A Systematic Review of Child Maltreatment Prevention Interventions in African Countries

Background and Purpose: Child maltreatment is a global public health problem, particularly in low-and middle-income countries where extreme poverty is prevalent. Data from 28 developing countries show the highest emotional (83%) and physical (43%) abuse rates in sub-Saharan Africa, where the majority of the world’s poor live (Akmatov, 2011). However, a comprehensive examination of the effectiveness of child maltreatment prevention interventions in African countries does not exist. To address this knowledge gap, this review addressed the following questions: 1)what are the types of child maltreatment prevention interventions implemented in African countries, 2) What are the methodological strengths and weaknesses of the studies reviewed, 3) What outcomes are measured across interventions, and 4) which interventions are most effective given the methodological rigor of the studies?

Methods: Nine databases were systematically searched to identify articles published through February, 2020. Studies were included if they were: 1) peer reviewed publication, online-first paper, written in English, 2) reported empirical research on a child maltreatment prevention intervention in any African country, and 3) evaluated specific intervention effects on behaviors, knowledge or attitudes of parents, children, or community members. Studies on medical interventions were excluded. The Methodological Quality Rating Scale (13 items) was adapted from Auslander et al (2012) to assess rigor of each study. Level of methodological rigor was combined with statistical significance for each outcome of interest to create an outcome attainment score to compare effectiveness and strength of the evidence. Outcomes were compared by intervention type and intervention length (brief, <=10 sessions vs extended, >10 sessions).

Results: Twelve unique studies from 5 African countries were included in this review. Intervention types included: skills training (n=9), economic strengthening (n=1) and combined interventions (n=2). Intervention length across studies was brief (n=4) and extended (n=6). Methodological rigor of studies was high with a median score of 12 (M= 10.58, SD= 3.77). Eight studies were RCT, 9 were replicated across multiple sites, but only 5 studies were adequately powered. Most commonly measured outcomes were physical abuse (n=9), positive parenting (n= 9), and harsh parenting (n=8). Five of 6 skills training interventions that measured harsh parenting were high rigor, of which 2 found significant positive effects. Two of 2 combined interventions that measured harsh parenting were high rigor, and both found significant positive effects. Five of 6 extended interventions and 2 of 3 brief interventions that measured positive parenting and physical abuse were high rigor. Out of these, 2 brief and 5 extended interventions found significant positive effects for increasing positive parenting and reducing physical abuse.

Conclusions and Implications: Evidence for reducing physical abuse and increasing positive parenting suggested brief and extended interventions were equally effective. Brief interventions are likely to be less expensive thus more cost effective prevention approach. The review also found combined interventions to be the most promising with the strongest evidence for reducing harsh parenting. Further research is needed to replicate these findings to strengthen the evidence-base to child abuse prevention in developing countries.