Abstract
Violence against children—which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence—continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent–child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.
Keywords
Violence among and against children and adolescents continues to present itself as a significant public health crisis (Butchart et al., 2016; World Health Organization [WHO], 2020). The WHO defines violence against children as including maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence (ranging from unwanted contact to completed rape) (Butchart et al., 2016). Violence against children (ranging from birth to 17 years old) can be perpetrated by adults (including but not limited to caregivers, school personnel) as well as other children (Butchart et al., 2016; Finkelhor et al., 2014; Letourneau et al., 2017).
Acts of violence against children (used interchangeably herein with childhood victimization) are forms of adverse childhood experiences and are disproportionately high in Sub-Saharan Africa (SSA). Estimates of the rates of childhood victimization in SSA document that it is widespread although estimates vary widely across studies. For example, in reviews of the literature, the rate of childhood sexual abuse in Africa is as high as 78% (Meinck et al., 2015). Rates of physical abuse are as high as 45% (and as high as 27% when limited specifically to an adult perpetrator) (Meinck et al., 2015). In a large study that obtained self-report data from randomly selected children in two South African provinces, the lifetime prevalence (and past-year incidence) rates were as follows: 56% (18%) physical abuse, 36% (12%) emotional abuse, and 9% (5%) sexual abuse. Furthermore, 69% of children reported any type of lifetime victimization (Meinck et al., 2016). Polyvictimization, or experiencing multiple forms of violence victimization during childhood, is also common among children in SSA (Carlson et al., 2020; Leoschut & Kafaar, 2017; Meinck et al., 2015, 2016).
Research in SSA documents that childhood victimization is associated with numerous short- and long-term deleterious outcomes, including sexually transmitted infections, mental health problems, health risk behaviors, unintended pregnancy, academic failure and employment challenges, physical injuries and death, and re-victimization and/or perpetration in adulthood (Abrahams & Jewkes, 2005; Adjorlolo et al., 2017; Brown et al., 2009; Culbreth et al., 2021; Fakunmoju & Bammeke, 2015; Gibbs et al., 2018; Girgira et al., 2014; Goodman et al., 2017; Hayes & van Baak, 2017; Muluneh et al., 2021). Childhood victimization in SSA can trigger family and social dysfunction, which is in part related to the intergenerational transmission of childhood victimization (Cromback & Bambonyé, 2015; Dekel, 2018). There is also some evidence that outcomes associated with child victimization in SSA are more severe than in other parts of the world, likely due to limited resources for victim services (Meinck et al., 2015). Given the high rates and deleterious outcomes of childhood victimization in SSA, primary prevention efforts are sorely needed in this region of the world.
There has been a growing body of research on childhood victimization in SSA and related advocacy efforts on the rights, welfare, and well-being of children in SSA, although evidence-based prevention has not been widely implemented and sustained in SSA (Hsiao et al., 2018; Radford et al., 2020; WHO, 2020). Primary prevention, or the prevention of child victimization before it occurs, differs from other forms of intervention or treatment, which focus on helping children cope with trauma to reduce deleterious impacts (Herrenkohl et al., 2019; Whitaker et al., 2005). A handful of reviews exist on childhood victimization and/or violence perpetrated against adults in SSA or low- and middle-income countries more broadly (Badoe, 2017; Cerna-Turoff et al., 2021; Hounmenou & Her, 2018; Meinck et al., 2015; Russell et al., 2020; Sabri et al., 2022; Skeen & Tomlinson, 2013; Yount et al., 2017). However, none provide systematic reviews of programs to prevent violence against children in SSA. Furthermore, none of these reviews outlined a comprehensive plan for the prevention of childhood victimization in SSA grounded in the most up-to-date literature. Although the WHO published INSPIRE in 2016, which served these purposes, much has been published since 2016, and we identified prevention programs published prior to 2016 not included in INSPIRE. The purpose of the current systematic review is to fill these gaps in the literature. Prior to delineating our specific call to action, we first provide an overview of the SSA context and summarize risk and protective factors for childhood victimization in SSA.
