Background Research on violence against children in Africa often relies on adult's qualitative accounts or on quantitative surveys that focus mainly on sexual abuse or on adverse childhood exposures. We seldom hear how young children describe their experiences and their perceptions of violence. Objective This study aimed to describe children's personal experiences and perceptions of violence. Participants and setting The study was conducted from 2022 to 2023 in peri-urban and rural Mpumalanga, South Africa with 23 children aged between 6 and 12 years who, together with their primary caregivers, were participants in a larger longitudinal cohort study. Methods We used in-depth interviews alongside arts-based methods for the children. Interviews underwent reflexive thematic analysis. Results Children were highly exposed to physical and emotional violence both in and outside of the home. Physical violence was used as a discipline method by teachers, parents, or children's caregivers. Severe occurrences involved adults using objects to discipline children, including steel pipes, shoes, or classroom materials. Most children associated violence with fear and pain. However, they described physical abuse as a morally "right" act if they understood it to be a form of discipline for their wrong behaviours. Attitudes condoning violence also enabled peer-to-peer violence. Children were not confident in reporting cases of violence inflicted by adults due to the fear of sanctions and the belief that violence from adults was "accepted". Conclusion In this sample, children had limited spaces that they marked as free from violence. Violence was normalised by the adults inflicting it, creating a state of cognitive dissonance among children, leading to victim blaming and, in turn, inflicting violence against same-age peers.
BACKGROUND: Climate-related shocks such as drought are increasingly recognised as threats to mental health, yet evidence remains limited on how these stressors affect adolescent girls and young women (AGYW) in Lesotho. This study examines the association between drought exposure and severe mental distress among AGYW in Lesotho and assesses whether household food insecurity moderates this relationship. METHODS: We analysed nationally representative cross-sectional data from 7,101 AGYW aged 13–24 years drawn from the 2018 Lesotho Violence Against Children and Youth Survey. Severe mental distress was measured using the Kessler-6 scale. Drought exposure was defined using district-level Integrated Food Security Phase Classification data. Multivariable logistic regression models assessed independent associations, and interaction terms were used to examine moderation by food insecurity. Predicted probabilities were estimated to illustrate combined effects. RESULTS: Drought exposure was associated with increased odds of severe mental distress (adjusted odds ratio [aOR] = 1.47; 95% CI: 1.01–2.15; p = 0.045). Food insecurity independently increased the odds of distress (aOR = 1.47; 95% CI: 1.06–2.05; p = 0.022). In the interaction model, the association between drought vulnerability and severe mental distress differed by food insecurity status (interaction aOR = 2.21; 95% CI: 1.15–4.27; p = 0.018). AGYW experiencing both drought and food insecurity had the highest predicted probability of severe mental distress. CONCLUSIONS: The association between drought vulnerability and severe mental distress among AGYW in Lesotho was stronger in food-insecure households. Integrated climate adaptation, food security, and mental health interventions may help protect vulnerable AGYW in drought prone settings such as Lesotho.
Measures of violence against children (VAC) categorise violence as physical, emotional, sexual violence and neglect. While used globally, these measures may not reflect how conflict-affected adolescents conceptualise harm. Drawing on child rights, structural violence, and feminist frameworks, this study explores how adolescents living in conflict-affected Democratic Republic of Congo (DRC) conceptualise violence. Methods We conducted four same-sex group discussions with 36 adolescents (20 girls, 16 boys) aged 13-17 years old in the DRC. Participants discussed daily experiences in their community: things they like, and good and bad things they experience. Inductive and deductive thematic analysis were used to identify forms of violence discussed, which were then mapped onto measures of VAC to explore how well existing tools capture their experiences. Results Adolescents described experiences of violence consistent with physical, emotional and sexual violence, child neglect and labour, which are all commonly recognised in existing tools. Less commonly recognised forms described included economic control, negative social perceptions and ill-labelling, taking on parental responsibility, and environmental hazards and safety concerns in the community. Gender differences emerged with economic maltreatment predominantly described by boys and sexual exploitation linked to unmet needs described only by girls. Conclusion When adolescents define harm in their own terms, they reveal forms of violence not captured by standard measures. These forms of harm also reflect the stage of development and positioning of adolescents in society. Research tools for conflict-affected adolescents should be co-developed with adolescents to ensure evidence and prevention strategies reflect and address the interconnected forms of harm.
