Sage Journals: Discover world-class research

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

childhood victimization child abuse adverse childhood experiences Sub-Saharan Africa review violence against children

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.

Table 1.

Examples of Risk and Protective Factors for Childhood Victimization in SSA.

Individual		Relational		Community
Risk	Protective	Risk	Protective	Risk	Protective
• Gender • Age • Disability • HIV status • Academic problems • Behavioral problems • Mental health problems • Drug and alcohol use • Orphan status	• Maternal employment • Social support • Knowledge of self-defense skills	• Household overcrowding • Living in a single parent household and/or with a nonnuclear family • Household poverty • Household food insecurity • Caregiver alcohol and drug use • Caregiver mental and physical health problems • Family dysfunction • Child–mother attachment problems • Parental rejection • Positive attitudes toward corporal punishment	• Maternal employment • Family support • Parental monitoring • Positive parenting skills • Empathic parenting • Healthy communication	• Community-level poverty • Community unemployment • Social stigma • Gender inequity • Crime • Inadequate social services	Cohesive communities Adequate childcare facilities Supportive and safe school environment Availability of health and social services strong community leadership

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.

Table 2.

Boolean Search Terms.

Africa OR SSA OR Sub-Saharan Africa OR Angola OR Benin OR Botswana OR Burkina Faso OR Burundi OR Cameroon OR Central African Republic OR Chad OR Congo OR Cote d'Ivoire OR Eritrea OR Ethiopia OR Gabon OR Gambia OR Ghana OR Guinea OR Guinea-Bissau OR Kenya OR Lesotho OR Liberia OR Madagascar OR Malawi OR Mali OR Mauritania OR Mauritius OR Mozambique OR Namibia OR Niger OR Nigeria OR Rwanda OR Senegal OR Sierra Leone OR Somalia OR South Africa OR United Republic of Tanzania OR Togo OR Uganda OR Zaire OR Zambia OR Zimbabwe
AND

abuse OR violence OR bullying OR assault OR rape OR victimization OR maltreatment OR neglect OR perpetration
AND

Child* OR Adolescen* OR Teen* OR Youth*OR “school aged” OR “young people” OR pre-school
AND
Prevent* OR deter* OR intervention OR treatment OR RCT

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.

Table 3.

Summary of Evaluated Programs to Prevent Violence Against Children in SSA.

