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Abstract
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What is already known about this topic?
Violence against children is a public health issue with important consequences, including the subsequent potential perpetration of violence by victims.
What is added by this report?
Analysis of data from Violence Against Children Surveys in four sub-Saharan African countries found that the prevalence of violence perpetration ranged among males from 29.5% in Nigeria to 51.5% in Malawi and among females from 15.3% in Zambia to 28.4% in Uganda. In all countries, a strong dose-response relationship was observed between the number of types of childhood violence experienced and odds of perpetrating violence.
What are the implications for public health practice?
The strong association between experiencing violence in childhood and later perpetration of violence highlights the importance of long-term, comprehensive interventions for both victims and perpetrators.
Violence is a major public health and human rights concern, claiming over 1.3 million lives globally each year. Despite the scope of this problem, population-based data on physical and sexual violence perpetration are scarce, particularly in low-income and middle-income countries. To better understand factors driving both children becoming victims of physical or sexual violence and subsequently (as adults) becoming perpetrators, CDC collaborated with four countries in sub-Saharan Africa (Malawi, Nigeria, Uganda, and Zambia) to conduct national household surveys of persons aged 13-24 years to measure experiences of violence victimization in childhood and subsequent perpetration of physical or sexual violence. Perpetration of physical or sexual violence was prevalent among both males and females, ranging among males from 29.5% in Nigeria to 51.5% in Malawi and among females from 15.3% in Zambia to 28.4% in Uganda. Experiencing physical, sexual, or emotional violence in childhood was the strongest predictor for perpetrating violence; a graded dose-response relationship emerged between the number of types of childhood violence experienced (i.e., physical, sexual, and emotional) and perpetration of violence. Efforts to prevent violence victimization need to begin early, requiring investment in the prevention of childhood violence and interventions to mitigate the negative effects of violence experienced by children.
From 2013 to 2015, CDC collaborated with Together for Girls and the governments of Malawi, Nigeria, Uganda, and Zambia to plan and implement Violence Against Children Surveys, which are nationally representative, multistage cluster surveys of adolescents and young adults aged 13-24 years. Surveys were administered via household, face-to-face interviews by host country interviewers trained by CDC and host country partners. Informed consent or assent was obtained for all participants. Multiple safeguards were incorporated into study protocols to protect the confidentiality and safety of participants, including provision of a list of available services for all participants and direct referral to social services for any victims requesting aid.† Study protocols were approved by host country and CDC institutional review boards.
This analysis examines lifetime perpetration of physical or sexual violence among persons of both sexes aged 13-24 years. Physical violence perpetration included ever punching, kicking, whipping, beating, choking, smothering, threatening with a weapon, attempting to drown, or intentionally burning another person. Sexual violence perpetration included forcing nonconsensual sexual intercourse or any other sex acts on another person. In Nigeria, Uganda, and Zambia, sex was defined as vaginal/anal penetration by the penis, hands, fingers, mouth, or objects, or oral penetration by the penis. In Malawi, sex was defined as vaginal, oral, or anal sex or the insertion of an object into an anus or vagina. Prevalence of physical and sexual violence was stratified by perpetration against an intimate partner versus a nonpartner.
Childhood experiences of violence victimization were also examined. Physical violence victimization was defined as ever being punched, kicked, whipped, beaten, choked, smothered, threatened with a weapon, held under water (attempted drowning), or intentionally burned by any person before age 18 years. Emotional violence victimization was defined as ever being told by one's parents or caregivers that he or she was not loved, that they wished he or she had never been born, or he or she was ridiculed or belittled before age 18 years. Sexual violence victimization was defined as unwanted sexual touching, unwanted attempted sex, physically forced sex, or pressured sex by any person.
Questionnaires for all countries included identical questions regarding perpetration of violence, demographics, and potential risk factors, such as experiences of violence in childhood and educational status. Questionnaires were administered in local languages appropriate to each of the four countries (Malawi: Chichewa and Tumbuka; Nigeria: English, Hausa, Igbo, and Yoruba; Uganda: English, Ateso-Karamajong, Luganda, Lugbara, Luo, Swahili, Runyankole-Rukiga, and Runyoro-Rutoro; and Zambia: English, Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja, and Tonga). The English survey instrument was translated into local languages, back-translated into English, and cross-validated by a language translation team prior to administration. In addition, the questionnaire was piloted in each country to ensure that the intent of questions was consistent after translation. Weighted percentages of participants reporting lifetime perpetration of physical or sexual violence were calculated for each independent variable. Logistic regression models were used to identify predictors of violence perpetration, adjusting for age at time of survey, marital status, sex, educational status, and experiencing any violence in childhood. To identify independent predictors of perpetration, adjusted models included all significant (p<0.05) factors in unadjusted analyses. Each type of childhood violence was entered in the model separately because of significant collinearity among types of violence. Analyses and data visualizations were conducted using SAS (version 9.4; SAS Institute).
Prevalence of violence perpetration varied by type of violence and country...
Language: en |