Abstract
SummaryBackgroundViolence against children from school staff is widespread in various settings, but few interventions address this. We tested whether the Good School Toolkit—a complex behavioural intervention designed by Ugandan not-for-profit organisation Raising Voices—could reduce physical violence from school staff to Ugandan primary school children.MethodsWe randomly selected 42 primary schools (clusters) from 151 schools in Luwero District, Uganda, with more than 40 primary 5 students and no existing governance interventions. All schools agreed to be enrolled. All students in primary 5, 6, and 7 (approximate ages 11–14 years) and all staff members who spoke either English or Luganda and could provide informed consent were eligible for participation in cross-sectional baseline and endline surveys in June–July 2012 and 2014, respectively. We randomly assigned 21 schools to receive the Good School Toolkit and 21 to a waitlisted control group in September, 2012. The intervention was implemented from September, 2012, to April, 2014. Owing to the nature of the intervention, it was not possible to mask assignment. The primary outcome, assessed in 2014, was past week physical violence from school staff, measured by students' self-reports using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool—Child Institutional. Analyses were by intention to treat, and are adjusted for clustering within schools and for baseline school-level means of continuous outcomes. The trial is registered at clinicaltrials.gov, NCT01678846.FindingsNo schools left the study. At 18-month follow-up, 3820 (92·4%) of 4138 randomly sampled students participated in a cross-sectional survey. Prevalence of past week physical violence was lower in the intervention schools (595/1921, 31·0%) than in the control schools (924/1899, 48·7%; odds ratio 0·40, 95% CI 0·26–0·64, p<0·0001). No adverse events related to the intervention were detected, but 434 children were referred to child protective services because of what they disclosed in the follow-up survey.InterpretationThe Good School Toolkit is an effective intervention to reduce violence against children from school staff in Ugandan primary schools.FundingMRC, DfID, Wellcome Trust, Hewlett Foundation.
Highlights
Recent national surveys suggest that, at least in some settings, violence from school staff could be an important but overlooked contributor to the overall health burden associated with violence against children
There are no nationally representative data in Uganda, but our own work in one district shows that more than 90% of children aged about 11–14 years report lifetime physical violence from school staff, with 88% reporting caning, and 8% reporting extreme physical violence such as ever being choked, burned, stabbed, or severely beaten up.7 4% had ever sought medical treatment for an injury inflicted by a staff member.[7]
Implications of all the available evidence Our results suggest that the Good School Toolkit can reduce physical violence from school staff to primary school children in Uganda
Summary
Exposure to physical violence in childhood is widespread and associated with increased risk of depressive disorders and suicide attempts,[1] poor educational attainment,[2] and increased risk of perpetrating or experiencing intimate partner violence in later relationships.[3,4] Recent national surveys suggest that, at least in some settings, violence from school staff could be an important but overlooked contributor to the overall health burden associated with violence against children. Assessments of interventions to reduce physical violence from school staff in low-income and middleincome settings are almost entirely absent from the literature.[8] One study in Jamaica that tested the Incredible Years intervention in preschools showed a large reduction in negative teacher behaviours[9] and improvements in child conduct disorder,[10] suggesting that it is possible to change teachers’ violent behaviour; we are not aware of any other trials on the topic
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