Keywords
Violence, School, Adolescent girls and boys, South Africa
Violence, School, Adolescent girls and boys, South Africa
We have re-run the analysis to deal with the cluster nature of the data. This altered the standard errors and confidence intervals which resulted in us updating Table 3. We have also added in an additional author (Glory Chidumwa) who led the reanalysis of the data for Table 3.
See the authors' detailed response to the review by Pauline Gulliver
See the authors' detailed response to the review by Andrew Gibbs
Violence is the ‘intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or neglect’1. Globally, 50% of children aged 2–17 years have experienced physical, sexual or emotional violence in the past year2. In South Africa (SA), those under 18 years old experience disproportionally high rates of violence. For example, in the South African ‘Birth to twenty cohort’, 48% and 49.2% of children experienced exposure of violence in their communities and at home, respectively3. Meinck et al.4 found that 32% of children reported at least one type of frequent monthly abuse. The 2016 Optimus Study, researching the extent of child abuse in SA with over 4000 participants, found that 42.2% had ever experienced some form of maltreatment, whether sexual, physical, emotional or neglect5. In the 2012 National School Violence Study, Burton and Leoschut5 surveyed almost 6000 learners across 121 SA schools. They found that 22.2% of learners aged between 12 –18 years had experienced some form of violence while at school in the past year6.
Adolescence is a formative period of development, as individuals transition from childhood to adulthood7. It is a period characterized by heightened vulnerabilities to certain risks that can have a substantial impact on future health trajectories7. Violence during childhood and adolescence can have lifelong adverse health, social and economic consequences8, increasing vulnerability to HIV acquisition9 due to risky sexual behaviours, poor school performance10,11 and higher levels of depression and suicide ideation12. Sex and gender become increasingly important when assessing vulnerability to violence13 and the social factors and biological changes that take place during adolescence, as these result in gendered differences in experiences of violence14. Current research highlights that girls are at higher risk of sexual violence compared to boys13,15,16, however, few papers report on risk factors associated with ever experiencing violence17.
The Girls Achieve Power Trial (GAP Year) is a cluster randomised controlled trial (cRCT) testing the effectiveness of a comprehensive sexuality education (CSE) asset-building intervention aiming to reduce school dropout among adolescent girls between grades 8–10 while shifting gender attitudes and encouraging positive behaviour change among adolescent boys18. We conducted an analysis of the baseline data to examine sex and geographical differences in the prevalence, patterns, location, time, perpetration, and reporting of violence experienced by adolescents attending school in three townships in two provinces. We present the results of the full cRCT elsewhere (manuscript forthcoming).
A baseline cross-sectional analysis was conducted in 3432 grade 8 participants enrolled into the GAP Year cRCT, between April 2017 – September 2018. Participants completed a knowledge, attitudes, perceptions, and behaviour survey at baseline. Twenty-six public high schools were selected across three townships (Soweto and Tembisa in Gauteng Province and Khayelitsha in the Western Cape (WC)). Schools were selected using the following inclusion criteria: mixed-sex public high schools in Tembisa, Soweto and Khayelitsha; in quintiles 1–31 which had not been exposed to any asset building interventions in the past six months. A one to one (1:1) random stratification scheme was employed, assigning 26 schools to either intervention or control groups.
The sample size was calculated based on the study’s primary outcome measures, namely dropout rate and increased reporting of GBV among adolescent girls, computed using cluster-randomized size methodology suggested by Hayes and Bennett19. The effect size of dropout was factored from other similar studies to account for a large conservative and representative sample size to measure outcomes. Based on other local studies, we hypothesize a reduction in drop-out rate from 17.8% as reported by Branson, Hofmeyr20 to less than 14% (estimated effect size of 20%), with an anticipated attrition rate of 5% per year based on a similar local study21. This resulted in a conservative sample size of 2730 adolescent girls and 1850 boys to determine the association between intervention and control school’s dropout rate and GBV variables. This was the upper limit for the sample size for the cRCT. For the cross-sectional study, we only included those who consented into the trial.
