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Research
Preventing violence against refugee adolescent girls: findings from a cluster randomised controlled trial in Ethiopia
  1. Lindsay Stark1,2,
  2. Khudejha Asghar1,
  3. Ilana Seff1,
  4. Gary Yu1,3,
  5. Teame Tesfay Gessesse4,
  6. Leora Ward5,
  7. Asham Assazenew Baysa5,
  8. Amy Neiman5,
  9. Kathryn L Falb5
  1. 1 Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
  2. 2 Brown School at Washington University in St. Louis, St. Louis, MO, United States
  3. 3 New York University Rory Meyers College of Nursing, New York City, New York, USA
  4. 4 Independent Consultant, Addis Ababa, Ethiopia
  5. 5 International Rescue Committee, New York City, New York, USA
  1. Correspondence to Dr Lindsay Stark; ls2302{at}cumc.columbia.edu

Abstract

Introduction Interpersonal violence is a critical public health concern in humanitarian contexts, but evidence of effective violence prevention programmes targeting adolescent girls is lacking. We investigated the efficacy of a life skills and safe spaces programme to reduce adolescent girls’ experiences of interpersonal violence in a refugee setting.

Methods In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 919 Sudanese and South Sudanese girls ages 13–19 years residing in refugee camps in Ethiopia. Girls were divided into 31 clusters, with 457 and 462 participants assigned to the intervention and control arms, respectively. Intervention clusters received 30 life skills sessions delivered in safe spaces and 8 complementary sessions for caregivers. The primary outcome was exposure to sexual violence in the previous 12 months. Secondary outcomes included disaggregated forms of sexual violence, physical violence, emotional violence, transactional sex, child marriage, feelings of safety, attitudes around rites of passage and perceptions of social support. Intent-to-treat analysis was used.

Results At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (adjusted OR =0.96, 95%  CI 0.59 to 1.57), other forms of violence, transactional sex or feelings of safety. The intervention was associated with improvements in attitudes around rites of passage and identified social supports. Additionally, the intervention showed a decrease in reported child marriage among girls who were married at baseline.

Conclusion While the intervention impacted key markers along the causal pathway to violence reduction, further research and programmatic adaptations are needed to prevent violence towards adolescents in humanitarian contexts.

Trial registration NCT02506543.

  • child health
  • public health
  • Prevention strategies
  • Cluster randomized trial

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bmjgh-2018-000825

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors LS is principal investigator and led manuscript development. KA led data analysis, supported manuscript development and data collection. IS supported data analysis, interpretation and manuscript development. Coinvestigators KF and LW supported conceptual development and study implementation. TTG managed oversight of data collection. AN and LW are responsible for assisting in tool adaptation and study implementation. All authors reviewed and approved the final manuscript prior to submission.

    • Funding The study was funded by the UK Department for International Development (grant #40080602). The funders played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Columbia University Medical Center IRB; Administration for Refugee and Returnee Affairs in Ethiopia; International Rescue Committee Internal Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Due to legal restrictions, data cannot be made publicly available. Data are owned by the International Rescue Committee (IRC). For more information about IRC data, please visit the following URL: http://www.whatworks.co.za/about/about-what-works. For data related inquiries please contact Kathryn Falb (Kathryn.Falb@rescue.org).

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