Janina Isabel Steinert

A parenting programme to prevent abuse of adolescents in South Africa: study protocol for a randomised controlled trial

BackgroundAn estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting and reduce adolescent behavioural problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.Methods/DesignThis is a pragmatic cluster randomised controlled trial, with stratified randomisation of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavioural problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3–8 months post-intervention. A 15–24-month follow-up is planned, but this will depend on the financial and practical feasibility given delays related to high levels of ongoing civil and political violence in the research sites.DiscussionThis is the first known trial of a parenting programme to prevent abuse of adolescents in a low- or middle-income country. The study will also examine potential mediating pathways and moderating factors.Trial registrationPan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. It can be found by searching for the key word ‘Sinovuyo’ on their website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119

Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa

Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low-income and middle-income countries, on abuse and parenting practices. Design Pragmatic cluster randomised controlled trial. Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa. Participants 552 families reporting conflict with their adolescents (aged 10–18). Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme. Main outcome measures Primary outcomes: abuse and parenting practices at 1 and 5–9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5–9 months postintervention. Blinding was not possible. Results At 5–9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P<0.001); corporal punishment (caregiver report IRR=0.55 (95% CI 0.37 to 0.83, P=0.004)); improved positive parenting (caregiver report d=0.25 (95% CI 0.03 to 0.47, P=0.024)), involved parenting (caregiver report d=0.86 (95% CI 0.64 to 1.08, P<0.001); adolescent report d=0.28 (95% CI 0.08 to 0.48, P=0.006)) and less poor supervision (caregiver report d=−0.50 (95% CI −0.70 to −0.29, P<0.001); adolescent report d=−0.34 (95% CI −0.55 to −0.12, P=0.002)), but not decreased neglect (caregiver report IRR 0.31 (95% CI 0.09 to 1.08, P=0.066); adolescent report IRR 1.46 (95% CI 0.75 to 2.85, P=0.264)), inconsistent discipline (caregiver report d=−0.14 (95% CI −0.36 to 0.09, P=0.229); adolescent report d=0.03 (95% CI −0.20 to 0.26, P=0.804)), or adolescent report of abuse IRR=0.90 (95% CI 0.66 to 1.24, P=0.508) and corporal punishment IRR=1.05 (95% CI 0.70 to 1.57, P=0.819). Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected. Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings. Trial registration number Pan-African Clinical Trials Registry PACTR201507001119966.

Relationships between poverty and AIDS Illness in South Africa: an investigation of urban and rural households in KwaZulu-Natal

ABSTRACT The association between poverty and HIV/AIDS in Sub-Saharan Africa remains contested. A better understanding of the relationship between the prevalence of poverty and the disease is essential for addressing prevention, treatment, and care. The present study interrogates this relationship, using a cross-sectional survey of 2477 households in urban and rural KwaZulu-Natal, South Africa. Structural equation modelling was employed to estimate the correlations between poverty and AIDS illness. The analysis revealed a correlation of rpb = 0.23, denoting that a higher level of household poverty was associated with a higher likelihood of being AIDS-unwell. Post hoc t-test showed that receipt of a disability grant by AIDS-affected households was associated with significantly lower poverty, compared to AIDS-affected households not receiving the grant, t(654) = 3.67, p < .01. Geographic location was found to confound the correlation: the strength of the relationship between poverty and AIDS was decreased to rpb = 0.15 (p < .001) for the urban and rpb = 0.16 (p < .001) for the rural sub-population. Findings suggest the importance of two sets of policies: those that address the potential upstream risk of poverty through economic interventions, and those that alleviate the impoverishing effects of AIDS illness for affected households.

One Size Fits All? The Validity of a Composite Poverty Index Across Urban and Rural Households in South Africa

Composite indices have been prominently used in poverty research. However, validity of these indices remains subject to debate. This paper examines the validity of a common type of composite poverty indices using data from a cross-sectional survey of 2477 households in urban and rural KwaZulu-Natal, South Africa. Multiple-group comparisons in structural equation modelling were employed for testing differences in the measurement model across urban and rural groups. The analysis revealed substantial variations between urban and rural respondents both in the conceptualisation of poverty as well as in the weights and importance assigned to individual poverty indicators. The validity of a ‘one size fits all’ measurement model can therefore not be confirmed. In consequence, it becomes virtually impossible to determine a household’s poverty level relative to the full sample. Findings from our analysis have important practical implications in nuancing how we can sensitively use composite poverty indices to identify poor people.