Grade 8 learners were selected for the trial as this grade marks the end of compulsory education in SA. The grade 8 learner age range is approximately 12–14 years; however due to learners repeating grades and other reasons, the age range is commonly wider with older learners enrolled up to 18 years20,22. All grade eight learners, at selected schools were eligible to participate in the baseline survey, irrespective of sex, age, or race.
The baseline interview consisted of an interviewer-administered survey collecting information on demographics, socio-economic status and knowledge and attitudes pertaining to school safety, social support and social networks, sexuality, gender and norms, sexual reproductive health and rights, and care-seeking behaviours. Following completion of this component of the interview, the participant was asked to complete a behavioural audio computer-assisted self-interview (ACASI), allowing learners to hear questions through headphones and respond on a tablet themselves, aiming to reduce social desirability bias. The majority did the interviewer administered survey first, although this was not always the case. The ACASI section, 20–30 minutes in duration, asked sensitive questions regarding the participant’s actual practices and behaviour, covering questions on multiple sexual partners, sexual history, substance abuse (alcohol, drugs) and experiences of different types of violence (physical, sexual, psychological, economic, corporal punishment, neglect, and cyberbullying), as well as the perpetrators, and place and time of violence. In the survey23, respondents were asked “Please specify the type of violence you have experienced (Select those that apply to you)” and were able to select all those types of violence that they had experienced23. Each of the types of violence experienced were then captured as separate variables in the dataset, as presented in Table 2.
For the purposes of this analysis the single item variables were then combined as a multiple response variable, for both boys and girls. Therefore, out of 621 participants that stated they had ever experienced violence, there were 744 responses to the types of violence experienced, – as some participants had experienced more than one type of violence.
The data for the baseline interview was collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at Wits Reproductive Health and HIV Institute24. REDCap is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources.
The completed surveys were stored on encrypted password-protected tablets and the synced data was stored on Wits RHI secured servers. All data from REDCap and ACASI systems were exported as csv files and then into StataCorp 201725. Descriptive analyses, together with a chi2 square test of independence, were used to describe provincial and gender differences in the socio-demographics and patterns of violence ever experienced. The outcome ‘’ever experienced violence’’ was used to estimate associations with other variables. A multivariate logistic regression analysis examined the independent association between experiences of violence vs sex and province, controlling for potential confounders. The bivariate risk and factors associated with violence were estimated using crude odds ratios, at 95% confidence interval (CI) and significance reported at alpha less than 5%. Significant p-values less than 20% from the one-way Analysis of Variance (ANOVA) were used to estimate the adjusted odds ratio at the multivariate level, while variables more than 20% were considered collinear variables. Furthermore, n-values of missing data are shown in the tables, but missing values were not included in the calculation of the percentage breakdown for each variable. All variables show the percentage breakdown and the corresponding p-value for recorded responses only. Participants’ age was presented in groups (12–14 years and 15–17 years), rather than a continuous variable. It should be noted that the “no” category has been removed for all dichotomous variables [variables with a Yes or No Response] shown in the tables in the Results.
The study was granted ethical approval from the University of the Witwatersrand Human Research Ethics Community (#M160940). Provincial research approval was obtained from Western Cape Department of Education and Gauteng Department of Education. Learner’s enrolment and participation was voluntary. Only those with written parental/guardian consent and individual assent were recruited into the study. Those who were 18 years and older, did not require parental consent but provided their own written informed consent, enabling them to participate. Initially in English, the survey was translated and back translated into Xhosa, commonly spoken in some study sites. All data collection was supervised by the research team. Interviewer environments were set up to ensure confidentiality. Where feasible, interviewers were the same sex as the participant. Participants could stop the interview process at any time and were free to refuse to respond to any question(s) they felt uncomfortable answering. Social workers were employed to provide psychosocial support to participants during data collection and study intervention and a social harm form was developed to facilitate prompt referrals, where needed. To ensure meaningful participant and stakeholder engagement, the study was guided by the Good Participatory Practice guidelines18.
