Child-led resistance in the streets of the global south: Decolonial perspectives of violence against children outside of family care.

BACKGROUND: Violence against children (VAC) remains an urgent global dilemma and researchers and policymakers alike continue to work tirelessly to devise strategies aiming to end VAC. However, the perspectives and expertise of children themselves remain underrepresented in the drafting and implementation of these strategies against VAC. This paper draws attention to the marginalization of children living outside of family care and centers their perspective. OBJECTIVE: This study aimed to characterize the forms of violence experienced by children living outside the family setting in Uganda, from the perspective of children themselves. The paper seeks to position the voicing of this perspective as a form of resistance against VAC from a decolonial perspective. PARTICIPANTS AND SETTING: The participatory research process included a total of 94 participants in various urban study sites in Kampala, Uganda. METHODS: The research team completed this qualitative study within a youth-driven participatory action research (YPAR) framework. Data collection techniques included interviews, focus groups, participatory visual methods and social cartography. RESULTS: Children living outside of family care experience grave forms of emotional, physical and sexual violence. Child participants present survival strategies that can inform future research and policies on violence prevention practice. CONCLUSIONS: The illustration of explicit violence outlined in this study represents a form of resistance children take against their perpetrators. The participatory youth researcher team urges future research and policy addressing VAC in Uganda to center these perspectives and expertise of children and adolescents in both programmatic and research initiatives aiming to end violence against children.

Improving Iodine Intake in Rural Haiti through Social Enterprise: A Cross-Sectional Study in the Central Plateau.

Iodine intake in Haiti has increased in recent years thanks to the "Bon Sel" social enterprise approach to salt fortification and distribution by the market segment. However, it was uncertain whether this salt reached remote communities. This cross-sectional study aimed to assess the iodine status of school-age children (SAC) and women of reproductive age (WRA) in a remote region of the Central Plateau. A total of 400 children (9-13 years) and 322 women (18-44 years) were recruited through schools and churches, respectively. Urinary iodine (UIC) and urinary creatinine (UCC) concentrations were measured in spot samples, and thyroglobulin (Tg) on dried blood spots. Their iodine intake was estimated, and dietary information collected. The median (IQR) UIC in SAC was 130 µg/L (79-204, n = 399), and in WRA, 115 µg/L (73-173, n = 322). The median (IQR) Tg in SAC was 19.7 µg/L (14.0-27.6, n = 370), and in WRA, 12.2 µg/L (7.9-19.0, n = 183); 10% of SAC had Tg > 40 µg/L. Estimated iodine intake was 77 µg/day and 202 µg/day in SAC and WRA, respectively. Iodized table salt was rarely consumed, though bouillon was used daily; this is hypothesized to be a major contributor to dietary iodine intake. Iodine intake in this remote region seems to have improved considerably since the 2018 national survey, though SAC remain at risk. These results point to the potential effectiveness of using social business principles to deliver humanitarian solutions.

"What's happening in Syria even affects the rocks": a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan.

BACKGROUND: Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions - urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees' experiences accessing NCD services in urban and semi-urban settings in Jordan. METHODS: A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan. RESULTS: The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors - government, NGO, private - is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions. CONCLUSIONS: Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.

Monitoring and reporting attacks on education in the Democratic Republic of the Congo and Somalia.

The United Nations' Monitoring and Reporting Mechanism is charged with documenting six grave violations against children in a time of conflict, including attacks on schools. Many of these incidents, however, remain unreported across the globe. This study explores whether or not a local knowledge base of education and child protection actors in North and South Kivu Provinces, Democratic Republic of the Congo, and in Mogadishu, Somalia, could contribute to a more complete record of attacks on education in those areas. Hundreds of semi-structured interviews were conducted with key informants across the three settings, and in total 432 attacks on education were documented. Purposive samples of these reports were verified and a large majority was confirmed. Local non-governmental organisations and education institutions were most knowledgeable about these incidents, but most never reported them to a monitoring authority. The study concludes that attack surveillance and response were largely insufficient, and recommends investing in mechanisms that utilise local knowledge to address these shortcomings.

Ugandan households: A Study of parenting practices in three districts.

