Changes in prevalence of violence and risk factors for violence and HIV among children and young people in Kenya: a comparison of the 2010 and 2019 Kenya Violence Against Children and Youth Surveys

 Study design

We analysed the 2010 and 2019 Kenya VACS, which are cross-sectional nationally representative household surveys of young people aged 13–24 years that are designed to produce national estimates of physical, sexual, and emotional violence. VACS use a three-stage cluster sampling approach with random selection of enumeration areas as the first stage, households as the second stage, and an eligible participant from the selected household as the third stage. VACS sampling was done without replacement. Sampling design, inclusion criteria, protocol details, and data collection procedures are summarised in table 1, and additional details are available in survey final reports and other publications.

UNICEFUS Centers for Disease Control and PreventionTogether for GirlsKenya Vision 2030
Violence against children in Kenya: findings from a 2010 National Survey.

Ministry of Labour and Social Protection of KenyaDepartment of Children’s Services
Violence Against Children Survey report.

US Centers for Disease Control and Prevention
Critical elements of interviewer training for engaging children and adolescents in global violence research. Best practices and lessons learned from the Violence Against Children survey.

  • Nguyen KH
  • Kress H
  • Villaveces A
  • Massetti GM
Sampling design and methodology of the Violence Against Children and Youth Surveys.

Table 1Implementation of the 2010 and 2019 Kenya Violence Against Children and Youth Surveys

CDC=US Centers for Disease Control and Prevention. DCS=Kenya Department of Children’s Services. EA=enumeration area. IRB=institutional review board. KNBS=Kenya National Bureau of Statistics. NASSEP=National Sample Survey and Evaluation Program. UCSF=University of California, San Francisco.

Both the 2010 and 2019 Kenya VACS included both male participants and female participants who spoke one of the survey languages listed in table 1. Both the surveys followed the same sampling, ethical review, and consenting procedures. For participants aged 13–17 years (minors), parental permission was obtained and assent from the minor participant, and participants aged 18 years or older and emancipated minors provided informed consent. Consent and assent were provided verbally and documented by interviewers on the paper consent document or tablets for the 2010 and 2019 surveys, respectively. Direct referrals to counselling services were offered to participants who needed and wanted services.
The main violence questions and sample selection information are shown in the appendix (pp 1–4). Sex-matched interviewers conducted in-person interviews with participants in private and facilitated direct referrals to counsellors as required. The 2010 protocol was reviewed and approved by the Ethical Review Committee of the Kenya Medical Research Institute and by the US Centers for Disease Contol and Prevention (CDC) institutional review board (IRB; protocol number 5964) and the 2019 protocol by the CDC, University of California, San Francisco, Kenyatta National Hospital/University of Nairobi, and Population Council IRBs (protocol number 6538).


The global VACS questionnaire draws questions from validated survey tools that have been extensively used in global contexts, using measures that have been cognitively tested and validated in VACS and other studies.

UNICEFUS Centers for Disease Control and PreventionTogether for GirlsKenya Vision 2030
Violence against children in Kenya: findings from a 2010 National Survey.

Ministry of Labour and Social Protection of KenyaDepartment of Children’s Services
Violence Against Children Survey report.

Published studies have demonstrated psychometric properties, reliability, and validity of the violence questionnaire tools employed in VACS.

  • Dunne MP
  • Zolotor AJ
  • Runyan DK
  • et al.
ISPCAN Child Abuse Screening Tools Retrospective version (ICAST-R): Delphi study and field testing in seven countries.

  • Zolotor AJ
  • Runyan DK
  • Dunne MP
  • et al.
ISPCAN Child Abuse Screening Tool Children’s Version (ICAST-C): instrument development and multi-national pilot testing.

The VACS questionnaire contains sections on demographics, risk and protective factors, violence victimisation, violence perpetration, sexual behaviour, HIV testing and services, violence service knowledge and uptake, and health outcomes. For this study, the main outcome variables were violence victimisation, context of violence, and risk factors for violence. All analyses were done with the entire sample of 13–24-year-olds stratified by sex and survey year.