Overall, 3432 eligible learners across 26 schools participated in the baseline survey: we included 2383 in the analysis as this was the number who completed both components of the survey. In some cases, due to lack of time for participants to complete both components at the same time, some learners were unable to complete both components. Table 1 shows the socio-demographic characteristics of the study respondents by sex and province: 63.1% (n=1504) were girls, the majority (81.5%, n=1938) were aged 12–14 years, and 96.9% (n=2309) were Black African. Approximately one-fifth (18.5%, n=440) were aged 15–17 years, 76% (n=337) of who have repeated a grade. Overall, 41.4% (n=967) of respondents resided with both parents and 68.8% (n=1 633) of learners had at least one parent/guardian employed. A similar proportion (67.3%, n=1498) lived in households that were recipients of a Government grant. At the time, 18.3% (n=436) of learners had ever had sex, with 14% (n=65) of these reporting their first sexual experience <10 years of age.
TOTAL | Sex | Province | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
(N=2 383) | Female | Male | Western Cape | Gauteng | ||||||||
(N=504) | (N=879) | (N=1 105) | (N=1 278) | |||||||||
% | N | % | N | % | N | P-Value | % | N | % | N | P-Value | |
Ever experienced violence | 25.9 | 617 | 21.1 | 316 | 34.3 | 301 | <0.001 | 28.3 | 312 | 23.9 | 305 | 0.014 |
missing | 4 | 3 | 1 | 3 | 1 | |||||||
TOTAL | 100 | 621 | 100 | 100 | 100 | 100 | ||||||
Type of Violence* | ||||||||||||
Physical violence | 35.7 | 276 | 35.3 | 143 | 36.0 | 133 | <0.001 | 41.0 | 157 | 30.4 | 119 | |
Psychological violence | 21.8 | 169 | 22.2 | 90 | 21.4 | 79 | 24.8 | 95 | 18.9 | 74 | ||
Sexual violence | 13.1 | 101 | 13.3 | 54 | 12.7 | 47 | 7.6 | 29 | 18.4 | 72 | ||
Neglect | 10.6 | 82 | 10.4 | 42 | 10.8 | 40 | 8.9 | 34 | 12.3 | 48 | ||
Cyberbullying/online | 7.6 | 59 | 7.2 | 29 | 8.1 | 30 | 6.8 | 26 | 8.4 | 33 | ||
Corporal punishment | 6.5 | 50 | 5.4 | 22 | 7.6 | 28 | 5.7 | 22 | 7.2 | 28 | ||
Economic abuse | 4.8 | 37 | 6.2 | 25 | 3.3 | 12 | 5.2 | 20 | 4.4 | 17 | <0.001 | |
TOTAL | 100 | 774 | 100 | 405 | 100 | 369 | 100 | 383 | 100 | 391 | ||
Experiences of one or more types of violence | ||||||||||||
1 | 84.7 | 526 | 83.4 | 266 | 86.1 | 260 | <0.001 | 84.8 | 267 | 84.6 | 259 | |
2 or more | 15.3 | 95 | 16.6 | 53 | 13.9 | 42 | 15.2 | 48 | 15.4 | 47 | 0.966 | |
TOTAL | 100 | 621 | 100 | 319 | 100 | 302 | 100 | 315 | 100 | 306 | ||
Place of violence*# | ||||||||||||
At school | 30.7 | 272 | 26.3 | 126 | 36.0 | 146 | <0.001 | 30.1 | 128 | 31.3 | 144 | |
Park^ | 17.5 | 155 | 20.2 | 97 | 14.3 | 58 | 17.1 | 73 | 17.8 | 82 | ||
Friend’s home | 12.9 | 114 | 11.5 | 55 | 14.5 | 59 | 11.5 | 49 | 14.1 | 65 | ||
At my home | 11.0 | 97 | 11.3 | 54 | 10.6 | 43 | 13.4 | 57 | 8.7 | 40 | ||
