BACKGROUND: Violence against children from school staff is anecdotally common in low- and middle-income countries, but data on prevalence and associations with mental health and educational outcomes are lacking.
METHODS: We report data from a cross-sectional survey conducted in June and July 2012 in Luwero District, Uganda. Forty-two primary schools representing 80% of students in the district were randomly selected; 100% agreed to participate. The International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool—Child Institutional; Strengths and Difficulties Questionnaire; and reading, spelling, and math tests were administered. We present descriptive statistics and logistic regression models, accounting for the complex sampling scheme used in the survey.
RESULTS: We surveyed 3706 students and 577 school staff members; 93.3% (SE 1.0%) of boys and 94.2% (SE 1.6%) of girls attending primary school reported lifetime experience of physical violence from a school staff member, and >50% reported experience in the past week. Past-week physical violence was associated with increased odds of poor mental health and, for girls, double the odds of poor educational performance (adjusted odds ratio = 1.78, 95% confidence interval = 1.19–2.66). For boys, significant interactions were present.
CONCLUSIONS: Despite a ban on corporal punishment in Ugandan schools since 1997, the use of violence against students is widespread and associated with poor mental health and educational performance. School violence may be an important but overlooked contributor to disease burden and poor educational performance in low- and middle-income settings.
- corporal punishment
- child maltreatment
- violence against children
- mental health
- primary school
- ICAST-CI —
- International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional
- SDQ —
- Strengths and Difficulties Questionnaire
- SRQ —
- Self-Report Questionnaire
What’s Known on This Subject:
Violence from school staff toward children is anecdotally widespread, but there are few empirical data on prevalence and health consequences, especially in low-income settings.
What This Study Adds:
Despite a ban on corporal punishment, just over 52% of children in Luwero District experienced physical violence from school staff members in the previous week. This was associated with poor mental health in boys and girls and poor educational performance in girls.
Exposure to violence in childhood has profound health and social consequences, including increased risk of depression,1 suicide,2 conduct disorder,3 disruptive behavior,4 and risky sexual behavior.5 In most countries, children spend more time at school than any other place besides the family home.6 Despite this, there is little information on the prevalence and health effects of violence experienced by children in schools in low- and middle-income settings.
Uganda is no exception. Corporal punishment was banned in Ugandan schools in 1997 by the Ministry of Education and Sports, yet there are widespread reports of physical punishment. One survey of >1400 children found that >80% had experienced caning and slapping by teachers.7 Qualitative studies also highlight that Ugandan girls experience sexual violence and harassment at school but are unable to report it for fear of reprisals,8 similar to other African settings.9,10
In this article, we report on the prevalence of physical, sexual, and emotional violence and neglect experienced by children attending primary school, both from school staff members and others, including parents. We hypothesized a priori that female students would experience more sexual violence and male students would experience more physical violence and injury and that children experiencing more physical violence from school staff would have worse mental health outcomes and educational achievement relative to peers who had experienced less violence. We also hypothesized that school staff members who reported using more violence toward students would have poorer mental health, have experienced more violence themselves, and would use more violence against nonstudents relative to staff who reported less use of violence toward students.
We analyzed baseline survey data from the Good Schools Study,11 which is a cluster randomized controlled trial of the Good School Toolkit. The Toolkit was developed by Raising Voices to prevent violence against children in school and improve educational outcomes (http://raisingvoices.org/good-school).
The survey took place in Luwero District, Uganda, in June and July 2012. Luwero is near Kampala and has both rural and urban areas.
We obtained a list of all 268 primary schools registered in Luwero in 2010 from the Ministry of Education and Sports. We excluded 97 small schools (with <40 students registered in Primary 5) and 20 schools with existing governance interventions. The remaining 151 schools formed our sampling frame. We stratified these 151 schools according to the gender ratio of pupils (>60% girls, >60% boys, or approximately even). Forty-two schools were randomly selected, proportional to the size of the stratum. One hundred percent of the schools agreed to participate. The sampled schools contain 79.7% of Primary 5, 6, and 7 students in Luwero. Within each school, we took a simple random sample of up to 130 pupils from Primary 5, 6, 7 and a complete sample of school staff. If there were <130 students in a school, all were invited to participate. Seventy-seven percent of sampled students provided data; 19% of students were absent from school during the week of the survey or for extended periods.
