The Demographic and Health Surveys Faculty Fellows Program: Successes, Challenges, and Lessons Learned.

Primarily funded by the United States Agency for International Development (USAID), the Demographic and Health Surveys (DHS) Faculty Fellows Program is designed to strengthen the institutional capacity of universities in low- and middle-income countries to use and analyze DHS data. This article provides an overview of the program's evolution and its current form; presents successes and impacts; and discusses challenges, lessons learned, and potential further directions.Initiated in 2008, the Fellows Program underwent several rounds of improvement. The current model involves a competitive team application process, 2 intensive in-person workshops, completion of a working paper of publishable quality, and the transfer of analysis skills learned during the fellowship to students and colleagues at home universities, all completed over 1 year. Since 2011, the Fellows Program has trained 152 researchers from 45 universities in 25 countries in Africa, Asia, and the Middle East. The program has not only strengthened individual skills in conducting research with data from large surveys but also substantially increased institutional capacity to analyze DHS data through fellows' capacity-building activities at their home universities. These successes have happened despite the many and continuing challenges related to fellows' diverse backgrounds, experience, skills, language barriers, logistical difficulties in organizing in-person workshops in fellows' countries, and sometimes fellows' varying levels of commitment.With continuous support from USAID, the program hopes to expand to more universities and countries, especially francophone countries. Overall, the DHS Faculty Fellows Program has proven to be highly successful and provides a model for other groups aiming to strengthen capacity for data use and research in low- and middle-income countries.

Violence against children in Latin America and the Caribbean: What do available data reveal about prevalence and perpetrators?

OBJECTIVE: To describe the prevalence of recent physical, sexual, and emotional violence against children 0 - 19 years of age in Latin America and the Caribbean (LAC) by age, sex, and perpetrator. METHODS: A systematic review and analysis of published literature and large international datasets was conducted. Eligible sources from first record to December 2015 contained age-, sex-, and perpetrator-specific data from LAC. Random effects meta-regressions were performed, adjusting for relevant quality covariates and differences in violence definitions. RESULTS: Seventy-two surveys (2 publications and 70 datasets) met inclusion criteria, representing 1 449 estimates from 34 countries. Prevalence of physical and emotional violence by caregivers ranged from 30% - 60%, and decreased with increasing age. Prevalence of physical violence by students (17% - 61%) declined with age, while emotional violence remained constant (60% - 92%). Prevalence of physical intimate partner violence (IPV) ranged from 13% - 18% for girls aged 15 - 19 years. Few or no eligible past-year estimates were available for any violence against children less than 9 years and boys 16 - 19 years of age; sexual violence against boys (any age) and girls (under 15 years); IPV except for girls aged 15 - 19 years; and violence by authority figures (e.g., teachers) or via gangs/organized crime. CONCLUSION: Past-year physical and emotional violence by caregivers and students is widespread in LAC across all ages in childhood, as is IPV against girls aged 15 - 19 years. Data collection must be expanded in LAC to monitor progress towards the sustainable development goals, develop effective prevention and response strategies, and shed light on violence relating to organized crime/gangs.

Violence against children in Latin America and the Caribbean: What do available data reveal about prevalence and perpetrators?

[ABSTRACT]. Objective. To describe the prevalence of recent physical, sexual, and emotional violence against children 0 – 19 years of age in Latin America and the Caribbean (LAC) by age, sex, and perpetrator. Methods. A systematic review and analysis of published literature and large international datasets was conducted. Eligible sources from first record to December 2015 contained age-, sex-, and perpetrator-specific data from LAC. Random effects meta-regressions were performed, adjusting for relevant quality covariates and differences in violence definitions. Results. Seventy-two surveys (2 publications and 70 datasets) met inclusion criteria, representing 1 449 estimates from 34 countries. Prevalence of physical and emotional violence by caregivers ranged from 30% – 60%, and decreased with increasing age. Prevalence of physical violence by students (17% – 61%) declined with age, while emotional violence remained constant (60% – 92%). Prevalence of physical intimate partner violence (IPV) ranged from 13% – 18% for girls aged 15 – 19 years. Few or no eligible past-year estimates were available for any violence against children less than 9 years and boys 16 – 19 years of age; sexual violence against boys (any age) and girls (under 15 years); IPV except for girls aged 15 – 19 years; and violence by authority figures (e.g., teachers) or via gangs/organized crime. Conclusion. Past-year physical and emotional violence by caregivers and students is widespread in LAC across all ages in childhood, as is IPV against girls aged 15 – 19 years. Data collection must be expanded in LAC to monitor progress towards the sustainable development goals, develop effective prevention and response strategies, and shed light on violence relating to organized crime/gangs.