On the way to and from school | 7.8 | 69 | 7.7 | 37 | 7.9 | 32 | 8.2 | 35 | 7.4 | 34 | ||
Mall | 5.6 | 50 | 6.5 | 31 | 4.7 | 19 | 6.3 | 27 | 5.0 | 23 | ||
Other Public spaces | 4.1 | 36 | 5.4 | 26 | 2.5 | 10 | 2.8 | 12 | 5.2 | 24 | ||
Internet/online | 4.0 | 35 | 4.4 | 21 | 3.5 | 14 | 4.2 | 18 | 3.7 | 17 | ||
Public toilets | 3.8 | 34 | 4.2 | 20 | 3.5 | 14 | 3.5 | 15 | 4.1 | 19 | ||
Family member’s home | 2.7 | 24 | 2.7 | 13 | 2.7 | 11 | 2.8 | 12 | 2.6 | 12 | 0.195 | |
TOTAL | 100 | 886 | 100 | 480 | 100 | 406 | 100 | 426 | 100 | 460 | ||
Time of violence* | ||||||||||||
Morning | 10.1 | 66 | 10.0 | 32 | 10.1 | 34 | <0.001 | 10.5 | 34 | 9.6 | 32 | |
During the day | 57.4 | 377 | 57.5 | 184 | 57.3 | 193 | 59.4 | 193 | 55.4 | 184 | ||
Evening/ At night | 32.4 | 213 | 32.5 | 104 | 32.3 | 109 | 30.2 | 98 | 34.6 | 115 | ||
Unsure/ Cannot remember | 0.2 | 1 | 0.0 | 0 | 0.3 | 1 | 0.0 | 0 | 0.3 | 1 | 0.137 | |
TOTAL | 100 | 657 | 100 | 320 | 100 | 337 | 100 | 325 | 100 | 332 | ||
Know the perpetrator | 66.7 | 414 | 64.9 | 207 | 68.5 | 207 | 65.7 | 207 | 67.7 | 207 | ||
TOTAL | 100 | 621 | 100 | 319 | 100 | 302 | 0.334 | 100 | 315 | 100 | 306 | 0.609 |
Perpetrator of violence* | ||||||||||||
Peer(s) | 38.4 | 168 | 39.0 | 81 | 38.0 | 87 | <0.001 | 36.3 | 77 | 40.4 | 91 | |
Stranger | 21.1 | 92 | 15.9 | 33 | 25.8 | 59 | 22.2 | 47 | 0.4 | 45 | ||
Parent/Guardian | 11.9 | 52 | 15.4 | 32 | 8.7 | 20 | 13.7 | 29 | 10.2 | 23 | ||
Sibling | 8.9 | 39 | 7.7 | 16 | 10.0 | 23 | 8.5 | 18 | 9.3 | 21 | ||
Partner | 7.1 | 31 | 9.1 | 19 | 5.2 | 12 | 9.0 | 19 | 6.7 | 12 | ||
Other Family Member | 6.2 | 27 | 7.2 | 15 | 5.2 | 12 | 4.7 | 10 | 7.6 | 17 | ||
Teacher | 4.8 | 21 | 2.4 | 5 | 7.0 | 16 | 2.8 | 6 | 20.0 | 15 | ||
Other | 1.4 | 6 | 2.9 | 6 | 0.0 | 0 | 2.4 | 5 | 0.0 | 1 | ||
Prefer not to say/Unsure | 0.2 | 1 | 0.5 | 1 | 0.0 | 0 | 0.5 | 1 | 0 | 0.270 | ||
TOTAL | 100 | 437 | 100 | 208 | 100 | 229 | 100 | 212 | 100 | 225 |
A higher percentage of younger respondents aged 12 – 14 years were females (85.5%, n=1 279) and from Gauteng Province (GP) (84.3% n=1075) compared to males (75.1, n=659) and those in the WC (78.3%, n=863)(p<0.001). WC respondents were more racially diverse, with 6.2% identifying as Coloured, compared to 0.4% in Gauteng (p<0.001). More WC respondents reside with both parents, compared to GP respondents (43.7% vs 39.4% respectively, p=0.002). More respondents’ parents are employed in WC (73.3% vs 64.9% respectively, p=0.001) and more receive a Government grant, compared to GP (74.1% vs 61.8% respectively, p=0.001). Those in the WC and males had a higher percentage of those who had ever had sex: 24.5% WC vs 13% GP (p<0.001), and 31.7% males vs 10.4% females (p<0.001). There were statistically significant differences in the age of sexual debut between females and males, with more males having sex under 10 years old (18.0% males vs 6.4% females, p<0.001).