For each participating school, head-teachers notified staff, students, and parents in advance of the survey. Parents could opt their child out of participation; otherwise individual children provided consent to participate. Staff members provided individual consent to participate in the staff survey. All data on violence and mental health were collected in a face-to-face interview; some of the educational performance data were collected in groups in a normal classroom setting. All interviewers received 3 weeks of training on how to ask about violence in a nonjudgmental way, how to preserve confidentiality, and on procedures to follow if participants became distressed. A comprehensive child protection plan designed by the study team in conjunction with local services was in place to provide support to those in need of services. We also had a trained counselor available to any child who requested counseling. The response of services is the subject of a separate article.12
All items were translated into Luganda and reviewed by a panel of teachers and Raising Voices staff to ensure that they would be appropriate for Ugandan child participants and school staff. Items were then cognitively tested and refined iteratively in a sample of ∼40 children and 20 school staff members from Kampala primary schools to ensure understanding and that meanings of original items were adequately captured. We then surveyed a larger sample of 697 children and 40 staff from Kampala schools to test distributions of items and to test study procedures.
Experiences of violence were measured by the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional (ICAST-CI)13 and some items from the World Health Organization Multi Country Study on Women’s Health and Domestic Violence against Women.14 Reliability and construct validity for the ICAST-CI were initially established in 4 countries, and the instrument has since been translated into 20 languages and used extensively in multicountry research.13 Lifetime and past-week experience of physical, sexual, and emotional violence and injuries were constructed as binary variables (see Table 1 for more details).
The Strengths and Difficulties Questionnaire (SDQ)15 brief screening instrument was used to measure symptoms of common childhood mental disorders, including depression, anxiety, and conduct disorder. This instrument has been used in >60 countries including several in Africa and validated in a variety of settings.15 In our sample, reliability for global difficulties scores was Cronbach α = .70. The global SDQ score was constructed as a categorical variable, with children having “high,” “medium,” or “low” levels of difficulties relative to their peers. To construct this measure responses to 20 items are summed, and children scoring in the highest decile of the overall distribution are deemed to have “high” difficulties, the next decile to have “medium” difficulties, and the remaining 80% to have “low” difficulties.15,16
Educational tests were adapted from a trial in Kenya17 and included word recognition tests in English and Luganda (scoring 1–40); timed reading tests in English and Luganda (scoring 1–62); and reading comprehension in English and Luganda (scoring 1–5). Tests administered in groups were silly sentences (which tests reading and cognitive ability, scoring 1–20), spelling in English (scoring 1–20), and basic math (scoring 1–40). Global educational performance score relative to peers was computed by adding up the number of times a student scored in the bottom third of the overall distribution for each individual educational test, divided by the number of completed tests. Those in the bottom 10% of students from this distribution were coded as “low performers” and those in the top 90% as “not low performers.”
Items from the ICAST-CI were adapted to ask staff about their use of specific acts of violence toward students in the past week, past year, and ever in their life. All variables were modeled as binary. Staff experiences of violence were measured using items from the World Health Organization Multi Country Study on Women’s Health and Domestic Violence against Women,14 and all were constructed as binary variables. Mental health and well-being was assessed using the Self-Report Questionnaire (SRQ)-20,14 which has been widely used and validated in a number of low- and middle-income settings. There is no validated cutoff for Ugandan populations, thus, consistent with previous research, we deemed the top 30% of the overall distribution as having a “high” score indicative of probable depression/anxiety.2 Cronbach’s α in our sample was .70.
All analyses were conducted by using Stata 12.0 (Stata Corp, College Station, TX)18 and were carried out separately for male and female participants. Missing data were excluded from analyses involving those variables (pairwise deletion).
Descriptive statistics on participants’ background characteristics, violence, SDQ score, and educational test performance are presented by gender and compared by using χ2 tests for binary variables, χ2 tests for trend for categorical variables, or t tests for continuous variables.
We tested our hypotheses by fitting logistic regression models for reported physical violence from school staff in the past week unadjusted and adjusted for a priori identified potential demographic confounders (see Table 5). We tested for interactions between all exposure variables. There were significant interactions between SDQ score with age and educational performance in boys, so separate adjusted models for boys with “low” plus “medium” levels of mental health difficulties and boys with “high” levels of difficulty are presented.
All analyses account for the sampling scheme used in the baseline survey; student responses are weighted to account for unequal probabilities of selection for students. SEs are adjusted for clustering at the school level by using Taylor linearization.19
Characteristics of Students and Staff
The survey was completed by 3706 students and 577 staff members, and their characteristics are summarized in Table 2; 78.7% of boys and 84.6% of girls were aged 11 to 14 years. Only 46.5% of boys and 51.0% of girls reported eating at least 3 meals in the day before the survey, indicating that approximately half of all students were possibly hungry. Staff had a mean age in their 30s; 69.2% of female staff and 52.6% of male staff were Baganda, the dominant tribe in the Luwero region. Most male and female staff were married or were living with someone as if married. Just under one-quarter were single, and 7.1% of women were divorced or widowed versus only 0.8% of men.
