Good School Toolkit-Secondary Schools to prevent violence against students: protocol for a pilot cluster randomised controlled trial.

INTRODUCTION: No whole-school interventions which seek to reduce physical, sexual and emotional violence from peers, intimate partners and teachers have been trialled with adolescents. Here, we report a protocol for a pilot trial of the Good School Toolkit-Secondary Schools intervention, to be tested in Ugandan secondary schools. Our main objectives are to (1) refine the intervention, (2) to understand feasibility of delivery of the intervention and (3) to explore design parameters for a subsequent phase III trial. METHODS AND ANALYSIS: We will conduct a pilot cluster randomised controlled trial, with two arms and parallel assignment. Eight schools will be randomly selected from a stratified list of all eligible schools in Kampala and Wakiso Districts. We will conduct a baseline survey and endline survey 18 months after the baseline, with 960 adolescents and 200 teachers. Qualitative data and mixed methods process data collection will be conducted throughout the intervention. Proportion of staff and students reporting acceptability, understanding and implementing with fidelity will be tabulated at endline for intervention schools. Proportions of schools consenting to participation, randomisation and proportions of schools and individual participants completing the baseline and endline surveys will be described in a Consolidated Standards of Reporting Trials diagram. ETHICS AND DISSEMINATION: The ethical requirements of our project are complex. Full approvals have been received from the Mildmay Ethics Committee (0407-2019), the Uganda National Council for Science and Technology (SS 6020) and the London School of Hygiene & Tropical Medicine (16212). Results of this study will be published in peer-reviewed academic journals, and shared with public bodies, policy makers, study participants and the general public in Uganda. TRIAL REGISTRATION NUMBER: PACTR202009826515511.

Child-led resistance in the streets of the global south: Decolonial perspectives of violence against children outside of family care.

BACKGROUND: Violence against children (VAC) remains an urgent global dilemma and researchers and policymakers alike continue to work tirelessly to devise strategies aiming to end VAC. However, the perspectives and expertise of children themselves remain underrepresented in the drafting and implementation of these strategies against VAC. This paper draws attention to the marginalization of children living outside of family care and centers their perspective. OBJECTIVE: This study aimed to characterize the forms of violence experienced by children living outside the family setting in Uganda, from the perspective of children themselves. The paper seeks to position the voicing of this perspective as a form of resistance against VAC from a decolonial perspective. PARTICIPANTS AND SETTING: The participatory research process included a total of 94 participants in various urban study sites in Kampala, Uganda. METHODS: The research team completed this qualitative study within a youth-driven participatory action research (YPAR) framework. Data collection techniques included interviews, focus groups, participatory visual methods and social cartography. RESULTS: Children living outside of family care experience grave forms of emotional, physical and sexual violence. Child participants present survival strategies that can inform future research and policies on violence prevention practice. CONCLUSIONS: The illustration of explicit violence outlined in this study represents a form of resistance children take against their perpetrators. The participatory youth researcher team urges future research and policy addressing VAC in Uganda to center these perspectives and expertise of children and adolescents in both programmatic and research initiatives aiming to end violence against children.

"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.

Intimate Partner Violence and Mental Health: Sex-Disaggregated Associations Among Adolescents and Young Adults in Uganda.

Experiences of intimate partner violence (IPV) victimization have well-established associations with poor mental health. There is also burgeoning evidence regarding the association between IPV perpetration and mental health in a small number of countries. However, there is a paucity of data about the gendered differences for these IPV experiences within sub-Saharan African. This study examines the association between IPV victimization, perpetration, and mental health outcomes for male and female adolescents and young adults in Uganda. Data on IPV perpetration were available for a nationally representative sample of 1,373 males and 2,022 females in Uganda. Observations were weighted to be representative of 13- to 24-year-olds in Uganda. Study procedures used multivariate logistic regression models to examine associations between ever-perpetration of IPV and four self-reported mental health variables: severe sadness, feelings of worthlessness, suicide ideation, and alcohol abuse. Models controlled for age, marital status, schooling, and past exposure to violence. Models were sex-disaggregated to examine sex-specific associations. Standard errors were adjusted for sampling stratification and clustering. Data analysis showed that males were more than twice as likely as females to perpetrate IPV (14% vs. 6%, respectively; p < .001), while odds of perpetration for both sexes were higher for those ever experiencing IPV (adjusted odds ratio [aOR] = 12.12 for males; aOR=4.73 for females). Male perpetrators had 2.93 greater odds of experiencing suicidal ideation (95% confidence interval [CI]: [1.78, 4.82], p < .001) and increased drinking behaviors (2.21, 95% CI: [1.39, 3.50], p < .001) when compared with non-perpetrating males. In addition, female perpetrators had 2.59 times greater odds of suicidal ideation (95% CI: [1.34,4.99], p < .01), as compared with non-perpetrating females. Our findings among youth and adolescents demonstrated associated but different experiences for males and females. Findings indicate the importance of understanding the relationship between IPV victimization and perpetration, and addressing these correlates with a gender-sensitive perspective to inform policy and programming.