Sexual violence among adolescent girls and young women in Malawi: A cluster-randomized controlled implementation trial of empowerment self-defense training

Michele R Decker, Shannon N. Wood, Esther Ndinda, Gayane Yenokyan, Jacob Sinclair, Nankali Maksud, Brendan Ross, Benjamin Omondi, Martin Ndirangu

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number1341
JournalBMC Public Health
Volume18
Issue number1
DOIs
StatePublished - Dec 4 2018

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Malawi
Sex Offenses
Randomized Controlled Trials
Students
Odds Ratio
Violence
Crime Victims
Conservation of Natural Resources
Disclosure
Risk Reduction Behavior
Random Allocation
Registries
Power (Psychology)
Clinical Trials
Education

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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Sexual violence among adolescent girls and young women in Malawi : A cluster-randomized controlled implementation trial of empowerment self-defense training. / Decker, Michele R; Wood, Shannon N.; Ndinda, Esther; Yenokyan, Gayane; Sinclair, Jacob; Maksud, Nankali; Ross, Brendan; Omondi, Benjamin; Ndirangu, Martin.

In: BMC Public Health, Vol. 18, No. 1, 1341, 04.12.2018.

Research output: Contribution to journalArticle

Decker, Michele R ; Wood, Shannon N. ; Ndinda, Esther ; Yenokyan, Gayane ; Sinclair, Jacob ; Maksud, Nankali ; Ross, Brendan ; Omondi, Benjamin ; Ndirangu, Martin. / Sexual violence among adolescent girls and young women in Malawi : A cluster-randomized controlled implementation trial of empowerment self-defense training. In: BMC Public Health. 2018 ; Vol. 18, No. 1.
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abstract = "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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