Too good to be true? United Nations peacebuilding and the democratization of war-torn states

This article examines the effectiveness of UN peacebuilding missions in democratizing war-torn states, emphasizing those missions that include democracy promotion components in their mandates. Based on a multinominal logistic regression, we reveal that democratization is significantly more likely if a UN peacebuilding mission is deployed. Furthermore, regimes categorized as more liberal at the outset have an increased risk of revealing antidemocratization trends over the post-war period. Oil wealth impedes democratization and clear victory of one conflict party makes regime transitions more likely, yet in both directions. Descriptive statistics suggest that an increase in the mission’s capacities may be conducive to democratization.

Spoilers of peace: Pro-government militias as risk factors for conflict recurrence

This study investigates how deployment of pro-government militias (PGMs) as counterinsurgents affects the risk of conflict recurrence. Militiamen derive material and non-material benefits from fighting in armed conflicts. Since these will likely have diminished after the conflict’s termination, militiamen develop a strong incentive to spoil post-conflict peace. Members of pro-government militias are particularly disadvantaged in post-conflict contexts compared to their role in the government’s counterinsurgency campaign. First, PGMs are usually not present in peace negotiations between rebels and governments. This reduces their commitment to peace agreements. Second, disarmament and reintegration programs tend to exclude PGMs, which lowers their expected and real benefits from peace. Third, PGMs might lose their advantage of pursuing personal interests while being protected by the government, as they become less essential during peacetimes. To empirically test whether conflicts with PGMs as counterinsurgents are more likely to break out again, we identify PGM counterinsurgent activities in conflict episodes between 1981 and 2007. We code whether the same PGM was active in a subsequent conflict between the same actors. Controlling for conflict types, which is associated with both the likelihood of deploying PGMs and the risk of conflict recurrence, we investigate our claims with propensity score matching, statistical simulation, and logistic regression models. The results support our expectation that conflicts in which pro-government militias were used as counterinsurgents are more likely to recur. Our study contributes to an improved understanding of the long-term consequences of employing PGMs as counterinsurgents and highlights the importance of considering non-state actors when crafting peace and evaluating the risk of renewed violence.

Socioeconomically Disadvantaged Adolescents and Educational Delay in Two Provinces in South Africa: Impacts of Personal, Family and School Characteristics.

No quantitative studies to date have specifically focused on the risk and protective factors for the educational resilience of socioeconomically disadvantaged adolescents who are not of compulsory school age in South Africa. This study compares the educational delay of 599 black adolescents aged 16 to 18 from socioeconomically disadvantaged communities in Western Cape and Mpumalanga to nationally and provincially representative estimates in South Africa. The paper also explores predictors for educational delay by comparing out-of-school adolescents (n = 64), and adolescents who are at least one year behind in school (n = 380), with adolescents in the age-appropriate grade or higher (n = 155). Risk factors for being behind included the following: male gender, past grade repetition, rural location and larger school size. Risk factors for being out of school were the following: past grade repetition, previous concentration problems at school, household poverty, and food insecurity. Protective factors for being in the age-appropriate grade included the following: living with biological caregivers, access to school counselling and attending schools in wealthier communities.

