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 in findings that carry ‘significant implications’ for addressing the impact of violence exposure on young children in low- and middle-income countries (LMICs).

Titled “Mental health and cognitive outcomes associated with early childhood violence exposure: a focus on children in low-middle income countries (LMICs)”, 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,” said 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 amongst 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 preschoolers 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,” said Tsunga.

“Tsunga’s thesis makes a critical contribution to understanding patterns of violence exposure of young children in LMICs, particularly in South Africa. 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,” said Professor Donald, commenting on the findings.

Tsunga emphasised 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 also added that the evidence presented in the thesis indicated 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. 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,” she said.

She further said: “The findings of this thesis resonate deeply within the South African context, where violence is a prevalent and pressing issue affecting many communities. 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 noted that the study also pointed to the resilience and adaptability of children when given the appropriate support, which was encouraging.