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Abstract

Gender-based violence (GBV) is a global health concern that affects individuals across various settings, including higher educational institutions (HEIs), where female students are particularly vulnerable. In Tanzania, GBV within HEIs remains under-researched, despite its potential impact on students’ well-being and academic performance. As part of a broader mixed-methods investigation on GBV among female students, this study specifically examined the reported prevalence and correlates of physical GBV in two Tanzanian higher education institutions, an often-overlooked area. We employed an analytical cross-sectional study design that included 296 female nursing students from Muhimbili University of Health and Allied Sciences (MUHAS) and Hubert Kairuki Memorial University (HKMU) in Dar es Salaam. Participants were recruited through total population sampling and data collected at the end of the academic years, from 1st August to 8th September in 2023, and 5th August to 20th December in 2024. Physical GBV included being threatened with harm, pushed, slapped, grabbed, hair pulled, hit with objects or fists, kicked, or subjected to suffocation, strangulation, stabbing, or shooting attempts. Data were collected using a self-administered questionnaire and analyzed using SPSS version 25, with bivariate and multivariable logistic regression performed to assess the sociodemographic correlates of physical GBV. The reported prevalence of physical GBV since enrollment in the HEIs was 10.1%, with a significant proportion of survivors not reporting or taking legal actions. Attending MUHAS had a higher likelihood of reporting physical GBV (AOR = 2.935; 95% CI: 1.233–6.985; P < .015). No other sociodemographic variables demonstrated a statistically significant association with physical GBV. This study found that 10.1% of female nursing students in the two Tanzanian universities reported experiencing physical GBV, yet disclosure and reporting rates remained notably low, underscoring the need for strengthened awareness, support services, and institutional mechanisms to address GBV within higher education settings.

Keywords

gender-based violence prevalence students nursing educational institutions cross-sectional studies risk factors

Introduction

Gender-based violence (GBV), which includes physical, sexual, and psychological harm, is a pervasive human rights violation and a major public health issue affecting individuals across diverse socio-economic and cultural contexts worldwide.¹ Educational institutions, particularly higher educational institutions (HEIs), are not exempt from this global challenge. A growing body of evidence indicates that female students are especially vulnerable to various forms of GBV in these settings, with perpetrators often including peers, faculty, and administrative staff.^2,3

Within sub-Saharan Africa, including Tanzania, the prevalence of GBV in HEIs is a matter of increasing concern. Research suggests that female students face inconsistent but significant exposure to GBV, exacerbated by entrenched patriarchal norms, unequal power dynamics, and institutional weaknesses such as inadequate policies and enforcement mechanisms.^4,5 This persistent problem not only threatens the fundamental rights and dignity of female students but also erodes the role of education as a transformative driver of societal development. These conditions contribute to a culture of silence and normalization of violence, which further undermines student safety, mental health, and academic performance. While GBV encompasses various forms, this study specifically focuses on physical violence. First, physical GBV has unique health and psychosocial consequences that warrant specific attention. Second, given the scope and resources of our study, we narrowed our focus to physical GBV to allow for a more in-depth analysis and clearer interpretation of findings.

Physical GBV in HEIs is a complex and multifaceted issue, shaped by interrelated individual, interpersonal, institutional, and sociocultural factors. At the individual level, contributors to perpetration include personal history of violence, substance use, and beliefs that condone aggression or male dominance.^6,7 Interpersonal factors such as peer pressure and abusive intimate relationships further elevate the risk.^8,9 Institutional drivers include poor campus security, lack of support systems, and failure to implement anti-violence policies effectively.¹⁰ On a broader level, societal norms that reinforce male superiority and tolerate violence as a form of control perpetuate the problem. Furthermore, intersecting identities, such as gender, disability, and socio-economic status, can compound vulnerability, creating additional barriers to safety and justice.^3,11 Ignoring physical GBV in HEIs risks perpetuating cycles of trauma that extend far beyond the individual, threatening the future leadership and empowerment of women in Tanzanian society.

