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Abstract

Background:

Sexual violence (SV) is a profound human rights violation and public health issue worldwide, with significant physical, psychological, and financial impacts. It disproportionately affects women and has both immediate and long-term consequences. In higher learning institutions (HLIs), SV remains prevalent, particularly in low- and middle-income countries, where addressing it is challenging due to the lack of context-specific, evidence-based interventions. Generating such interventions first requires robust evidence on the prevalence and associated factors of SV within local settings.

Objectives:

This study assessed the prevalence of SV and its contributing factors in Tanzania’s HLIs, with the aim of providing insights that can inform the design of context-specific interventions to reduce SV in these settings.

Design:

This study employed a quantitative, cross-sectional, analytical design.

Methods:

The study was conducted among female nursing students at Muhimbili University of Health and Allied Sciences, a public institution, and Herbert Kairuki Memorial University, a private institution, in Dar es Salaam. Data were collected through a self-administered questionnaire and analyzed using the IBM SPSS version 25. The chi-square test was used to assess associations between sociodemographic factors and SV, followed by multiple logistic regression to identify factors independently associated with SV.

Results:

Of the 296 participants, 21 (7.1%) reported experiencing SV since enrollment at the university, with fellow students primarily identified as perpetrators. Reporting of SV and legal actions was very low, with only 9.5% reporting incidents and 4.8% taking legal action. Studying at a public university (adjusted odds ratio: 4.939; 95% confidence interval: 1.611, 15.141; p = 0.005) was a statistically significant factor associated with the experience of SV.

Conclusion:

This study revealed notable SV prevalence among female students in the two HLIs, especially the public institution. Underreporting and lack of legal action persist, with students often perpetrators. Urgent institutional interventions are needed to raise awareness, promote reporting, and target perpetrators.

Plain language summary

How common sexual violence is and what contributes to it: A study of female nursing students in Tanzanian universities

Background: Sexual violence (SV) is a serious global issue that affects many people, especially women. It causes lasting physical, emotional, and financial harm. In colleges and universities, especially in low- and middle-income countries like Tanzania, SV is still common, and finding effective ways to address it remains a challenge. Purpose of the Study: This study looked at how common SV is among female nursing students in Tanzania and what factors may contribute to it. The goal was to help create better ways to prevent and respond to SV in these settings. How the Study Was Done: Researchers surveyed 296 female nursing students from one public and one private university in Dar es Salaam. Students filled out anonymous questionnaires about their experiences. Key Findings: About 7% of the students said they had experienced sexual violence since starting university. Most cases involved fellow students as the offenders. Very few victims reported the incidents or saw legal action taken. Students at the public university were more likely to report SV. Conclusion: Sexual violence is a real problem in Tanzanian universities, especially public ones. More action is needed to raise awareness, encourage reporting, and address student perpetrators.

Keywords

sexual violence prevalence associated factors nursing students higher learning institutions

Introduction

Sexual violence (SV) is one of the common forms of violence against women, alongside physical, psychological, and economic violence.¹ In a recent study in sub-Saharan Africa (SSA), for example, the overall lifetime prevalence of gender-based violence (GBV) was estimated at 53%, with SV at 26%, physical violence at 19%, and psychological violence at 27%.² SV is a profound human rights violation and a major public health issue worldwide, with a high prevalence and extensive human and financial costs.^3,4 There is no universally agreed-upon definition for SV, and this is challenging since it is defined differently in different settings and contexts. Nevertheless, SV is defined by the World Health Organization (WHO) as “any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting.” It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part, or object, attempted rape, unwanted sexual touching, and other non-contact forms.⁵ Global statistics indicate that about 1 in 3 (31%) of women have been subjected to either physical and/or sexual intimate partner violence or non-partner SV in their lifetime, with the rate being higher (36.6%) in the African region.⁶