The Sub-Saharan African Context
SSA is a subcontinent of 46 countries with complex geographies and histories. Most countries in SSA are currently classified as low- or middle-income countries, and rates of poverty are high in these countries (Collings, 2012; Dako-Gyeke, 2019). Not only is the gross domestic product (GDP) among the bottom quarter of regions in the world (World Bank, 2022) but also the Human Development Index (a measure of life expectancy, access to knowledge, and standard of living) is lower in many nations in SSA than in countries in other regions of the world (Mukherjee et al., 2016). These high rates of poverty and poor indicators of human development contribute to unique sociocultural and economic problems associated with childhood victimization such as extreme malnutrition and starvation as well as HIV/AIDS (Dako-Gyeke, 2019; Evidence to End FGM/C, 2018; Kassa & Grace, 2020; Ssewamala & Sensoy Bahar, 2022). Childhood victimization can be both a cause and a consequence of poverty and multilevel adversities experienced in such contexts.
More than 50% of the population in SSA are children and adolescents (Atilola, 2017). However, public social protection expenditures in SSA were some of the lowest in the world (International Labour Office, 2017). Indeed, countries in SSA spent less than 0.6% of their GDP on social protection for children under the age of 14, whereas European countries (excluding Eastern Europe) spent on average 2.5% of their GDP on social protection for children (International Labour Office, 2017). Child protection systems vary drastically across SSA but are consistently under-resourced and understaffed (Meinck et al., 2015).
Risk and Protective Factors for Childhood Victimization in SSA
Risk and protective factors for childhood victimization can be organized across the social ecology (Centers for Disease Control and Prevention, 2015). The socio-ecological model considers the complex interplay between risk and protective factors at the individual, relational, community, and societal levels (Centers for Disease Control and Prevention, 2015). Understanding these factors, especially those that are modifiable, for childhood victimization in SSA provides foundational information regarding the types of factors that need to be targeted in comprehensive primary prevention initiatives.
Table 1 summarizes risk and protective factors across the socio-ecological model for childhood victimization that draws upon other systematic reviews and meta-analyses (Badoe, 2017; Cerna-Turoff et al., 2021; Hounmenou & Her, 2018; Meinck et al., 2015; Russell et al., 2020; Skeen & Tomlinson, 2013; Yount et al., 2017). It is important to note that much of the research on risk and protective factors for childhood victimization in SSA is based on research comprising small, convenient samples, cross-sectional designs, and qualitative research. Nevertheless, this research provides important foundational insights into starting points for the primary prevention of childhood victimization in SSA. As seen in Table 1, we did not find a strong focus or evidence on protective factors, which are critical in designing strength-focused prevention efforts.
Examples of Risk and Protective Factors for Childhood Victimization in SSA.
Note. The table above provides examples summarized in comprehensive reviews and meta-analyses (Badoe, 2017; Cerna-Turoff et al., 2021; Hounmenou & Her, 2018; Meinck et al., 2015; Russell et al., 2020; Skeen & Tomlinson, 2013; Yount et al., 2017). SSA = Sub-Saharan Africa.
Methodology
Study Inclusion Criteria
To be included in a systematic review, the study must have been (1) written in English and (2) published in a peer-reviewed journal article and (3) must have presented implementation and/or outcome data on child/adolescent victimization prevention programming in SSA. Relatedly, to be included, a study must have also included a search term for (1) SSA (or related term), (2) abuse (or related term), (3) child (or related term), and (4) prevention (or related term; see Table 2). Programs that focused on domestic violence outcomes without specifically assessing children’s exposure to domestic violence were not included. Also, studies that discussed programs without providing any implementation and/or outcome data were not included. We included studies that measured intermediary outcomes (e.g., parenting skills) only when they also included outcomes for childhood victimization or proxies for childhood victimization (e.g., attitudes toward sexual abuse of children). Studies that focused on treatment, intervention, and/or recovery from violent victimization were excluded as the focus of this review is on the prevention of violence against children.
Boolean Search Terms.
Search Strategy
Research studies were found by searching international electronic databases, including Academic Search Premier, APA PsycArticles, APA PsycInfo, and MedLine. The search was conducted in August 2022, and all relevant studies ever published to date were included. Next, the authors searched INSPIRE: Seven Strategies for Ending Violence Against Children (WHO, 2020) to identify additional programs to prevent violence against children that may have been missed during the searching of international electronic databases. Finally, the authors reviewed the reference list of the studies that met INSPIRE criteria.
Search Outcome
An initial search of international electronic databases resulted in 465 peer-reviewed articles. Abstracts and titles of all studies identified by the search strategy were reviewed by the first author and were either included or excluded based on the inclusion criteria. Of the 465 articles, 433 articles were excluded because they did not meet inclusion criteria, leaving an initial total of 32 articles. Next, the first and third authors reviewed the reference list of the 32 articles that met criteria. This produced eight additional articles. Then, the first and fourth authors reviewed INSPIRE: Seven Strategies for Ending Violence Against Children (WHO, 2016), and an additional one article was identified. Finally, referrals from one of the peer reviewers and self-referral resulted in six additional articles. In all, 47 articles were included in the current review.