Programs that Focus on Economic Strengthening (n = 4)
Program Name (Citations)	Program Overview	Methodology	Results
Government of Zimbabwe’s HSCT Program (Chakrabarti et al., 2020)	HSCT Program combines cash transfers to poor households and shares supplemental materials about child well-being materials. Transfers are made to households once in two months at designated payment points. The amount given depends on household size.	Wards were assigned to treatment or control conditions. For analyses specific to child abuse, youth (ages 13–20; sample sizes ranged from 807 to 2,319 across time points) completed questions about experiences with/exposure to physical violence at baseline and 12- and 48-month postintervention.	Although there were no reductions in physical violence experienced by youth at the 12-month-follow-up, at the 48-month follow-up there was a 19% decline in physical violence experienced by youth in treatment wards compared to control wards. Results also indicated that the ability to purchase food, improvements in caregiver well-being and reduction in youth labor may be mechanisms through which HSCT reduces physical abuse of children.
Mashinani (Sarnquist, 2018)	Mashinani (together we can succeed economically) is an 8-week program that included business training, assistance, creating a business plan, a small initial loan, weekly business, and social support meetings.	82 adult women from the intervention community (informal settlement in Nairobi Kenya) and 81 adult women in a wait list control community (a different informal settlement in Nairobi) completed baseline and 4-month follow-up surveys.	Violence against children in the household decreased significantly in the treatment relative to the control group.
SBSP (Masa et al., 2020)	SBSP included interactions with bank staff, bank transactions at school, and financial literacy. The marketing campaign was a one-time visit from bank staff followed by bank transactions that happened at a bank branch (not at school).	100 schools in Ghana were randomly assigned to the SBSP group, marketing campaign group, or control group—two treatment and control groups. Participants were 957 sexually experienced youth in Ghana, age ranging 10–19 years. Data collection included a baseline survey and a three-year follow-up survey.	Participation in the SBSP and the social marketing were associated with lower probability of sexual victimization compared to youth in the control condition. The effect size for reductions in sexual victimization was great for the youth in the SBSP treatment condition compared to the marketing treatment condition.
TU and TU+ (Ismayilova & Karimli, 2020)	Economic intervention included microfinance education training and seed capital grants. The family coaching intervention included five months of monthly education on topics such as early and forced marriage, education, and violence against children.	360 West African families were randomized into three conditions: control, economic intervention, and economic intervention plus family coaching. Children and caregivers completed baseline and 12- and 24-month follow-up surveys.	Caregivers in the economic intervention plus family coaching reported redacted use of harsh parenting compared to other groups, as well as greater intermediary variables such as parent–child relationship quality.
Programs that Focus on Teachers/School Environments (n = 4)
Program Name (Citations)	Program Overview	Methodology	Results
EmpaTeach intervention (Fabbri et al., 2021)	The EmpaTeach intervention 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.	14 schools were randomly assigned to receive the EmpaTeach intervention; there were 13 control schools. Nyarugusu Refugee Camp (in Tanzania) students (N = 1,493) completed baseline and follow-up surveys.	Prevalence of past-week violence at midline (2 months postintervention) and endline (10 months after the intervention) was not statistically different in intervention and control schools suggesting that there was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers toward primary or secondary school students.
Good School Toolkit (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)	The Good School Toolkit is a complex behavioral intervention that aims to change operational cultural at the school level, including multilayered training, processes, and school-led activities that seek to create a better learning environment, respecting others, understanding power relationships, using non-violent discipline, and enhancing teaching techniques.	42 Ugandan schools randomized to intervention or waitlist conditions and staff and students completed a baseline and 18-month post-test survey (caregivers completed the 18-month follow-up only). Sample sizes varied across time points and study aims.	Devries et al. (2015) : Prevalence of past week physical violence was lower in the intervention schools than in the control schools Devries et al. (2017) : Intervention was associated with an overall reduction in any form of violence from staff and/or peers in the past week toward both male and female students. Injuries as a result of violence from school staff were also lower in male and female students. Some suggestion that the Toolkit may have stronger effects in boys than girls. Devries et al. (2018) : Physical violence from school staff was lower in intervention schools among students with no function difficulties, some functional difficulties, and students with disabilities. Intervention also reduced violence from peers, with no evidence of difference by disability status. Kayiwa et al. (2017) : The program improved staff perceptions of school climate and improved staff mental health and job satisfaction, all of which may explain, in part, reductions in abuse of children in school settings. Knight et al. (2018) : Physical violence from school staff was lower in intervention schools among students overall. However, some students remained at increased risk for experiencing violence from staff including students, students with poor mental health, and students who experienced violence from others. Merrill et al. (2018) : Intervention effects were observed for students’ greater 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, and lower normative beliefs accepting use of physical discipline (based on caregiver reports). Greco et al. (2018) : The cost per violence aversion case was found to be $24 demonstrating the program is cost-effective. Kyegombe et al. (2017) : Qualitative analysis suggested intervention improve student–teacher relationships, positive discipline, and encouragement of positive behavior through rewards and praise.
ICC-T (Kaltenbach et al., 2018; Nkuba et al., 2018; Ssenyonga et al., 2022)	The ICC-T seeks to reduce teachers’ use of violence against students via enhancing student–teacher interactions, effective discipline strategies, and identifying “burdened” students.	Kaltenbach et al.: 30 teachers in Tanzania who completed surveys before, immediately after, and 3 months after the intervention Nkuba et al.: Cluster randomized controlled trial of 8 schools with 158 teachers and 486 students in Tanzania. Teachers and students completed surveys prior to and three months postintervention. Ssenyonga et al.: Cluster RCT of 343 teachers and 548 students from ten secondary schools in Uganda. Teachers and students completed surveys prior to and three months postintervention.	Kaltenbach et al.: Results showed that there were high levels of acceptability and feasibility. Nkuba et al.: Results showed that there were high levels of acceptability and feasibility. Efficacy supported by student and teacher reports of decreases in emotional and physical violence and decreases in positive attitudes toward violence. Ssenyonga et al.: Results showed that there were high levels of acceptability and feasibility. Results from teacher data showed decreases in physical violence toward students in treatment compared to control schools (emotional violence stayed the same in treatment schools but increased in control schools). Student data found an intervention effect for emotional violence but not physical violence.
Teachers’ Diploma Programme on Psychosocial Care, Support, and Protection (Kaljee et al., 2017)	The Teachers’ Diploma Programme on Psychosocial Care, Support, and Protection is a 15-month long-distance learning program focused on enhancing school environments, fostering psychosocial support, and facilitating school–-community relationships.	Cluster RCT of 40 primary schools in Zambia. Teachers (n = 325) and students (n = 1,378) completed surveys at baseline and 15-month postintervention.	Positive outcomes for intervention students compared to control students regarding reductions in sexual abuse and bullying which may have been driven by student changes in future orientation, respect, support, and safety as well as teacher changes in the intervention group in self-care, teaching resources, safety, social support, and gender equity.
Programs that Focus on Entire Families (n = 4)
Program Name (Citations)	Program Overview	Methodology	Results
Families Matter! Program (Miller et al., 2013, 2015; Shaw et al., 2021; Vandenhoudt et al., 2010)	5-session program designed to promote positive parenting and effective parent-child communication about sexuality	Miller et al. (2013) : Article describes implementation in 8 countries; no specific methodology Miller et al. (2015) : 18 narratives were used to guide program enhancement Shaw et al., (2021) : Pre-post design with 248 parent-child (ages 9–12) dyads in Zimbabwe. Post-test was 3-months postintervention. There was no control group. Vandenhoudt et al. (2010): Pre-post design among 375 parents of 10- to 12-year-olds in Kenya. Post-test was 12-months postintervention. There was no control group.	Miller et al. (2013) : On average >90% of participants attended all five sessions; engaging stakeholders and community members was critical to success; technical assistance and responsiveness to specific fields contributed to success Miller et al. (2015) : Article describes enhancement of a new program session based on child sexual abuse narratives Shaw et al., (2021) : Caregivers and children reported significantly higher levels of parental monitoring and communication about child sexual abuse from pre to postintervention. Significantly more parents also reported conversations with people in their community about child sexual abuse and knowledge of where to access services if their child was abused from pre to postintervention. Vandenhoudt et al. (2020): 94% attended all five intervention sessions and reported high levels of satisfaction. From pre to postintervention, parents and children reported greater use of parental positive reinforcement, parental monitoring, and increased frequency of parent-child communication about sexual issues. Although children reported improvements in their relationships with caregivers, caregivers did not report improvements in parent-child relationships.
Sinovuyo Teen (Shenderovich et al., 2018, 2019, 2020)	Sinovuyo Teen is a 14-week program for teen caregivers and children that seeks to improve parenting skills and reduce maltreatment.	270 “high-risk” families (caregivers and youth 10 to 17) in RCT who completed baseline, one-month posttest, and 5- to 9-month postintervention survey.	Shenderovich et al. (2018) : Caregivers attended 50% of sessions, and children attended 64% of sessions. Stressors such as poverty were not predictive of session attendance but children from overcrowded households were more likely to attend than those not in overcrowded households. Shenderovich et al. (2019) : Participation and implementation factors did not predict participant outcomes other than higher fidelity predicted higher child-reported maltreatment at follow-up. Shenderovich et al. (2020) : In the intervention arm the incidents of physical and emotional maltreatment reported by caregivers reduced; there were no moderators of program outcomes.