SV is widely documented across academic settings worldwide, including higher learning institutions (HLIs), as evidenced by a systematic review of international studies.⁷ Reported prevalence rates among university students vary considerably due to differences in definitions, forms of SV assessed, time frames, and study methodologies.^8,9 Despite this variation, evidence consistently demonstrates that SV remains a persistent problem within HLIs, with estimates ranging from 4.7% to 58% and disproportionately affecting female students.¹⁰ Several factors contribute to the experience of SV among female students, including demographic characteristics, institutional climate, financial status, educational environment, geographic location, and institutional size and density.¹¹ Despite the documented incidence of SV and its adverse consequences, female students rarely seek help, whether from informal sources or authorities.⁹ Key barriers to accessing support services include feelings of shame, guilt, and embarrassment, as well as concerns about family and friends discovering the incident, and a belief that the victimization was not serious enough to report.¹⁰

The consequences SV among female students extend beyond immediate harm to deeply affect their educational trajectories within HLIs. Survivors often experience declines in academic performance, including lower grade point averages, difficulties with concentration and self-regulated learning, and increased dropout rates.^12
–14 In addition, SV contributes to psychological distress, such as depression, anxiety, post-traumatic stress, suicidal thoughts, and substance use, that further undermines students’ ability to engage in academic and social life on campus.^12,15,16 The stigma associated with SV can also discourage help-seeking, isolate survivors from peers, and erode their sense of safety within the university environment.^17,18 Collectively, these consequences limit female students’ ability to pursue and complete higher education successfully, highlighting the urgent need for targeted prevention and support strategies within HLIs.

Addressing SV in HLIs requires an evidence-based understanding of its prevalence, causes, and risk factors to design effective responses.¹⁹ However, in low- and middle-income countries (LMICs), efforts to curb SV and other forms of GBV are constrained by policies that often rely on evidence from high-income countries. Such policies do not adequately reflect the unique institutional, cultural, and resource contexts of HLIs in LMICs.²⁰ This gap persists largely because few empirical studies have examined SV within HLIs in LMICs, limiting the evidence base needed to inform context-appropriate interventions and policies.²¹ Existing GBV frameworks in these settings tend to emphasize legal processes and grievance mechanisms while overlooking institutional dynamics and the role of perpetrators in sustaining environments where SV occurs.²² In Tanzania, for example, while a national GBV policy exists,²³ its translation into effective action within HLIs remains limited, partly due to the lack of evidence on the magnitude of various forms of GBV and associated factors in these settings. Against this backdrop, our study addresses this critical gap by examining the prevalence and correlates of SV among female nursing students in Tanzanian HLIs, thereby generating context-specific evidence to inform policies and interventions that better protect female students and foster safer learning environments.

Female nursing students

This study focuses on female nursing students in Tanzanian HLIs, a distinct group of academically capable young women. Admission into nursing programs requires strong performance in science subjects and readiness for intensive coursework and clinical training. Their academic and clinical responsibilities may influence both their exposure to GBV and their willingness to report it. Focusing on this group provides valuable insight into how SV experiences can affect the educational and professional trajectories of female students in health training programs.

Methods

Study design

This study utilized a quantitative cross-sectional design, conducted in HLIs, to examine the prevalence of SV and the factors associated with it among female nursing students. This design was considered ideal for drawing statistical conclusions and making comparisons between different subgroups within the target population.²⁴ The study has followed the STROBE guidelines for reporting observational studies.²⁵

Study setting

The study was conducted at the Schools of Nursing at Muhimbili University of Health and Allied Sciences (MUHAS) and Herbert Kairuki Memorial University (HKMU) in Dar es Salaam, representing a public and a private university, respectively. MUHAS is a leading health training institution with seven schools, while HKMU is the oldest and most prominent private medical university in Tanzania. The focus on the Schools of Nursing was chosen because they have a higher proportion of female students compared to other faculties, aligning directly with the study objectives.

Population

The study population consisted of female undergraduate nursing students enrolled in these institutions. Since the Schools of Nursing at MUHAS and HKMU had the highest proportion of female students compared to other faculties, they were purposively selected. This was a pragmatic decision intended to capture experiences in a population with higher female representation, but it does not ensure representativeness of all female students in HLIs across Tanzania. Accordingly, the findings should be interpreted as context-specific rather than generalizable to other disciplines or institutions.

