Date of Award

Spring 4-20-2018

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

DR. XIANGMING FANG

Second Advisor

DR. SHERYL STRASSER

Abstract

Background: Violence against children (VAC) is a devastating problem in sub-Saharan Africa and a major public health problem globally. The World Health Organization (WHO) defines violence against children as all forms of (physical, emotional, sexual abuse or neglect, commercial and other forms of exploitation), causing potential harm to the well-being of a child’s survival, development, and dignity. The World Health Organization (WHO) estimates that 40 million children aged 15 years and younger fall victim to violence each year. In African countries, violence against children is seldom recognized and the injury perpetrated are rarely reported and managed adequately.

Aim: The purpose of this study is to systematically synthesize the evidence relating violence against children (VAC) and mental health outcomes among populations in sub-Saharan

Africa, and to propose policy recommendations to intensify legal consequences for perpetrators, and provide support for VAC victims to receive long-term mental health services.

Methods: A review of literature was conducted, searching Medline/PubMed, Embase, Web of Science, PsychInfo, EBSCO, CINAHL-EBSCO, Cochrane databases for primary research studies related to key search terms: (violence against children, exposure to childhood violence, mental health outcomes, children, sub-Saharan Africa) involving children before the age of eighteen and in Sub-Saharan countries. Eligible study results were analyzed using Review STATA version 13.0. To provide fixed and random effects AOR to generate pooled odds ratios (AOR) of the association between violence in childhood and mental health outcome, data were analyzed using the random effects model. Subgroup analyses by gender were conducted to identify potential methodological moderators.

Results: Twenty published studies (15 cross-sectional, 3 prospective, 3 cohorts and 1 case-control studies) involving populations in nine sub-Saharan countries – Kenya (1 study), Malawi (2 studies), Namibia (1 study), Nigeria (1 study), South Africa (9 studies), Swaziland (3 studies), Tanzania (1 study) and Uganda (2 studies) were included in the review. Overall all forms of childhood violence were significantly associated with mental health outcomes. Children who experienced any form of violence were most likely burdened with depression, compared to other types mental health outcomes. However, violence-type predictors varied by gender. While boys were three times more at odds to develop depression from emotional abuse [AOR 3.17, 95% CI (1.61–4.72)], girls were two times more likely to develop depression from sexual violence [AOR 2.133, 95% CI (1.704–2.562)].

Conclusion: Findings from this review confirms that all forms of violence in childhood have a significant impact on mental health outcomes. Lack of data can hinder efforts to reveal the pervasive nature of violence in childhood. This in turn limits the effectiveness of initiatives to prevent it. Thus, there is need for high-quality follow-up studies, comprehensive social and mental health programs, and supportive child protection services.

Available for download on Thursday, April 25, 2019

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