Prospective risk and protective factors for intimate partner violence victimisation among women: a systematic review and meta-analysis

Abstract Background The lifetime prevalence of intimate partner violence (IPV), violence committed by a current or former partner, is estimated to be 30% among women worldwide. Effective prevention requires targeting conditions that increase and decrease the risk of IPV—or risk and protective factors, respectively. We aimed to systematically review and quantify the associations between prospective longitudinal risk and protective factors and IPV against women and identify evidence gaps. Methods Systematic searches were conducted in English in 16 databases including Medline and PsycINFO from inception to June 1, 2016, using free-text terms and controlled vocabulary for violence, partner, adults, and study design. English-language studies that prospectively analysed an adjusted association between any risk or protective factor or factors and self-reported IPV victimisation among women were included. Study quality was assessed with the Cambridge Quality Checklists. Studies investigating the same risk or protective factor using similar measures, and with appropriate data available, were combined to compute odds ratios using random-effects meta-analyses. Heterogeneity was indicated by I 2 and τ 2 . All results, including those not meta-analysed, were synthesised with harvest plots to illustrate evidence gaps and trends towards negative or positive associations. This study is registered with PROSPERO, number CRD42016039213. Findings Of 18 608 studies identified, 60 were included, and 35 meta-analysed. The strongest evidence for modifiable risk factors for IPV against women were unplanned pregnancy (odds ratio 1·66, 95% CI 1·20–1·31) and having parents with less than a high school education (1·55, 1·10–2·17). Being older (0·96, 0·93–0·98) and married (0·93, 0·87–0·99) were protective. Interpretation Study limitations include English-language restrictions and low statistical power. Nevertheless, to our knowledge this is the first systematic, meta-analytical review of all risk and protective factors for IPV against women without location, time, or publication restrictions. Education and sexual health interventions may be effective targets for preventing IPV against women, with young, unmarried women most at risk. More prospective evidence for perpetrator-related and context-related risk and protective factors for womens IPV experiences outside the USA is urgently needed to inform global recommendations. Funding Rhodes Trust, Canadian Institutes of Health Research (DFS152265).

OP92 A systematic review of prospective risk and protective factors for intimate partner violence victimisation among women

Note: Presentation moved to health inequalities 2 session on wednesday Background Rates of intimate partner violence (IPV) against women are unacceptably high worldwide. There has been no systematic review in over 10 years of all risk and protective factors without location or peer-review restrictions. Resultantly, there is no recent, systematically-developed model of the causes of IPV at all levels (individual, relationship, community, and structural) that accounts for differences, similarities, and evidence-gaps across low- to high-income contexts. This remains a barrier to the effective prevention of IPV, with significant uncertainty over what works and within which contexts. We aimed to systematically review all prospective, longitudinal risk and protective factors of IPV victimisation among women. Methods Systematic searches were conducted in 16 databases and references of relevant studies were hand-searched. Published or unpublished studies in English that prospectively analysed the association between any risk or protective factor(s) and self-reported IPV victimisation among women, controlling for at least one other variable, were included. Study quality was assessed using the Cambridge Quality Checklists. Study screening, extraction, and quality appraisal were completed and checked by three independent reviewers. Results were graphically synthesised using harvest plots, which allow for the synthesis of heterogeneous evidence and identification of trends towards negative, null, or positive associations. Results Searches retrieved 10 444 unique results. After title and abstract review, 387 studies were screened by full-text. Sixty studies from 35 cohorts met inclusion criteria. Most studies were from the USA (80.0%). A total of 71 risk/protective factors were identified, mostly at the individual- (n=21) or relationship-level (n=25) rather than the community- (n=7) or structural-level (n=18). Variables that showed positive or a mix of null-positive associations with women’s IPV victimisation were: at the individual-level, women’s identification as non-white, younger age, alcohol use, depressive symptoms, antisocial behaviour, aggressive personality, and experience of child abuse; at the relational-level, partners’ identification as non-white, alcohol use, antisocial behaviour, low relationship satisfaction, poor parental relationship quality, and experience of low parental monitoring; and at the structural-level, partners’ unemployment, women’s lower education, and financial difficulties. Other variables were under-studied (< 2 studies) or showed mixed or mainly null effects. Conclusion Significant work is needed to develop an ecological model of IPV against women using prospective data. Many commonly accepted risk factors for IPV victimisation among women such as exposure to inter-parental violence and community factors have little (if any) prospective evidence from outside the USA. Further prospective research on the aetiology of IPV against women is needed to inform rigorous prevention models.