Peer violence perpetration and victimization: Prevalence, associated factors and pathways among 1752 sixth grade boys and girls in schools in Pakistan

BACKGROUND

Child peer violence is a global problem and seriously impacts health and education. There are few research studies available in Pakistan, or South Asia. We describe the prevalence of peer violence, associations, and pathways between socio-economic status, school performance, gender attitudes and violence at home.

METHODS

1752 children were recruited into a cluster randomized controlled trial conducted on 40 fairly homogeneous public schools (20 for girls and 20 for boys), in Hyderabad, Pakistan. This was ranging from 20-65 children per school. All children were interviewed with questionnaires at baseline.

RESULTS

Few children had no experience of peer violence in the previous 4 weeks (21.7% of girls vs.7% of boys). Some were victims (28.6%, of girls vs. 17.9% of boys), some only perpetrated (3.3% of girls vs. 2.5%) but mostly they perpetrated and were victims (46.4%.of girls vs 72.6%. of boys). The girls' multivariable models showed that missing the last school day due to work, witnessing her father fight a man in the last month and having more patriarchal gender attitudes were associated with both experiencing violence and perpetration, while, hunger was associated with perpetration only. For boys, missing two or more days of school in the last month, poorer school performance and more patriarchal attitudes were associated with both victimization and perpetration. Witnessing father fight, was associated with peer violence perpetration for boys. These findings are additionally confirmed with structural models.

DISCUSSION

Peer violence in Pakistan is rooted in poverty and socialization of children, especially at home. A critical question is whether a school-based intervention can empower children to reduce their violence engagement in the context of poverty and social norms supportive of violence. In the political context of Pakistan, reducing all violence is essential and understanding the potential of schools as a platform for intervention is key.

Attitude towards gender roles and violence against women and girls (VAWG): baseline findings from an RCT of 1752 youths in Pakistan

BACKGROUND

Violence against women is driven by gender norms that normalize and justify gender inequality and violence. Gender norms are substantially shaped during adolescence. Programs offered through schools offer an opportunity to influence gender attitudes toward gender equity if we understand these to be partly shaped by peers and the school environment.

OBJECTIVE

We present an analysis of the baseline research conducted for a randomized controlled trial with 1752 grade 6 boys and girls and their attitudes toward gender roles, VAWG, and associated factors.

METHODS

We used baseline data from a  cluster randomised control study. Interviews were conducted in 40 public schools in Hyderabad, with 25-65 children per school. Questions were asked about attitudes toward gender roles, peer-to-peer perpetration, and victimization experiences, and family life, including father- or in-law-to- mother violence and food security. Multiple regression models were built of factors associated with gender attitudes for boys and girls.

RESULTS

Our result have shown youth attitudes endorsing patriarchal gender beliefs were higher for boys, compared to girls. The multiple regression model showed that for boys, patriarchal gender attitudes were positively associated with hunger, depression, being promised already in marriage, and being a victim and/or perpetrator of peer violence. For girls gender attitudes were associated with hunger, experiencing corporal punishment at home, and being a perpetrator (for some, and victim) of peer violence.

CONCLUSION

Youth patriarchal attitudes are closely related to their experience of violence at school and for girl's physical punishment, at home and for boys being promised in early marriage. We suggest that these variables are indicators of gender norms among peers and in the family. The significance of peer norms is that it provides the possibility that school-based interventions which work with school peers have the potential to positively impact youth patriarchal gender attitudes and foster attitudes of gender equality and respect, and potentially to decrease youth victimization and perpetration.

Surgical treatment for developmental dysplasia of the hip- a single surgeon series of 47 hips with a 7 year mean follow up)

The treatment of developmental dysplasia of the hip (DDH) in children remains controversial. We describe the clinical and radiological outcomes of  47 hips in 43 children treated with open surgery by one surgeon between 2004 and 2008 for DDH. The mean age at operation was 25 months (5 to 113) with a mean follow up of  89 months  (22 to 169). At the latest follow up 40 of the 45 hips where Severin grades were recordable (89%) were graded as excellent or good, Severin class I or II. Clinically significant AVN (grade II to III  according to the Kalamchi and MacEwen classification) was seen in 6  (13%) of the hips. We found a pelvic osteotomy to be a risk factor for AVN  (p 0.02) and age at operation to be a risk factor for poor morphology at final follow up (p 0.03). Over 18 months old a pelvic osteotomy should be performed in selective cases depending on intra-operative stability, but we will now consider doing this as a staged procedure and delaying the osteotomy for a period of time after open reduction to reduce the risk of AVN.

Endoscopic correction of intractable stress incontinence with silicone micro-implants

OBJECTIVE

To assess the clinical value of silicone micro-implants (Macroplastique, Uroplastique, Bioplastique) in the treatment of intractable genuine stress incontinence.

MATERIALS AND METHODS

Between January 1992 and March 1995, 34 patients with failed previous surgery for genuine stress incontinence were treated with transurethral submucosal injection of Macroplastique.

RESULTS

The initial success rate was high, 90% at 1 month and 75% at 3 months postoperatively. However, at 2 years of follow-up the success rate fell to 48%. Patient satisfaction was high.

CONCLUSION

Macroplastique is a relatively simple and effective day-case procedure for intractable genuine stress incontinence. It may have a place as a last-resort surgery for genuine stress incontinence predominantly due to sphincter incompetence in an unfit patient with failed previous anti-incontinence procedures despite good repositioning of the bladder neck. However, many more patients and a much longer follow-up are needed before any further meaningful statements can be made about the success or failure of this material.

Macrocephaly with hamartomas: Bannayan-Zonana syndrome

Familial macrocephaly with mesodermal hamartomas is described as a distinct syndrome in nine individuals from four families. Constant manifestations include symmetrical macrocephaly without ventricular enlargement, mild neurological dysfunction, and postnatal growth deceleration. Speech and motor delays observed in all the children were usually well compensated by adulthood. Two children had mild mental retardation and seizures which may have been related to intracerebral hemorrhage in one. Mesodermal hamartomas were present in affected persons from all four families, with 60% of individuals manifesting only discrete lipomas and hemangiomas. More serious tumors, including intracerebral hemangiomas, hemangiomatous involvement of the bone, and aggressive lipomas occurred in 40%. Other findings that make it possible to delineate a recognizable syndrome include down-slanting palpebral fissures (66%), a high palate (67%), joint hyperextensibility (55%), pectus excavatum (22%), strabismus or amblyopia (33%), and prolonged drooling (44%). The Bannayan-Zonana syndrome is an autosomal-dominant trait with male predominance of affected individuals.