The consequences of physical GBV for students in HEIs are profound and far-reaching. Victims often experience psychological outcomes such as anxiety, depression, and post-traumatic stress disorder (PTSD), alongside academic difficulties including absenteeism, poor performance, and disengagement.^12,13 Physical impacts range from minor injuries to chronic disabilities. Moreover, the presence of GBV on campus creates a climate of fear and insecurity, eroding students’ trust in institutional structures and diminishing their overall sense of belonging and well-being.¹³ Although Tanzania-specific data on the impact of physical GBV is limited, studies from related contexts suggest similar negative effects.^14,15

Despite growing awareness, significant knowledge gaps remain regarding the extent and drivers of physical GBV in Tanzanian HEIs. Current literature lacks comprehensive national or regional data on the prevalence of physical GBV, as well as detailed analyses of the multi-level factors contributing to it.^16,17 There is also insufficient understanding of how sociocultural intersecting factors shape risk and resilience among students. Although notable initiatives, such as university-led campaigns and collaborations with partners including UNESCO’s 16 Days of Activism Against Gender-Based Violence, have been implemented to raise awareness and prevent GBV on campuses, their reach, consistency, and long-term effectiveness remain poorly documented.¹⁸ Furthermore, while policies addressing sexual harassment exist in some HEIs, they often fall short of addressing the broader spectrum of GBV, particularly in terms of prevention, reporting, and survivor support. Addressing these gaps is not only a research imperative but a moral and societal necessity to safeguard the health, rights, and academic futures of female students.

This study addresses these critical gaps by examining the reported prevalence and correlates of physical GBV among female nursing students at two Tanzanian HEIs. By examining factors at the individual, institutional, and contextual levels, the study generates context-specific evidence to inform policy, enhance institutional response mechanisms, and provide valuable insights into the development of safer, more inclusive educational environments.

Materials and Methods

Study Design

This investigation employed a quantitative analytical approach with an analytical cross-sectional study design to determine the prevalence and correlates of physical GBV among female students in HEIs. This methodological approach was chosen for its capacity to generate statistical inferences about the target population and to facilitate comparative analysis across various subgroups.¹⁹ The study has followed the STROBE guidelines for reporting observational studies.²⁰

Study Setting

The research was conducted in the Schools of Nursing at 2 HEIs in Dar es Salaam, Tanzania: Muhimbili University of Health and Allied Sciences (MUHAS), a public institution, and Hubert Kairuki Memorial University (HKMU), a private institution. These institutions were purposively selected to include 1 public and 1 private institution in the city. MUHAS is recognized as a leading national center for health training, research, and consultancy, with its School of Nursing being 1 of 7 constituent schools, including Pharmacy, Public Health, Dentistry, and the 3 medical schools (Biomedical Sciences, Clinical Medicine, and Diagnostic Medicine) under the College of Medicine. The MUHAS School of Nursing offers undergraduate programs in Nursing, Midwifery, and Nurse Anesthesia, as well as postgraduate degrees in nursing. Conversely, HKMU is Tanzania’s oldest private medical university, comprising 5 schools: Medicine, Nursing, Pharmacy, Public Health, and Dentistry. Its School of Nursing delivers both undergraduate and diploma programs.

Study Population

The study population consisted of female undergraduate students enrolled in the Schools of Nursing at MUHAS and HKMU. Female students were selected due to their disproportionate vulnerability GBV compared to male counterparts, as evidenced not only by global statistics but also by studies conducted in HEIs across sub-Saharan Africa.^2,3,21-23 In addition, within the limits of available resources, the School of Nursing offered a clearly defined and accessible population of female students, allowing the use of total population sampling to maximize participation and minimize sampling bias. Participants were drawn from all 3 nursing tracks, Bachelor of Science in Nursing, Midwifery, and Nurse Anesthesia, offered at the selected institutions. The study encompassed students from all academic years (first through fourth), as each program spans a duration of 4 years.

Inclusion and Exclusion Criteria

Inclusion criteria were female nursing students enrolled in the 2022/2023 and 2023/2024 academic years at the Schools of Nursing of MUHAS and HKMU. Students who were absent during the data collection period, including those absent due to illness, were excluded.

Sample Size and Sampling Procedure

Since the total eligible population across both institutions was 361 female students, a total population sampling approach was employed, including all eligible students to maximize participation and ensure comprehensive representation.