Results
Across the 47 articles, results from 22 programs were reported. There are fewer programs than there are articles since some programs are associated with several different articles (e.g., multiple evaluation studies or presenting different components of the same data from evaluation studies). The findings are presented in Table 3 and organized as follows: programs that focus on economic strengthening, programs that focus on teachers and schools, programs that focus on entire families, programs that focus on caregivers only, and programs that focus on children/youth only. To date, no research has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values as a child victimization prevention strategy. Countries heavily represented in the research include Zimbabwe, Ghana, Kenya, Uganda, South Africa, Zambia, Tanzania, Malawi, Mozambique, and Nigeria. SSA covers 46 countries as per the World Bank’s regional classification and our review covers only 10 countries, 9 of which are English-speaking countries. While efforts made in many of these prevention initiatives were remarkable in terms of combining evidence-based components across settings, the evaluation framework was not always well-developed (e.g., lacked randomization), samples were sometimes small, and other methodological challenges were present (e.g., low retention, lack of information on psychometrics of measures, sole reliance on self-report). There was a wide variability in the reporting of the intervention effectiveness outcomes although most studies found promising effects on at least some outcomes. Table 3 provides a more detailed summary of the nature of each evaluated intervention and the findings of each evaluation.
Summary of Evaluated Programs to Prevent Violence Against Children in SSA.
Note. SSA = Sub-Saharan Africa; HSCT = Harmonized Social Cash Transfer; SBSP = School-based savings program; TU = Trickle Up; ICC-T = Interaction Competencies with Children for Teachers; REAL = Responsible, Engaged, and Loving; SAPEP = Sexual Abuse Prevention Education Package; GBV =gender-based violence; YMOT = Your Moment of Truth.
Programs That Focus on Economic Strengthening
Four studies have evaluated initiatives—including cash transfers, business training, and financial literacy—to strengthen the economic status of children, caregivers, and families in SSA with the ultimate goal of reducing childhood victimization and other deleterious outcomes associated with poverty (Chakravarty et al., 2012; Ismayilova & Karimli, 2020; Masa et al., 2020; Sarnquist, 2018). Results from these four studies all found that economic interventions significantly reduced violence against children. One study shed light on the mechanisms (e.g., ability to purchase food, improvements in caregiver well-being, and reduction in youth labor) through which economic interventions may reduce violence against children (Chakrabarti et al., 2020), and another study found that the outcome of economic interventions was more robust when coupled with family coaching/skills training for parents (Masa et al., 2020). In all, programs that focus on economic strengthening of families are important components of comprehensive prevention of violence against children in SSA.
Programs That Focus on Teachers/Schools
Thirteen studies have evaluated four programs on violence against children prevention in SSA that focus on teachers and schools. The most widely studied program is the Good School Toolkit, which uses training and school-led activities to encourage respectful school climates including nonviolent discipline (Devries et al., 2015, 2017, 2018; Greco et al., 2018; Kayiwa et al., 2017; Knight et al., 2018; Kyegombe et al., 2017; Merrill et al., 2018). Research shows that the Good School Toolkit reduces violence against children as reported by multiple sources and that mechanisms of change include perceived emotional support from teachers and peers, students’ greater identification with their school, students’ and staffs’ lower acceptance of physical discipline practices in school, and students’ and staffs’ greater perceived involvement in school operation, lower normative beliefs accepting use of physical discipline, and improved staff mental health and job satisfaction. Although less widely researched, other programs such as the EmpaTeach intervention (which uses empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies to prevent physical violence toward students from teachers—Fabbri et al., 2021) and the Teachers’ Diploma Programme on Psychosocial Care, Support, and Protection (which focuses on enhancing school environments, fostering psychosocial support, and facilitating school–community relationships—Kaljee et al., 2017) were shown to reduce violence against children. However, the data are more mixed for the Interaction Competencies with Children for Teachers (which seeks to enhance student–teacher interactions, effective discipline strategies, and identifying “burdened” students) although it has been shown to move the needle on some forms of violence (e.g., physical) but not others (e.g., emotional—Kaltenbach et al., 2018; Nkuba et al., 2018; Ssenyonga et al., 2022).
