A study by Lucinda Tsunga, a PhD graduand from the University of Cape Town (UCT), has described alarmingly high levels of violence exposure in young South African children which could have significant implications for addressing the profound impact of violence exposure on young children in low- and middle-income countries (LMICs).
Tsunga will graduate on 3 September with a PhD in paediatrics. She began full-time study towards her cotutelle PhD in 2019 at UCT and the University of Bristol.
Titled “Mental health and cognitive outcomes associated with early childhood violence exposure: a focus on children in low-middle income countries (LMICs)”, the thesis was supervised by Professor Kirsty Donald, deputy director of UCT’s Neuroscience Institute. Her other supervisors were Professor Abigail Fraser and Associate Professor Jon Heron, both from the University of Bristol.
The systematic reviews conducted within the thesis showed that approximately 70% of 17 studies from 20 LMICs identified a link between exposure to violence and poor cognitive outcomes in children. Additionally, all 58 studies reviewed from 26 LMICs found associations between violence exposure and mental health problems.
“This consistent evidence highlights the pervasive impact of violence on both cognitive and emotional development in young children,” says Tsunga.
The empirical study conducted under the umbrella of Drakenstein Child Health Study (DCHS) – a South African birth cohort led by professor Heather Zar – found that a significant proportion of children, between 72% and 75%, were found to have been exposed to domestic or community violence at a young age (3.5 to six years old).
The study demonstrated that exposure to violence, including domestic victimisation and witnessing community violence by age 4.5 years, was associated with increased internalising behaviours such as anxiety and depression, and externalising behaviours such as aggression and hyperactivity, by five years of age. It also found that polyvictimisation – exposure to multiple types of violence – was linked to increased prevalence of externalising behaviours among the children at age five.
Tsunga also described negative associations between lifetime exposure to violence and cognitive outcomes – such as selective attention, receptive language, nonverbal intelligence, and inhibition.
The DCHS was used to assess the patterns of lifetime violence exposure among pre-schoolers directly. “The study provided a unique opportunity to explore various health and developmental issues in a context characterised by high levels of social and environmental challenges,” says Tsunga.
Data was collected from a diverse population of mothers and their children with assessments conducted at multiple time points. The study focused on examining the associations between violence exposure by age 4.5 and subsequent mental health and cognitive outcomes at age five. Standardised assessment tools were used to evaluate mental health outcomes such as internalising and externalising behaviours, as well as cognitive outcomes including selective attention, receptive language, nonverbal intelligence, and inhibition.
“Tsunga’s thesis makes a critical contribution to understanding patterns of violence exposure of young children in LMICs, particularly in South Africa,” says Prof Donald. “Her work clearly highlights this often silent epidemic and is a call to professionals and policy makers at all levels to be alert to this issue and to support initiatives that focus on protecting mothers and children and public health measures that prioritise this.”
Tsunga emphasises that the findings highlighted the pressing need for early interventions to reduce the negative impact of violence on both mental health and cognitive development. She adds that the evidence presented in the thesis indicates that children in high-violence environments are vulnerable to developing emotional and cognitive issues at a young age which can have lasting effects on their overall development and future well-being.
“Policymakers and practitioners should prioritise developing and implementing interventions aimed at reducing violence exposure and providing support for affected children,” Tsunga says. “Additionally, the study highlights the importance of incorporating violence prevention and intervention strategies into public health policies, particularly in LMICs where the burden of violence is high. By addressing these issues early on it is possible to improve developmental outcomes for children and reduce the long-term consequences of violence exposure.
“The findings of this thesis resonate deeply within the South African context, where violence is a prevalent and pressing issue affecting many communities,” she continues. “As a psychologist working in this environment I find the results concerning and insightful. They reveal the pervasive impact of violence on young children’s mental health and cognitive development, which aligns with the experiences of many children in South Africa. The high rates of domestic and community violence exposure reported in the study highlight the urgent need for targeted interventions and support systems to protect and nurture our children’s development.”
She says it is concerning to see how violence exposure can lead to increased internalising and externalising behaviours and negatively impact cognitive functions like attention and language.
“This underscores the need for psychologists and mental health professionals to be equipped with strategies and resources to address these issues effectively,” she says.
She notes that the study also points to the resilience and adaptability of children when given the appropriate support – which was encouraging. “It suggests that with the right interventions we can mitigate some of the adverse effects of violence exposure and foster healthier developmental outcomes. This aligns with my professional commitment to advocating for comprehensive support systems and interventions that are culturally and contextually relevant.
“Future research should explore more robust associations between specific types of violence exposure and developmental outcomes – with a particular emphasis on understanding the long-term impacts,” Tsunga says. “Longitudinal studies that follow children over time would provide valuable insights into the lasting effects of violence exposure and inform the development of targeted interventions.
“Additionally, research should consider the cultural and socio-economic contexts of LMICs to ensure that interventions and policies are tailored to the specific needs and challenges faced by these communities,” she says. “By addressing these gaps in knowledge, future research can contribute to more effective strategies for preventing violence and mitigating its adverse consequences on child development.”