In this study, the term “survivor” is used to emphasize agency, resilience, and recovery, consistent with trauma-informed and rights-based approaches.²⁶ The term “victim” is used only when referring to legal definitions or contexts where the emphasis is on the violation rather than the individual’s recovery process.

Inclusion and exclusion criteria

All female undergraduate nursing students enrolled in the two institutions were included. Students unavailable at the time of data collection (e.g., due to illness) were excluded.

Sample size and sampling procedure

An initial sample size of 413 was calculated using the standard formula for sample size determination, n_o = z²pq/e²,²⁷ where n_o represents the sample size, z is the z-score corresponding to a 95% confidence level (1.96), and p is the estimated proportion (57.7%, derived from a similar study in Ethiopia),²⁸ q is 1 − p, and e is the level of precision (0.05). However, since the nursing student population at the two universities was small, a total population sampling strategy was employed instead.

Data collection and procedures

Data collection for this study was conducted at the end of the academic year from August 1, 2023, to September 8, 2023, for the academic year 2022/2023, and from August 5, 2024, to December 20, 2024, for the academic year 2023/2024. A self-administered structured questionnaire in English was used to collect data from participants. This questionnaire comprised items on sociodemographic characteristics (age, marital status, religion, year of study, type of residence, living arrangement, and monthly pocket money) as well as experiences of SV, which were adapted from the uniSAFE questionnaire and previous studies.^29
–32 The SV section featured six items assessing incidents since enrollment at the university. Participants responded with “yes” or “no” to each item, and a response of “yes” to at least one item was considered an indication of having experienced SV.

To ensure appropriateness, the tool was reviewed by subject experts in public health and nursing education for content validity. It was then piloted among 20 nursing students, whose data were excluded from the final analysis. Feedback from the pilot confirmed the clarity of the tool, and no adjustments were required. The internal consistency of the SV items was assessed using Cronbach’s alpha, which yielded a coefficient of 0.794, indicating good reliability. No exploratory factor analysis was conducted due to the small number of items. Although the questionnaire was not a standardized Tanzanian tool, its adaptation, expert review, and piloting enhanced its cultural relevance and feasibility in the study context.

Data collection was conducted by the authors with the support of two trained research assistants, following the obtainment of informed consent. Of the 173 eligible female students at MUHAS and 188 at HKMU, 146 and 150, respectively, completed the questionnaires and were included in the final analysis. This high response rate (82%) was achieved by working closely with class representatives, who helped legitimize the study and facilitate transparent communication. Additionally, emphasizing confidentiality, anonymity, and the importance of the research for improving student safety and welfare further enhanced the response rate.

Statistical analysis

Data for this study were analyzed using the Statistical Package for the Social Sciences (SPSS), version 25 developed by the International Business Machines Corporation (IBM). Univariate analysis was conducted to summarize the descriptive statistics, which were presented in a table. Continuous variables were summarized using means and standard deviations (SDs), while categorical variables were summarized using frequencies and percentages. Associations between categorical variables were assessed using the chi-square test. Both bivariate and multiple logistic regression analyses were conducted to examine the relationship between sociodemographic factors and experiences of SV. Variables with a p-value of ⩽0.2 from the unadjusted model were included in the adjusted model to control for potential confounders. A p-value of <0.05 was considered the threshold for determining statistical significance.

Results

Participants’ sociodemographic characteristics

Among 296 participants, the overall mean age was 26.1 (SD = 5.0), 225 (76.0%) were single, 215 (72.6%) were Christians, 133 (44.9%) were first year students, and about three-quarters (n = 225, 76.0%) were living off-campus. There was a significant difference between the public and private students about their mean age (t-test, p < 0.001), marital status (chi-square test, p < 0.001), religion (chi-square test, p = 0.009), year of study (chi-square test, p < 0.001), type of residency (chi-square test, p < 0.014), and living arrangement (chi-square test, p < 0.001). Table 1 summarizes the sociodemographic characteristics of the participants according to the type of university attended.

Table 1.

Sociodemographic characteristics by type of university (N = 296).