Sinovuyo Caring Families Teen Programme (Cluver et al., 2016; Cluver et al., 2017; Doubt et al., 2017)	10-session parenting program that focuses on improving parent and adolescent social support, parent-adolescent communication, and non-violent, consistent discipline.	Cluver et al. (2016) : 230 participants (caregivers and adolescents) completed pre- and postintervention surveys Cluver et al. (2017) : Pre-to post-test design in high-poverty rural South Africa with 60 caregiver-adolescent dyads. Doubt et al. (2017) : Semi-structured interviews with caregivers and adolescents (n = 42) after the intervention, observations of sessions (n = 9) and focus group discussions (n = 240 people).	Cluver et al. (2016) : Reductions in child abuse, inconsistent discipline, and poor parental monitoring. Increases in adolescent and caregiver social support and reductions in adolescent and caregiver depression and parenting stress and substance use. Cluver et al. (2017) : Reductions in child abuse as well as positive parenting and perceived parent and adolescent social support. Doubt et al. (2017 ): Participants reported via qualitative data that change driven by atmosphere (mutual respect, openness, being valued, validation, reciprocity) conducive to learning alternatives and spending time together to learn positive behaviors all led to reductions in abuse.
Skhokho (Jewkes et al., 2019)	Skhokho is a workbook that included enhanced teaching materials and a parenting program. Four sessions for parents and four sessions for teens. Session content addresses harmful gender norms, cultural tolerance of violence, and poor relationship skills.	RCT (control vs. school package vs. school package and family package) of 3756 participants (12–15 years old and caregivers) completed surveys at baseline and 18-month follow-up.	There were no significant differences on primary outcomes (e.g., physical intimate partner violence (IPV), sexual IPV, severe IPV, and non-partner rape), although effects were in the intended directions with school and family package showing slower non-partner rape than the control arm. Several secondary outcomes showed significant effects. For example, among boys, the schools intervention arm, compared to control, showed favorable effects for childhood trauma, bullying, and gender attitudes, and condom/contraceptive use, and for girls, the schools arm showed favorable effects for depression, bullying, and condom/contraceptive use.
Programs that Focus on Parent and Caregivers Only (n = 6)
Program Name (Citations)	Program Overview	Methodology	Results
“Malezi Bora na Maisha Mazuri” (Good Parenting for a Good Life) (Murphy et al., 2021)	12 sessions with interactive activities focusing on nonviolent child behavior management; also includes mid-week phone consultation. Programming was for children of street-connected women in Kenya.	Mixed method approach of feasibility data, focus groups, and pre-post surveys (post-tests were administered on the last day of programming); participants were 30 mothers in Kenya.	Increase in parenting skills and decrease in parenting stress from pre to post and reduction in physical abuse from pre to post test. Data also supported feasibility and acceptability.
Parenting for Lifelong Health (Cluver et al., 2016, 2020; Cluver et al., 2017; 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)	12 weekly sessions lasting 2–2.5 hours, 8 sessions with caregivers and adolescents jointly, four sessions with caregivers and adolescents separately. Program focuses on strengthening the ability of caregivers to provide a protective environment and positive parenting techniques.	Cluver et al. (2016) : 115 adolescent-caregiver dyads (adolescents aged 10–17), living in rural and peri-urban communities. Pre-post designed used. Cluver et al. (2017): 30 adolescent-caregiver dyads (adolescents aged 10–17), living in South Africa’s Eastern Cape province. Pre-post design used. Cluver et al. (2018) : 552 families (adolescent aged 10-18) in Eastern Cape province, South Africa. Cluver et al. (2020) : 552 families (adolescents aged 10-18) in South Africa’s Eastern Cape province. Pre-post design used. Ward et al. (2020) : 296 child-caregiver dyads (children aged 2–9 years) in Cape Town.	Cluver et al. (2016) : Reductions in child abuse, adolescent problem behavior, negative parenting, adolescent and caregiver depression, parenting stress, and caregiver substance use. Improvements in positive, involved parenting, and receipt of social support among both adolescents and caregivers. Cluver et al. (2017) : Reductions in child abuse and adolescent behavior. Improvements in positive parenting and perceived access to social support for both parents and adolescents. Cluver et al. (2018) : Lower abuse and corporal punishment. Improved positive parting, involved parenting, and less poor supervision. Reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, and substance use. Increased social support. Cluver et al. (2020) : Improved parenting skills, caregiver mental health, alcohol/drug avoidance, and household-level economic welfare. Suggests improving caregiver well-being and coping strategies leads to improvements for children and that combining parenting and economic strengthening programs may boost effectiveness against violence. Ward et al. (2020) : Increases in positive parent and child behavior, fewer child problem behaviors, and trend toward less physical and psychological discipline.
Parenting for Respectability (Wight et al., 2022)	Parenting for Respectability is a 16 sessions program for parents and caregivers of children aged from 0 to 17 years that addresses harsh parenting using attachment theory.	40 semi-structured interviews and three focus groups with program participants in Uganda.	The program was perceived to reduce harsh parenting and was deemed to be acceptable and culturally appropriate.
REAL Fathers Initiative (Ashburn et al., 2017)	The REAL Fathers Initiative is a 12-session father mentoring program and poster campaign delivered by volunteer mentors with the goal of reducing child exposure to violence at home.	Men (N = 500) in Uganda were surveyed at baseline and then again 10-months after the intervention period.	Fathers who received the intervention reported reductions in child physical punishment compared to fathers in the control condition.
Sinovuyo Caring Families Program for Young Children (Lachman et al., 2017; Lachman et al., 2018)	12 weekly sessions for caregivers of children ages 3–8 that focuses on parenting skills to prevent child abuse	68 low-income parents of children ages 3–8 randomly assigned to treatment or wait-list control condition and completed baseline survey and immediate post-test survey and observational session as well as parent interviews, facilitator focus groups and supervision sessions, and program observations.	Lachman et al. (2017) : Increases in treatment group in caregiver-reported positive parenting and observed parent-child play. Lachman et al. (2018) : High levels of engagement and acceptability and feasibility. Also, “thematic analyses identified seven themes related to program feasibility: (a) supporting participant involvement, (b) engagement in collaborative learning, (c) strengthening facilitator competency, (d) delivering nonviolent discipline skills, (e) contextualizing content, (f) receptivity to existing practices, and (g) resistance to new skills.”
SASA! (Kyegombe et al., 2015)	SASA! Is a program for individuals and communities that goes through four phases of change (Start, Awareness, Support, Action) to prevent violence against women	82 participants (36 women and 36 men) completed postintervention interviews and pre and post surveys in an RCT	Quantitative data suggests that children’s exposure to IPV was reduced in the treatment compared to the control condition. Qualitative data suggested that parenting and discipline practices among couples who experienced IPV also changed, improving parent-child relationships and reducing harsh parenting. Finally, some participants reported intervening to prevent violence against children.
Programs that Focus on Children/Youth Only (n = 4)
Program Name (Citations)	Program Overview	Methodology	Results
Go Girls! (Burke et al., 2019)	Go Girls! Is an intervention for adolescent girls that includes business training and health education to reduce HIV transmission in Mozambique.	49 interviews were conducted with girls who participated in the program, 24 interviews with girls’ heads of households; 36 interviews with influential boys/men that girls identified; and 12 focus group discussions; all were about one year postintervention	Qualitative findings suggested that the intervention was that girls had money to stay in or return to school and/or to buy necessities for themselves and their households, all of which was perceived to reduce their need for transactional or intergenerational sex. However, some girls did not make a profit and some businesses were not sustainable. Also, at times the intervention appeared to be implemented in a way that reinforced inequitable gender norms resulting in some girls feeling ashamed when they reengaged in risky sex after their businesses failed.
IMpower (Baiocchi, 2017; Decker et al., 2018; Kågesten et al., 2021; Sarnquist et al., 2014; Sinclair et al., 2013)	12 hour program (six 2-hour classes) that teaches girls to recognize danger, use verbal and physical self-defense skills to thwart a sexual assault, and to seek help for experiences of victimization.	Baiochi: 3147 girls in treatment primary schools and 2539 girls in control primary schools completed surveys prior to and 12 months after the intervention Decker et al.: Cluster RCT of primary and secondary schools in Malawi. Girls in treatment (n = 3,812) and control (n = 4,020) schools completed surveys prior to and 10.5 months after the intervention. Kagesten et al.: Focus groups and interviews with girls (n = 53) who participated in larger trials evaluating program effectiveness. Sarnquist et al.: Girls in treatment (n = 1,978) and control (n = 428) schools completed surveys prior to and 10.5 months after the intervention. Sinclair et al.: Girls in treatment (n = 402) and control (n = 120) schools completed surveys prior to and 10 months after the intervention.	Baiochi: Compared to girls in the control school, girls in the treatment school reported at follow-up less sexual assault victimization, greater self-efficacy, and greater sexual assault disclosure. Decker et al.: Girls in treatment schools reported increases in self-defense knowledge and reductions in sexual assaults compared to girls in the control schools. Kagesten et al.: Girls discussed the ways in which the IMpower program increased their self-confidence and helped them to recognize and resist sexual assault via verbal and physical strategies. Sarnquist et al.: Girls in treatment schools reported increases in sexual assault disclosure and reductions in sexual assaults compared to girls in the control schools. Sinclair et al.: Girls in treatment schools reported increases in sexual assault disclosure and reductions in sexual assaults compared to girls in the control schools. The majority of girls in treatment schools also reported using self-defense skills to thwart a sexual assault.
SAPEP (Ogunfowokan & Fajemilehin, 2012)	SAPEP is an educational intervention spread out over 10 days (30 minutes each day) that includes information about definitions and concepts of sexual harassment, sexual exploitation, and rate; information about victims, perpetrations, and settings, consequences, myths, and prevention strategies	200 high school girls from two public, mixed sex secondary schools in Nigeria completed baseline surveys and 4- and 7-month posttest surveys.	SAPEP education impacts knowledge of sexual abuse prevention, even seven months postintervention. The intervention did not have an impact on rape-related attitudes.
YMOT (Kågesten et al., 2021; Keller et al., 2017)	YMOT is an educational curriculum (six, 2-hour sessions) focused on improving boys’ and men’s’ attitudes toward girls and women and increasing bystander intervention in situations of GBV.	Keller et al.: 1,250 boys YMOT vs. 293 boys who received life skills. Data were collected at baseline and 9 months after intervention. Kagesten et al.: Focus groups and interviews with boys (n = 57) who participated in larger trials evaluating program effectiveness.	Keller et al.: Boys in the treatment condition (YMOT) had significantly higher positive attitudes toward girls/women at follow-up, whereas scores for SOC participants declined. The percentage of boys in the YMOT group who successfully intervened when witnessing violence was 78% for verbal harassment, 75% for physical threat, and 74% for physical or sexual assault. The percentage of boys in the control group who successfully intervened was 38% for verbal harassment, 33% for physical threat, and 26% for physical or sexual assault. Kagesten et al.: Boys discussed increased ability to avoid risky behaviors and problematic peer groups and to understand and respect consent.

