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      Does the Good Schools Toolkit Reduce Physical, Sexual and Emotional Violence, and Injuries, in Girls and Boys equally? A Cluster-Randomised Controlled Trial

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          Abstract

          We aimed to investigate whether the Good School Toolkit reduced emotional violence, severe physical violence, sexual violence and injuries from school staff to students, as well as emotional, physical and sexual violence between peers, in Ugandan primary schools. We performed a two-arm cluster randomised controlled trial with parallel assignment. Forty-two schools in one district were allocated to intervention ( n = 21) or wait-list control ( n = 21) arms in 2012. We did cross-sectional baseline and endline surveys in 2012 and 2014, and the Good School Toolkit intervention was implemented for 18 months between surveys. Analyses were by intention to treat and are adjusted for clustering within schools and for baseline school-level proportions of outcomes. The Toolkit was associated with an overall reduction in any form of violence from staff and/or peers in the past week towards both male (aOR = 0.34, 95%CI 0.22–0.53) and female students (aOR = 0.55, 95%CI 0.36–0.84). Injuries as a result of violence from school staff were also lower in male (aOR = 0.36, 95%CI 0.20–0.65) and female students (aOR = 0.51, 95%CI 0.29–0.90). Although the Toolkit seems to be effective at reducing violence in both sexes, there is some suggestion that the Toolkit may have stronger effects in boys than girls. The Toolkit is a promising intervention to reduce a wide range of different forms of violence from school staff and between peers in schools, and should be urgently considered for scale-up. Further research is needed to investigate how the intervention could engage more successfully with girls.

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          The Good School Toolkit for reducing physical violence from school staff to primary school students: a cluster-randomised controlled trial in Uganda

          Summary Background Violence against children from school staff is widespread in various settings, but few interventions address this. We tested whether the Good School Toolkit—a complex behavioural intervention designed by Ugandan not-for-profit organisation Raising Voices—could reduce physical violence from school staff to Ugandan primary school children. Methods We randomly selected 42 primary schools (clusters) from 151 schools in Luwero District, Uganda, with more than 40 primary 5 students and no existing governance interventions. All schools agreed to be enrolled. All students in primary 5, 6, and 7 (approximate ages 11–14 years) and all staff members who spoke either English or Luganda and could provide informed consent were eligible for participation in cross-sectional baseline and endline surveys in June–July 2012 and 2014, respectively. We randomly assigned 21 schools to receive the Good School Toolkit and 21 to a waitlisted control group in September, 2012. The intervention was implemented from September, 2012, to April, 2014. Owing to the nature of the intervention, it was not possible to mask assignment. The primary outcome, assessed in 2014, was past week physical violence from school staff, measured by students' self-reports using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool—Child Institutional. Analyses were by intention to treat, and are adjusted for clustering within schools and for baseline school-level means of continuous outcomes. The trial is registered at clinicaltrials.gov, NCT01678846. Findings No schools left the study. At 18-month follow-up, 3820 (92·4%) of 4138 randomly sampled students participated in a cross-sectional survey. Prevalence of past week physical violence was lower in the intervention schools (595/1921, 31·0%) than in the control schools (924/1899, 48·7%; odds ratio 0·40, 95% CI 0·26–0·64, p<0·0001). No adverse events related to the intervention were detected, but 434 children were referred to child protective services because of what they disclosed in the follow-up survey. Interpretation The Good School Toolkit is an effective intervention to reduce violence against children from school staff in Ugandan primary schools. Funding MRC, DfID, Wellcome Trust, Hewlett Foundation.
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            Exposure to childhood sexual and physical abuse and subsequent educational achievement outcomes.