Variable	Category	Overall		MUHAS		HKMU		χ²	p-value
Variable	Category	n	(%)	n	%	n	%	χ²	p-value
Age (years)	Mean (SD)	26.1 (5.0)		25.1 (3.4)		27.1 (6.0)		t-test	<0.001
Age category	18–24	125	42.2	61	41.8	64	42.7	17.895	<0.001
	25–34	145	49.0	82	56.2	63	42.0
	35–49	26	8.8	3	2.0	23	15.3
Marital status	Single	225	76.0	127	87.0	98	65.3	19.025	<0.001
Marital status	Married/cohabiting	71	24.0	19	13.0	52	34.7
Religion	Christian	215	72.6	116	79.5	99	66.0	6.736	0.009
Religion	Muslim	81	27.4	30	20.5	51	34.0
Year of study	First year	133	44.9	69	47.3	64	43.5	25.533	<0.001
	Second year	74	25.0	28	19.2	46	31.3
	Third year	66	22.3	29	19.9	37	25.2
	Fourth year	23	7.8	20	13.7	0	0.0
Residency type	Campus	71	24.0	44	30.1	27	18.0	5.977	0.014
Residency type	Outside campus	225	76.0	102	69.9	123	82.0
Living arrangement	Alone in rent house	60	20.3	36	24.7	24	16.0	25.392	<0.001
	In group rent house	139	47.0	82	56.2	57	38.0
	With family	48	16.2	14	9.6	34	22.7
	With relatives	18	6.1	7	4.8	11	7.3
	With partner	31	10.5	7	4.8	24	16.0
Monthly budget (in TZS^a)	Up to 10,000	18	6.1	10	6.8	8	5.3	9.491	0.091
	>10,000–50,000	27	9.1	16	11.0	11	7.3
	>50,000–100,000	44	14.9	19	13.0	25	16.7
	>100,000–150,000	58	19.6	30	20.5	28	18.7
	>150,000–200,000	71	24.0	42	28.8	29	19.3
	>200,000	78	26.4	29	19.9	49	32.7

χ²: chi-square test; MUHAS: Muhimbili University of Health and Allied Sciences; HKMU: Herbert Kairuki Memorial University; SD: standard deviation.

One USD was equivalent to 2635 TZS.

Sexual violence prevalence

Of all participants, 21 (7.1%) reported having experienced some form of SV since enrollment at the university. Table 2 summarizes the percentage score for each SV-assessed item. The item with the highest score was “Attempted to extort sexual favors from you in exchange for something within their power to grant or withhold, such as a gift or academic favor (e.g., a grade)” and the one with the lowest score was “Made you take part in any form of sexual activity when you could not consent because you were asleep, drunk or drugged.”

Table 2.

Percentage scores for each item on sexual violence experience among participants (N = 296).

An item of sexual violence	Sexual violence experience since enrollment at the university
	Yes		No
	n	%	n	%
1. Attempted to extort sexual favors from you in exchange for something within their power to grant or withhold, such as a gift or academic favor (e.g., a grade)	13	4.4	283	95.6
2. Extorted sexual favors from you in exchange for something within their power to grant or withhold, such as a gift or academic favor (e.g., a grade)	5	1.7	291	98.3
3. Attempted to force you into sexual intercourse by holding you down or hurting you in some way	6	2.0	290	98.0
4. Forced you into sexual intercourse by holding you down or hurting you in some way	4	1.4	292	98.6
5. Made you take part in any form of sexual activity when you did not want to, or you were unable to refuse, or you were afraid of what might happen if you refused	6	2.0	290	98.0
6. Made you take part in any form of sexual activity when you could not consent because you were asleep, drunk, or drugged	2	0.7	294	99.3

Among participants who experienced SV, the commonly reported perpetrators were students (n = 5, 23.8%), followed by a partner (n = 4, 19.0%), a stranger (n = 4, 19.0%), a teacher/lecturer (n = 3, 14.3%), and others (n = 3, 14.3%). Among these participants, 13 (68.4%) had experienced the incident once, 5 (26.3%) twice, and 1 (5.3%) three times. Only 4 (11.8%) of them shared the incident with a family member, and only 2 (10.5%) took legal action. In general, only 4 (16.7%) had shared the incident with somebody, with major reasons for not sharing being feeling of shame (n = 10, 50.0%), being afraid of parents or public reaction (n = 10, 35.5%), not knowing what to do (n = 2, 10.0%), and being afraid of the perpetrator (each n = 1, 5.0%).