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.

ORCID iDs

Katie M. Edwards

Natira Mullet

Author Biographies

Katie M. Edwards, PhD, is an associate professor at the University of Nebraska, Lincoln where she directs the Interpersonal Violence Research Laboratory. Using community-based participatory action research, she seeks to answer two questions in her work: (1) How do we prevent sexual and related forms of violence? and (2) How do we most effectively support survivors in the aftermath of violent victimization? To date, she has published more than 200 peer-reviewed journal articles, and over the past 10 years she has accrued over 22 million dollars in funding for her research.

Manasi Kumar is a Senior implementation scientist with the Brain and Mind Institute at the Aga Khan University in Nairobi, Kenya and affiliate Professor at the Department of Psychiatry University of Nairobi, Kenya. Her work focuses on health disparities, measurement and interventions targeting adverse childhood experiences, and depression interventions for vulnerable children and adolescents in Sub-Saharan Africa. Most of her work is directed toward perinatal adolescents and women and adolescents living with HIV. She has received funding from NIMH, Fogarty International Centre and UK’s NIHR to develop contextualized strategies and solutions for LMICs.

Emily A. Waterman is an applied developmental scientist. The aim of her research program is to both prevent sexual and dating violence among adolescents and young adults and improve outcomes for victims of sexual and dating violence. She conducts research on risk and protective factors for sexual and dating violence as well as outcome evaluations of preventative interventions. She has evaluated a variety of preventative interventions for adolescents and young adults in the areas of violence, substance use, bullying, and leisure time. She has been supported by the National Institutes of Health and Centers for Disease Control. She has a PhD in Human Development and Family Studies from Penn State University.

Natira Mullet, PhD, is an assistant professor at North Dakota State University in Human Development and Family Science. Her work focuses on utilizing cultural and familial protective factors to reduce interpersonal trauma and resulting substance use and mental health outcomes in marginalized communities.

Beatrice Madeghe, PhD, is a public health and maternal mental health researcher. Currently, she is coordinating a randomized controlled trial for implementing and evaluating group interpersonal therapy for postnatal depression in Lebanon and Kenya, the study being Supporting Mothers’ Mental health with Interpersonal Therapy. She is passionate about implementing interventions aiming to improve women’s mental health, nutritional health, and newborn outcomes. She, who began her career early, completed her PhD recently and has published eight papers.

Otsetswe Musindo is a PhD external student at Vrije Universiteit Amsterdam, Faculty of Behavioral and Movement Sciences. Her academic work has focused on neurocognitive functioning and mental health among children and adolescents living with HIV in LMICs. She is currently a Clinical Psychologist at Selibe Phikwe Government Hospital, Botswana. In addition, she is an adjunct lecturer at the Department of Psychiatry, School of Medicine, University of Botswana.

References

Abrahams

Jewkes

(2005). Effects of South African men’s having witnessed abuse of their mothers during childhood on their levels of violence in adulthood. American Journal of Public Health, 95(10), 1811–1816. https://doi.org/10.2105/AJPH.2003.035006

Adjorlolo

Adu-Poku

Andoh-Arthur

Botchway

Mlyakado

B. P.

(2017). Demographic factors, childhood maltreatment and psychological functioning among university students' in Ghana: A retrospective study. International Journal of Psychology, 52(S1), 9–17. https://doi.org/10.1002/ijop.12248

Ashburn

Kerner

Ojamuge

Lundgren

(2017). Evaluation of the responsible, engaged, and loving (REAL) fathers initiative on physical child punishment and intimate partner violence in Northern Uganda. Prevention Science, 18(7), 854–864. https://doi.org/10.1007/s11121-016-0713-9

Atilola

(2017). Child mental-health policy development in sub-Saharan Africa: Broadening the perspectives using Bronfenbrenner's ecological model. Health Promotion International, 32(2), 380–391. https://doi.org/10.1093/heapro/dau065

Badoe

(2017). A critical review of child abuse and its management in Africa. African journal of emergency medicine, 7(Supplement), S32–S35. https://doi.org/10.1016/j.afjem.2017.09.002

Baiocchi

Omondi

Langat

Boothroyd

D. B.

Sinclair

Pavia

Mulinge

Githua

golden

N. H.

Sarnquist

(2017). A behavior-based intervention that prevents sexual assault: The results of a matched-pairs, cluster-randomized study in Nairobi, Kenya. Prevention Science, 18(7), 818–827. https://doi.org/10.1007/s11121-016-0701-0

Basile

K. C.

DeGue

Jones

Freire

Dills

Smith

S. G.

Raiford

J. L.

(2016). STOP SV: A technical package to prevent sexual violence. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from March 2021, https://stacks.cdc.gov/view/cdc/39126

Bertrand

J. T.

(2004). Diffusion of innovaitons and HIV/AIDS. Journal of Health Communication, 9(S1), 113–121. https://doi.org/10.1080/10810730490271575

Britto

P. R.

Lye

S. J.

Proulx

Yousafzai

A. K.

Matthews

S. G.

Vaivada

Perez-Escamilla

Rao

Fernald

L. C.

MacMillan

Hanson

Wachs

T. D.

Yao

Yoshikawa

Cerezo

Leckman

J. F.

Bhutta

Z. A

., & Early Childhood Development Interventions Review Group for the Lancet Early Childhood Development Series Steering Committee. (2017). Nurturing care: Promoting early childhood development. The Lancet, 389(10064), 91–102. https://doi.org/10.1016/S0140-6736(16)31390-3

10.

Brown

C. H.

Curran

Palinkas

L. A.

Aarons

G. A.

Wells

K. B.

Jones

Collins

L. M.

Duan

Mittman

B. S.

Wallace

(2017). An overview of research and evaluation designs for dissemination and implementation. Annual Review of Public Health, 38, 1–22.

11.

Brown

D. W.

Riley

Butchart

Meddings

D. R.

Kann

Harvey

A. P.

(2009). Exposure to physical and sexual violence and adverse health behaviours in African children: Results from the Global School-Based Student Health Survey. Bulletin of the World Health Organization, 87, 447–455. https://doi.org/10.2471/BLT.07.047423

12.

Burke

H. M.

Packer

González-Calvo

Ridgeway

Lenzi

Green

A. F.

Moon

T. D.

(2019). A longitudinal qualitative evaluation of an economic and social empowerment intervention to reduce girls’ vulnerability to HIV in rural Mozambique. Evaluation and Program Planning, 77, 101682. https://doi.org/10.1016/j.evalprogplan.2019.101682

13.

Butchart

Hillis

Burton

(2016). INSPIRE: Seven strategies for ending violence against children. World Health Organization. https://apps.who.int/iris/handle/10665/207717

14.

