Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020.

Background: Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods: We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results: Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions: SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.

Risk factors and health consequences of physical and emotional violence against children in Zimbabwe: a nationally representative survey.

INTRODUCTION: This study provides, for the first time, comparable national population-based estimates that describe the nature and magnitude of physical and emotional violence during childhood in Zimbabwe. METHODS: From August to September 2011, we conducted a national population-based survey of 2410 respondents aged 13-24 years, using a two-stage cluster sampling. Regression models were adjusted for relevant demographics to estimate the ORs for associations between violence, risk factors and various health-related outcomes. RESULTS: Respondents aged 18-24 years report a lifetime prevalence (before the age of 18) of 63.9% (among girls) to 76% (among boys) for physical violence by a parent or adult relative, 12.6% (girls) to 26.4% (boys) for humiliation in front of others, and 17.3% (girls) to 17.5% (boys) for feeling unwanted. Almost 50% of either sex aged 13-17 years experienced physical violence in the 12 months preceding the survey. Significant risk factors for experiencing physical violence for girls are ever experiencing emotional abuse prior to age 13, adult illness in the home, socioeconomic status and age. Boys' risk factors include peer relationships and socioeconomic status, while caring teachers and trusted community members are protective factors. Risk factors for emotional abuse vary, including family relationships, teacher and school-level variables, socioeconomic status, and community trust and security. Emotional abuse is associated with increased suicide attempts for both boys and girls, among other health outcomes. CONCLUSION: Physical and emotional violence often work in tandem causing poor mental and physical health outcomes. Understanding risk factors for violence within the peer or family context is essential for improved violence prevention.

Childhood sexual violence in Zimbabwe: evidence for the epidemic against girls.

Sexual abuse during childhood is a public health and human rights concern throughout the world, including Sub-Saharan Africa. In 2011, Zimbabwe initiated national prevalence data collection on violence against children to inform government policy and programs. We interviewed 567 females and 589 males, aged 18-24 years following standardized and previously tested survey methods from the region. Of females 32.5%, and of males 8.9%, reported experiencing sexual violence before age 18. Most female (62.7%) and male (47.9%) victims of sexual violence experienced more than one incident of sexual violence prior to age 18 years. Three in four females (77.7%) and one in four males (26.7%) of those who experienced sexual violence reported that the first incident was perpetrated by a boyfriend or girlfriend. Few victims received professional help (2.7% of females and 2.4% of males who had reported experiencing sexual violence). Violence against girls is at epidemic levels in Zimbabwe. Most sexual violence against girls occurs within the context of peer relationships. Child victims who seek potentially life-saving support tend not to receive it. This study is evidence of a national public health and child rights emergency in the country and a case for increased, longer-term investment by the government and its development partners in policy reform for enhancing adolescent girls' empowerment and protection.