Factors associated with sexual violence

A chi-square test was performed to assess sociodemographic factors associated with SV experience among participants (Table 3). Only one factor, that is, type of university (χ² = 9.046, p = 0.003) showed a significant difference in the experience of SV among participants.

Table 3.

Chi-square associations between sociodemographic characteristics and sexual violence since enrollment.

Variable	Category	Experienced sexual violence				χ²	p-value
		Yes		No
		n	%	n	%
Age groups (years)	18–24	13	10.4	112	89.6	3.619	0.164
	25–34	7	4.8	138	95.2
	35–49	1	3.8	25	96.2
Marital status	Single	17	7.6	208	92.4	0.302	0.582
Marital status	Married/cohabiting	4	5.6	67	94.4
Religion	Christian	16	7.4	199	92.6	0.144	0.705
Religion	Muslim	5	6.2	76	93.8
University	Public (MUHAS)	17	11.6	129	88.4	9.046	0.003
Private (HKMU)	Public (MUHAS)	4	2.7	146	97.3
Year of study	First year	11	8.3	122	91.7	5.953	0.114
	Second year	4	5.4	70	94.6
	Third year	2	3.0	64	97.0
	Fourth year	4	17.4	19	82.6
Residency type	Campus	6	8.5	65	91.5	0.261	0.610
Residency type	Outside campus	15	6.7	210	93.3
Living arrangement	Alone in rent house	5	8.3	55	91.7	2.032	0.730
	In group rent house	12	8.6	127	91.4
	With family	2	4.2	46	95.8
	With relatives	1	5.6	17	94.4
	With partner	1	3.2	30	96.8
Monthly pocket money (in TZS)	Up to 10,000	2	11.1	16	88.9	2.628	0.757
	>10,000–50,000	2	7.4	25	92.6
	>50,000–100,000	3	6.8	41	93.2
	>100,000–150,000	6	10.3	52	89.7
	>150,000–200,000	5	7.0	66	93.0
	>200,000	3	3.8	75	96.2

MUHAS: Muhimbili University of Health and Allied Sciences; HKMU: Herbert Kairuki Memorial University.

As presented in Table 4, both bivariate and multiple logistic regression analyses were performed to examine the relationship between sociodemographic factors and experiences of SV. In the unadjusted model, studying at MUHAS (crude odds ratio: 4.810; 95% confidence interval (CI): 1.578, 14.663; p = 0.006) was significantly associated with the experience of SV. Other sociodemographic factors did not show a statistically significant relationship. Similarly, after adjusting the factors in the multiple logistic regression, studying at MUHAS (adjusted odds ratio: 4.621; 95% CI: 1.357, 15.730; p = 0.014) remained statistically significant, unlike other factors. The values of the Hosmer-Lemeshow test were a chi-square of 8.371, p = 0.398, indicating a good model fit for the data.

Table 4.

Bivariate and multivariate logistic regression analyses of sociodemographic factors associated with sexual violence among participants.