Carlson

Namy

Norcini Pala

Wainberg

M. L.

Michau

Nakuti

Knight

Allen

Ikenberg

Naker

(2020). Violence against children and intimate partner violence against women: Overlap and common contributing factors among caregiver-adolescent dyads. BMC Public Health, 20(1), 124. https://doi.org/10.1186/s12889-019-8115-0

15.

Centers for Disease Control and Prevention. (2015). The social-ecological model: A framework for prevention. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html

16.

Centers for Disease Control and Prevention. (2019). Preventing adverse childhood experiences: Leveraging the best available evidence. National Center for Injury Prevention and Control Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf

17.

Centers for Disease Control and Prevention. (2021). Popular opinion leaders. https://www.cdc.gov/hiv/effective-interventions/prevent/popular-opinion-leader/index.html

18.

Cerna-Turoff

Fang

Meierkord

Yanguela

Bangirana

C. A.

Meinck

(2021). Factors associated with violence against children in low-and middle-income countries: A systematic review and meta-regression of nationally representative data. Trauma, Violence, & Abuse, 22(2), 219–232. https://doi.org/10.1177/1524838020985532

19.

Chakrabarti

Handa

Angeles

Seidenfeld

(2020). A cash plus program reduces youth exposure to physical violence in Zimbabwe. World Development, 134, 105037. https://doi.org/10.1016/j.worlddev.2020.105037

20.

Chakravarty

Hoff

C. C.

Neilands

T. B.

Darbes

L. A.

(2012). Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS and Behavior, 16(7), 1944–1948. https://doi.org/10.1007/s10461-012-0181-6

21.

Children

S. T.

(2017). Stolen Childhoods. https://www.savethechildren.org/content/dam/usa/reports/emergency-response/end-of-childhood-report.PDF

22.

Cislaghi

Heise

(2018). Theory and practice of social norms interventions: Eight common pitfalls. Global Health, 14(1), 83. https://doi.org/10.1186/s12992-018-0398-x

23.

Cluver

Meinck

Yakubovich

Doubt

Redfern

Ward

Salah

De Stone

Petersen

Mpimpilashe

Romero

R. H.

Ncobo

Lachman

Tsoanyane

Shenderovich

Loening

Byrne

Sherr

Kaplan

Gardner

(2016). Reducing child abuse amongst adolescents in low-and middle-income countries: A pre-post trial in South Africa. BMC Public Health, 16, 567. https://doi.org/10.1186/s12889-016-3262-z

24.

Cluver

Shenderovich

Meinck

Berezin

Doubt

Ward

C. L.

Parra-Cardona

Lombard

Lachman

Wittesaele

Wessels

Gardner

(2020). Parenting, mental health and economic pathways to prevention of violence against children in South Africa. Social Science & Medicine, 262, 113194. https://doi.org/10.1016/j.socscimed.2020.113194

25.

Cluver

L. D.

Lachman

J. M.

Ward

C. L.

Gardner

Peterson

Hutchings

J. M.

Mikton

Meinck

Tsoanyane

Doubt

Boyes

Redfern

A. A.

(2017). Development of a parenting support program to prevent abuse of adolescents in South Africa: Findings from a pilot pre-post study. Research on Social Work Practice, 27(7), 758–766. https://doi.org/10.1177/1049731516628647

26.

Cluver

L. D.

Meinck

Steinert

J. I.

Shenderovich

Doubt

Romero

R. H.

Lombard

C. J.

Redfern

Ward

C. L.

Tsoanyane

Nzima

Sibanda

Wittesaele

De Stone

Boyes

M. E.

Catanho

McLaren Lachman

Salah

Nocuza

Gardner

(2018). Parenting for lifelong health: A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. BMJ global health, 3(1), e000539. https://doi.org/10.1136/bmjgh-2017-000539

27.

Cluver

L. D.

Meinck

Steinert

J. I.

Shenderovich

Doubt

Romero

R. H.

Lombard

C. J.

Redfern

Ward

C. L.

Tsoanyane

Nzima

Sibanda

Wittesaele

De Stone

Boyes

M. E.

Catanho

McLaren Lachman

J. S.

Nasteha Nocuza

Gardner

(2018). Parenting for lifelong health: A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. BMJ Global Health, 3(1), e000539. https://doi.org/10.1136/bmjgh-2017-000539

28.

Coker

A. L.

Bush

H. M.

Brancato

C. J.

Clear

E. R.

Recktenwald

E. A.

(2019). Bystander program effectiveness to reduce violence acceptance: RCT in high schools. Journal of Family Violence, 34(3), 153–164. https://doi.org/10.1007/s10896-018-9961-8

29.

Collings

S. J.

(2012). Child sexual abuse experiences mediate the relationship between poverty and posttraumatic stress disorder. Social Behavior and Personality, 40, e2730. https://doi.org/10.2224/sbp.2012.40.6.983

30.

Cromback

Bambonyé

(2015). Intergenerational violence in Burundi: Experienced childhood maltreatment increases the risk of abusive child rearing and intimate partner violence. European Journal of Psychotraumatology, 6. https://doi.org/10.3402/ejpt.v6.26995

31.

Culbreth

Masyn

K. E.

Swahn

M. H.

Self-Brown

Kasirye

(2021). The interrelationships of child maltreatment, alcohol use, and suicidal ideation among youth living in the slums of Kampala, Uganda. Child Abuse & Neglect, 112, 104904. https://doi.org/10.1016/j.chiabu.2020.104904

32.

Dako-Gyeke

(2019). Perspectives of key informants on child abuse: Qualitative evidence from Northern Ghana. Child and Adolescent Social Work Journal, 36, 15–169. https://doi.org/10.1007%2Fs10560-018-0560-6

33.

Decker

M. R.

Wood

S. N.

Ndinda

Yenokyan

Sinclair

Maksud

Ross

Omondi

Ndirangu

(2018). Sexual violence among adolescent girls and young women in Malawi: a cluster-randomized controlled implementation trial of empowerment self-defense training. BMC Public Health, 18(1341), 1–12. https://doi.org/10.1186/s12889-018-6220-0

34.

Dekel

(2018). Exploring adverse parent-child relationships from the perspective of convicted child murderers: A South African qualitative study. PLoS ONE, 13, e0196772. https://doi.org/10.1371/journal.pone.0196772

35.

Devries

Kuper

Knight

Allen

Kyegombe

Banks

L. M.

Kelly

Naker

(2018). Reducing physical violence toward primary school students with disabilities. Journal of Adolescent Health, 62(3), 303–310. https://doi.org/10.1016/j.jadohealth.2017.09.004

36.

Devries

K. M.

Knight

Allen

Parkes

Kyegombe

Naker

(2017). Does the Good Schools Toolkit reduce physical, sexual and emotional violence, and injuries, in girls and boys equally? A cluster-randomised controlled trial. Prevention Science, 18(7), 839–853. https://doi.org/10.1007/s11121-017-0775-3

37.

Devries

K. M.

Knight

Child

J. C.

Mirembe

Nakuti

Jones

Sturgess

Allen

Kyegombe

Parkes

Walakira

Elbourne

Watts

Naker

(2015). The Good School Toolkit for reducing physical violence from school staff to primary school students: A cluster-randomised controlled trial in Uganda. The Lancet Global Health, 3(7), e378–e386. https://doi.org/10.1016/S2214-109X(15)00060-1

38.