Ugandan households play a central role in child care and protection, and household-level practices influence the ways in which children are protected from adversities. This study was designed to identify community perceptions of protective and harmful parenting practices in three districts in Uganda. It employed free-listing interviews to determine priorities and practices deemed to be important in providing care and protection to children. Findings suggest that parenting practices can be grouped into seven basic themes, which are: Investing in children's future, Protection, Care, Enterprising, Relationship with neighbors, Intimate partner relationship, and Child Rearing. Investing in children's future, including educating children, was cited most often as a hallmark of positive parenting; while failure to care for children was most often cited as a hallmark of negative parenting. Concrete behaviors, such as walking a daughter to school; sewing a son's torn pants before going to church; and structuring study time at home were identified as concrete actions Ugandan parents undertake daily to promote their children's well-being. Conversely, specific contextual aspects of neglect and abuse were identified as central components of negative parenting, including lack of investment in children's education and not serving as a good role model. Building on community strengths is recommended as a principal means of enhancing household resilience and reducing childhood risk.

Measuring Physical Violence and Rape Against Somali Women Using the Neighborhood Method.

This study was conducted to estimate prevalence of gender-based violence (GBV) among female Somalis in Ethiopian refugee camps and host communities, compare prevalence in camps and communities, and compare prevalence in flight and in camp. Systematic random sampling was used to select households in Awbare camp (n = 85), Awbare town (n = 76), and Kebribeyah camp (n = 83). GBV was common and overwhelmingly domestic. Prevalence was higher in Awbare town than Kebribeyah camp. Women were at increased risk of GBV in camp compared with in flight. The domestic nature of GBV in humanitarian settings requires attention. Assumptions about violence in humanitarian settings should be further tested.

Assessing the impact of microfinance programming on children: an evaluation from post-tsunami Aceh.

This paper presents an evaluation of the long-term impact of microfinance programmes on Acehnese children during the post-tsunami recovery. The study, conducted from June to August 2010, examined the impact of microfinance programming six years after the tsunami. The sample consisted of 185 microfinance participants, with a comparison group of 192 individuals who did not participate in microfinance programmes. All respondents were parents, interviewed through a structured survey. The study used four child protection indicators-diet, health, childcare and education-in contrast to traditional repayment rate indicators. The primary results were insignificant with respect to all four child protection indicators, suggesting that, with respect to these indicators, there was no long-term difference between the impact of microfinance on beneficiaries' children and non-beneficiaries' children. These findings signify a need for microfinance actors to move beyond traditional indicators of economic success to evaluate the social changes microfinance programmes are presumed to effect.

Measuring the incidence and reporting of violence against women and girls in liberia using the 'neighborhood method'.

BACKGROUND: This paper reports on the use of a "neighborhood method" to measure the nature and incidence of violence against women and girls in post-conflict Liberia. METHODS: The study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent's household, and those of her four closest neighbors to make up the full sample. FINDINGS: Households in the sample contained 7015 females (1687 girls, 4586 women, 742 age missing) in Montserrado and 6632 (2070 girls, 4167 women, 95 age missing) in Nimba. In the previous 18 months 54.1% (CI 53.1-55.1) and 55.8% (CI 54.8-56.8) of females in Montserrado and Nimba respectively were indicated to have experienced non-sexual domestic abuse; 19.4% (CI 18.6-20.2) and 26.0% (CI 25.1-26.9) of females in Montserrado and Nimba respectively to have been raped outside of marriage; and 72.3% (CI 70.7-73.9) and 73.8% (CI 72.0-75.7) of married or separated women in Montserrado and Nimba respectively to have experienced marital rape. Husbands and boyfriends were reported as the perpetrators of the vast majority of reported violence. Strangers were reported to account for less than 2% of the perpetrators of rape in either county. Incidents were most commonly disclosed to other family members or to friends and neighbors, and less often to formal authorities such as the police, court or community leaders. Incidents were approaching fifty times more likely to be reported to police if perpetrated by strangers rather than intimate partners. CONCLUSIONS: Violence against women and girls is widespread in the areas studied. Programming needs to address the fact that this violence is primarily occurring in the household, where most incidents go unreported outside the immediate family or social circle. Police and hospital reports severely under-represent these known perpetrators. Inter-interviewer variance and differences in reports for self and neighbors for some outcomes caution the precision and validity of some estimates. However, the potential utility of the neighborhood method for estimating prevalence rates with an accuracy suitable for programmatic purposes in conflict-affected and post-conflict settings is noted.

What are the most effective early response strategies and interventions to assess and address the immediate needs of children outside of family care?

