Violence against primary school children with disabilities in Uganda: A cross-sectional study

Karen M Devries, PhD1*, Nambusi Kyegombe, PhD1, Maria Zuurmond, MSc1, Jenny Parkes, PhD2, Jennifer C Child, MSc1, Eddy J Walakira, PhD3, Dipak Naker, MA4

1London School of Hygiene & Tropical Medicine, London, UK2Institute of Education, London, UK3Makerere University, Kampala, Uganda4Raising Voices, Kampala, Uganda

Improving health worldwide

www.lshtm.ac.uk

Violence against disabled children

• 150 million children live with disabilities globally • A recent systematic review found 3 to 4 times the levels of violence

versus non-disabled children in high income countries• Almost nothing is known about violence against disabled children in

lower income countries

• We used data from the Good Schools Study in Uganda to: 1) compare the prevalence of different types of violence in disabled and non-

disabled students2) describe the most common perpetrators of violence3) to explore whether disability confers increased risk of violence after accounting

for demographic and mental health factors

Study setting and design• Design: baseline cross-sectional survey

from a cluster-randomised controlled trial

• 42 primary schools, representing 1 district in Uganda

• 3700 students aged 11-14 and 500 staff interviewed in June 2012

• Interviewer-administered questionnaire using mobile phones

• Measuring violence: ICAST-CI• Referral plan for children for children

who disclosed abuse

Measuring Disability:

“Do you have any mental or physical disability? For example, do you have trouble seeing, walking, speaking, fits, or anything else?” Response options: None, Trouble seeing, Trouble hearing, Trouble walking/with movement, Trouble with speech, Fits, Other.

Measuring Violence:

More than 40 items measuring specific acts of emotional, physical, sexual violence and neglect. “Have you ever been hit, slapped, kicked, physically forced to have sexual intercourse with someone, locked out, not given food as punishment”

Prevalence of disability• 271 disabled and 3475 non-

disabled students • 8.8% of boys and 7.6% of girls

reported a disability.• Difficulties:

– 2.8% with sight– 1.4% with hearing– 0.9% with movement– 3.1% reported an ‘other’ form of

disability – 1.0% of boys but only one girl

reported difficulties with speech

Levels of violence •

Boys (n=1769) Girls (n=1937)

CharacteristicNo disability,

%Disabled, % P

No disability, %

Disabled, % P

Any violence from any perpetrator 95.3 96.2 0.644 95.5 99.5 0.009

Physical violence 93.4 95.8 0.379 94.6 99.1 0.010

Sexual violence 3.8 7.1 0.092 12.3 23.6 0.002

Emotional violence and neglect

59.4 63.6 0.400 57.5 65.2 0.140

Main perpetrators among disabled students

Physical: male peersSexual: ‘others’

Emotional: school staff

Physical: school staffSexual: ‘others’, male peers

Emotional: school staff

Associations in boysEmotional violence/neglect

versus no emotional violence/neglect

Sexual violence versus no sexual violence

Physical Violence from non-school staff versus no violence from non-school

staff

Past week physical violence from school staff

versus no past week violence from school staff

aORa (95%CI) p aORa (95%CI) p aORa (95%CI) p aORa (95%CI) p

Girls Disability

1.36 (0.86-2.13) 0.179 2.15 (1.33-3.48) 0.002 1.26 (0.80-1.99) 0.309 1.46 (1.00-2.12) 0.047

Boys Disability

1.08 (0.74-1.56) 0.672 1.17 (0.80-1.69) 0.409 0.62 (0.48-0.81) 0.001

Increased risk of violence, adjusted for other factors

aAdjusted for: age, number of meals eaten yesterday, household crowding, working outside home, mental health difficulties

What does it mean?

• High prevalence in all students• Disabled girls (and probably boys) at even higher risk of sexual

violence• Disabled girls in particular remain at high risk of sexual violence and

physical violence from school staff, even after accounting for other factors

• School in a main environment of risk, but also for potential interventions

• Tailored and accessible interventions needed

Thank you!Research team:Karen Devries, Louise Knight,

Jennifer Child, Nambusi Kyegombe, Liz Allen, Charlotte Watts, Diana Elbourne (LSHTM)

Jenny Parkes (IoE) Eddy Walakira (Makerere University) Dipak Naker (Raising Voices)

Donors: DfID, UK MRC, Wellcome Trust,

Hewlett Foundation, Bernard van Leer Foundation, Unicef Uganda

Raising Voices team:Willington Sseskade and the

implemtation teamJanet NakutiAngel MiriembeGood Schools Publications:

•Devries K, Kyegombe N, Zuurmond M et al. Violence against primary school children with disabilities in Uganda: A cross-sectional study. BMC Public Health. forthcoming.•Devries K, Allen E, Child J, et al. The Good Schools Toolkit to prevent violence against children in Ugandan primary schools: study protocol for cluster-randomised controlled trial. Trials. 2013;14:232.•Devries K, Child J, Allen E, et al. School violence, mental health and educational performance in Ugandan primary school children: A cross-sectional survey. Pediatrics. 2014;133(1):1-9.•Child J, Naker D, Horton J, Walakira E, Devries K. Responding to abuse: Children’s experiences of child protection in a central district, Uganda. Child Abuse and Neglect 2014. http://dx.doi.org/10.1016/j.chiabu.2014.06.009