Doubt

Bray

Loening-Voysey

Cluver

Byrne

Nzima

King

Shenderovich

Steinert

Medley

(2017). “It has changed”: Understanding change in a parenting program in South Africa. Annals of Global Health, 83(5–6), 767–776. https://doi.org/10.1016/j.aogh.2017.10.021

39.

Edwards

K. M.

Banyard

V. L.

Sessarego

S. N.

Mitchell

K. J.

Chang

(2019). Evaluation of a bystander-focused violence prevention program with high school students. Prevention Science, 20(4), 488–498. https://doi.org/10.1007/s11121-019-01000-w

40.

Edwards

K. M.

Banyard

V. L.

Waterman

E. A.

Hopfauf

S. L.

Shin

H. S.

Simon

Valente

T. W.

(2022). Use of social network analysis to identify popular opinion leaders for a youth-led sexual violence prevention initiative. Violence Against Women, 28(2), 664–685. https://doi.org/10.1177/1077801221994907

41.

Edwards

K. M.

Waterman

E. A.

Kagunda

Bikeri

(2019). Popular opinion leaders' perspectives on preventing gender-based violence and problem drinking among Kenyan college students: A brief report. Journal of Interpersonal Violence, 36(19–20), 9838–9849. https://doi.org/10.1177/0886260519861654

42.

Ellsberg

Murphy

Blackwell

Macrae

Reddy

Hollowell

Hess

Contreras-Urbina

(2021). “If you are born a girl in this crisis, you are born a problem”: Patterns and drivers of violence against women and girls in conflict-affected South Sudan. Violence Against Women, 27(15–16), 3030–3055. https://doi.org/10.1177/1077801221996463

43.

Evidence to End FGM/C. (2018). Exploring the association between female genital mutilation/cutting and early/child marriage. Population Council. https://doi.org/10.31899/sbsr2018.1017

44.

Fabbri

Rodrigues

Leurent

Allen

Qiu

Zuakulu

Nombo

Kaemingk

De Filippo

Torrats-Espinosa

Shayo

Barongo

Greco

Tol

Devries

K. M.

(2021). The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial. PLOS Medicine, 18(10), e1003808. https://doi.org/10.1371/journal.pmed.1003808

45.

Fakunmoju

S. B.

Bammeke

F. O.

(2015). Anxiety disorders and depression among high school adolescents and youths in Nigeria: Understanding differential effects of physical abuse at home and school. Journal of Adolescence, 42, 1–10. https://doi.org/10.1016/j.adolescence.2015.03.012

46.

Finkelhor

Shattuck

Turner

H. A.

Hamby

(2014). The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 55(3), 329–333. https://doi.org/10.1016/j.jadohealth.2013.12.026

47.

Ganz

Neville

F. G.

Kassanjee

Ward

C. L.

(2020). Parental misperceptions of in-group norms for child discipline. Journal of Community & Applied Social Psychology, 30(6), 628–644. https://doi.org/10.1002/casp.2466

48.

Gatz

Russell

L. A.

Grady

Kram-Fernandez

Clark

Marshall

(2005). Women's recollections of victimization, psychological problems, and substance use. Journal of Community Psychology, 33(4), 479–493. https://doi.org/10.1002/jcop.20064

49.

Gibbs

Dunkle

Washington

Willan

Shai

Jewkes

(2018). Childhood traumas as a risk factor for HIV-risk behaviours amongst young women and men living in urban informal settlements in South Africa: A cross-sectional study. PLoS One, 13(4), e0195369. https://doi.org/10.1371/journal.pone.0195369

50.

Girgira

Tilahun

Bacha

(2014). Time to presentation, pattern and immediate health effects of alleged child sexual abuse at two tertiary hospitals in Addis Ababa, Ethiopia. BMC Public Health, 14(1), 92. https://doi.org/10.1186/1471-2458-14-92

51.

Goodman

M. L.

Grouls

Chen

C. X.

Keiser

P. H.

Gitari

(2017). Adverse childhood experiences predict alcohol consumption patterns among Kenyan mothers. Substance Use & Misuse, 52(5), 632–638. https://doi.org/10.1080/10826084.2016.1245748

52.

Greco

Knight

Ssekadde

Namy

Naker

Devries

(2018). Economic evaluation of the Good School Toolkit: An intervention for reducing violence in primary schools in Uganda. BMJ Global Health, 3(2), e000526. https://doi.org/10.1136/bmjgh-2017-000526

53.

Hayes

B. E.

van Baak

(2017). Risk factors of physical and sexual abuse for women in Mali: Findings from a nationally representative sample. Violence Against Women, 23(11), 1361–1381. https://doi.org/10.1177/1077801216658979

54.

Herrenkohl

T. I.

Lonne

Scott

Higgins

(2019). New directions for public health approaches: Key themes and issues. In Herrenkohl

(Ed.), Re-visioning public health approaches for protecting children (Vol. 9, pp. 487–499). Springer. https://doi.org/10.1007/978-3-030-05858-6_28

55.

Hounmenou

Her

(2018). Distinctiveness in the commercial sexual exploitation of children in Sub-Saharan Africa: A review of the literature. Journal of Human Trafficking, 4(4), 298–326. https://doi.org/10.1080/23322705.2017.1365567

56.

Hsiao

Fry

Ward

C. L.

Ganz

Casey

Zheng

Fang

(2018). Violence against children in South Africa: The cost of inaction to society and the economy. BMJ Global Health, 3(1), e000573. https://doi.org/10.1136/bmjgh-2017-000573

57.

International Labour Office. (2017). Global estimates of modern slavery: Forced labour and forced marriage. International Labour Organization and Walk Free Foundation. https://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/publication/wcms_575479.pdf

58.

Ismayilova

Karimli

(2020). Harsh parenting and violence against children: A trial with ultrapoor families in Francophone West Africa. Journal of Clinical Child & Adolescent Psychology, 49(1), 18–35. https://doi.org/10.1080/15374416.2018.1485103

59.

Jewkes

Gevers

Chirwa

Mahlangu

Shamu

Shai

Lombard

(2019). RCT evaluation of Skhokho: A holistic school intervention to prevent gender-based violence among South African Grade 8s. PLoS One, 14(10), e0223562. https://doi.org/10.1371/journal.pone.0223562

60.

Kågesten

A. E.

Oware

P. M.

Ntinyari

Langat

Mboya

Ekström

A. M.

(2021). Young people’s experiences with an empowerment-based behavior change intervention to prevent sexual violence in Nairobi informal settlements: A qualitative study. Global Health: Science and Practice, 9(3), 508–522. https://doi.org/10.9745/GHSP-D-21-00105

61.

Kaljee

Zhang

Langhaug

Munjile

Tembo

Menon

Stanton

Malungo

(2017). A randomized-control trial for the teachers’ diploma programme on psychosocial care, support and protection in Zambian government primary schools. Psychology, Health & Medicine, 22(4), 381–392. https://doi.org/10.1080/13548506.2016.1153682

62.

Kaltenbach

Hermenau

Nkuba

Goessmann

Hecker

(2018). Improving interaction competencies with children—A pilot feasibility study to reduce school corporal punishment. Journal of Aggression, Maltreatment & Trauma, 27(1), 35–53. https://doi.org/10.1080/10926771.2017.1357060

63.

Kassa

M. D.

Grace

J. M.

(2020). Race against death or starvation? COVID-19 and its impact on African populations. Public Health Reviews, 41(1), 30. https://doi.org/10.1186/s40985-020-00139-0

64.