Deaths among sexually exploited adolescent girls (SEAG) and female sex workers (FSW) are under-researched and under-reported. Although excess mortality during the COVID-19 pandemic has been documented among vulnerable populations, specific data on SEAG and FSW remain scarce. This lack of reliable data limits the ability of sex worker organizations and public health programs to design effective interventions or respond to shifting risks. We applied the Community Knowledge Approach to collect peer-reported data on deaths of FSW. Participants included 853 FSW across eight cities in Kenya, Nigeria, and the Democratic Republic of the Congo (DRC). Data collection took place in 2022 (Kenya and Nigeria) and 2023 (DRC), covering deaths during the COVID-19 pandemic. A total of 3,810 FSW deaths were reported, including 324 SEAG (<18 years) deaths: 1,482 deaths in the DRC, 870 in Kenya, and 1,458 in Nigeria. Overall, maternal causes resulted in 28.5% of deaths, with abortion alone responsible for 19.2%. Homicide was the leading individual cause (22.6%), followed by HIV/AIDS (11.7%) and suicide (8.8%). Of 280 peripartum deaths, 175 resulted in stillbirths or neonatal deaths. The majority of the deceased (2,243; 58.9%) were mothers, leaving behind 4,310 children. Among deaths of SEAG, maternal causes and homicide were the leading causes of death. Over one-third (110; 35.0%) were pregnant at the time of death; another third (105; 33.5%) were already mothers. The youngest reported age at death was 11. In the DRC, 30.0% of deceased SEAG were daughters of FSWs. This study reveals a substantial, largely invisible death toll among SEAG and FSW during the pandemic. Many of these deaths could have been prevented through existing, cost-effective interventions. The findings underscore an urgent need for targeted public health responses and mortality surveillance for this neglected population-both to prevent further deaths and to mitigate the long-term consequences for the children left behind.
Introduction Forensic medical opinions are central to classifying offences against health. Examinations determine whether violence resulted in bodily harm; in many cases, the victims are minors. Methods and results We analyzed 670 incidents of violence against minors in the Wielkopolska region (2015-2020) using anonymized forensic examinations commissioned by the police or requested by victims/legal guardians. Minors were defined as individuals aged <18 years. Descriptive statistics (mean, median, SD, IQR, range) and chi-square/Fisher tests were used; significance was set at p=0.05. Victims and perpetrators were predominantly male. Bruises were the most common injury, and the head was the most frequently affected region. More than half of incidents occurred in public spaces. Discussion An estimated one billion children worldwide experience violence each year; the true burden is likely higher because of underreporting. Many incidents never reach law enforcement, limiting available data. Although numerous social and preventive programs aim to reduce violence against children, its persistence indicates a need for broader, more comprehensive prevention. Conclusions Violence against minors remains a major public health and social concern. Large-scale prevention programs are needed, and training for healthcare and educational professionals is crucial because they are often the first to recognize abuse and initiate appropriate intervention.
Bielecka A, Burchardt B, Dolińska-Kaczmarek K et al.
Sexual violence (SV) is a global crisis that affects individuals across all demographics, with disproportionate impact on women, children, and marginalized communities. This paper explores the prevalence, consequences, and barriers survivors face in accessing care and justice. It highlights the physical, psychological, and social toll of SV against women and emphasizes the importance of survivor-centered approaches in healthcare, legal, and social support systems. In this paper, the FIGO Committee on Women Facing Crises outlines key recommendations for governmental authorities, healthcare providers, and non-governmental organizations (NGOs) for comprehensive care of SV survivors, including the establishment of integrated care models, legal reforms, and public awareness campaigns. Successful examples are presented as scalable solutions. This paper concludes by advocating for collaborative, multisectoral efforts and long-term strategies between relevant stakeholders to meet the needs of SV survivors with dignity and justice.