Students’ Experience of Violence From School Staff
Lifetime experience of physical violence from school staff was nearly universal, with 93% of boys and 94% of girls reporting exposure (Table 3). Slightly >52% of students had experienced physical violence from school staff in the past week. Severe physical violence was reported by 7% of students, with 1.8% of reporting severe physical violence in the past week; 2.3% of girls and 1.9% of boys reported lifetime sexual violence from school staff, and past-week experience was reported by 0.8% of girls and 0.5% of boys. Emotional violence and neglect were also common, with nearly a third of students reporting lifetime experience and slightly >11% reporting past-week experience.
Of the 3476 children who reported lifetime experience of physical and/or sexual violence from school staff, 65.0% of boys and 69.1% of girls reported injuries. More than a quarter of students reported injuries in the past week. Prevalence of moderate injury was significantly higher in girls than boys, with 25.6% of girls reporting experience over their lifetime and 6.8% in the past week, but 17.4% of boys reporting moderate injury over their lifetime and 4.6% in the past week. Among boys 4.4% reported a severe injury over their lifetime, compared with 5.0% of girls, and ∼1% of both boys and girls reported a severe injury in the past week.
Violence from other persons besides school staff was also common. The prevalence of lifetime physical violence from other persons was more common in girls (54.8% vs 43.7% of boys); sexual violence was also far more common in girls (11.8% vs 2.5%). Prevalence of emotional violence and neglect was similar in girls and boys (48.6% and 49.4%).
Associations Between Physical Violence, Mental Health, and Educational Performance in Students
Crude associations are displayed in Table 4. In both male and female students, past-week physical violence was associated with medium and high levels of reported difficulties on the SDQ. For girls, those who reported past-week physical violence had nearly double the odds of being a low performer on educational tests versus girls who did not report violence. For boys, this relationship went in the opposite direction, with boys who reported past-week physical violence from school staff less likely to be low performers on educational tests.
Adjusted models reveal that for girls (Table 5), past-week physical violence was independently associated with increased odds of poor mental health (high levels of difficulty on the SDQ) and low performance on educational tests. These relationships held even after controlling for experiences of violence by non–school staff and for experience of sexual and/or emotional violence or neglect from school staff, as well as demographic variables.
For boys, adjusted models revealed a more complex picture (Table 5). For the boys with low and medium difficulties, past-week physical violence was independently associated with medium levels of mental health difficulties (versus low levels), after controlling for demographic factors and experience of other forms of violence. Boys who reported past-week violence were less likely to report poor educational test performance. Boys reporting a disability were also less likely to report past-week physical violence. In the boys with high levels of difficulties, after controlling for experiences of other forms of violence from school staff, past-week physical violence was related to lower odds of low educational performance, at a larger magnitude than in boys with medium and low difficulties.
Which School Staff Members Use Violence?
Both male and female school staff members reported similar levels of use of physical violence against their students; 80.8% of men and 75.7% women reported lifetime use of violence (Table 6), and 40.2% of men and 42.6% of women reported use of violence in the past week. For female staff, higher SRQ scores, experience of intimate partner violence, nonpartner sexual violence, or childhood sexual abuse were not associated with increased odds of using physical violence against students in the past week in crude analyses. For male staff members, high SRQ score was not associated with increased odds of using violence. However, both experiencing intimate partner violence and/or childhood sexual abuse as well as use of violence against people other than students was associated with increased odds of using physical violence against students.
Despite a ban on corporal punishment in Ugandan schools since 1997, nearly all primary school children in Luwero have experienced physical violence from a school staff member in their lifetime, and >50% in the past week. Even after controlling for experience of other forms of violence from school staff and violence from non–school staff, students reporting past-week physical violence from school staff had higher levels of mental health difficulties, and for girls, nearly double the odds of low educational performance. Approximately 40% of school staff reported using physical violence, and for male staff members, experiencing violence themselves and using violence against others was associated with increased odds of using physical violence against students.
Comparison With Other Studies
We report results from one of the first surveys using a probability sample and standardized assessments to document school violence and its association with poor mental health and school performance in a low-income setting. In central Uganda, where Luwero District is located, 79.6% of primary school–age children were actually enrolled in school in 2011, making our results relevant for a large number of children.20 In contrast to other research, we found more violence from school staff versus any other perpetrators. The US Centers for Disease Control survey in Tanzania showed that 52.6% of female and 50.8% of male respondents aged 13 to 24 had experienced violence from teachers, and nearly 60% had experienced physical violence from parents.21 However, this survey included children both in and out of school, thus the total prevalence of school violence may have been higher if only those attending school were included.