OBJECTIVES: Children outside of family care face increased risk of threats to their well-being, have lower educational achievement, and experience adverse developmental outcomes. While it is generally accepted that early response and intervention is critical to reducing the risk of harm for children who have been separated from their families, it is not always clear what the most effective early response strategies are for assessing and addressing their immediate needs. The purpose of this review was to identify evidence-based early response strategies and interventions for improving the outcomes of children outside of family care, including children of and on the street, institutionalized children, trafficked children, children affected by conflict and disaster, and who are exploited for their labor. METHODS: A multi-phased, systematic evidence review was conducted on peer-reviewed and gray literature, which yielded a total of 101 documents that met the inclusion criteria and were reviewed. RESULTS: Overall there is a weak evidence base regarding assessment and early response interventions for children living outside of family care. Few studies included careful outcome measures or comparison groups. Although few proven interventions emerged, the review identified several promising early interventions and approaches. In emergency settings, family tracing and reunification is a highly effective response in regard to separated children, whereas placing children in institutional care is problematic, with the possible exception of time-limited placements of formerly recruited children in interim care centers. Livelihood supports are promising in regard to preventing and responding to children living outside family care. Other promising interventions include psychosocial support, including the use of traditional cleansing rituals as appropriate, educational supports such as Child Friendly Spaces, the maintenance of family connectedness for children of or on the streets, the use of community-based approaches that aid social integration, and approaches that enable meaningful child participation. A recurrent theme was that to be effective, all assessments and interventions must fit the context. CONCLUSION: A strong need exists for strengthening the evidence base regarding the effectiveness of early assessments and responses to children living outside family care and for using the evidence to guide operational policy and practice. Recommendations regarding policy, practices, and research emerged from the review process.

Data surveillance in child protection systems development: an Indonesian case study.

OBJECTIVES: Successful implementation of child protection program interventions and child and family welfare services is contingent upon the availability and use of good quality information, as emphasized by the recent Convention on the Rights of the Child's General Comment 13. Yet, the role of information within child protection is not well understood, and ongoing efforts to strengthen child protection systems have not systematically examined this critical function. Recognizing these shortcomings, the Government of Indonesia and UNICEF commissioned a study to identify a "road map" for a national child protection information system. METHODS: The used desk review, semi-structured interviews, focus groups and site visits to identify existing data collection practices, and analyze the appropriateness and efficiency of information management mechanisms from the national down to the community level. RESULTS: The results show that the prevailing situation in Indonesia is characterized by a lack of accurate information on all necessary aspects of child care and protection including magnitude of problems, causality analysis and impact of programmatic responses. There is no lead actor for child protection at the national level, and there are no agreed upon data collection priorities, procedures or methods for a shared data collection system. CONCLUSION: The study suggests a need to reframe the dominant language from a "child protection information management system" to a "child protection surveillance system" to promote clearer data collection objectives and activities. Identifying a government ministry to lead child protection efforts and to forge closer partnerships among relevant actors will be required to support a national surveillance system. Additionally, addressing obstacles that limit child protection incident detection at the community level is critical. In addition to strengthening Indonesia's system, this study's approach and findings have the potential to help to inform ongoing child protection system development initiatives in other countries as well.

Developing a template for National Child Protection Index Reports.

OBJECTIVES: What impact does the strengthening of child rights have on the experience and circumstances of children? CRC General Comment 13 emphasizes that defining measurable targets for improvements in child protection is a key element of efforts to strengthen child rights and well-being across the world. This paper describes an attempt to identify key domains relevant to such mapping of child protection indicators, and the feasibility of collecting data-from existing data sources or otherwise-to complete a "National Child Protection Index Report" summarizing achievements and concerns at a national level. METHODS: A process of inter-agency consultation was facilitated by the CPC Learning Network to establish a template for the Index Report. The template was modeled on that used for the "Countdown to 2015" maternal, neonatal and child health initiative, aiming to capture indices not only of key protection risks but also implementation and coverage of key protection measures. The work drew on indicator development and policy initiatives by a number of international child protection agencies. The template developed was used as a basis to pilot national data collection in Indonesia and, at a sub-national level, in northern Uganda. FINDINGS: The template provides a concise summary of protection issues of relevance to a broad range of constituencies, global and national. However, in the pilot settings, existing routine data collection was inadequate to effectively populate a large proportion of indicators. Mechanisms of collating findings from discrete assessments-another potential source of data for completion of the index report-were also generally underdeveloped. PRACTICE IMPLICATIONS: In settings where state infrastructure allows the collection and analysis of routine data in such domains as health and economic activity, such efforts should be extended to the child protection sector. Discrete assessments by governmental or non-governmental agencies also provide significant potential for more effective sharing and collation of information. National Child Protection sub-clusters or equivalent structures can play an important role in facilitating both of these processes.