Data Collection Tool and Procedures

Data were collected at the end of the academic calendar in 2 phases: 1 August–8 September 2023 and 5 August–20 December 2024. The first phase was not completed due to logistical challenges, including students’ departure for holidays. When data collection resumed, first-year students from the 2023/2024 academic year were included after completing 1 full year of study. A structured, self-administered questionnaire in English, previously used in similar studies in countries such as Ethiopia and Nigeria, was utilized.^23-25 The tool captured sociodemographic information and experiences of physical violence, with 4 binary-response items (Yes/No) assessing exposure to physical GBV since university enrollment, adopted from a previously validated WHO VAW study instrument for estimating gender-based violence against women.²⁶ The 4 questions were: (1) “Threatened to hurt you physically,” (2) “Pushed or shoved you, slapped you, grabbed or pulled your hair,” (3) “Threw a hard object at you, beat you with a fist or a hard object, or kicked you,” and (4) “Tried to suffocate or strangle you, cut or stabbed you, or shot at you.” A respondent was categorized as having experienced physical GBV if they answered affirmatively to at least 1 of the 4 items.

Participants were approached at the beginning of break times (tea or lunch breaks) or after the last session of the day. They were informed about the study details, including ethical procedures and voluntary participation, and written informed consent was obtained. Questionnaires were then distributed and collected by the research team, who ensured proper documentation, addressed any queries, and reviewed the questionnaires for completeness before collection. Completing the questionnaire took approximately 10 to 15 min. The number of eligible participants from MUHAS and HKMU was 173 and 188, respectively. Of these, 146 from MUHAS and 150 from HKMU agreed to participate and were included in the final analysis, yielding an overall response rate of 82%.

Data Analysis

Data were initially entered into an Excel sheet, cleaned, and then transferred to IBM SPSS Statistics version 25 for analysis. Descriptive statistics were computed for all variables: continuous variables were summarized using means and standard deviations, while categorical variables were presented as frequencies and percentages. Associations between categorical variables were examined using Chi-square tests, including a comparison of physical GBV reporting between the 2 academic years, which revealed no statistically significant difference.

To identify correlates of physical violence, bivariate logistic regression analyses were initially performed. Variables with a P-value < .2 in bivariate analysis were subsequently entered into a multivariate logistic regression model to adjust for potential confounding effects. Statistical significance was established at a P-value < .05.

Results

Sociodemographic Characteristics of Participants

The 296 participants in this study had a mean age of 26.1 years (SD = 5.0). The majority were single (n = 225, 76.0%), Christian (n = 215, 72.6%), and lived off campus (n = 225, 76.0%). There were statistically significant differences between the 2 institutions in terms of mean age (independent t-test, P < .001), marital status (Chi-square test, P < .001), religion (Chi-square test, P = .009), residence status (Chi-square test, P = .014), and type of accommodation (Chi-square test, P < .001). Table 1 summarizes sociodemographic characteristics of participants according to the institution.

Table 1.

Participants’ Sociodemographic Characteristics by Institution (N = 296).

		Institution
		Total	MUHAS		HKMU
Variable	Category	n (%)	n	%	n	%	P value
Mean age (SD)		26.1 (5.0)	25.1 (3.4)		27.1 (6.0)		<.001
Marital status	Single	225 (76.0)	127	87.0	98	65.3	<.001
Marital status	Married/cohabiting	71 (24.0)	19	13.0	52	34.7
Religion	Christian	215 (72.6)	116	79.5	99	66.0	.009
Religion	Muslim	81 (27.4)	30	20.5	51	34.0
Academic level	Junior students	207 (69.9)	69	66.4	110	73.3	.196
	Senior students	89 (30.1)	77	33.6	40	26.7
Residency status	Campus	71 (24.0)	44	30.1	27	18.0	.014
	Off campus	225 (76.0)	102	69.9	123	82.0
Accommodation type	Living alone	60 (20.3)	36	24.7	24	16.0	<.001
	Sharing with others	139 (47.0)	79	56.2	57	38.0
	With partner/relatives	97 (32.8)	31	19.2	69	46.0
Monthly money	Less than 150 000 TSh.	147 (49.7)	75	51.4	72	48.0	.562
	150 000 TSh. and above	149 (50.3)	71	48.6	78	52.0