Similar to other studies examining sexual and physical abuse from any perpetrator in high-income settings,22 we also find children who experience more violence have poor mental health and, for girls, poor performance on school tests. For boys, relationships between physical violence and educational outcomes are in the opposite direction to girls, and much stronger in those with higher levels of mental health difficulties versus those without. Ugandan classrooms are large, and there are varied levels of ability in students. It may be that boys who are doing well in school but who score higher on mental health difficulty measures behave more disruptively in class because they are not engaged in lessons, which then is associated with violence from teachers. Additional research is needed to investigate and understand the relationship between physical violence and educational performance in boys.
Contrary to our hypothesis, staff members’ mental health was not related to increased use of physical violence against students. Experiences of intimate partner and sexual violence predicted increased use of violence against students among men but not among women. It is important to note that men’s self-reported experience of intimate partner violence is highly correlated with their use of violence against intimate partners. Men who use intimate partner violence also report more fights at work and other conflicts,23 possibly indicating a general predisposition to use violence as a means of conflict resolution.
We present some of the first rigorous data on violence from school staff and health consequences in a low-income setting. Although it is clear that experiences of violence in students are associated with adverse mental health conditions and poor educational test results, our cross-sectional survey does not allow inference as to whether these are a cause or consequence of experiencing violence. There is also the possibility that previous exposure to trauma and violence outside the school setting may be influencing children’s behavior in the classroom, making them more vulnerable to violence from school staff. Although we employed extensive interviewer training, it is possible that some children did not feel comfortable disclosing their experiences of violence during interviews. Sexual violence in particular may have been underreported because of the shame and stigma associated with these experiences.
Implications and Future Directions
Given this high prevalence, school violence could be a major contributor to poor health and educational outcomes in this population. We know from longitudinal studies in high-income settings that children who experience violence from other students in school may be more likely to miss classes and to drop out, which directly affects their educational performance and life trajectory.6 Abused children are at increased risk of developing conduct disorder, which predicts later use of violence in adult relationships.24 The levels of violence from school staff observed here underline the need to consider school violence in prevention interventions, in addition to home and parenting interventions.
Violence from school staff against children is widespread and associated with poor mental health and educational performance. Interventions to reduce violence against children and prevent adverse consequences need to address violence from school staff.
- Accepted October 9, 2013.
- Address correspondence to Karen M. Devries, PhD, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom. E-mail:
Dr Devries, principal investigator of the Good Schools Study, designed the study, oversaw the baseline survey, performed the data analysis, and wrote the manuscript; Ms Child participated in the design of the Good Schools Study, managed the fieldwork for the baseline survey, and critically revised the manuscript; Drs Allen, Walakira, and Parkes participated in the design of the Good Schools Study and critically revised the manuscript; Mr Naker developed the Good School Toolkit, initiated the idea of doing a study, participated in the design of the Good Schools Study, and critically revised the manuscript; and all authors approved the manuscript as submitted.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Supported by the Hewlett Foundation.
POTENTIAL CONFLICT OF INTEREST: Mr Naker developed the Good School Toolkit; this article describes results from the baseline survey of a trial testing the Toolkit. The other authors have indicated they have no potential conflicts of interest to disclose.
- Devries KM,
- Watts C,
- Yoshihama M,
- et al.,
- WHO Multi-Country Study Team
- Pinheiro PS
- Naker D
- ↵Leach F, Fiscian V, Kadzamira E, Lemani E, Machakanja P. An Investigative Study of the Abuse of Girls in African Schools. London, UK: Department for International Development; 2003
- ↵Parkes J, Heslop J. Stop Violence Against Girls in School: A Cross-Country Analysis of Baseline Research From Ghana, Kenya and Mozambique. Johannesberg, South Africa: ActionAid International; 2011
- Child J,
- Walakira E,
- Naker D,
- Devries KM
- ↵ICAST-C: The ISPCAN Child Abuse Screening Tool—Child Version. Manual and Proposed Guidelines for Pilot Administration. Aurora, CO: International Society for the Prevention of Child Abuse and Neglect; 2006
- Garcia-Moreno CJ,
- Ellsberg H,
- Heise M,
- Watts LC
- Goodman R,
- Ford T,
- Simmons H,
- Gatward R,
- Meltzer H
- ↵Department of Health. Strengths and Difficulties Questionnaire. London, UK: Department of Health.
- ↵Intercooled Stata. 12.0 ed. Houston, TX: Stata Corp; 2012
- Eltinge JL,
- Sribney WM
- ↵MEASURE DHS. Uganda DHS Survey 2011. Calverton, MD: Uganda Bureau of Statistics and MEASURE DHS; 2012
- Tanzania UNICEF,
- Centers for Disease Control and Prevention, Muhimbili University of Health and Allied Sciences
- Copyright © 2014 by the American Academy of Pediatrics