Reducing child abuse amongst adolescents in low- and middle-income countries: A pre-post trial in South Africa

Abstract

BackgroundNo known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. ‘Parenting for Lifelong Health’ (http://tiny.cc/whoPLH) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research aims of this first pre-post trial in South Africa were: i) to identify indicative effects of the programme on child abuse and related outcomes; ii) to investigate programme safety for testing in a future randomised trial, and iii) to identify potential adaptations.MethodsTwo hundred thirty participants (adolescents and their primary caregivers) were recruited from schools, welfare services and community-sampling in rural, high-poverty South Africa (no exclusion criteria). All participated in a 12-week parenting programme, implemented by local NGO childcare workers to ensure real-world external validity. Standardised pre-post measures with adolescents and caregivers were used, and paired t-tests were conducted for primary outcomes: abuse (physical, emotional abuse and neglect), adolescent behaviour problems and parenting (positive and involved parenting, poor monitoring and inconsistent discipline), and secondary outcomes: mental health, social support and substance use.ResultsParticipants reported high levels of socio-economic deprivation, e.g. 60 % of adolescents had either an HIV-positive caregiver or were orphaned by AIDS, and 50 % of caregivers experienced intimate partner violence. i) indicative effects: Primary outcomes comparing pre-test and post-test assessments showed reductions reported by adolescents and caregivers in child abuse (adolescent report 63.0 % pre-test to 29.5 % post-test, caregiver report 75.5 % pre-test to 36.5 % post-test, both p < 0.001) poor monitoring/inconsistent discipline (p < .001), adolescent delinquency/aggressive behaviour (both p < .001), and improvements in positive/involved parenting (p < .01 adolescent report, p < .001 caregiver report). Secondary outcomes showed improved social support (p < .001 adolescent and caregiver reports), reduced parental and adolescent depression (both p < .001), parenting stress (p < .001 caregiver report) and caregiver substance use (p < .002 caregiver report). There were no changes in adolescent substance use. No negative effects were detected. ii) Programme acceptability and attendance was high. There was unanticipated programme diffusion within some study villages, with families initiating parenting groups in churches, and diffusion through school assemblies and religious sermons. iii) potential adaptations identified included the need to strengthen components on adolescent substance use and to consider how to support spontaneous programme diffusion with fidelity.ConclusionsThe programme showed no signs of harm and initial evidence of reductions in child abuse and improved caregiver and adolescent outcomes. It showed high acceptability and unexpected community-level diffusion. Findings indicate needs fo...

Exploring opportunities for coordinated responses to intimate partner violence and child maltreatment in low and middle income countries: a scoping review

“…Two of the studies were based in South Africa, two in Uganda, one in Liberia and one in Thailand. Of the six studies, two described programmes that were designed to address IPV and CM jointly (Ashburn, Kerner, Ojamuge, & Lundgren, 2016;Hatcher, Colvin, Ndlovu, & Dworkin, 2014;Van den Berg et al, 2013); one was designed to address IPV, but reported unintended outcomes for CM (Abramsky et al, 2014(Abramsky et al, , 2016Kyegombe et al, 2015); and three were designed to address CM, but reported unintended outcomes for IPV (Cluver, Lachman et al, 2016;Cluver, Meinck et al, 2016;Sim, Annan, Puffer, Salhi, & Betancourt, 2014). Table 1 presents four studies which used a randomised controlled trial with a nested qualitative component: REAL Fathers in Uganda (Ashburn et al, 2015); SASA!…”

“…Table 2 presents one study which used a pre-post non-randomised design. Sinovuyo Caring Families in South Africa is distinct from other parenting programmes described, as it targets older children who have been identified as having behavioural problems or a suspected history of abuse (Cluver, Lachman et al 2016;Cluver, Meinck et al 2016). Designed specifically to address CM, it also reported outcomes for IPV, both measured quantitatively.…”

“…Similarly, reports of changes in relation to harsh and abusive parenting practices were based on caregiver accounts (Ashburn et al, 2015;Kyegombe et al, 2015; and only two studies included follow-up interviews with children (Cluver, Lachman et al, 2016;Cluver, Meinck et al, 2016;Sim, Annan, et al, 2014). Two of the trials and the pre-post pilot study had short follow-up periods (Cluver, Lachman et al, 2016;Cluver, Meinck et al, 2016;Sim, Annan, et al, 2014). Longitudinal research using mixed methods designs is needed to strengthen the evidence in LMIC regarding sustainability of programme outcomes.…”

“…A second, larger pre-post study of Sinovuyo was conducted with 115 adolescents and their caregivers (Cluver, Meinck et al, 2016). At the two to six week follow-up physical, emotional abuse and neglect of adolescents within the home significantly decreased according to adolescent and caregiver reports (p < .001) dropping from an average score of 4.33 (SE.57) to 1.33 (SE.27) for adolescents and 11.32 (SE.84) to 1.68 (SE.36) for caregivers.…”

Empowerment and Accountability and Multi‐layered Contexts of Influences: Parenting and the Avoidance of Harm in Harare, Zimbabwe

“…The Tirere Pamwe program is built on the integration of life course development research, community epidemiology, and preventive intervention (Schiavo, ; Trickett et al, ). Child maltreatment is a pressing problem that co‐occurs in individuals and neighbourhoods (L. Cluver, Meinck et al., ; Ravi & Ahluwalia, ), and can sometimes be predicted by common precursors, and prevented through protective factors that mediate or moderate exposure to risky situations (Dawes & Ward, ; Finkelhor, Turner, Ormrod, & Hamby, ; Masinda & Muhesi, ). There is much overlap in these risk and protective factors.…”