledge was poor. These results highlight the serious risks for DS in terms of HIV/STI and unwanted pregnancies. DS were interested in receiving healthcare from ADDAD; this was motivated by the organization's trusting and understanding community-based environment, and DS' fear of discrimination in healthcare facilities. This study highlights the relevance of tackling the defense of rights and sexual health promotion for DS at the community level. Its findings can help identify research questions to evaluate the extent to which DS constitute a key HIV population.

The Epidemiology of Young People's Work and Experiences of Violence in Nine Countries: Evidence from the Violence against Children Surveys

Globally, 497 million young people (15-24 years) are in the labour force. The current research on work and violence indicates reciprocal links across the life course. This study draws on data from 35,723 young people aged 13-24 years in the Violence Against Children Surveys (VACS) in nine countries to describe the epidemiology of work in order to explore associations between (1) current work and violence and (2) childhood violence and work in a hazardous site in young adulthood. The prevalence of past-year work among 13-24-year-olds was highest in Malawi: 82.4% among young men and 79.7% among young women. In most countries, young women were more likely to be working in family or domestic dwellings (range: 23.5-60.6%) compared to men (range: 8.0-39.0%), while men were more likely to be working on a farm. Work in a hazardous site was higher among young men compared to women in every country. Among children aged 13-17 years, we found significant positive associations between past-year work and violence among girls in three countries (aORs between 2.14 and 3.07) and boys in five countries (aORs 1.52 to 3.06). Among young people aged 18-24 years, we found significant positive associations among young women in five countries (aORs 1.46 to 2.61) and among young men in one country (aOR 2.62). Associations between childhood violence and past-year work in a hazardous site among 18-24-year-olds were significant in one country among girls and in three countries among boys. Continued efforts are needed to prevent hazardous work, improve work environments, and integrate violence prevention efforts into workplaces.

Workplace Violence Against Adolescents, Uganda, 2014–2019

Objectives. To describe the prevalence of and risk factors for workplace violence among Ugandan adolescents.

Methods. The analysis focused on adolescents recruited at primary schools who participated in the endline survey of a trial in 2014 (at ages 11–14 years) and were followed up in 2018–2019 (at ages 17–19 years). The analysis was restricted to those engaged in past-year paid work (n = 1406). We estimated the prevalence of past-year workplace violence and used mixed-effects multivariable logistic regression to explore associations with characteristics measured in early adolescence, current life circumstances, and work-related factors.

Methods. The analysis focused on adolescents recruited at primary schools who participated in a 2014 survey and were followed up in 2018–2019. The analysis was restricted to those engaged in past-year paid work (n = 1406). We estimated the prevalence of past-year workplace violence and used mixed-effects multivariable logistic regression to explore associations with characteristics measured in early adolescence, current life circumstances, and work-related factors.

Results. Overall, 40% (95% confidence interval [CI] = 37%, 43%) of adolescents in paid work experienced past-year workplace violence; odds were doubled among female domestic workers (vs retail/trade workers; adjusted odds ratio [AOR] = 2.07; 95% CI = 1.28, 3.35). Experiences measured in early adolescence, including eating less than 3 meals the previous day, experiencing severe physical violence (male adolescents: AOR = 1.48; 95% CI = 1.11, 1.98; female adolescents: AOR = 1.69; 95% CI = 1.13, 2.53) and bullying, and having poor mental health (male adolescents: AOR = 2.32 95% CI = 1.37, 3.92; female adolescents: AOR = 2.27; 95% CI = 1.05, 4.89), were associated with increased odds of workplace violence. Current life circumstances (fewer household assets, more moves, functional difficulties, poorer mental health) were also associated with workplace violence.

Conclusions. Interventions are needed to address the high prevalence of workplace violence across all sectors, with female domestic workers particularly vulnerable. Early prevention of violence and poor mental health may be promising. (Am J Public Health. 2022;112(11):1651–1661. https://doi.org/10.2105/AJPH.2022.306983 )

Are Child Domestic Workers Worse Off than Their Peers? Comparing Children in Domestic Work, Child Marriage, and Kinship Care with Biological Children of Household Heads: Evidence from Zimbabwe

Child domestic work is a hidden form of child labour driven by poverty and social norms. However, little is known about the situations of child domestic workers. This study aims to describe and analyse gender-specific working conditions, health, and educational outcomes among hidden child domestic workers (CDWs) living in third-party homes relative to married children, biological children, and other children in kinship care. Data from the 2019 Zimbabwe Multiple Indicator Cluster Survey (MICS) were analysed. Descriptive statistics and bivariable logistic regression were used to describe frequency and estimated prevalence. Directed Acyclic Graphs (DAGs) were used to identify exposures and inform the selection of covariates. Multivariable logistic regression models were fitted to estimate the effect of each exposure variable. The prevalence of CDWs was 1.5% and CDWs were mainly girls and living in much wealthier households with more educated household heads while married girls were living in much poorer households. When compared among girls themselves, being a CDW was significantly associated with having a functional disability, while married girls were more frequently engaged in hazardous working conditions. We provide the first intersectional analysis comparing work, violence, and health outcomes among CDWs, married children and other children. Child protection measures are needed to safeguard children in domestic work and marriages.