Reported Physical GBV Experience

The proportion of students who reported having experienced physical GBV since joining the institution was 10.1% (n = 30), with 10 of these students (one-third) reporting multiple forms of physical GBV. The most commonly reported item was “Threatened to hurt you physically” (n = 23, 7.8%). In contrast, the least reported items, each affecting only 2 participants (0.7%), “Threw a hard object at you, beat you with a fist or a hard object, or kicked you” and “Tried to suffocate or strangle you, cut or stabbed you, or shot at you.” Among 26 victims who reported perpetrators of physical GBV, the most frequently mentioned was either a fellow student or partner (n = 10, 36.5%), followed by a stranger (n = 5, 19.2%), and a teacher or lecturer (n = 1, 3.8%). Among the 27 victims who reported the frequency of experiencing physical GBV, 14 (51.9%) had experienced once, 5 (18.5%) twice, 4 (14.8%) 3 times, and 4 (14.8%) 4 or more times. However, of the 27 victims, only 11 (40.7%) shared with a family member, 2 (7.4%) took legal actions, and 11 (40.7%) did not share at all with anybody. The most commonly reported reason among the 11 victims who did not share or disclose experiences of physical GBV was not knowing what to do (n = 4, 36.4%), followed by feelings of shame, fear of parents’ reactions, and fear of public reaction, each reported by 2 victims (18.2%).

Correlates of Reporting Physical GBV

The Chi-square test (or Fisher’s Exact tests) was performed to initially determine sociodemographic correlates of reporting physical GBV since enrollment at the university. Significant differences were observed between the 2 universities (Chi-square = 7.699, P = .006) and in the monthly pocket money (Chi-square test = 3.861, P value = .049), where students studying at MUHAS and having less monthly pocket money had a higher likelihood of reporting physical GBV, as shown in Table 2.

Table 2.

Sociodemographic correlates of reporting physical GBV (N = 296).

		Reported Physical GBV since enrollment
		Yes		No
Variable	Category	n	%	n	%	X ²	P value
Age groups (years)	18-24	16	12.8	109	87.2	1.687	.194
	25-49	14	8.2	157	91.8
Marital status	Single	27	12.0	198	88.0	3.582	.071^a
Marital status	Married/cohabiting	3	4.2	68	95.8
Religion	Christian	23	10.7	192	89.3	0.273	.601
Religion	Muslim	7	8.6	74	91.4
Institution	MUHAS	22	15.1	124	84.9	7.699	.006
Institution	HKMU	8	5.3	142	94.7
Academic level	Junior students	18	8.7	189	91.3	1.566	.211
	Senior students	12	13.5	77	86.5
Residency type	Campus	5	7.0	66	93.0	0.981	.322
	Outside campus	25	11.1	200	88.9
Accommodation type	Living alone	8	13.3	52	86.7	0.845	.655
	Sharing with others	13	9.4	126	90.6
	With partner/relatives	9	9.3	88	90.7
Monthly pocket money	Less than TZS. 150 000	20	13.6	127	86.4	3.861	.049
	TZS. 150 000 and above	10	6.7	139	93.3

X² = Chi-square test.

Fishers exact test.

Bivariate and multiple logistic regression analyses were performed to examine the sociodemographic correlates of reporting physical GBV since joining the institution, as indicated in Table 3. In the unadjusted model, students studying in at MUHAS institution (COR: 3.149; 95% CI: 1.354, 7.326; P = .008) had a higher likelihood of reporting physical GBV experience. In the adjusted model, studying at MUHAS (AOR: 2.935; 95% CI: 1.233, 6.985; P = < .015) remained statistically significant. The Chi-square value for the Hosmer-Lemeshow test was 9.097 with a P-value of .246, suggesting a good model fit. In addition, we conducted a sensitivity analysis excluding university type, and the results were consistent.

Table 3.

Sociodemographic correlates of reporting physical GBV experience (N = 296).

