Catherine L Ward

• Ph.D.
• Professor (Associate) at University of Cape Town

Importance Sexual violence against children is a global concern, yet worldwide figures of its prevalence are scant. Objective To estimate the global prevalence of sexual violence against children using national-level population-based studies. Data Sources We searched the PubMed, Embase, CINAHL, Web of Science, PsycINFO, ERIC, and APA PsycArticles...

Background Encouraging positive parenting practices through evidence-based interventions is vital for the achievement of SDG target 16.2, which aims to eradicate all forms of violence against children while promoting their safety and mental wellbeing. As low- and middle- income countries increasingly adopt parenting programs, policymakers and imple...

The quality of parenting program implementation significantly affects the extent to which a program is delivered effectively as well as the likelihood of it becoming embedded in everyday services. The group based Parenting for Lifelong Health for Young Children (PLH-YC) program for parents of children aged 2–9 years was developed specifically for i...

Training in non-violent discipline is important to prevent violence against children and ensure that their caregivers remain a safe base for them. This paper aims to deepen understanding of non-violent discipline by exploring attunement as a mechanism in the effectiveness of non-violent discipline tools. Attunement describes the sensitive responsiv...

The high prevalence of child maltreatment requires innovative, scaleable solutions. Three community-wide surveys (2012, 2013, and 2016) in Touwsranten, South Africa, assessed parents’ positive parenting and corporal punishment; their mental health, substance misuse, parenting stress and intimate partner violence; children’s mental health; and inter...

This study investigates the co-occurrence of intimate partner violence (IPV) against mothers and their risk of perpetrating child maltreatment (CM) in North Macedonia, the Republic of Moldova, and Romania. Risk factors for IPV, CM, and their co-occurrence were identified. Two samples (N1 = 112, N2 = 701) of mothers with children with behavioral pro...

Child maltreatment is a global public health problem. It can have detrimental and long-lasting effects on the development and health of children and occurs most frequently at the hands of parents and caregivers. These guidelines provide evidence-based recommendations on parenting interventions for parents and caregivers of children aged 0-17 years...

Objective This study aimed to evaluate the factor structure of the Depression Anxiety and Stress Scale (DASS‐21) among caregivers of young children in Southeastern Europe. Background The DASS‐21 is a widely used measure in prevention and intervention research with families. Studies regarding the scale's psychometric properties among caregivers, pa...

Purpose: This study examines the feasibility of a culturally adapted parenting intervention (MaPa Teens) within the national cash transfer system to reduce violence against adolescents, the first such program in the Philippines. Methods: Thirty caregiver-adolescent dyads who were beneficiaries of a government conditional cash transfer program pa...

Background The International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool (Children's Version), known as the ICAST-C Version 3, is used widely to assess violence against children, but there is limited psychometric evidence, especially on content validity. Objective This study aimed to assess the content val...

Despite high levels of alcohol-related injury in South Africa, there are no screening and brief intervention (SBI) programs in any hospital trauma centres. We conducted semi-structured interviews with 16 trauma centre staff (8 doctors, 7 nurses, 1 social worker) focused on barriers and enablers to the future implementation of a SBI program. Data we...

Aggressogenic parenting styles are associated with increased rates of callous and unemotional traits, and in turn, with antisocial behaviours. Traumatic brain injury is also associated with antisocial behaviour, but not callous and unemotional traits specifically. No study has previously investigated these three variables, aggressogenic parenting,...

We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. In August 2020–May 2021, we interviewed (1) staff from three community-based organisations delivering evidence-informed parenting interventions and other psychosocial services for...

Measures that produce valid and reliable antenatal depressive symptom scores in low-resource country contexts are important for efforts to illuminate risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates analyses of similarities and differences...

Background: South Africa (SA)'s high rate of interpersonal violence persists as a leading public health problem for the country. The first South African Comparative Risk Assessment Study (SACRA1) in 2000 quantified the long-term mental and physical health burden attributable to interpersonal violence by supplementing the direct injury burden of di...

Parental engagement in parenting programs is essential for good outcomes but can be challenging for many families. In low- and middle-income countries, where resources are limited and there are fewer support services, there is little research examining the factors that influence engagement. This mixed-methods study explored factors associated with...

Objective This study assessed the psychometric properties of three versions of the Parenting Scale (PS; original PS, 13‐item version, and 10‐item version) in three European middle‐income countries. Background The PS is one of the most frequently used questionnaires for measuring dysfunctional discipline strategies. Although its validity has been e...

Objective ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap. Method We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to a...

Background This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). Methods A total of 118...

Maternal prenatal stress places a substantial burden on mother’s mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pre...

ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and foetal development; however, there has been almost no research examining their impact during pregnancy. We used data (n=1204) from a longitudinal birth cohort study spanning eight countries to address this gap. ADHD symptoms in the third trimes...

COVID-19 pandemic has created new pressures for many families, and organisations supporting them. In interviews with staff from three community-based organisations in Cape Town, South Africa, and other stakeholders, we looked at how organisations adapted their delivery of two evidence-informed parenting interventions and other services for families...