In total, 25.9% of all learners had ever experienced violence (n=617) (Table 2). This was higher among boys than girls (34.3% vs 21.1%, p=<0.001) and higher in WC compared to GP (28.3% vs 23.9%, p=0.014). Of these, physical violence was most common (35.7%, n=276), followed by psychological violence (21.8%, n=169), sexual violence (13.1%, n= 101), neglect (10.6%, n=82), cyberbullying (7.9%, n=59), corporal punishment (6.5%, n=50), and economic abuse (4.8%, n=37). Physical violence was more common in boys, although still high in girls (36.0% vs 35.3%). Psychological violence was more common in girls, compared to boys (22.2% vs 21.4%). The WC had more physical violence than GP (41.0% vs. 30.4%), as well as psychological (24.8% vs. 18.9%), but GP had over double the reports of sexual violence (18.4% vs. 7.6%), respectively (p=<0.001). Of those who reported ever experiencing violence (n=621), 15.3% (n=95) indicated having ever experienced more than one form of violence (polyvictimisation).
Overall, school was the most common place (30.7%, n=272) where violence was experienced followed by the park2 (17.5%, n=155) or at their friends’ home (12.9%, n=114). There were statistically significant sex differences in the places of violence, boys were more likely to experience violence at school compared to girls (36.0% vs 26.3% p=0.001). Girls were then more likely to experience violence in the park compared to boys (20.2% vs 14.3% p=0.001). There were no statistical differences across provinces in place violence was experienced.
Most violence took place during the day (57%, n=377), followed by evening/at night (32.4% n=213) and 10.1% (n=66) in the morning. The majority of those who had ever experienced violence knew the perpetrator (66.7%, n=414), while the rest (n=207) preferred not to say. Most violence was perpetrated by peers (38.4%, n=168), followed by strangers (21.1%, n=92), parent/guardians (11.9%, n=52) or siblings (8.9%, n=39). After peers, boys were more likely to experience violence from a stranger (25.8% vs. 15.9% respectively, p=0.001). Table 2 shows the baseline experiences of violence by sex and province.
Table 3 outlines the factors associated with ever experiencing violence, all six variables have statistical significance at the unadjusted level: sex (OR 1.96 CI 1.60 - 2.39), age group (1.82 CI 1.42 - 2.34), ever used substances (OR 2.23 CI 1.9 - 2.63), ever had sex (OR 2.04 CI 1.62 - 2.58), ever repeated a grade (1.66 CI 0.53 - 0.82) and feeling worthless (OR 1.36 CI 1.11 - 1.68).
