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Preventing Abuse of Children in the Context of AIDS in sub-Saharan Africa

Final Report Summary - PACCASA (Preventing Abuse of Children in the Context of AIDS in sub-Saharan Africa)

Violence against children has severe and negative impacts. Rates are highest in the global South
but there is a major evidence gap in both theoretical understanding of prevention and in effective
programmes. The PACCASA project has conducted groundbreaking and exceptionally impactful
science. It has developed and rigorously tested the first effective family violence prevention program
for adolescents in Africa: ‘Sinovuyo Teen’. Within a year of publication of randomised trial results,
the programme has been scaled up into 15 countries in Africa, Asia, Eastern Europe and the
Caribbean. In doing so, PACASSA has contributed to the theoretical understanding of child abuse
prevention in high-poverty settings, showing the crucial role of economic strengthening in supporting
families to achieve their parenting goals.

The project built close partnerships with external stakeholders: the World Health Organisation,
UNICEF and USAID-PEPFAR. By co-conducting development and research, we demonstrated
the potential of science to collaborate effectively beyond academia for maximised impact.

Programme development and testing was an extensive four-stage process from 2012 to 2018.
Throughout, the research faced major challenges including extended political violence prior to the
2016 elections, and during the randomised trial. A comprehensive development phase included
input from 50 experts and qualitative work with caregivers and adolescents. The programme was
then prototype-tested in two pre-post tests (n=290) to refine content and establish safety. These
showed strong results of violence reduction.

The final programme was tested in a pragmatic cluster randomised trial in South Africa (n=1104),
with 40 rural and urban sites. The trial showed a 48% reduction in physical maltreatment, a 28%
reduction in emotional maltreatment and a 23% reduction in poor parental monitoring (an
essential component in adolescent HIV risk reduction). The programme also reduced adult and
child substance use, parental stress and depression, parental endorsement of corporal
punishment,and improved economic welfare and financial management. Cost-effectiveness
analyses also showed cost savings of £2,146 per case of abuse.

This research has brought forward the field of understanding causal factors and pathways to child
abuse prevention in low-income settings. Mediation and moderation analyses within the randomised
trial as well as in-depth qualitative research have identified core pathways of poverty and parental
depression. In addition, the study has identified the strength of caregivers’ desire to find non-violent
solutions within parenting. This was not a program that changed norms. Instead, it supported
families to develop the shared skills that allowed them to have the kind of relationships that they
aspired to.

The project has been extended further than our original goals: to co-develop a suite of parenting
programmes for different child ages as a joint academic and non-academic initiative ‘Parenting for
Lifelong Health’. With a shared commitment to making evidence available for the public good,
programme manuals and research toolkits are licensed via Creative Commons and are available
for free via the WHO (https://www.who.int/violence_injury_prevention/violence/child/plh/en/) and
UNICEF websites (https://www.unicef-irc.org/research-family-and-parenting/). The programme is
endorsed by WHO, UNICEF, USAID and the Global Partnership to End Violence against Children.

The ERC has made a brave commitment to ‘high-risk, high-gain’ research. When we started this
project, we underestimated those risks. But PACASSA has created a child abuse prevention
programme that is now scaled into 15 low-resource countries, with further scale-up planned. We
thank the ERC for making these incredible gains possible.