Background Childhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children’s future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting pro...

Background Parenting interventions and conditional cash transfer (CCT) programmes are promising strategies to reduce the risk of violence against children, but evidence of the effectiveness of combining such programmes is lacking for families in low- and middle-income countries with children over two years of age. This study examined the effectiven...

This research prioritization aimed to identify major research gaps in maternal, newborn, child and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic. We adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes and scoring criteria. We approached diver...

Substance use among adolescents is prevalent in the Western Cape, South Africa. Caregivers may be concerned about adolescent substance use, which may have a negative impact on both parties. We conducted a qualitative study consisting of three focus groups with caregivers (n = 21) in order to explore their perceptions of their child’s substance use,...

Background : Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergeneratio...

Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of t...

A Correction to this paper has been published: https://doi.org/10.1007/s00737-021-01122-7

Aims This paper explores the number and characterization of latent classes of adverse childhood experiences across the Evidence for Better Lives Study cohort and investigates how the various typologies link to prenatal substance use (i.e., smoking, alcohol, and illicit drugs) and poor infant outcomes (i.e., infant prematurity and low birth weight)....

Abstract Background This feasibility pilot of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention c...

Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing ser...

Abusive head trauma (AHT, formerly known as Shaken Baby Syndrome) is a serious form of maltreatment of young children. It appears to be virtually absent in South Africa, which is puzzling in a country where maltreatment rates are several times higher than the global average. Children under age 3 are most vulnerable to injury or death from shaking....

Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of t...

Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and has thus been hypothesised to be partially responsible for interg...

Measures that produce valid and reliable antenatal depressive symptom scores in low resource country contexts are important for research efforts to better understand risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates cross-country analysis of...

Rates of child maltreatment are higher in low- and middle-income countries due to risk factors such as social inequities, economic adversity, and sociocultural norms. Given the evidence showing the effectiveness of parenting interventions to prevent child maltreatment, this study embarked on a cultural adaptation of an evidence-based parenting prog...

Background Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs)....

Background This pre-post trial of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content assoc...

Harsh parenting attitudes and behaviors negatively impact children’s behavior and development, and are linked to heightened levels of violence in children. Parent training programs are effective preventive interventions, but only reach caregivers who attend them. In this study, programs were implemented alongside a community mobilization process, i...

Violence against children is a widespread problem with devastating consequences, and corporal punishment is a risk factor for more serious forms of physical abuse. One reason for the persistence of corporal punishment may be the lack of awareness of positive disciplinary alternatives. Nonviolent options offered to caregivers and teachers must be ef...

Introduction Violence against children is a health, human rights and social problem affecting approximately half of the world’s children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- a...

Understanding gang disengagement is important for the development of effective interventions. This research sought to examine how former South African gang members understand their gang disengagement. Two rounds of life history interviews were conducted with 12 former gang members. Thematic narrative analysis was used to analyze the interview data....

Background Parenting programs based on social learning theory have increasing empirical evidence for reducing violence against children. Trials are primarily from high-income countries and with young children. Globally, we know little about how parenting programs work to reduce violence, with no known studies in low or middle-income countries (LMIC...

Purpose This study investigated process and outcomes of the Parenting for Lifelong Health (PLH) for Young Children and for Adolescents programs implemented as part of routine service delivery in postconflict settings. Methods These group-based programs were delivered by trained facilitators to 97 caregivers (PLH for Young Children) and 108 caregiv...

The influence of perceived social norms on behaviour has been studied in a variety of domains. However, little research has examined their application to child discipline. This study explored social norms perceptions and their associations with parental discipline in greater Cape Town, South Africa. A cross-sectional study of 195 mothers (using con...

Despite global shifts toward prevention of school corporal punishment, the practice remains widespread. This systematic review focused on (a) prevalence, (b) associated mental health and behavioral factors, and (c) correlates that may be risk or protective factors. Studies included in this review were peer-reviewed, published in English between 198...

Objective Birth cohort studies (BCS) have generated a wealth of invaluable basic scientific and policy-relevant information on a wide range of issues in child health and development. This study sought to explore what research questions are currently a priority for the next generation of BCS using a 3-round Delphi survey of interdisciplinary experts...

Background: The intersection of violence exposure and mental health problems is a public health crisis for South African (SA) adolescents. Understanding the impact of community violence on adolescent mental health can inform future interventions. Objectives: To assess pathways between community violence exposure and internalising and externalisi...

Background: Child mental health problems continue to be a major global concern, especially in low- and middle-income countries (LMICs). Parenting interventions have been shown to be effective for reducing child behavior problems in high-income countries, with emerging evidence supporting similar effects in LMICs. However, there remain substantial...

Background Parenting programs suitable for delivery at scale in low‐resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low‐cost 12‐session program designed to increase positive parenting and reduce harsh parenting and conduct problems in children aged 2–9. Methods Two...

Introduction Families in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing prevention-oriented parenting programmes have been shown to be effective in reducing...

Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes....

