Research assessing familial violence against adolescents, using caregiver–adolescent dyads, is limited in post-conflict settings. This study aimed to determine the prevalence and factors associated with adolescent-reported familial abuse in post-conflict northern Uganda. It also assessed the relationship between abuse subtypes and (a) beliefs supporting aggression and (b) adolescent well-being and life satisfaction. A randomly selected community-based sample of 10- to 17-year-old adolescents (54% girls) and their caregivers ( N = 427 dyads) in two northern Uganda districts was used. Abuse outcomes were adolescent reported. All measures used standardized tools that have been adapted for research in resource-limited settings. Analyses used multivariable linear regressions in Stata 14/IC. Overall, physical, emotional, and sexual abuse rates were 70% (confidence interval [CI] = [65.7, 74.4]), 72% (CI = [67.4, 76.0]), and 18.0% (CI = [14.0, 21.2]), respectively. Polyvictimization was 61% (CI = [55.4, 64.7]). There were no gender differences regarding adolescent reports of physical and emotional abuse, but adolescent girls were more likely to report sexual abuse and polyvictimization than adolescent boys. All forms of adolescent-reported abuse (except sexual abuse) were associated with caregiver reports of harsh disciplinary practices. In addition, emotional abuse was associated with physical and sexual abuse. Physical abuse was associated with being an orphan and emotional abuse. Sexual abuse was associated with being a girl, older adolescent age, living in a larger household, and emotional abuse. Polyvictimization was positively associated with being an orphan, younger caregiver age, caregiver-reported poor monitoring and supervision, and higher household socioeconomic status, but negatively associated with lower parental role satisfaction. Physical and emotional (but not sexual) abuse and polyvictimization were associated with beliefs supporting aggression among adolescents. All abuse subtypes were associated with lower levels of perceived well-being and life satisfaction among adolescents in this study. Child abuse prevention programs have the potential to improve adolescent–caregiver interaction and interrupt the violence transmission cycle in this setting.

Background: Comprehensive neuropsychological testing for adolescents living with HIV is rare and often impractical for overstretched healthcare systems in low-resourced settings. This study aimed to 1) test the potential of a simple algorithm to screen for cognitive and functional difficulties among at-risk adolescents, and 2) using this algorithm, investigate the correlates of cognitive and functional difficulties in a large community-traced sample of South African adolescents. Methods: The study interviewed 10-19-year-old adolescents living with HIV (n = 1059) and uninfected community controls (n = 467), attending 53 public health facilities in the Eastern Cape in 2014-15. Cognitive and functional difficulties were assessed using an algorithm (either adolescent reports of memory, attention or concentration problems, or < 60% total recall on a memory task, or caregiver reports of an adolescent being a ‘slow-learner’, or attending a special needs school) and adolescent reports of functional difficulties. Data on healthcare and psychosocial variables were also collected. Multivariable logistic regressions tested correlates of cognitive and functional difficulties, controlling for sociodemographic and household covariates. Results: Across the sample, the prevalence of cognitive and functional difficulties was 19.3% (95% CI: 17.4-21.4). Adolescents living with HIV had significantly higher rates of cognitive and functional difficulties than community controls (21.9% vs. 13.5%, p<.001). Validating the algorithm with self-reported school grade repetition (lifetime) and number of grades repeated, cognitive and functional difficulties were associated with higher odds of lifetime grade repetition (aOR1.62 95%CI 1.24-2.11) and a higher likelihood of repeating multiple grades (β=0.27, p<.001). Independent of covariates, potential correlates of cognitive and functional difficulties among adolescents were higher depressive symptoms (aOR1.18 95%CI1.11-1.26), concurrent infections (aOR1.92 95%CI1.44-2.58), and more often missing school for clinic appointments (aOR1.66 95%CI1.24-2.23). Conclusions: Cognitive and functional difficulties were more prevalent among adolescents living with HIV than community controls and were associated with psychosocial, physical health, and healthcare factors. Simple algorithms – like the one tested in this study – may be feasible for use in low-resourced settings, following validation against neuropsychological assessment batteries in specialised facilities. Routine screening for cognitive and functional difficulties may be integrated into HIV care to identify adolescents for additional support.