Programs That Focus on Entire Families
Eleven studies have evaluated four programs on violence against children prevention in SSA that focus on entire families. The most widely researched programs that focus on the entire families are the Families Matter! Program (Miller et al., 2013, 2015; Shaw et al., 2021; Vandenhoudt et al., 2010) and the Sinovuyo Program—both versions of the program for adolescent caregivers (Shenderovich et al., 2018, 2019, 2020) and their families and the version of the program for caregivers of adolescents (Cluver et al., 2016, 2017; Doubt et al., 2017). The Families Matter! Program is designed to promote positive parenting and effective parent–child communication about sexuality. The Sinovuyo Program seeks to improve parenting skills and reduce maltreatment. There is compelling evidence that these programs (Families Matter! and the Sinovuyo Program) are both acceptable and feasible (although session attendance in Sinovuyo Teen was low) and lead to reductions in violence against children. Although only one study has examined its effectiveness, Skhokho (which addresses harmful gender norms, cultural tolerance of violence, and poor relationship skills) (Jewkes et al., 2019) is effective at adolescents’ exposure to violence. Mechanisms of change in programs that focus on entire families include reductions in parenting stress, increases in parenting skills, increases in child-caregiver communication, and increases in family bonding/relational quality and closeness of child-caregivers.
Programs That Focus on Caregivers Only
Twelve studies have evaluated six programs on violence against children prevention in SSA that focus on caregivers only. The most widely researched program for caregivers is Parenting for Lifelong Health (Cluver et al., 2016, 2007, 2020; Cluver, Meinck, Steinert, Shenderovich, Doubt, Romero, Lombard, Redfern, Ward, Tsoanyane, Nzima, Sibanda, Wittesaele, De Stone, Boyes, Catanho, McLaren Lachman, Salah, et al., 2018; Cluver, Meinck, Steinert, Shenderovich, Doubt, Romero, Lombard, Redfern, Ward, Tsoanyane, Nzima, Sibanda, Wittesaele, De Stone, Boyes, Catanho, McLaren Lachman, Nocuza, et al., 2018; Ward et al., 2020). Parenting for Lifelong Health focuses on bolstering the capacity for caregivers to provide a protective environment and positive parenting techniques. Research from multiple evaluation studies document reductions in violence against children. Although not as extensively studied, other programs (see Table 3 for a description)—“Malezi Bora na Maisha Mazuri” (Good Parenting for a Good Life) (Murphy et al., 2021), Parenting for Respectability (Wight et al., 2022), Responsible, Engaged, and Loving Fathers Initiative (Ashburn et al., 2017), Sinovuyo Caring Families Program for Young Children (Lachman et al., 2017; Lachman et al., 2018), and SASA! (Kyegombe et al., 2015) have also found actual (via quantitative pre- and post-survey data) or perceived (via qualitative data) reductions in violence against children. Mechanisms of change in programs that focus on caregivers only include mechanisms similar to programs that focus on entire families and include reductions in parenting stress, increases in parenting skills, increases in child-caregiver communication, and increases in family bonding/relational quality and closeness of child-caregivers. One study also found that SASA! (Kyegombe et al., 2015) was perceived by participants to have led to their increased positive bystander behavior when witnessing violence against children (in other words intervening to prevent violence against children).
Programs That Focus on Children/Youth
Nine studies have evaluated four programs on violence against children prevention in SSA that focus on children/youth only. The most widely studied program is IMpower, an empowerment self-defense program for girls in high-risk environments (Baiocchi, 2017; Decker et al., 2018; Kågesten et al., 2021; Sarnquist et al., 2014; Sinclair et al., 2013). Results from studies evaluating the impact of IMpower document that it reduces sexual violence victimization among girls and increases their proclivity to report/disclose sexual victimization to others via increased verbal and physical resistance skills, confidence to use skills, and empowerment. Your Moment of Truth (YMOT) (Kågesten et al., 2021; Keller et al., 2017) is the boys’ program administered in tandem with the IMpower program for girls. YMOT focuses on improving boys’ and men’s’ attitudes toward girls and women and increasing bystander intervention in situations of gender-based violence. Results from studies examining the impact of YMOT find that the program increases gender equitable attitudes and positive bystander behavior in situations of gender-based violence. Other empowerment and/or skills-based programs (see Table 3 for a description), specifically Go Girls! (Burke et al., 2019) and Sexual Abuse Prevention Education Package (Ogunfowokan & Fajemilehin, 2012), although less researched, have promising but mixed findings.