Variables	Sexual violence experience since enrollment at the university				COR (95% CI)	p-value	AOR (95% CI)	p-value
	Yes		No
	n	%	n	%
Age groups (years)
18–24	13	10.4	112	89.6	2.902 (0.363, 23.219)	0.315	1.085 (0.113, 10.460)	0.944
25–34	7	4.8	138	95.2	1.268 (0.149, 10.758)	0.828	0.456 (0.044, 4.701)	0.509
35–49	1	3.8	25	96.2	Ref.		Ref.
Marital status
Single	17	7.6	208	92.4	1.369 (0.445, 4.210)	0.584	-	-
Married/cohabiting	4	5.6	67	94.4	Ref.
Religion
Christian	16	7.4	199	92.6	1.222 (0.433, 3.452)	0.705	-	-
Muslim	5	6.2	76	93.8	Ref.
University
Public (MUHAS)	17	11.6	129	88.4	4.810 (1.578, 14.663)	0.006	4.621 (1.357, 15.730)	0.014
Private (HKMU)	4	2.7	146	97.3	Ref.		Ref.
Year of study
First year	11	8.3	122	91.7	0.428 (0.124, 1.483)	0.181	0.476 (0.125, 1.815)	0.277
Second year	4	5.4	70	94.6	0.271 (0.062, 1.187)	0.083	0.517 (0.105, 2.532)	0.415
Third year	2	3.0	64	97.0	0.148 (0.025, 0.874)	0.035	0.230 (0.037, 1.442)	0.117
Fourth year	4	17.4	19	82.6	Ref.		Ref.
Residency type
Campus	6	8.5	65	91.5	1.292 (0.482, 3.467)	0.611	-	-
Outside campus	15	6.7	210	93.3	Ref.
Living arrangement
Alone in rent house	5	8.3	55	91.7	2.727 (0.304, 24.433)	0.370	-	-
In group rent house	12	8.6	127	91.4	2.835 (0.355, 22.654)	0.326	-	-
With family	2	4.2	46	95.8	1.304 (0.113, 15.027)	0.831	-	-
With relatives	1	5.6	17	94.4	1.765 (0.104, 30.052)	0.695	-	-
With partner	1	3.2	30	96.8	Ref.
Monthly pocket money
Up to 10,000	2	11.1	16	88.9	3.125 (0.482, 20.252)	0.232	1.950 (0.265, 14.333)	0.512
>10,000–50,000	2	7.4	25	92.6	2.000 (0.316, 12.663)	0.462	1.075 (0.152, 7.589)	0.942
>50,000–100,000	3	6.8	41	93.2	1.829 (0.353, 9.477)	0.472	1.386 (0.248, 7.759)	0.710
>100,000–150,000	6	10.3	52	89.7	2.885 (0.690, 12.058)	0.147	1.880 (0.410, 8.622)	0.416
>150,000–200,000	5	7.0	66	93.0	1.894 (0.436, 8.230)	0.394	1.303 (0.280, 6.062)	0.736
>200,000	3	3.8	75	96.2	Ref.

Hosmer-Lemeshow test χ² = 8.371, p = 0.398. COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval; MUHAS: Muhimbili University of Health and Allied Sciences; HKMU: Herbert Kairuki Memorial University.

Discussion

The purpose of this study was to examine the prevalence of sexual SV and its associated factors among nursing students in one public and one private university in Tanzania. The findings reveal a notable proportion of participants reporting experiencing SV during their pursuit of higher education. The experience of SV was further exacerbated by a pervasive culture of silence, where incidents of SV were seldom reported, and legal actions were rarely pursued. Shame and fear of parental or societal repercussions were identified as significant barriers to reporting and seeking legal recourse. Additionally, the study revealed that being enrolled at MUHAS was the only significant factor associated with higher likelihood of reporting SV experiences, underscoring the role of institutional characteristics in addressing or perpetuating these issues. This singular significant association highlights the importance of institutional context in shaping vulnerability. These results highlight the need for targeted institutional interventions to combat SV and foster a safer, more supportive learning environment that enables female students to pursue and achieve their higher education aspirations.^33
–35

A notable 7.1% of participants in our study reported experiencing SV since enrollment, highlighting the presence of SV in the two institutions. This prevalence is consistent with the 5%–25% range reported in the Sexual Assault and Sexual Misconduct survey by the Association of American Universities.³⁶ However, our prevalence rate is notably lower compared to those reported in other African countries, including studies in SSA, South Africa, Nigeria, and a systematic review and meta-analysis in Ethiopia, where rates ranged from 19% to 47%.^18,31,37,38 Additionally, the prevalence in our study is lower than the global rate of 17.4% among female students in HLIs, as reported by a systematic review and meta-analysis.³⁹ It is important to note that accurately determining the overall prevalence of SV is challenging due to variations in definitions and methodologies across studies.³ While the lower rate observed in our study may reflect regional or methodological differences, it underscores the need for continued efforts to better understand and address SV in academic settings. Although limited to two institutions, our findings provide important baseline evidence and context-specific insights that can inform interventions within Tanzanian HLIs.