Both the 2010 and 2019 surveys assessed four forms of sexual violence: unwanted sexual touching, unwanted attempted sex, forced sex, and pressured sex. Lifetime sexual violence was defined as having experienced one or more of these forms of sexual violence at any age (0–24 years) by any perpetrator.

In 2010, physical violence questions were asked for three perpetrator types: (a) intimate partner, (b) parents, adult caregivers, and other adult relatives, and (c) adults in the community or neighbourhood. In 2019, peer physical violence was added, but this measure was not included in the present analysis (because there was no 2010 comparator). Lifetime physical violence was defined as having experienced physical violence at any age (0–24 years) from one or more of the three perpetrator types included in both surveys.

Both 2010 and 2019 VACS assessed emotional violence by adults, with the 2010 survey asking about any adults, whereas the 2019 survey asked specifically about parents, adult caregivers, and other adult relatives. The 2010 VACS assessed whether any adult had made the respondent feel humiliated or unwanted, or if the respondent had been threatened with or experienced actual abandonment. The 2019 VACS asked whether an adult relative ever made the respondent feel unloved, said hurtful words like they wished the respondent was dead or was never born, or ridiculed the respondent. To compare emotional violence between surveys, the 2010 questions on abandonment were excluded. Any lifetime emotional violence was defined as experiencing any emotional violence at any age (0–24 years) from an adult.

Any lifetime violence included those who had experienced lifetime sexual, physical, or emotional violence.

Both VACS assessed the age at the first incident of any form of sexual violence, and disclosure and service seeking (ie, told someone, knew a place to seek service, sought service, and received service, among those who experienced any lifetime sexual violence).

Both VACS assessed violence risk factors, including multiple sexual partners (two or more sexual partners in the past 12 months); infrequent condom use (sometimes or never used condoms in the past 12 months); never tested for HIV; sexually transmitted infection (ever had symptoms or diagnosis of sexually transmitted infection); and child marriage (marriage before age 18 years).

Both VACS assessed inequitable gender attitudes with the following yes or no statements: only men, not women, should decide when to have sex; if someone insults a boy or man, he should defend his reputation with force if he needs to; there are times when a woman should be beaten; women who carry condoms have sex with a lot of men; and a woman should tolerate violence to keep her family together. The surveys assessed attitudes towards acceptance of wife beating with the following yes/no statements: it is acceptable for a man to hit or beat his wife (i) if she goes out without telling him, (ii) if she neglects the children, (iii) if she argues with him, (iv) if she refuses to have sex with him, and (v) if she burns the food.

 Statistical analysis

The study sample was weighted to represent the population using a three-step weighting procedure, as follows: computation of base weight, adjustment of base weight for differential non-response, and calibration of the post-stratification weight to census data. Demographic characteristics and weighted prevalence of violence, context, and risk factors for violence and HIV were assessed. The analyses to assess change were done in two parts, as follows: unadjusted difference using Pearson χ2 test, which is equivalent to the Z test for comparing two independent proportions,

Testing the equality of two or more proportions from independent samples.

and adjusted difference using logistic regression analyses and controlling for age, educational attainment, marital status, orphan status, rural versus urban status, and previous pregnancy. Logistic regression models tested each violence variable independently while controlling for covariates and a dummy variable for year. Unadjusted logistic regression models were also run to show changes in estimates between the adjusted and unadjusted models (appendix p 5). Differences were considered statistically significant if the two-sided p value associated with the Pearson χ2 test or the logistic regression was less than 0·05.

All “Don’t know” and “Declined” responses were set to missing and were not included in any calculations. Pairwise deletion was used to handle missing data. Sensitivity analyses assessed the effects of changing variable definitions, inclusion or exclusion of some variables from the logistic regression models, and different age groupings on the trends observed. All analyses were stratified by sex.

  • Waxman R
  • Fenton MC
  • Skodol AE
  • Grant BF
  • Hasin D
Childhood maltreatment and personality disorders in the USA: specificity of effects and the impact of gender.

Analyses used SAS software version 9.4, accounting for the complex survey design (weight, cluster, and strata) of the 2010 and 2019 Kenya VACS.


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Publish date : 2021-11-22 23:30:11

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