Kayiwa

Clarke

Knight

Allen

Walakira

Namy

Merrill

K. G.

Naker

Devries

(2017). Effect of the good school toolkit on school staff mental health, sense of job satisfaction and perceptions of school climate: Secondary analysis of a cluster randomised trial. Preventive Medicine, 101, 84–90. https://doi.org/10.1016/j.ypmed.2017.05.022

65.

Keller

Mboya

B. O.

Sinclair

Githua

O. W.

Mulinge

Bergholz

Paiva

Golden

N. H.

Kapphahn

(2017). A 6-week school curriculum improves boys’ attitudes and behaviors related to gender-based violence in Kenya. Journal of Interpersonal Violence, 32(4), 535–557. https://doi.org/10.1177/0886260515586367

66.

Kelly

J. A.

(2004). Popular opinion leaders and HIV prevention peer education: Resolving discrepant findings, and implications for the development of effective community programmes. AIDS Care, 16(2), 139–150. https://doi.org/10.1080/09540120410001640986

67.

Knight

Allen

Mirembe

Nakuti

Namy

Child

J. C.

Sturgess

Kyegombe

Walakira

E. J.

Elbourne

Naker

Devries

K. M.

(2018). Implementation of the good school toolkit in Uganda: A quantitative process evaluation of a successful violence prevention program. BMC Public Health, 18(1), 608. https://doi.org/10.1186/s12889-018-5462-1

68.

Kyegombe

Abramsky

Devries

K. M.

Michau

Nakuti

Starmann

Musuya

Heise

Watts

(2015). What is the potential for interventions designed to prevent violence against women to reduce children's exposure to violence? Findings from the SASA! study, Kampala, Uganda. Child Abuse & Neglect, 50, 128–140.

69.

Kyegombe

Namakula

Mulindwa

Lwanyaaga

Naker

Namy

Nakuti

Parkes

Knight

Walakira

Devries

K. M.

(2017). How did the Good School Toolkit reduce the risk of past week physical violence from teachers to students? Qualitative findings on pathways of change in schools in Luwero, Uganda. Social Science & Medicine, 180, 10–19. https://doi.org/10.1016/j.socscimed.2017.03.008

70.

Lachman

J. M.

Cluver

Ward

C. L.

Hutchings

Mlotshwa

Wessels

Gardner

(2017). Randomized controlled trial of a parenting program to reduce the risk of child maltreatment in South Africa. Child Abuse & Neglect, 72, 338–351. https://doi.org/10.1016/j.chiabu.2017.08.014

71.

Lachman

J. M.

Kelly

Cluver

Ward

C. L.

Hutchings

Gardner

(2018). Process evaluation of a parenting program for low-income families in South Africa. Research on Social Work Practice, 28(2), 188–202.

72.

Leoschut

Kafaar

(2017). The frequency and predictors of poly-victimisation of South African children and the role of schools in its prevention. Psychology, Health & Medicine, 22(Suppl 1), 81–93. https://doi.org/10.1080/13548506.2016.1273533

73.

Letourneau

E. J.

Schaeffer

C. M.

Bradshaw

C. P.

Feder

K. A.

(2017). Preventing the onset of child sexual abuse by targeting young adolescents with universal prevention programming. Child Maltreatment, 22(2), 100–111. https://doi.org/10.1177/1077559517692439

74.

Masa

Chowa

Sherraden

(2020). An evaluation of a school-based savings program and its effect on sexual risk behaviors and victimization among young Ghanaians. Youth & Society, 52(7), 1083–1106. https://doi.org/10.1177/0044118X18824730

75.

Meinck

Cluver

L. D.

Boyes

M. E.

Loening-Voysey

(2016). Physical, emotional and sexual adolescent abuse victimisation in South Africa: Prevalence, incidence, perpetrators and locations. J Epidemiol Community Health, 70(9), 910–916. https://doi.org/10.1136/jech-2015-205860

76.

Meinck

Cluver

L. D.

Boyes

M. E.

Mhlongo

E. L.

(2015). Risk and protective factors for physical and sexual abuse of children and adolescents in Africa: A review and implications for practice. Trauma, Violence, & Abuse, 16(1), 81–107. https://doi.org/10.1177/1524838014523336

77.

Merrill

K. G.

Knight

Namy

Allen

Naker

Devries

K. M.

(2018). Effects of a violence prevention intervention in schools and surrounding communities: Secondary analysis of a cluster randomised-controlled trial in Uganda. Child Abuse & Neglect, 84, 182–195. https://doi.org/10.1016/j.chiabu.2018.06.007

78.

Miller

K. S.

Lasswell

S. M.

Riley

D. B.

Poulsen

M. N.

(2013). Families matter! Presexual risk prevention intervention. American Journal of Public Health, 103(11), e16-e20. https://doi.org/10.2105/AJPH.2013.301417

79.

Miller

K. S.

Winskell

Pruitt

K. L.

Saul

(2015). Curriculum development around parenting strategies to prevent and respond to child sexual abuse in sub-Saharan Africa: A program collaboration between families matter! And global dialogues. Journal of Child Sexual Abuse, 24(8), 839–852. https://doi.org/10.1080/10538712.2015.1088913

80.

Minkler

Wallerstein

(2003). Introduction to community based participatory research. In Minkler

Wallerstein

(Eds.), Community based participatory research for health (1st ed.). Jossey-Bass. http://hdl.handle.net/10822/1003840

81.

Minkler

Wallerstein

(Eds.) (2011). Community-based participatory research for health: From process to outcomes (2nd ed.). Jossey-Bass. https://www.amazon.com/Community-Based-Participatory-Research-Health-Outcomes/dp/0470260432

82.

Mukherjee

Kovacevic

Abdreyeva

Bonini

Calderon

Cazabat

Hsu

Y.-C.

Lengfelder

Luongo

Mukhopadhyay

Nayyar

Tapia

(2016). Human development report. United Nations Development Programme. https://sustainabledevelopment.un.org/content/documents/25212016_human_development_report.pdf

83.

Muluneh

M. D.

Francis

Agho

Stulz

(2021). A systematic review and meta-analysis of associated factors of gender-based violence against women in Sub-Saharan Africa. International Journal of Environmental Research and Public Health, 18(9), 4407. https://doi.org/10.3390/ijerph18094407

84.

Murphy

Embleton

Lachman

J. M.

Owino

Kirwa

Makori

Braitstein

(2021). “From analog to digital”: The feasibility, acceptability, and preliminary outcomes of a positive parenting program for street-connected mothers in Kenya. Children and Youth Services Review, 127, 106077. https://doi.org/10.1016/j.childyouth.2021.106077

85.

Nkuba

Hermenau

Goessmann

Hecker

(2018). Reducing violence by teachers using the preventative intervention Interaction Competencies with Children for Teachers (ICC-T): A cluster randomized controlled trial at public secondary schools in Tanzania. PLoS One, 13(8), e0201362. https://doi.org/10.1371/journal.pone.0201362

86.

Ogunfowokan

A. A.

Fajemilehin

R. B.

(2012). Impact of a school-based sexual abuse prevention education program on the knowledge and attitude of high school girls. The Journal of School Nursing, 28(6), 459–468. https://doi.org/10.1177/1059840512446949

87.

