1. Violence against primary school children with disabilities in Uganda: A cross-sectional study Karen M Devries, PhD 1*, Nambusi Kyegombe, PhD 1, Maria Zuurmond, MSc 1, Jenny Parkes, PhD 2, Jennifer C Child, MSc 1, Eddy J Walakira, PhD 3, Dipak Naker, MA 4 1 London School of Hygiene & Tropical Medicine, London, UK 2 Institute of Education, London, UK 3 Makerere University, Kampala, Uganda 4 Raising Voices, Kampala, Uganda Improving health worldwide www.lshtm.ac.uk

2. Violence against disabled children 150 million children live with disabilities globally A recent systematic review found 3 to 4 times the levels of violence versus non-disabled children in high income countries Almost nothing is known about violence against disabled children in lower income countries We used data from the Good Schools Study in Uganda to: 1) compare the prevalence of different types of violence in disabled and non- disabled students 2) describe the most common perpetrators of violence 3) to explore whether disability confers increased risk of violence after accounting for demographic and mental health factors

3. Study setting and design Design: baseline cross-sectional survey from a cluster-randomised controlled trial 42 primary schools, representing 1 district in Uganda 3700 students aged 11-14 and 500 staff interviewed in June 2012 Interviewer-administered questionnaire using mobile phones Measuring violence: ICAST-CI Referral plan for children for children who disclosed abuse Measuring Disability: “Do you have any mental or physical disability? For example, do you have trouble seeing, walking, speaking, fits, or anything else?” Response options: None, Trouble seeing, Trouble hearing, Trouble walking/with movement, Trouble with speech, Fits, Other. Measuring Violence: More than 40 items measuring specific acts of emotional, physical, sexual violence and neglect. “Have you ever been hit, slapped, kicked, physically forced to have sexual intercourse with someone, locked out, not given food as punishment”

4. Prevalence of disability 271 disabled and 3475 non- disabled students 8.8% of boys and 7.6% of girls reported a disability. Difficulties: – 2.8% with sight – 1.4% with hearing – 0.9% with movement – 3.1% reported an ‘other’ form of disability – 1.0% of boys but only one girl reported difficulties with speech

5. Levels of violence Boys (n=1769)Girls (n=1937) Characteristic No disability, % Disabled, %P No disability, % Disabled, %P Any violence from any perpetrator 95.396.20.64495.599.50.009 Physical violence 93.495.80.37994.699.10.010 Sexual violence 3.87.10.09212.323.60.002 Emotional violence and neglect 59.463.60.40057.565.20.140 Main perpetrators among disabled students Physical: male peers Sexual: ‘others’ Emotional: school staff Physical: school staff Sexual: ‘others’, male peers Emotional: school staff

6. Associations in boys Emotional violence/neglect versus no emotional violence/neglect Sexual violence versus no sexual violence Physical Violence from non-school staff versus no violence from non-school staff Past week physical violence from school staff versus no past week violence from school staff aOR a (95%CI)p p p p Girls Disability 1.36 (0.86-2.13)0.1792.15 (1.33-3.48)0.0021.26 (0.80-1.99)0.309 1.46 (1.00- 2.12) 0.047 Boys Disability 1.08 (0.74-1.56)0.6721.17 (0.80-1.69)0.409 0.62 (0.48- 0.81) 0.001 Increased risk of violence, adjusted for other factors a Adjusted for: age, number of meals eaten yesterday, household crowding, working outside home, mental health difficulties

7. What does it mean? High prevalence in all students Disabled girls (and probably boys) at even higher risk of sexual violence Disabled girls in particular remain at high risk of sexual violence and physical violence from school staff, even after accounting for other factors School in a main environment of risk, but also for potential interventions Tailored and accessible interventions needed

8. Thank you! Research team: Karen Devries, Louise Knight, Jennifer Child, Nambusi Kyegombe, Liz Allen, Charlotte Watts, Diana Elbourne (LSHTM) Jenny Parkes (IoE) Eddy Walakira (Makerere University) Dipak Naker (Raising Voices) Donors: DfID, UK MRC, Wellcome Trust, Hewlett Foundation, Bernard van Leer Foundation, Unicef Uganda Raising Voices team: Willington Sseskade and the implemtation team Janet Nakuti Angel Miriembe Good Schools Publications: Devries K, Kyegombe N, Zuurmond M et al. Violence against primary school children with disabilities in Uganda: A cross- sectional study. BMC Public Health. forthcoming. Devries K, Allen E, Child J, et al. The Good Schools Toolkit to prevent violence against children in Ugandan primary schools: study protocol for cluster-randomised controlled trial. Trials. 2013;14:232. Devries K, Child J, Allen E, et al. School violence, mental health and educational performance in Ugandan primary school children: A cross-sectional survey. Pediatrics. 2014;133(1):1-9. Child J, Naker D, Horton J, Walakira E, Devries K. Responding to abuse: Children’s experiences of child protection in a central district, Uganda. Child Abuse and Neglect 2014. http://dx.doi.org/10.1016/j.chiabu.2014.06.009