            This paper examined the relationship between exposure to sexual and physical abuse (CSA and CPA) in childhood and later educational achievement outcomes in late adolescence and early adulthood in a birth cohort of over 1,000 children studied to age 25. Retrospective data on CSA and CPA were gathered at ages 18 and 21 and used to form a best estimate of exposure to CSA and CPA. The relationship between CSA, CPA, and self-reported educational outcomes to 25 years was examined using logistic regression models that took into account social background, parental factors, and individual factors. Increasing exposure to CSA and CPA was significantly associated with failing to achieve secondary school qualifications (CSA: B=.53, SE=.13, p<.0001; CPA: B=.62, SE=.12, p<.0001), gaining a Higher School Certificate (CSA: B=-.48, SE=.13, p<.001; CPA: B=-.78, SE=.14, p<.001), attending university (CSA: B=-.29, SE=.13, p<.05; CPA: B=-.45, SE=.13, p<.001), and gaining a university degree (CSA: B=-.54, SE=.18, p<.005; CPA: B=-.64, SE=.17, p<.001). Adjustment for confounding social, parental, and individual factors explained most of these associations. After control for confounding factors, omnibus tests of the associations between CSA and outcomes and CPA and outcomes failed to reach statistical significance (CSA: Wald chi(2) (4)=7.72, p=.10; CPA: Wald chi(2) (4)=8.26, p=.08). The effects of exposure to CSA and CPA on later educational achievement outcomes are largely explained by the social, family, and individual context within which exposure to abuse takes place.
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              Child abuse in 28 developing and transitional countries--results from the Multiple Indicator Cluster Surveys.

              Child abuse is a recognized public health and social problem worldwide. Using data from the Multiple Indicator Cluster Surveys (MICS) we aimed to (i) compare different forms of child abuse across countries and regions, and (ii) examine factors associated with different forms of child abuse. Information on child abuse was available in 28 developing and transitional countries from the third round of the MICS conducted in 2005 and 2006 (n = 124 916 children aged between 2 and 14 years). We determined the prevalence of psychological, and moderate and severe physical abuse for the preceding month and examined correlates of different forms of child abuse with multilevel logistic regression analysis. A median of 83, 64 and 43% of children in the African region experienced psychological, and moderate and severe physical abuse, respectively. A considerably lower percentage of children in transitional countries experienced these forms of abuse (56, 46 and 9%, respectively). Parental attitudes towards corporal punishment were the strongest variable associated with all forms of child abuse. The risk of all forms of child abuse was also higher for male children, those living with many household members and in poorer families. Child abuse is a very common phenomenon in many of the countries examined. We found substantial variations in prevalence across countries and regions, with the highest prevalence in African countries. Population-based interventions (e.g. educational programmes) should be undertaken to increase public awareness of this problem. Actions on changing parental attitudes towards corporal punishment of children may help to prevent child abuse. The specific local situation in each country should be considered when selecting intervention strategies.
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                Author and article information

                Contributors
                +4420 7958 8164 , karen.devries@lshtm.ac.uk
                Journal
                Prev Sci
                Prev Sci
                Prevention Science
                Springer US (New York )
                1389-4986
                1573-6695
                10 April 2017
                10 April 2017
                2017
                : 18
                : 7
                : 839-853
                Affiliations
                [1 ]ISNI 0000 0004 0425 469X, GRID grid.8991.9, London School of Hygiene and Tropical Medicine, ; 15-17 Tavistock Place, London, WC1H 9SH UK
                [2 ]ISNI 0000000121901201, GRID grid.83440.3b, University College London-Institute of Education, ; London, UK
                [3 ]GRID grid.430356.7, Raising Voices, ; Kampala, Uganda
                Article
                775
                10.1007/s11121-017-0775-3
                5602101
                28397155
                0dd70876-b433-45a4-a3fc-b42ea078d302
                © The Author(s) 2017

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Funding
                Funded by: UK Medical Research Council
                Funded by: DfID
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Funded by: FundRef http://dx.doi.org/10.13039/100004439, William and Flora Hewlett Foundation;
                Categories
                Article
                Custom metadata
                © Society for Prevention Research 2017

                Medicine
                violence,bullying,gender,school-based interventions,uganda
                Medicine
                violence, bullying, gender, school-based interventions, uganda

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