Objectives To evaluate the pilot implementation of Parwarish (Parenting for Lifelong Health-Teens) programme on reducing violence against adolescents and improving parenting practices, mental health, gender attitudes, resilience and financial coping among families in disadvantaged communities in North India. Design Pilot implementation study using a pre-post study design. Setting Community-based implementation in three disadvantaged settings in North India, including urban informal settlements, rural agricultural areas and remote tribal communities. Participants A total of 239 adolescents (aged 12-18 years) and 478 parents from 239 families were recruited using purposive and snowball sampling; all participants completed baseline assessment, with follow-up conducted within 6 weeks after intervention completion. Interventions A 14-week group-based parenting intervention delivered weekly in community settings, focusing on communication, problem-solving, non-violent discipline and financial management, facilitated by trained community members. Primary and secondary outcome measures Primary outcomes were parent and youth-reported maltreatment. Secondary outcomes included parenting practices, adolescent behaviour, mental health, resilience, gender-equitable attitudes and financial coping. Results Significant improvements were observed across all outcomes. Among adolescents, positive parenting increased (β=13.7; 95% CI 12.43 to 14.98), youth behaviour improved (β=9.12; 95% CI 8.11 to 10.13), resilience increased (β=9.53; 95% CI 8.19 to 10.86) and harsh discipline decreased (β=-8.69; 95% CI -10.45 to -6.94). Among parents, positive parenting improved (β=10.6; 95% CI 9.43 to 11.85), youth behaviour improved (β=11.11; 95% CI 10.20 to 12.02), harsh discipline decreased (β=-10.60; 95% CI -12.23 to -8.96) and financial coping improved (β=-4.97; 95% CI -5.98 to -3.97). Conclusions This low-cost, community-delivered pilot implementation of the Parwarish intervention was associated with improvements in parenting practices and in mental health and resilience among adolescents and parents. While causal inference is limited by the study design, the findings support further evaluation using controlled designs. It suggests potential for scale-up in similar low-resource settings. Trial registration number ACTRN12622000858796.
Purpose Prolonged exposure to armed conflict is associated with elevated rates of PTSD in civilian populations, such as Indian-administered Kashmir. This review aimed to systematically synthesise research on prevalence, risk factors, and correlates of PTSD among civilians in this setting and their association with armed conflict exposure. Methods A systematic review following PRISMA guidelines was conducted for empirical studies published up to 2025. Sixteen quantitative studies met the inclusion criteria. Due to heterogeneity in study design, sampling, and PTSD assessment, findings were synthesised narratively. Results Reported PTSD prevalence varied across studies. Among community-based adult samples, prevalence ranged from 15.9% to 24.5%, with higher screening-based estimates in selected populations, including college students (up to 49.8%) and children (up to 40%) meeting a PCL-C threshold for probable PTSD. Higher prevalence was observed among women, socioeconomically disadvantaged groups, orphans, and individuals with direct conflict-related injuries. Several studies reported dose-response relationships between cumulative trauma exposure and PTSD, with PTSD symptoms commonly reported even years after exposure and comorbid with depression, anxiety, and substance misuse. Several limitations of existing literature were identified, such as considerable variation in study quality and reliance on cross-sectional research. Conclusion This review reveals substantial levels of PTSD among civilians in Indian-administered Kashmir. It highlights variability driven by methodological differences in measurement, sampling, and exposure assessment. Greater consistency in assessment and study design and more longitudinal studies are needed to strengthen psychiatric epidemiological evidence in armed conflict settings to inform psychiatric support approaches in prolonged armed conflict settings. The findings highlight how the scale of need for psychiatric care in Kashmir exceeds capacity, prompting a need to explore possible low-resource interventions options such as community-based and task-shared approaches, options which may also be applicable in other militarised, low-resource settings. Systematic review registration https://osf.io/3ztxq.