VARIABLE | N1 | % | Bivariate model | Multivariable model | ||
---|---|---|---|---|---|---|
OR (95% CI) | P-value | AOR (95% CI) | P-value | |||
Sex | ||||||
Female | 316 | 51.2% | Reference | Reference | ||
Male | 301 | 48.8% | 1.96 (1.6; 2.39) | <0.001 | 1.68 (1.32; 2.14) | <0.001 |
P-value<0.001 | ||||||
Age (years) | ||||||
12 to 14 | 458 | 74.2% | Reference | Reference | ||
15–18 | 159 | 25.8% | 1.82 (1.42; 2.34) | <0.001 | 1.41 (1.04; 1.89) | 0.025 |
P-value<0.001 | ||||||
Province | ||||||
Western Cape | 312 | 50.6% | Reference | Reference | ||
Gauteng | 305 | 49.4% | 0.79 (0.63; 1.01) | 0.057 | 0.84 (0.67; 1.06) | 0.144 |
P-value= 0.014 | ||||||
Substance use | ||||||
No | 410 | 66.5% | Reference | Reference | ||
Yes | 207 | 33.5% | 2.23 (1.9; 2.63) | <0.001 | 1.9 (1.59; 2.28) | <0.001 |
P-value<0.001 | ||||||
Ever had sex | ||||||
No | 451 | 73.1% | Reference | Reference | ||
Yes | 166 | 26.9% | 2.04 (1.62; 2.58) | <0.001 | 1.42 (1.1; 1.83) | 0.008 |
P-value<0.001 | ||||||
Repeated grade | ||||||
No | 221 | 35.8% | Reference | Reference | ||
Yes | 396 | 64.2% | 0.66 (0.53; 0.82) | <0.001 | 0.92 (0.69; 1.22) | 0.550 |
P-value<0.001 | ||||||
I sometimes feel worthless | ||||||
No | 351 | 57.7% | Reference | Reference | ||
Yes | 257 | 42.3% | 1.36 (1.11; 1.68) | 0.003 | 1.33 (1.09; 1.63) | 0.005 |
P-value<0.001 | ||||||
Population group | ||||||
African | 598 | 96.9% | Reference | |||
Coloured | 19 | 3.1% | 1 (0.45; 2.27) | 0.991 | ||
P-value= 0.985 | ||||||
Household structure | ||||||
Both parents | 247 | 40.6% | Reference | |||
Other relative / Guardian / Child-headed household | 119 | 19.6% | 1.11 (0.82; 1.5) | 0.511 | ||
Single parent | 242 | 39.8% | 0.99 (0.77; 1.27) | 0.924 | ||
P-value= 0.663 | ||||||
Parent employed? | ||||||
No | 436 | 70.8% | Reference | |||
Yes | 180 | 29.2% | 0.88 (0.7; 1.1) | 0.264 | ||
P-value= 0.209 | ||||||
Parent receives grant? | ||||||
No | 389 | 68.1% | Reference | |||
Yes | 182 | 31.9% | 0.95 (0.8; 1.14) | 0.608 | ||
P-value= 0.656 | ||||||
Sexual debut age (years) | ||||||
<10 | 24 | 13.4% | Reference | |||
10 to 13 | 87 | 48.6% | 1.01 (0.6; 1.7) | 0.967 | ||
14–16 | 67 | 37.4% | 1.29 (0.83; 1.99) | 0.256 | ||
>16 | 1 | 0.6% | 0.34 (0.04; 2.91) | 0.326 | ||
P-value= 0.436 |
Boys (p<0.001), those aged 15–17 years (P<0.001), those who had ever used substances (p<0.001), ever had sex (p<0.001), those who had ever repeated a grade (p<0.001) and those who felt worthless (p=0.001) were more likely to ever experience violence. There was some evidence that living in WC (p=0.057) was associated with ever experiencing violence. Racial group (p=0.991), household structure (p=0.926), parent/guardian employment status (p=0.264), government grant recipient (p=0.608), sexual debut (p=0.398) were not found to be statistically associated with ever experiencing violence and therefore they are excluded from Table 3.
When adjusted, the following five variables remained significant: sex, age, ever used substances, ever had sex and self-worth. The adjusted multivariable analysis showed that the odds of boys ever experiencing violence were increased 1.57 times (aOR 1.68; 95% CI 1.32 - 2.14 - p<0.001) than girls. The odds of those aged 15–17 years having ever experienced violence were increased by 41% (aOR 1.41 - 95% CI 1.04 - 1.89 - p=0.025) compared to those 12–14 years. The odds of those who had ever used substances having ever experienced violence were increased by 92% (aOR 1.90 - 95% CI 1.59 - 2.28 - p<0.001) compared to those who had not used substances. The odds of those who sometimes felt worthless having ever experienced violence were increased by 35% (aOR 1.33 - 95% CI 1.09 - 1.63, 0.005) compared to those who thought their life was worthwhile. The odds of those who had ever had sex, having ever experienced violence were icreased by 42% (aOR 1.42 - 95% CI 1.1 - 1.83 - p=0.008) compared to those who had never had sex.