	Reported physical GBV (yes)
Variables	n	%	COR (95% CI)	P-value	AOR (95% CI)	P-value
Age groups (years)
18-24	16	12.8	Ref		Ref
25-49	14	8.2	1.646 (0.772, 3.512)	.197	1.251 (0.542, 2.890)	.599
Marital status
Single	27	12.0	Ref		Ref
Married/cohabiting	3	4.2	3.091 (0.909, 10.514)	.071	1.751 (0.465, 6.597)	.408
Religion
Christian	23	10.7	Ref
Muslim	7	8.6	1.266 (0.521, 3.076)	.602	–	–
Institution
MUHAS	22	15.1	Ref		Ref
HKMU	8	5.3	3.149 (1.354, 7.326)	.008	2.935 (1.233, 6.985)	.015
Academic level
Junior students	18	8.7	Ref
Senior students	12	13.5	0.611 (0.281, 1.329)	.214	–	–
Residency type
Campus	5	7.0	Ref
Outside campus	25	11.1	0.606 (0.223, 1.647)	.326	–	–
Accommodation type
Living alone	8	13.3	Ref
Sharing with others	13	9.4	1.491 (0.584, 3.810)	.404	–	–
With partner/relatives	9	9.3	1.504 (0.547, 4.139)	.429	–	–
Monthly pocket money
Less than 150 000 TSh.	20	13.6	Ref		Ref
150 000 TSh. and above	10	6.7	2.189 (0.987, 4.854)	.054	1.887 (0.816, 4.366)	.138

Hosmer-Lemeshow test: Chi-square = 9.097, P = .246.

COR = crude odds ratio; AOR = adjusted odds ratio; CI = confidence interval.

Discussion

The findings of this study reveal a significant understanding of the prevalence and correlates of reporting physical GBV experience in the 2 universities. The results indicate that 10.1% of female nursing students reported having experienced physical GBV since enrollment at the universities, with one-third among the victims reporting multiple forms, and students studying at MUHAS reporting a higher prevalence. These findings align with previous research in sub-Saharan Africa,^27,28 highlighting students’ vulnerability in resource-constrained educational environments. However, the observed prevalence in the 2 universities is relatively lower than that reported in South Africa,²⁹ possibly due to differences in cultural and institutional factors affecting reporting rates.

This study found that students at MUHAS reported a higher likelihood of physical GBV experiences compared to those at HKMU, suggesting institution-specific differences. In the bivariate analysis, lower monthly pocket money was also associated with reporting physical GBV; however, this association did not remain significant in the multivariable logistic regression. This indicates that socio-economic factors may still play a role but require further investigation. Given that only 2 institutions were studied, the findings should be interpreted with caution. Further research involving a larger and more diverse sample of HEIs is recommended to substantiate and clarify these differences.

Sociodemographic characteristics such as age, marital status, religion, academic level, residency, and monthly pocket money were not significantly associated with reporting physical GBV experiences in this study. This finding aligns with some previous research but contrasts with others conducted in similar African contexts. For instance, while our results are consistent with certain multi-country studies across sub-Saharan Africa that found limited predictive value in individual demographic characteristics, they diverge from Ethiopian findings, where younger and unmarried students were reported to have significantly higher risks of GBV exposure.^30,31 These discrepancies suggest that the institutional environment may mediate or override conventional demographic risk factors. In HEIs, especially in urban Tanzanian contexts, social dynamics, institutional culture, and structural conditions may play a more prominent role than age or marital status in shaping GBV vulnerability.

Notably, our findings also contrast with the study by Abubeker et al, which identified limited financial resources as a key determinant of GBV risk among university students in Nigeria.²² Economic vulnerability is increasingly recognized as a structural driver of GBV. Students with constrained financial resources may be less capable of resisting coercion, accessing support services, or exiting abusive relationships. This economic dependence not only limits agency but may also entrench power asymmetries that perpetrators exploit, thereby reinforcing cycles of abuse.^32-36 Broader regional evidence further supports this perspective. An analysis involving 25 sub-Saharan African countries linked GBV risk with structural socioeconomic disadvantage, particularly young age, low educational attainment, and poverty, indicating that systemic vulnerabilities may exert stronger influence than individual-level demographics, especially within institutional settings.³⁷

In the Tanzanian context, qualitative research has similarly highlighted the role of financial dependence in perpetuating GBV. One study found that women’s economic reliance on others significantly undermines their ability to leave abusive situations or seek justice, thereby increasing their exposure to violence.³⁸ These insights support the argument that structural and economic conditions within HEIs, not just individual characteristics, are stronger predictors of GBV among female students.³⁹