[RESUMEN]. Objetivo. Describir la prevalencia de la violencia física, sexual y emocional infligida recientemente en niños y niñas de 0 a 19 años en América Latina y el Caribe (ALC) según la edad, el sexo y el agresor. Métodos. Se llevó a cabo una revisión y un análisis sistemáticos de la bibliografía publicada en los grandes conjuntos de datos. Las fuentes desde los primeros registros hasta diciembre del 2015 que cumplían los criterios fueron las que contenían datos específicos de América Latina y el Caribe en función de la edad, el sexo y el agresor. Se realizaron metarregresiones de los efectos aleatorios, con ajustes pertinentes para las covariables de calidad y las diferencias en las definiciones de violencia. Resultados. Setenta y dos encuestas (2 publicaciones y 70 conjuntos de datos) cumplieron los criterios de inclusión, que representaban 1.449 estimaciones de 34 países. La prevalencia de la violencia física y emocional infligida por cuidadores fue del 30% al 60% y disminuyó al aumentar la edad. La prevalencia de la violencia física infligida por estudiantes (17% a 61%) disminuyó con la edad, mientras que la violencia emocional se mantuvo constante (60% a 92%). La prevalencia de la violencia física infligida por la pareja fue de 13% a 18% para las niñas en edades de 15 a 19 años. Fueron pocas o inexistentes las estimaciones que cumplieran los criterios realizadas el año pasado sobre: la violencia de todo tipo contra los niños y las niñas menores de 9 años y los niños entre los 16 y 19 años; la violencia sexual contra los niños de cualquier edad y las niñas menores de 15 años; la violencia infligida por la pareja, salvo en niñas de 15 a 19 años; y la violencia infligida por figuras de autoridad (por ejemplo profesores) o por pandillas o el crimen organizado. Conclusión. La violencia emocional y física infligida por los cuidadores y estudiantes es generalizada en América Latina y el Caribe en todas las edades en la niñez, al igual que la violencia infligida por la pareja hacia niñas en edades entre los 15 y 19 años. Se debe ampliar la recopilación de datos en América Latina y el Caribe para dar seguimiento al progreso hacia los objetivos de desarrollo sostenible, elaborar estrategias eficaces de prevención y respuesta, y arrojar luz sobre la violencia en relación con el crimen organizado y las pandillas.

[RESUMO]. anos de idade na América Latina e no Caribe (ALC), discriminada por idade, sexo e autor da agressão. Métodos. Foi realizada uma revisão sistemática e análise da literatura publicada e de grandes conjuntos de dados internacionais. As fontes qualificadas do primeiro registro de dezembro de 2015 continham dados provenientes da ALC, discriminados por idade, sexo e autor da agressão. Foi usada a técnica de metarregressão de efeitos aleatórios, com ajuste para covariáveis de interesse de qualidade e para diferenças nas definições de violência. Resultados. Setenta e dois levantamentos (2 publicações e 70 conjuntos de dados) satisfizeram os critérios de inclusão, representando 1.449 estimativas provenientes de 34 países. A prevalência da violência física e emocional por cuidadores variou de 30% a 60%, sendo que este percentual diminuiu com o aumento da idade. A prevalência da violência física escolar (17% a 61%) diminuiu com a idade e a prevalência da violência infantil emocional ficou constante (60% a 92%). A prevalência da violência física por parceiro íntimo variou de 13% a 18% nas adolescentes entre 15 e 19 anos de idade. Foram encontradas poucas estimativas para o ano precedente, ou as estimativas existentes não satisfizeram os critérios, quanto à violência infantil em crianças menores de 9 anos e adolescentes do sexo masculino entre 16 e 19 anos de idade, à violência sexual contra meninos (em qualquer idade) e meninas (menores de 15 anos), à violência por parceiro íntimo, exceto em meninas entre 15 e 19 anos de idade e à violência infligida por figuras de autoridade (como professores) ou gangues/crime organizado. Conclusão. A violência física e emocional no ano precedente praticada por cuidadores e na escola é generalizada na ALC e ocorre em todas as faixas etárias na infância, assim como a violência por parceiro íntimo contra as adolescentes entre 15 e 19 anos de idade. A coleta de dados deve ser ampliada na ALC para monitorar o progresso rumo ao alcance dos objetivos de desenvolvimento sustentável, criar estratégias efetivas de prevenção e resposta à violência e identificar a violência relativa ao crime organizado/quadrilhas.

"Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites.

BACKGROUND: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths. METHODS: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken. CONCLUSIONS: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.

Who perpetrates violence against children? A systematic analysis of age-specific and sex-specific data.

OBJECTIVE: The epidemiology of violence against children is likely to differ substantially by sex and age of the victim and the perpetrator. Thus far, investment in effective prevention strategies has been hindered by lack of clarity in the burden of childhood violence across these dimensions. We produced the first age-specific and sex-specific prevalence estimates by perpetrator type for physical, sexual and emotional violence against children globally. DESIGN: We used random effects meta-regression to estimate prevalence. Estimates were adjusted for relevant quality covariates, variation in definitions of violence and weighted by region-specific, age-specific and sex-specific population data to ensure estimates reflect country population structures. DATA SOURCES: Secondary data from 600 population or school-based representative datasets and 43 publications obtained via systematic literature review, representing 13 830 estimates from 171 countries. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Estimates for recent violence against children aged 0-19 were included. RESULTS: The most common perpetrators of physical and emotional violence for both boys and girls across a range of ages are household members, with prevalence often surpassing 50%, followed by student peers. Children reported experiencing more emotional than physical violence from both household members and students. The most common perpetrators of sexual violence against girls aged 15-19 years are intimate partners; however, few data on other perpetrators of sexual violence against children are systematically collected internationally. Few age-specific and sex-specific data are available on violence perpetration by schoolteachers; however, existing data indicate high prevalence of physical violence from teachers towards students. Data from other authority figures, strangers, siblings and other adults are limited, as are data on neglect of children. CONCLUSIONS: Without further investment in data generation on violence exposure from multiple perpetrators for boys and girls of all ages, progress towards Sustainable Development Goals 4, 5 and 16 may be slow. Despite data gaps, evidence shows violence from household members, peers in school and for girls, from intimate partners, should be prioritised for prevention. TRIAL REGISTRATION NUMBER: PROSPERO 2015: CRD42015024315.

Married women's risk of STIs in developing countries: the role of intimate partner violence and partner's infection status.

Data for nationally representative samples of cohabiting couples in six developing countries show that intimate partner violence (IPV) increases the risk of self-reported sexually transmitted infections (STIs) for currently married women (ORs = 1.4-2.2) in all six countries, and that the strength of this relationship is not diminished by controls for proximate determinants such as husband's self-reported STI status and men's and women's higher-risk behaviors. The robustness of the IPV-STI relationship suggests the need to acknowledge IPV as an STI risk factor for women on par with other recognized risk factors such as multiple sexual partners and unprotected sexual intercourse.

Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries.

We aimed to describe the prevalence of intimate partner violence (IPV) during pregnancy across 19 countries, and examine trends across age groups and UN regions. We conducted a secondary analysis of data from the Demographic and Health Surveys (20 surveys from 15 countries) and the International Violence Against Women Surveys (4 surveys from 4 countries) carried out between 1998 and 2007. Our data suggest that intimate partner violence during a pregnancy is a common experience. The prevalence of IPV during pregnancy ranged from approximately 2.0% in Australia, Cambodia, Denmark and the Philippines to 13.5% in Uganda among ever-pregnant, ever-partnered women; half of the surveys estimated prevalence to be between 3.9 and 8.7%. Prevalence appeared to be higher in African and Latin American countries relative to the European and Asian countries surveyed. In most settings, prevalence was relatively constant in the younger age groups (age 15-35), and then appeared to decline very slightly after age 35. Intimate partner violence during pregnancy is more common than some maternal health conditions routinely screened for in antenatal care. Global initiatives to reduce maternal mortality and improve maternal health must devote increased attention to violence against women, particularly violence during pregnancy.

Reproductive health and domestic violence: are the poorest women uniquely disadvantaged?

We use Demographic and Health Survey data from Cambodia, the Dominican Republic, and Haiti to compare women in different poverty and violence categories in terms of their experience of selected reproductive health outcomes. "Poor" women are those who belong to the bottom quintile of households arrayed according to a widely accepted asset-based wealth index. The results suggest that women who are both poor and have experienced violence are not unique in their reproductive health disadvantage. In particular, for all three reproductive health outcomes we consider the negative association with having experienced violence cuts across all women, poor and wealthy.