We assessed learners’ experiences of different types of violence and found that there were sex differences: boys have higher odds of ever experiencing violence compared to girls. This is confirmed by other recent South African studies3,5,26, indicating that boys were more likely to report some form of abuse in their lifetimes, although those forms tend to be different, compared to girls. Among those who did experience violence, we found that both boys and girls experienced similar rates of physical, psychological and sexual violence: these findings are confirmed by other studies5,13. Interestingly, girls experienced almost double the economic abuse as their male counterparts. Given the higher odds of males experiencing violence overall, primary violence prevention interventions are needed to tackle harmful cultural norms that perpetuate violence among boys and decrease tolerance of violence overall27,28. Stepping Stones29,30, Family Matters3 31 and SASA!32 are interventions that could be implemented, targeting both boys and girls, men and women, as adults play a key role in the reduction of violence against children and adolescents. These programs should target both boys and girls, men and women, as parents play a key role in the reduction of violence against children and teens17.
Violence most often took place at school, during the day, with the majority knowing the perpetrator, as a peer. This is supported by findings from the National School Safety Framework survey conducted in 15 government funded high schools in the same schools33. Kutywayo et al., found that the poor enforcement of discipline at school experienced by male learners, correlated with and is confirmed by the high rates of peer provocation and relational aggression experienced at a school level33. Kutywayo et al., provide several strategies for tackling school peer violence in their recent manuscript33. Despite being banned through the National Education Policy Act of 1996, corporal punishment4, is still experienced by this cohort of learners as well as across many SA schools34,35. Given the sensitivity of this question and the emotional implications of disclosure, it is understandable that some learners did not wish to disclose the perpetrator. In light of the fact that the perpetrator may well be the educator, schools need to strengthen the implementation of protocols36 that guide the reporting of violence at school level and frameworks to create a safer school environment37. Secondary violence prevention interventions should also be strengthened to improve the immediate response to those who have experienced violence. This could be done by adopting survivor-centred first line support using the World Health Organisation’s LIVES5 framework38 and strengthening the referral pathways into post violence care.
We also found statistically significant associations between substance use, ever had sex and experiences of violence, confirmed by existing South African research39–42 and other research on the continent43–45. Attention should therefore be on the scale up of behavioural interventions, focusing on CSE and increasing risk perception to reduce the likelihood that adolescents will engage in potentially harmful behaviours such as substance use and early sexual debut46. It is also important to note that these variables have the potential to be outcomes as well as risk factors for experiencing violence. Further research needs to be conducted to determine the temporal relationship between these variables as this has the potential to change the response required for these results.
Of concern is the fact that those who thought their life was worthless were more likely to ever experience violence which is confirmed by South African literature39. This strong association between experiencing violence and low self-worth reinforces the need for empowerment interventions: increasing self-esteem and self-efficacy could be critical to reducing their risk of experiencing violence47 but could also support them following their experience of violence. Structural interventions such as DREAMS6,7 48 and the She Conquers campaign49 are also critical structural interventions to support girl empowerment and work with boys to end violence.
With almost a quarter of our participants having ever experienced violence (25.9%), the majority of those aged 15–17 years, and the link between childhood experiences of violence, high risk of adverse mental health outcomes, substance abuse, harmful gender attitudes50–54 and increased perpetration of violence later in life55–57, it is key that violence prevention interventions start from a young age to limit childhood exposure to violence and break the cycle of violence. We recommend that all violence prevention strategies adopt an ecological approach, encompassing children, young adolescents, parents, educators, community members, local organisations and politicians to ensure a wide range of stakeholders are involved42. Improved surveillance of the range of types, locations, and perpetrators of violence against children, as well as of access to key prevention interventions, is essential to target prevention and monitor progress.
When reviewing these findings, the following strengths and limitations should be considered. A strength of this study is that it was conducted in 26 schools in three highly populated diverse townships of South Africa and is therefore generalisable to other South African settings. Another strength is that it provides data on a variety of different types of violence, often excluded in other manuscripts. We also provide updated school violence data, building on previous studies conducted in 20165 and 20126.
