"We should be at the table together from the beginning": perspectives on partnership from stakeholders at four research institutions in sub-Saharan Africa.

BACKGROUND: Global health research partnerships have been scrutinised for how they operate and criticised for perpetuating inequities. Guidance to inform fair partnership practice has proliferated and the movement to decolonise global health has added momentum for change. In light of this evolving context, we sought in this study to document contemporary experiences of partnership from the perspective of stakeholders in four sub-Saharan African research institutions. METHODS: We conducted qualitative interviews with 20 stakeholders at research institutions in four countries in anglophone eastern and southern Africa. Interview questions were informed by published guidance on equitable research partnerships. Data was analysed through an iterative process of inductive and deductive coding, supported by NVivo software. RESULTS: Early-career, mid-career and senior researchers and research administrators from four sub-Saharan African research institutions described wide-ranging experiences of partnership with high-income country collaborators. Existing guidelines for partnership provided good coverage of issues that participants described as being the key determinants of a healthy partnership, including mutual respect, role clarity and early involvement of all partners. However, there was almost no mention of guidelines being used to inform partnership practice. Participants considered the key benefits of partnership to be capacity strengthening and access to research funding. Meanwhile, participants continued to experience a range of well-documented inequities, including exclusion from agenda setting, study design, data analysis and authorship; and relationships that were exploitative and dominated by high-income country partners' interests. Participants also reported emerging issues where their institution had been the prime recipient of funds. These included high-income country partners being unwilling to accept a subordinate role and failing to comply with reporting requirements. CONCLUSIONS: Insights from stakeholders in four sub-Saharan African research institutions suggest that contemporary global health research partnerships generate considerable benefits but continue to exhibit longstanding inequities and reveal emerging tensions. Our findings suggest that long-term support targeted towards institutions and national research systems remains essential to fulfil the potential of research led from sub-Saharan Africa. High-income country stakeholders need to find new roles in partnerships and stakeholders from sub-Saharan Africa must continue to tackle challenges presented by the resource-constrained contexts in which they commonly operate.

Factors Associated With Violence Against Children in Low- and Middle-Income Countries: A Systematic Review and Meta-Regression of Nationally Representative Data.

BACKGROUND: This systematic review and meta-regression sought to identify the relative importance of factors associated with physical, emotional, and sexual violence against children in low- and middle-income countries. Understanding of factors associated with violence is important for targeted programming and prevention on the population level. METHODS: We searched 17 electronic databases from 1989 to 2018 and reports from child violence surveys. Nationally representative studies that described evidence on potential factors associated with violence against children under 18 years old were included. The search was restricted to the English language. Factors were synthesized quantitatively using robust variance estimation, with 95% confidence intervals, for each violence type. RESULTS: We identified 8,346 unduplicated studies, and 103 publications met our eligibility criteria. The data distribution was uneven across region, country income status, factors, and violence types. Of the 94 eligible studies quantitatively synthesized, no specific factors were significant for physical violence. Lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence, and being a girl was associated with sexual violence. CONCLUSION: A broad spectrum of factors merit consideration for physical violence policy and prevention among the general population of children in low- and middle-income countries. Conversely, a tailored approach may be warranted for preventing emotional and sexual violence. Information is unequally distributed across countries, factors, and violence types. Greater emphasis should be placed on collecting representative data on the general population and vulnerable subgroups to achieve national reductions in violence against children.

Ugandan households: A Study of parenting practices in three districts.

Ugandan households play a central role in child care and protection, and household-level practices influence the ways in which children are protected from adversities. This study was designed to identify community perceptions of protective and harmful parenting practices in three districts in Uganda. It employed free-listing interviews to determine priorities and practices deemed to be important in providing care and protection to children. Findings suggest that parenting practices can be grouped into seven basic themes, which are: Investing in children's future, Protection, Care, Enterprising, Relationship with neighbors, Intimate partner relationship, and Child Rearing. Investing in children's future, including educating children, was cited most often as a hallmark of positive parenting; while failure to care for children was most often cited as a hallmark of negative parenting. Concrete behaviors, such as walking a daughter to school; sewing a son's torn pants before going to church; and structuring study time at home were identified as concrete actions Ugandan parents undertake daily to promote their children's well-being. Conversely, specific contextual aspects of neglect and abuse were identified as central components of negative parenting, including lack of investment in children's education and not serving as a good role model. Building on community strengths is recommended as a principal means of enhancing household resilience and reducing childhood risk.