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Table 4 Overview of quantitative studies focusing mostly on non-partner sexual violence

From: Effectiveness of secondary and tertiary prevention for violence against women in low and low-middle income countries: a systematic review

Study Country and setting Study design and sample Intervention Outcomes Global quality rating
Allon 2015 [30] Democratic Republic of the Congo
Treatment sites in the towns of Kakwende and Kasika
Controlled clinical trial.
Female Congolese victims of sexual violence were enrolled in one of two therapies, based on provider’s opinion of most appropriate treatment.
Individual therapy
n = 8
Group therapy
n = 28
The individual therapy consisted of 2 sessions of eye movement desensitisation and reprocessing (EMDR) therapy.
The group therapy consisted of 2 sessions of modified EMDR-Integrative Group Treatment Protocol (IGTP).
Both therapies were delivered by a visiting Israeli doctor.
Subjective intensity of distress measured pre-and immediately post-treatment using SUD score.
Mean SUD score decreased from 9.0 (±1.3) to 4.8 (±2.9) immediately post-treatment for EMDR-IGTP group (p < 0.0001), and from 9.3 (±0.9) to 1.9 (±2.2) for individual therapy group.
NSD between pre-intervention SUD scores between individual and EMDR-IGTP group, but significant difference post-intervention (p < 0.01), with individual therapy more effective in lowering SUD scores.
IES scores decreased from mean of 52 before group therapy to 33 afterwards (n = 6), p < 0.03.
MODERATE
Bass et al. 2013 [31] Democratic Republic of the Congo
NGO offices in 14 villages in South Kivu and 2 villages in North Kivu provinces
Cohort study (two groups).
6 village clusters were randomized to receive one of two therapies and female survivors of sexual assault with clinically significant psychological problems were enrolled.
Cognitive processing therapy group
n = 157
Individual support comparison group n = 248
Cognitive processing therapy consisted of 1 individual 1-h session and 11 group sessions with 6–8 women each.
Women in the individual support comparison group were invited to access individual psychosocial and case-management support as desired.
Depression and anxiety symptoms assessed by a questionnaire administered pre-treatment, immediately post and 6-months post treatment.
Group therapy: probable PTSD reduced from 60% prevalence pre-treatment to 8% post-treatment and 9% 6 months later (p < 0.001). These measures were 83% to 54% to 42% for individual support (p < 0.001). Probable depression or anxiety reduced from 71% to 10%, then 9% at 6 months for group therapy (p < 0.001), and 83% to 54% to 42% for individual support (p < 0.001).
Symptom improvements significantly greater for group therapy compared to individual support.
STRONG
Deb, Mukherjee, and Mathews 2011 [37] Kolkata, India
Schools and shelters
Cross-sectional study.
Sexually-abused girls, aged 13–18, were purposively selected from 4 randomly selected shelters for the intervention group. A comparison group of non-sexually abused girls of the same ages were randomly selected from 4 nearby schools.
Comparison group
n = 120
Intervention group
n = 120
Sexually-abused girls received a minimum of weekly individual and group counselling for at least 2 months. Among sexually abused girls, 58.3% found counselling to be beneficial.
A statistically significant difference in aggression was seen between sexually-abused girls who found counselling to be beneficial and sexually-abused girls who did not find counselling beneficial.
Difference between mean aggression scores 14.00
95% CI 8.12, 21.68
p = 0.00
WEAK
Hall et al. 2014 [32] As in Bass et al. 2013 As in Bass et al. 2013 As in Bass et al. 2013 Social capital measured using a questionnaire administered pre and post intervention. Group therapy associated with increased group membership and participation (p < 0.05) at 6 month follow up. Emotional support seeking increased from pre to post- intervention (p < 0.05) but was not maintained at 6 months. NSD between group therapy and individual support for contact with non-kin social networks, instrumental support network size or financial network size. STRONG
Hogwood et al. 2014 [35] Rwanda Cohort study (one group).
Rwandan women caring for their children born from rape were purposively selected to receive the intervention, mainly based on their geographic location and receipt of previous support from a local NGO.
n = 40
Twelve fortnightly counselling groups of 10 members, led by female graduate-level trained Rwandan counsellors. The aims of the counselling groups were to encourage within-group social support, address emotional pain, assist in disclosure of rape to children, improve parenting skills and relationships. Questionnaire administered pre-intervention, at halfway, post-intervention and 3 months post.