In the Tanzanian context, the observed low prevalence of SV may be partly attributed to underreporting. Cultural norms that discourage open discussion of sexual matters, fear of stigma, and potential repercussions from parents or communities often prevent female students from disclosing experiences of SV.⁴⁰ Moreover, aspects of our survey design, such as the binary response format, may have limited the extent to which participants felt able to disclose sensitive experiences.⁴¹ The exclusion of non-contact forms of SV, such as verbal harassment and technology-facilitated sexual violence (TFSV), may also have contributed to a lower prevalence estimate, despite the increasing importance of digital interactions in students’ lives.^42,43 These methodological limitations suggest that our prevalence rate is a conservative estimate, which should be interpreted with caution rather than as an absence of a problem.

In our study, students were identified as the primary perpetrators of SV, followed by a partner, a stranger, and academic staff. This suggests that peer relationships may play a significant role in perpetrating SV among female students. This finding is somewhat consistent with a study conducted in Nigeria, where male students were reported as the primary perpetrators, followed by a partner and strangers, though academic staff were not included in the list of perpetrators.³¹ Similarly, in Ethiopia, fellow students (college friends) were identified as the main perpetrators, followed by strangers, partners, and academic staff.²⁸ In contrast, another study in Nigeria reported a different pattern, with partners and academic staff being more commonly mentioned than students as perpetrators.⁴⁴ The presence of multiple categories of perpetrators, including fellow students, partners, strangers, and academic staff, underscores the complex and multifaceted nature of SV in this context. It highlights the need for targeted interventions that address not only students but also other groups within the academic community to effectively prevent and address SV.

Less than a quarter of participants who experienced SV in our study reported the incident, and approximately 10% pursued legal action against the perpetrator. This highlights the low prevalence of SV reporting and legal recourse among female nursing students in the two institutions. Key barriers to reporting or seeking legal action included fear of parental or public reaction, uncertainty about the reporting process, and fear of retaliation from the perpetrator. Similar findings have been documented in Nigeria, where non-reporting and failure to take legal action were attributed to factors such as lack of knowledge, shame, fear of stigma, and concerns about parental reactions or retaliation from the perpetrator.³¹ A multi-country study in Europe further supports our findings, showing that students are often reluctant to report experiences of GBV.⁴⁵ In contrast, a multi-country study in SSA reported that more than three-quarters of students reported GBV and sought informal support from friends, partners, or family members, while fewer than one-third turned to formal sources, such as university administrators or the police.¹⁸ These discrepancies underscore the need for HLIs and policymakers to enhance GBV support services, prioritize awareness campaigns, reduce stigma, strengthen legal protections, and ensure confidentiality in reporting.^13,46,47

Participants enrolled at MUHAS were approximately five times more likely to experience SV compared to those at HKMU. This finding suggests that institutional-specific factors may significantly influence the prevalence of SV. Existing evidence underscores the role of institutional characteristics in generally shaping GBV outcomes. For example, factors such as the enforcement of anti-GBV policies, the availability of support services, and the institutional climate can influence the prevalence of GBV.³¹ In addition, institutions with male-dominated hierarchical structures, neoliberal managerialist approaches, and gender-ineffective leadership may exacerbate the occurrence of GBV.⁴⁸ Such institutional barriers often hinder the effective implementation of transformative anti-GBV policies.⁴⁹ Furthermore, variations in the scope and nature of GBV programs across HLIs may contribute to differences in SV experiences between these institutions.⁵⁰ These findings underscore the urgent need for targeted interventions to address SV in HLIs, including efforts to promote cultural and social change, as well as to influence institutional policies and attitudes toward SV.^49,51 Given that this was the only statistically significant factor, our interpretation emphasizes institutional context as a key lever for change, rather than individual-level predictors.