Discussion
Results from this systematic literature review suggest that programs that focus on (1) economic strengthening, (2) teachers/schools, (3) entire families, (4) caregivers only, and (5) children/youth only are generally effective in reducing violence against children by promoting mechanisms of change (e.g., parenting skills, enhanced parent–child relationships, and resistance skills for children). However, many studies are riddled with limitations such as nonrandomized trials, short follow-up periods, small samples, and focus on a singular country or region in SSA. Furthermore, we know little about the synergistic impact of comprehensive programming cross-cutting multiple domains. For example, combining programming that focuses on entire families as well as programming specifically for caregivers and children alongside economic strengthening efforts could arguably have more robust and sustainable outcomes than any of these programs alone. Future research is needed to test this hypothesis and examine the ways to enhance uptake of evidence-based programs to prevent violence against children in regions of SSA where little to no evaluation research has occurred and rates of violence against children are especially high (Children, 2017; Ellsberg et al., 2021; Wirtz et al., 2020).
Furthermore, to date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children despite calls from organizations such as the WHO, UNICEF CDC, and the African Union that prevention initiatives are needed at the outer realms of the social ecological model if we are to truly move the needle on preventing violence against children (Basile et al., 2016; Butchart et al., 2016; Centers for Disease Control and Prevention, 2019). The joint programming of UNICEF and WHO has called for policies and laws that support economic, social, and gender equalities as well as policies and laws that hold perpetrators accountable, reduce alcohol and drug use, limit access to firearms and weapons, keep children in school, and ensure children have access to caring adults (Butchart et al., 2016, UNICEF and WHO, 2021).
Social norms-based intervention may also be an important piece of comprehensive prevention. For example, research in South Africa documents that parents overestimate the extent to which other parents are engaging in violent parenting and that these overestimations predict parents’ own use of violent behaviors toward their children (Ganz et al., 2020). Thus, one approach might be to create social norm campaigns to educate communities on actual levels of violence. More specifically, in an informal settlement in Nairobi, for example, if caregivers believe that 50% of other caregivers have slapped or hit their child in the past year but the reality is that only 10% have actually done this, a social norms marketing campaign might present as one of several posters in the informal settlement something like: “90% of caregivers in [name of informal settlement] did NOT hit or slap their child in the past year.” The implementation of social norms-based intervention will be most effective if they are conducted in a culturally sensitive manner and promote protective norms by building upon positive cultural beliefs and cultural strengths and acknowledge structural factors that impact behavior (Cislaghi & Heise, 2018). Finally, whereas a benefit of social norms intervention is that they are less costly than intensive parenting skills interventions (Gatz et al., 2005), they may not be sufficient in changing targeted individual behavior. Some caregivers may require more intensive skills-training interventions and, for families living in poverty, economic support is also likely a key component of effective prevention of violence against children.
Closely related to social norms interventions are bystander interventions, which train individuals on how to safely and effectively respond to emergency situations (Basile et al., 2016; Coker et al., 2019; Edwards et al., 2019; Polanin et al., 2012). Bystander interventions are most used as a prevention tool for bullying, dating violence, and sexual assault/harassment among adolescents (Basile et al., 2016; Coker et al., 2019; Edwards et al., 2019; Polanin et al., 2012). Indeed, bystander intervention is not widely used anywhere in the world, including SSA, for child victimization prevention although it could hold great promise in this arena. A few studies included in this review pointed to potential intervention effects on bystander behavior to prevent violence against children (Keller et al., 2017; Kyegombe et al., 2015). Training community members on how to intervene before, during, and after incidents of childhood victimization could not only stop individual incidents of childhood victimization but also lead to community norms that are intolerant of childhood victimization, thus reducing caregivers’ proclivity to perpetrate, something documented in community-wide bystander-focused prevention approaches to sexual and dating violence in the United States (Basile et al., 2016; Coker et al., 2019).
Given the limited funding for prevention efforts in SSA, it is critical that initiatives be feasible to implement, which might include reliance on community workers/laypersons, utilize minimal supplies/technology (as programs may need to be delivered in spaces without electricity, etc.), and that commercialized programs are affordable to low-resourced agencies implementing programming when possible. Funding for initiatives in SSA is most likely to come from private donors, foundations, and higher income countries, but also national governments within SSA should have a vested interest in the prevention of childhood victimization in SSA because prioritization of prevention makes a sound investment case for a brighter future. Indeed, the costs of inaction are tremendous (Badoe, 2017). For example, IMpower, a highly effective program for reducing sexual violence among girls in SSA, has been shown to be cost-effective; the program costs $1.75 (USD) for each rape prevented compared to $86 (SD) for one post-rape visit to a Nairobi hospital (Sarnquist et al., 2014). Finally given that resources are limited, it may be important to direct resources to children who are most at risk for victimization, at least as a starting point, given the realities that all children in SSA cannot immediately receive access to comprehensive programming.