Senior students in our study reported higher rates of physical GBV than juniors, though the difference was not statistically significant. This contrasts with studies from Ethiopia and Nigeria, where first-year students were more vulnerable due to unfamiliarity with campus environments and weaker social support systems.^40-42 The higher rates among seniors in our study may reflect cumulative exposure over time, greater involvement in intimate relationships, or increased likelihood of reporting due to maturity and awareness. Contextual factors such as institutional norms and reporting culture may also explain this discrepancy.^43,44

Although residency type was not significantly associated with physical GBV reporting overall, off-campus students reported a slightly higher prevalence. One possible explanation is that students living off-campus may face longer cumulative exposure to risk, as earlier-year students are more likely to reside on-campus, while those living off-campus may have been enrolled for several years, thereby increasing their chances of reporting GBV. This interpretation is consistent with findings from Tanzania’s Ardhi University, where off-campus female students reported greater insecurity, including robbery and rape, and with studies from Uganda and Kenya documenting similar risks among off-campus students.^45,46 These observations suggest that living arrangements may influence exposure to GBV, though further research is required to disentangle the role of safety, length of enrollment, and other contextual factors.

Our study also found that many female students who reported physical GBV did not disclose the incident to anyone or pursue legal action. Common reasons included a lack of knowledge on what to do, shame, and fear of reactions from parents and the public. This highlights the urgent need for stronger institutional support and response mechanisms. Unlike South African universities, which have established frameworks for gender-based violence response units,⁴⁷ Tanzanian universities lack comprehensive frameworks to support victims. The absence of well-defined reporting channels and legal protection further discourages victims from coming forward, contributing to the underreporting of GBV cases. Addressing this issue requires urgent policy interventions, including the implementation of gender-sensitive training and stronger campus security measures.⁴⁸

This study has several limitations. First, reliance on self-reported data may have introduced recall or social desirability bias, as some participants might have underreported experiences of physical GBV due to fear, shame, or concerns about confidentiality. Second, the cross-sectional design limits the ability to infer causal relationships between physical GBV and associated factors. Third, the sample was drawn from only 2 health-related HEIs, which may limit the generalizability of findings to other Tanzanian HEIs, particularly technical colleges, faith-based HEIs, or rural campuses with different social and administrative contexts. Finally, the study may not have captured important contextual variables, such as campus safety policies, institutional response mechanisms, and community-level factors, which are crucial for understanding variations in GBV risk. However, the findings of this study offer valuable insights into physical GBV among female nursing students in Tanzanian HEIs and can inform the design and implementation of targeted GBV interventions in these settings.

Conclusion

This study found that 10.1% of female nursing students in the two Tanzanian universities reported experiencing physical GBV, with disclosure and reporting rates remaining very low. Students at MUHAS had higher odds of experiencing physical GBV, with many victims reporting threats or harm from peers or intimate partners. The low levels of disclosure and limited legal action underscore gaps in awareness, support services, and institutional response. These findings point to an urgent need for comprehensive GBV prevention and response strategies, encompassing awareness campaigns, accessible and safe reporting mechanisms, and strengthened policy interventions, to protect female students and promote safer academic environments.

Footnotes

Acknowledgements

We extend our heartfelt appreciation to the Schools of Nursing at MUHAS and HKMU for their approval and support in facilitating this study. Our sincere thanks also go to the female nursing students who generously contributed their time and insights, which were vital to the success of this research. We also gratefully acknowledge the Brocher Foundation for providing residency support, during which the data analysis and manuscript writing were completed.

ORCID iD

Joel Seme Ambikile

Ethical Considerations

This study was approved by the Muhimbili University of Health and Allied Sciences Research Ethics Committee (approval: MUHAS-REC-02-2023-1542) on February 23, 2023.

Consent to Participate

Written informed consent was obtained from all participants before participation.

Author Contributions

Conceptualization, J.S.A.; Data curation: J.S.A., N.E.M., E.M., Formal analysis: J.S.A., P.K.; Investigation: J.S.A., E.M., N.E.M., P.K.; Methodology: J.S.A., P.K. Project administration, J.S.A.; Resources: J.S.A., E.M.; Supervision: J.S.A., E.M.; Validation: J.S.A., P.K.; Writing – original draft, J.S.A., E.M., P.K.; Writing – review & editing, J.S.A., E.M., N.E.M., P.K.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All data generated or analyzed during this study are included in this published article and its Supplemental information files.

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