Polanin

J. R.

Espelage

D. L.

Pigott

T. D.

(2012). A meta-analysis of school-based bullying prevention programs' effects on bystander intervention behavior. School Psychology Review, 41(1), 47–65. https://doi.org/10.1080/02796015.2012.12087375

88.

Radford

Allnock

Hynes

Shorrock

(2020). Action to end child sexual abuse and exploitation: A review of the evidence. Unicef. http://hdl.handle.net/10547/625019

89.

Russell

Higgins

Posso

(2020). Preventing child sexual abuse: A systematic review of interventions and their efficacy in developing countries. Child Abuse & Neglect, 102, 104395. https://doi.org/10.1016/j.chiabu.2020.104395

90.

Sabri

Selke

Smudde

Bourey

Murray

S. M.

(2022). Gender-based violence interventions in low-and middle-income countries: A systematic review of interventions at structural, community, interpersonal, individual, and multiple levels. Trauma, Violence, & Abuse. Advance online publication. 1–17. https://doi.org/10.1177/15248380221126181

91.

Sarnquist

Omondi

Sinclair

Gitau

Paiva

Mulinge

Cornfield

D. N.

Maldonado

(2014). Rape prevention through empowerment of adolescent girls. Pediatrics, 133(5), e1226–e1232. https://doi.org/10.1542/peds.2013-3414

92.

Sarnquist

Ouma

Lang'at

Lubanga

Sinclair

Baiocchi

M. T.

Cornfield

D. N.

(2018). The effect of combining business training, microfinance, and support group participation on economic status and intimate partner violence in an unplanned settlement of Nairobi, Kenya. Journal of Interpersonal Violence, 36(7–8), 3903–3921. https://doi.org/10.1177/0886260518779067

93.

Shaw

Cham

H. J.

Galloway

Winskell

Mupambireyi

Kasese

Bangani

Miller

(2021). Engaging parents in zimbabwe to prevent and respond to child sexual abuse: A pilot evaluation. Journal of Child and Family Studies, 30(5), 1314–1326. https://doi.org/10.1007/s10826-021-01938-y

94.

Shenderovich

Cluver

Eisner

Murray

A. L.

(2020). Moderators of treatment effects in a child maltreatment prevention programme in South Africa. Child Abuse & Neglect, 106, 104519. https://doi.org/10.1016/j.chiabu.2020.104519

95.

Shenderovich

Eisner

Cluver

Doubt

Berezin

Majokweni

Murray

A. L.

(2018). What affects attendance and engagement in a parenting program in South Africa? Prevention Science, 19(7), 977–986. https://doi.org/10.1007/s11121-018-0941-2

96.

Shenderovich

Eisner

Cluver

Doubt

Berezin

Majokweni

Murray

A. L.

(2019). Delivering a parenting program in South Africa: the impact of implementation on outcomes. Journal of Child and Family Studies, 28(4), 1005–1017. https://doi.org/10.1007/s10826-018-01319-y

97.

Sinclair

Otieno

Mulinge

Kapphahn

Golden

N. H.

(2013). A self-defense program reduces the incidence of sexual assault in Kenyan adolescent girls. Journal of Adolescent Health, 53(3), 374–380. https://doi.org/10.1016/j.jadohealth.2013.04.008

98.

Skeen

Tomlinson

(2013). A public health approach to preventing child abuse in low-and middle-income countries: A call for action. International Journal of Psychology, 48(2), 108–116. https://doi.org/10.1080/00207594.2012.737467

99.

Ssenyonga

Katharin

Mattonet

Nkuba

Hecker

(2022). Reducing teachers’ use of violence toward students: A cluster-randomized controlled trial in secondary schools in Southwestern Uganda. Children and Youth Services Review, 138, 106521. https://doi.org/10.1016/j.childyouth.2022.106521

100.

Ssewamala

F. M.

Sensoy Bahar

(2022). Children at the intersection of hiv, poverty, and mental health in Sub-Saharan Africa (SSA). In Ssewamala

F. M.

Sensoy Bahar

McKay

M. M.

(Eds.), Child behavioral health in Sub-Saharan Africa (pp. 3–17). Springer. https://doi.org/10.1007/978-3-030-83707-5_1

101.

Starmann

Heise

L. L.

Kyegombe

Devries

K. M.

Abramsky

Michau

Musuya

Watts

Collumbien

(2018). Examining diffusion to understand the how of SASA!, A violence against women and HIV prevention intervention in Uganda. BMC Public Health, 18(1), 616. https://doi.org/10.1186/s12889-018-5508-4

102.

UNICEF & WHO. (2021). Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. World Health Organization and the United Nations Children’s Fund (UNICEF). Licence: CC BY-NC-SA 3.0 IGO.

103.

Vandenhoudt

Miller

K. S.

Ochura

Wyckoff

S. C.

Obong'o

C. O.

Otwoma

N. J.

Poulsen

M. N.

Menten

Marum

Buvé

(2010). Evaluation of a US evidence-based parenting intervention in rural Western Kenya: from parents matter! To families matter! AIDS Education and Prevention, 22(4), 328–343. https://doi.org/10.1521/aeap.2010.22.4.328

104.

Ward

C. L.

Wessels

I. M.

Lachman

J. M.

Hutchings

Cluver

L. D.

Kassanjee

Nhapi

Little

Gardner

(2020). Parenting for Lifelong Health for Young Children: A randomized controlled trial of a parenting program in South Africa to prevent harsh parenting and child conduct problems. Journal of Child Psychology and Psychiatry, 61(4), 503–512. https://doi.org/10.1111/jcpp.13129

105.

Whitaker

D. J.

Lutzker

J. R.

Shelley

G. A.

(2005). Child maltreatment prevention priorities at the Centers for Disease Control and Prevention. Child Maltreatment, 10(3), 245–259. https://doi.org/10.1177/1077559505274674

106.

Wight

Sekiwunga

Namutebi

Zalwango

Siu

G. E.

(2022). A Ugandan parenting programme to prevent gender-based violence: Description and formative evaluation. Research on Social Work Practice, 32(4), 448–464. https://doi.org/10.1177/10497315211056246

107.

Wirtz

A. L.

Poteat

T. C.

Malik

Glass

(2020). Gender-based violence against transgender people in the United States: A call for research and programming. Trauma, Violence, & Abuse, 21(2), 227–241. https://doi.org/10.1177/1524838018757749

108.

World Bank. (2022). Sub-Saharan Africa. In Global economic prospects: The global economy in transition. World Bank Group. https://doi.org/10.1596/978-1-4648-0483-0_ch2_SSA

109.

World Health Organization. (2020). Global status report on preventing violence against children 2020. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/332394/9789240004191-eng.pdf

110.

Yount

K. M.

Krause

K. H.

Miedema

S. S.

(2017). Preventing gender-based violence victimization in adolescent girls in lower-income countries: Systematic review of reviews. Social Science & Medicine, 192, 1–13. https://doi.org/10.1016/j.socscimed.2017.08.038

Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review

Abstract

Keywords

The Sub-Saharan African Context

Risk and Protective Factors for Childhood Victimization in SSA

Methodology

Study Inclusion Criteria

Search Strategy

Search Outcome

Results

Programs That Focus on Economic Strengthening

Programs That Focus on Teachers/Schools

Programs That Focus on Entire Families

Programs That Focus on Caregivers Only

Programs That Focus on Children/Youth

Discussion

Concluding Thoughts

Footnotes

Authors’ Note

Declaration of Conflicting Interests

Funding

ORCID iDs

Author Biographies

References