It is also critical that initiatives to prevent violence against children be created or adapted with input from community members, including children and caregivers as well as community stakeholders (e.g., educators, child protection groups, religious/cultural leaders), consistent with models of community-based participatory action research (CBPAR) (Minkler & Wallerstein, 2003, 2011). CBPAR may help to not only enhance community buy-in and uptake but sustainability as well. Relatedly, interventions transported from high-income countries to SSA would need to undergo rigorous stakeholder dialogue and engagement for cultural contextualization as well as need to be tested whether this would work well in different settings. As such, communities should have input throughout and elements of interventions from other settings tailored to the local context.
Furthermore, investment in multilevel training and capacity development is paramount. Professions and professionals that interface with children and adolescents will need to be educated about violence against children and the prevention approach needs to be embedded within routine programming within social protection, labor, educational, and health sectors. Given limited resources, it is critical that paraprofessionals implement and sustain and train the trainer, including task-sharing practices. Also, diffusion effects are ideal because they mean that more than those just exposed to the program/initiative will benefit and may also help to promote intergenerational sustainability. In other areas of health behavior (e.g., HIV), research in various regions of the world including SSA suggests that laypersons who hold social capital (i.e., popular opinion leaders) can be trained to change prevention-related attitudes and behaviors (Bertrand, 2004; Centers for Disease Control and Prevention 2021; Starmann et al., 2018), and there are models of how to ensure diffusion occurs in prevention programming and how to measure it effectively (Centers for Disease Control and Prevention 2021; Edwards et al., 2022; Edwards et al., 2019; Kelly, 2004).
Monitoring and evaluation are critical so that resources are not being spent on ineffective initiatives. Nurturing care and INSPIRE frameworks offer opportunity to embed outcome and indicator development such as number of professional trainings held to address childhood victimization in schools, primary and specialist health facilities, trainings of young parents in the community and through interface with early childhood development programs, reporting on how UN Convention on the Rights of the Child and UN convention on the rights of people with disabilities guidelines are followed and implemented to address childhood victimization and violence exposures. There are a number of recommendations to develop culturally and contextually relevant tools and approaches to program and policy development and evaluation in SSA (Britto et al., 2017; Butchart et al., 2016), which we encourage readers to review because an exhaustive review of these methods is beyond the scope of this paper. A number of continuous quality improvement models exist in the field of prevention and beyond; some emphasize building internal capacity and utilizing local knowledge (Brown et al., 2017), which may be key features of monitoring and evaluation in the SSA context.
Concluding Thoughts
In sum, violence against children in SSA is a global public health crisis that leads to a host of deleterious short- and long-term outcomes. As such, there is an urgency for the immediate implementation and evaluation of comprehensive, multilevel childhood victimization prevention strategies. The field of prevention science and its application in the lower-resource contexts of SSA need tailored interventions, skilled multidisciplinary teams of researchers and policy and community advocates and practitioners to work in tandem to arrive at effective, scalable, acceptable, and cost-effective solutions. Creative solutions, reviewed herein, are needed to fund and sustain effective initiatives. Local and global ownership and leadership in promoting action, recognizing the costs of inaction around this area, and commitment to act are critical. It would be critical to develop cost-effective solutions so that their uptake is not daunting given that SSA countries have to prioritize development activities of importance to their populace. It is also important that future studies focus on the framework and evaluation designs that can capture the contextual factors better and provide improved metrics and process evaluation guidelines. It would also be important to do knowledge transfer and capacity building within these countries so that learnings and gains made can be shared and researchers, program managers, program designers, and policy makers can be trained on improved evaluation of programs addressing childhood victimization. We recognize the tremendous amount of effort that has already gone into this work, and we hope that this paper provides additional context to promote continued dialogue and sparks a renewed collective effort to make significant strides in SSA to prevent violence against children.
Footnotes
Authors’ Note
Manasi Kumar is also affiliated with Brain and Mind Institute, Aga Khan University, Kenya.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