Background Despite significant socio-economic progress and a decade of interventions aimed at improving nutrition, malnutrition remains a significant problem among children under the age of five in Rwanda. While several studies have been conducted to identify important risk factors for malnutrition in Rwanda, none have specifically assessed the association between intimate partner violence (IPV) and child nutritional status. Therefore, this study aimed to examine the association between women's exposure to IPV and the nutritional status of their children in Rwanda. Methods The study analyzed secondary data from the Rwanda Demographic and Health Survey 2019-20 (RDHS 2019/20). Data was gathered on women's emotional, physical, and sexual IPV experiences, as well as the anthropometric characteristics of their children aged under five. To determine the association between IPV exposure and child nutrition status, we used a multinomial logistic regression model. A weighted sample of 1277 women with at least one child under 5 years old, were studied. Results This study found that among 1,277 ever-married or partnered women, 36% (95% CI: 33.2%-38.7%) experienced physical IPV, 33.8% (95% CI: 31.2%-36.5%) experienced emotional IPV, and 14.6% (95% CI: 12.7%-16.7%) experienced sexual IPV. Overall, 45.7% (95% CI: 43.0%-48.5%) reported experiencing at least one form of IPV. Among their children, the prevalence of stunting was 30.7% (95% CI: 27.8%-33.1%), while 7% (95% CI: 5.6%-8.4%) were underweight, and 25.3% (95% CI: 22.8%-27.6%) experienced either stunting or underweight status. The results indicate that children whose mothers experienced sexual IPV were more likely to be underweight and stunted compared to their counterparts (ARRR = 2.53, 95% CI: 1.13-5.67). Conclusion Maternal experience of sexual intimate partner violence is associated with a higher likelihood of stunting and underweight among their children. Therefore, the study's findings underline the importance of effective interventions to address violence against women, as well as nutrition-based policies and programs to reduce malnutrition among children under the age of five.
Introduction Parents are crucial as providers of nurturing care for their children to grow and thrive. A community-based multicomponent intervention for women's health and early childhood health and development was conducted in rural Vietnam, spanning from mid-pregnancy through the first postpartum year. A cluster-randomised controlled trial of the programme conducted between 2018 and 2021 found that children aged 2 years whose parents were in the intervention group and had received the programme had higher cognitive, language and motor development than those in the control group who had received the usual standard of care. The intervention was also found to be cost-effective and improve equity. The aim of this follow-up study is to examine the mid-term effects of the intervention and describe the views of caregivers, service providers and policymakers on the programme, the evidence of its impact and its translation into policies and practice. Methods and analysis This is a follow-up study of participants in a cluster-randomised controlled trial to examine the mid-term effects of the intervention when children are 7 and 9 years old in Vietnam. We will re-enrol mother-child dyads from the original trial (622 women and their children in the intervention; 546 dyads in the control group). The primary outcome is children's intellectual ability. Secondary outcomes include children's emotional and behavioural development, quality of life, anthropometric indices, health conditions, health behaviour and education and parenting, maternal mental health, maternal quality of life, cardiovascular health and biomarkers of ageing together with women's and children's experiences of family violence.Outcomes will be measured using culturally and linguistically adapted standardised tools and study-specific structured questions. Differences in outcomes between trial groups will be assessed using mediation analyses and mixed-effects models, including a fixed effect for the trial group and adjusting for cluster effects as a random effect based on the intention-to-treat principle. An economic evaluation will estimate the cost-effectiveness of the intervention in improving child development at ages 7 and 9 years from healthcare and societal perspectives. A qualitative study will be conducted alongside the follow-up study using purposive sampling to describe the perspectives of caregivers, service providers and policymakers on the intervention, the evidence about its impact and its integration into national policies and services. Ethics and dissemination Ethics approval was obtained from the Monash University Human Research Ethics Committee (2025-46034-125952). Study findings will be disseminated through multiple channels, including peer-reviewed publications, national and international conference presentations, seminars, policy briefings, lay language summaries to communes and media reports. Trial registration number ACTRN12625001113448.
