TY - JOUR
T1 - Sexual violence among adolescent girls and young women in Malawi
T2 - A cluster-randomized controlled implementation trial of empowerment self-defense training
AU - Decker, Michele R.
AU - Wood, Shannon N.
AU - Ndinda, Esther
AU - Yenokyan, Gayane
AU - Sinclair, Jacob
AU - Maksud, Nankali
AU - Ross, Brendan
AU - Omondi, Benjamin
AU - Ndirangu, Martin
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/12/4
Y1 - 2018/12/4
N2 - Background: Globally, sexual violence is prevalent, particularly for adolescent women. This cluster-randomized controlled implementation trial examines empowerment self-defense (ESD) for sexual assault risk reduction among school-age women in Malawi. Methods: The unit of randomization and analysis was the school (n = 141). Intervention participants received a 12-h intervention over 6 weeks, with refreshers. Primary outcomes were past-year prevalence and incident rate of sexual violence. Secondary outcomes included confidence, self-defense knowledge, and, for those victimized, violence disclosure. Interaction effects on outcomes were evaluated with Poisson models with school-correlated robust variance estimates for risk ratios and incident rate ratios (baseline n = 6644, follow-up n = 4278). Results: Past-year sexual assault prevalence was reduced among intervention students (risk ratio [RR] 0.68, 95% CI 0.56, 0.82), but not control students (interaction effect p < 0.001). Significant increases in self-defense knowledge were observed solely among intervention students (RR 3.33, 95% CI 2.76, 4.02; interaction effect p < 0.001). Significant changes in sexual violence prevalence and knowledge were observed for both primary and secondary students. Favorable reductions were also observed in sexual violence incident rate among students overall (interaction effect p = 0.01). Conclusions: This intervention reduced sexual violence victimization in both primary and secondary school settings. Results support the effectiveness of ESD to address sexual violence, and approach the elimination of violence against women and girls set forth with Sustainable Development Goal #5. Implementation within the education system can enable sustainability and reach. Trial registration: Pan African Clinical Trials Registry PACTR201702002028911. Registered 09 February 2017. Retrospectively registered.
AB - Background: Globally, sexual violence is prevalent, particularly for adolescent women. This cluster-randomized controlled implementation trial examines empowerment self-defense (ESD) for sexual assault risk reduction among school-age women in Malawi. Methods: The unit of randomization and analysis was the school (n = 141). Intervention participants received a 12-h intervention over 6 weeks, with refreshers. Primary outcomes were past-year prevalence and incident rate of sexual violence. Secondary outcomes included confidence, self-defense knowledge, and, for those victimized, violence disclosure. Interaction effects on outcomes were evaluated with Poisson models with school-correlated robust variance estimates for risk ratios and incident rate ratios (baseline n = 6644, follow-up n = 4278). Results: Past-year sexual assault prevalence was reduced among intervention students (risk ratio [RR] 0.68, 95% CI 0.56, 0.82), but not control students (interaction effect p < 0.001). Significant increases in self-defense knowledge were observed solely among intervention students (RR 3.33, 95% CI 2.76, 4.02; interaction effect p < 0.001). Significant changes in sexual violence prevalence and knowledge were observed for both primary and secondary students. Favorable reductions were also observed in sexual violence incident rate among students overall (interaction effect p = 0.01). Conclusions: This intervention reduced sexual violence victimization in both primary and secondary school settings. Results support the effectiveness of ESD to address sexual violence, and approach the elimination of violence against women and girls set forth with Sustainable Development Goal #5. Implementation within the education system can enable sustainability and reach. Trial registration: Pan African Clinical Trials Registry PACTR201702002028911. Registered 09 February 2017. Retrospectively registered.
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U2 - 10.1186/s12889-018-6220-0
DO - 10.1186/s12889-018-6220-0
M3 - Article
C2 - 30514264
AN - SCOPUS:85057608890
SN - 1471-2458
VL - 18
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 1341
ER -