The impact of the school-based Psychosocial Structured Activities (PSSA) program on conflict-affected children in Northern Uganda.

BACKGROUND: Children in northern Uganda have undergone significant psychosocial stress during the region's lengthy conflict. A Psychosocial Structured Activities (PSSA) program was implemented in 21 schools identified as amongst those most severely affected by conflict-induced displacement across Gulu and Amuru Districts. The PSSA intervention comprised a series of 15 class sessions designed to progressively increase children's resilience through structured activities involving drama, movement, music and art (with additional components addressing parental support and community involvement). METHOD: Eight schools were selected by random quota sampling from those schools receiving the PSSA intervention. Two hundred and three children were identified in these schools as being scheduled to receive intervention, and were followed up 12 months later following engagement with PSSA activities. A comparison group comprised 200 children selected from schools that had met inclusion criteria for receipt of intervention, but were not scheduled for intervention coverage until later. Preliminary research used participatory focus group methodology to determine local indicators of child well-being as viewed by parents, teachers, and children respectively. Pre- and post- assessments focused on ratings for each child - by parents, teachers and children - with respect to these indicators. RESULTS: Significant increases in ratings of child well-being were observed in both intervention and comparison groups over a 12-month period. However, the well-being of children who had received the PSSA intervention increased significantly more than for children in the comparison group, as judged by child and parent (but not teacher) report. This effect was evident despite considerable loss-to-follow-up at post-testing as a result of return of many households to communities of origin. CONCLUSION: General improvement in child well-being over a 12-month period suggests that recovery and reconstruction efforts in Northern Uganda following the onset of peace had a substantive impact on the lives of children. However, exposure to the PSSA program had an additional positive impact on child well-being, suggesting its value in post-conflict recovery contexts.

Defining best practice in care and protection of children in crisis-affected settings: a Delphi study.

Thirty specialists in humanitarian work supporting the care and protection of children in crisis settings completed a 3-phase Delphi consultation. Proposals of best practice were elicited, reviewed, and rated by participants. A high level of consensus support was reached for 55 statements. These statements emphasized utilization of existing resources, participation, and inclusivity. The influences of resilience theory, social ecology, and cultural sensitivity were clearly evident. The utilization of developmental theory could be strengthened in relation to more differentiated understanding of the operation of protective influences and conceptualization of such influences in terms of "adaptive systems." Wider research engagement by development scientists in diverse cultural settings and clear formulation of findings for practitioners and policy makers would further support evidence-based humanitarian practice.

Children and fighting forces: 10 years on from Cape Town.

It is 10 years since the adoption of the Cape Town Principles and Best Practices on the Prevention of Recruitment of Children into the Armed Forces and on Demobilization and Social Reintegration of Child Soldiers in Africa. The field of programming for the reintegration of children associated with armed forces and armed groups has made significant strides in this period. However, important gaps in the knowledge base remain. This paper examines empirical evidence that supports lessons learned from work with children formerly connected with fighting forces. It evaluates what is known, where promising practice exists, and lacunae in five programming areas: psychosocial support and care; community acceptance; education, training and livelihoods; inclusive programming for all war-affected children; and follow-up and monitoring. While the 2007 Paris Commitments to Protect Children from Unlawful Recruitment or Use by Armed Forces or Groups mark an emerging consensus on many issues, there is still a critical need for more systematic studies to develop the evidence base supporting intervention in this area.

Using the 'protective environment' framework to analyse children's protection needs in Darfur.

A major humanitarian concern during the continuing crisis in Darfur, Sudan, has been the protection of children, although there has been little in the way of comprehensive analysis to guide intervention. Founded on a situational analysis conducted between October 2005 and March 2006, this paper documents the significant threats to children's well-being directly linked to the political conflict. It demonstrates the role of non-conflict factors in exacerbating these dangers and in promoting additional protection violations, and it uses the 'protective environment' framework (UNICEF Sudan, 2006a) to identify systematic features of the current environment that put children at risk. This framework is shown to provide a coherent basis for assessment and planning, prompting broad, multidisciplinary analysis, concentrating on preventive and protective action, and fostering a systemic approach (rather than placing an undue focus on the discrete needs of 'vulnerable groups'). Constraints on its present utility in emergency settings are also noted.

Political violence and development: an ecologic approach to children in war zones.

This article looks at the experiences of children in war from a psychosocial and social ecologic perspective. In contrast to clinical approaches, it offers a conceptualization of how the impacts of political violence and war are socially mediated. It suggests that psychologic assistance to war-affected children often occurs not through the provision of therapy by outsiders but via support from insiders.