Participants rated groups as helpful (mean 7/10 at mid-point, 9/10 at end).
Life satisfaction increased between time one, two and three (p < 0.0005) but decreased at follow up (p < 0.005). 65% increase in social support over course of intervention (p < 0.0005).
Acceptance of being a parent to the child, and reporting of “very good” relationship with child increased 47% and 33% respectively (p < 0.0005).
WEAK
Hustache et al. 2009 [36] Republic of the Congo
MSF clinic in Brazzaville, during a period of conflict (2002–2003)
Cohort study (one group).
Women over age 15, raped by unknown military personnel were enrolled.
n = 64
Individual psychological counselling offered as part of post-rape care, specifically addressing
- social and familial concerns
- coping strategies
- acceptance, future plans
Global functioning:
Medium-extreme impairment in global functioning in 89.3% participants pre-intervention and 28.6% post-intervention, p = 0.04. Effect maintained 1–2 years post-treatment.
However 31.3% participants report familial detachment, 3.1% met PTSD diagnostic criteria, 40.6% report re-experiencing symptoms 1–2 years after intervention.
WEAK
Lekskes, van Hooren, and de Beus 2007 [33] Liberia
Rural villages
Controlled clinical trial. Liberian women who had experienced sexual violence during conflict were enrolled in one of two intervention groups, or the waiting list control group.
Waiting list control group
n = 21
Trauma counselling group
n = 58
Support and skills training group
n = 54
The trauma counselling group received a 3-month program, consisting of 8 individual sessions and group counselling.
The support and skills training group received skill training to support income generation, and discussed gender issues and sexual abuse.
The waiting list control group were pre-selected for either intervention.
Decrease in PTSD score (from 2.6 to 2.0) from pre-intervention to immediately post-intervention for the counselling group.
Slight increase in PTSD score (1.5 to 1.7) for WHDP group.
Increase in PTSD score for control group (2.0 to 2.5).
(Significance not described)
Reduction in PTSD scores for women in both interventions if initial PTSD score was high (statistics not described).
WEAK
O’Callaghan et al. 2013 [38] Democratic Republic of the Congo
Secondary school in the town of Beni, North Kivu province
Randomised controlled trial. 12–17 year old female Congolese victims or witnesses of sexual abuse were randomized to the intervention or control groups:
Control group
n = 28
Intervention group
n = 24
Group based, culturally modified Cognitive Behaviour Therapy (CBT) was delivered to the intervention group for 2 h, 3 days/week for five weeks.
The control group was waitlisted for the intervention.
PTSD, depression and anxiety symptoms assessed using validated measures, pre-intervention post-intervention and 3-months post. Greater improvements across all measures in intervention group compared to control (p < 0.001 for PTSD, Depression +Anxiety and conduct, p < 0–.024 for prosocial behaviour). Highly significant improvement in symptoms of PTSD with large effect size (P < 0.001, d = 2.04) anxiety and depression (p < 0.001, d = 2.45) conduct problems (p < 0.001, d = 0.95) and pro-social behaviour (p < 0.001, d = −1.57) between pre-intervention and 3 month follow up. STRONG
Parcesepe et al. 2016 [40] Mombasa, Kenya
HIV prevention drop-in centres
Randomised controlled trial. Women over 18 who engaged in transactional sex in the past 6 months, were moderate risk drinkers and visited a HIV prevention drop-in centre were randomised to the intervention or control groups:
Control group
n = 408
Intervention group
n = 410
WHO’s Brief Intervention for Hazardous and Harmful Drinking, adapted for the context of alcohol use and sex work, was delivered to the intervention group through 6 monthly individual sessions with trained nurse counsellors.
The control group received 6 monthly individual sessions with trained nurse counsellors, focused on non-alcohol related nutrition information.
Questionnaire administered pre-intervention, immediately post-intervention and 6 months post. Compared to the control group, the intervention group experienced significant decreases in physical violence from paying sexual partners in the last 30 days, 6 months post-intervention (OR = 0.45, 95% CI 0.23–0.85, p = 0.01).
The intervention group also experienced significant reductions in physical violence from non-paying partners in the last 30 days at 6 months post-intervention, compared to the control group (OR = 0.57, 95% CI 0.38–0.92, p = 0.02).
STRONG