Whilst the final sample size was substantially less than originally planned, the results maintain power to draw these conclusions. Data collection relied upon retrospective recollections which may result in an under-reporting of violence58. The study was cross-sectional therefore only representing one point in time. There were no questions in the survey to establish recency of violence making it difficult to establish individual incidence of violence or if it was ongoing. The time of day when violence was experienced was not clearly defined and therefore left up to each participant’s interpretation. In addition, there was insufficient power to determine different factors associated with different experiences of violence.
There were many participants who did not complete both components of the survey and were therefore excluded from this analysis. This was linked to the time of data collection: data collection typically took place after school leaving a short period of time for data collection. Some learners did not have sufficient time to complete both components afterschool and were requested to return the following day to complete the second component. In these instances, we experienced challenges in getting the participants back to complete the second component, possibly due to lack of interest or lack of time. To overcome this, we have only included those who completed both components of the survey in the analysis.
These limitations are unlikely to alter our primary findings.
Ever experiencing violence is strongly associated with being a boy, being aged 15–17 years, used substances, never having had sex and lower self-esteem. With a quarter of our adolescent participants having ever experienced violence (physical, sexual, psychological, economic, corporal punishment, neglect, and cyberbullying), there is an urgent need for wider adoption, scaling, and sustaining of evidence-based primary violence prevention interventions as well as structural interventions to reduce the high burden of violence against adolescent boys and girls. Interventions must target stakeholders across the ecological model, including very young adolescents, to tackle the harmful cultural norms that perpetuate violence.
Written informed consent for publication of the participants details obtained from the participants and their parents/guardian.
Harvard Dataverse: GAP Year_Violence REDCap and ACASI data, https://doi.org/10.7910/DVN/AHHWNL23.
This project contains the following underlying data:
Harvard Dataverse: GAP Year_Violence REDCap and ACASI data, https://doi.org/10.7910/DVN/AHHWNL23.
This project contains the following extended data:
- GAP Year Boys ACASI Survey Questionnaire.pdf
- GAP Year Girls ACASI Survey Questionnaire.pdf
- GAP Year Boys REDCap Survey Questionnaire.pdf
- GAP Year Boys REDCap Survey Questionnaire.pdf
Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).
We would like to acknowledge the participants and their parents for their valued contribution to this research. The National Department of Education stakeholders within the School Safety Directorate, as well as provincial, district and school stakeholders also provided guidance and support during this research. Clarence Yah was the Senior Researcher, leading the research. Kiran Kalpee, Khuthala Mabetha and the GAP Year fieldworkers managed the dataset and Indigo MO who supported with data collection. Mags Beksinska provided technical review. Grassroots Soccer and Sonke Gender Justice were our study partners, implementing the GAP Year intervention, also supported with school buy-in.
3 The Families Matter! Program (FMP) is an evidence-based, parent-focused intervention designed to promote positive parenting and effective parent-child communication about sexuality and sexual risk reduction, including risk for child sexual abuse and gender-based violence, for parents or caregivers of 9–12 year olds in Africa
4 Defined as any kind of violent action inflicted on children by teachers or school administrators as punishment for disciplinary purposes
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Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Public health, violence, South Africa
References
1. Davies HT, Crombie IK, Tavakoli M: When can odds ratios mislead?. BMJ. 1998; 316 (7136): 989-91 PubMed Abstract | Publisher Full TextCompeting Interests: No competing interests were disclosed.
Reviewer Expertise: public health, violence, South Africa
Is the work clearly and accurately presented and does it cite the current literature?
Yes
Is the study design appropriate and is the work technically sound?
Partly
Are sufficient details of methods and analysis provided to allow replication by others?
Yes
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Gender-based violence, epidemiology
Is the work clearly and accurately presented and does it cite the current literature?
Partly
Is the study design appropriate and is the work technically sound?
Yes
Are sufficient details of methods and analysis provided to allow replication by others?
No
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: public health, violence, South Africa
Alongside their report, reviewers assign a status to the article:
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Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list:
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