In our study, sociodemographic factors such as age, marital status, religion, academic level, residency type, living arrangement, and monthly pocket money did not show a significant association with experiences of SV, suggesting that these factors did not influence SV in this context. However, studies conducted in different settings have identified several sociodemographic factors as significant predictors of GBV, including SV, in HLIs. These factors include younger age, being single or in a relationship, religious affiliation, longer tenure at the university, campus residency, living alone in a rented house, having a roommate with a boyfriend, and lower social status, including financial conditions.^{28,31,37,47,52} The discrepancies in sociodemographic factors associated with GBV, including SV, across studies may be due to contextual and methodological differences, such as variations in sociocultural environments and sample size. These factors highlight the complexity of GBV experiences and the need to consider local contexts when examining the role of sociodemographic variables in influencing SV. Therefore, although most sociodemographic factors were not significant in our study, the contribution of the institutional setting reinforces the importance of addressing structural determinants rather than attributing SV risk solely to individual student characteristics.

Strengths and limitations

This study has several strengths and limitations. The high response rate of over 82%, combined with the inclusion of both public and private HLIs, enhances the comparative value of our findings. Such a response rate is notably high for research on SV and reflects the effectiveness of our recruitment strategies. However, the limited number of study sites and modest sample size preclude generalization to all HLIs in Tanzania. The purely quantitative nature of this study and its focus on a highly specific group of women limit the depth of understanding. Incorporating a mixed-methods design with qualitative interviews would have provided richer insights. While relevant, the six items used to assess SV did not capture the full WHO definition, which includes non-contact forms such as verbal harassment, stalking, and exposure to sexually explicit content, nor did the study address TFSV, such as cyberstalking, non-consensual sharing of intimate images, and online harassment. Consequently, the operational definition may underrepresent the broader spectrum of SV experiences. The culture of silence and social desirability bias may have further contributed to underreporting. To mitigate these limitations, participants were assured of confidentiality and anonymity and encouraged to respond honestly. Despite these constraints, the findings provide valuable insights into the prevalence of SV and its associated factors, which can inform the development of targeted, context-specific interventions for female students in HLIs.

Conclusion and recommendations

Our study highlights a notable reported SV prevalence issue among female students in the study settings, mirroring trends observed globally. However, there is a significant underreporting of incidents and a lack of legal action, with students being the primary perpetrators, followed by partners, strangers, and academic staff. These findings underscore the urgent need for institutional and targeted interventions to raise awareness about SV among female students and to foster a culture of reporting. Additionally, programs aimed at addressing students as primary perpetrators of SV should be prioritized, while still acknowledging the role of other perpetrator groups.

We recommend that HLIs should implement gender-sensitive policies that specifically address the prevention of SV and the unique needs of female students. Universities should establish confidential, accessible, and student-friendly reporting systems, alongside dedicated GBV support units staffed with trained personnel. Evidence-based interventions, such as bystander programs and awareness campaigns, should be adapted to the local context and regularly evaluated for effectiveness.^53,54 Both staff and students should receive continuous training on recognizing, preventing, and appropriately responding to SV.

Footnotes

Acknowledgements

First, we would like to express our sincere gratitude to the Schools of Nursing at MUHAS and HKMU for granting permission to conduct this study. We also extend our appreciation to the female nursing students for their time and the valuable information they provided, which was instrumental to the success of this study. Finally, we would like to acknowledge the Brocher Foundation for their residency support, during which data analysis and article preparation were completed.

ORCID iD

Joel Seme Ambikile

Ethical considerations

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

Consent to participate

All participants provided written informed consent prior to participating.

Consent for publication

Not applicable.

Author contributions

Joel Seme Ambikile: Conceptualization; Investigation; Writing – original draft; Methodology; Validation; Writing – review & editing; Formal analysis; Project administration; Data curation; Supervision.

Ezekiel Mbao: Methodology; Writing – review & editing; Formal analysis; Project administration; Resources; Investigation.

Neema Mawi: Writing – review & editing; Writing – original draft; Methodology; Project administration; Investigation.

Pius Kagoma: Investigation; Writing – review & editing; Methodology; Formal analysis.

Data availability statement

Data associated with this article had been uploaded as Supplementary Material with this submission.

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