The 2030 Global Agenda for Sustainable Development includes ending all forms of violence against children as an explicit goal (SDG target 16.2). This chapter highlights the scientific basis and potential of parent education and skills development programs to prevent child maltreatment, and describes the Parenting for Lifelong Health (PLH)-Philippin...

Child maltreatment is a prevalent public health problem in both developed and developing countries. While many studies have investigated the relationship between violence against children and health of the victims, little is known about the long term economic consequences of child maltreatment, especially in developing countries. Using data from th...

Intimate partner violence during pregnancy (P-IPV) can have significant adverse impacts on both mother and foetus. Existing P-IPV interventions rightly focus on the safety of the mother and reducing re-victimisation; yet expanding these to address the adverse impact on the foetus has considerable potential for preventing long term negative developm...

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, dissem...

Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric prop...

Background: We aimed to complete a nationally representative study of sexual violence against children in South Africa, and its correlates, since we could identify no other such study. Methods: For this nationally representative, cross-sectional study in South Africa, households were selected by use of a multistage sampling frame, stratified by...

Burgeoning research on the well-being of young people in recent years has made it difficult to identify conceptual gaps in the literature. We conducted a review of South African research in this area to better understand the use and measurement of the construct, as well as factors associated with it. The search of multiple databases identified 28 s...

Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low-income and middle-income countries, on abuse and parenting practices. Design Pragmatic cluster randomised controlled trial. Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa. Participa...

Despite the extent and magnitude of violence against children in South Africa, political and financial investments to prevent violence against children remain low. A recent costing study investigating the social burden and economic impact of violence against children in South Africa found notable reductions to mental and physical health outcomes in...

Background Depression contributes substantially to the burden of disease in South Africa. Little is known about how neighbourhoods affect the mental health of the people living in them. Methods Using nationally representative data (N=11,955) from the South African National Income Dynamics Study and the South African Indices of Multiple Deprivation...

The purpose of this study was to estimate the economic burden of violence against children in South Africa. We assembled summative estimates of lifetime prevalence, calculated the magnitude of associations with negative outcomes, and thereby estimated the economic burden of violence against children. According to our calculations, 2.3 million and 8...

Parenting programs in high-income countries have been shown to reduce the risk of child maltreatment. However, there is limited evidence of their effectiveness in low- and middle-income countries. The objective of this study was to examine the initial effects of a parenting program in reducing the risk of child maltreatment in highly-deprived and v...

In the effort to address behavioural risk factors – which contribute significantly to the global burden of disease – there is a growing movement in public health towards the use of interventions informed by behavioural science. These interventions have the benefit of being amenable to testing in randomised controlled trials, are cost-effective and,...

Aims: This study aimed to explore how women who drank alcohol while pregnant understand and make sense of alcohol use. Methods: Using social representation theory and elements of Foucauldian discourse analysis, 14 narrative episodic interviews were conducted in a Western Cape, South African community with women who drank alcohol while pregnant, and...

Many children across the world are exposed to school violence, which undermines their right to education and adversely affects their development. Studies of interventions for school violence suggest that it can be prevented. However, this evidence base is challenging to navigate. We completed a systematic review of interventions to reduce four type...

Background An estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of thi...

Background No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. ‘Parenting for Lifelong Health’ (http://tiny.cc/whoPLH) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research ai...

Abstract Background No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. ‘Parenting for Lifelong Health’ ( http://tiny.cc/whoPLH ) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. R...

Children living in low- and middle-income countries, such as South Africa, face elevated risks of child maltreatment. Although evidence-based parenting programs have been shown to reduce rates of abuse in high-income countries, few studies have examined their effectiveness in low- and middle-income countries. Moreover, local cultural contexts may r...

Objective: This mixed-methods process evaluation examined the feasibility of a parenting program delivered by community facilitators to reduce the risk of child maltreatment in low-income families with children aged 3–8 years in Cape Town, South Africa (N ¼ 68). Method: Quantitative measures included attendance registers, fidelity checklists, sati...

Objective: This study investigated the opinions of mothers living in battered women’s shelters about the acceptability of programme materials, preferences for delivery methods, and barriers to use of the Positive Parenting Programme (Triple P). Method: Thirty-two mothers of three- to eight-year-olds were recruited from three shelters in Cape Town,...

The large-scale delivery of evidence-based parenting programmes is key to nation building in South Africa. In order to achieve change, parents must participate in these programmes. This policy brief aims to contribute to an understanding of participation by exploring the barriers and facilitators encountered by a sample of parents who were invited...

Purpose: Violence against children increases in adolescence, but there is a research and practice gap in research-supported child abuse prevention for the adolescent years. A pilot program for low-resource settings was developed in collaboration with nongovernmental organizations, government, and academics in South Africa, using research-supported...

Purpose Violence against children increases in adolescence, but there is a research and practice gap in research-supported child abuse prevention for the adolescent years. A pilot program for low-resource settings was developed in collaboration with nongovernmental organizations, government, and academics in South Africa, using research-supported p...

Effective parenting programmes are central to successful violence prevention efforts. Although parenting programmes are available in South Africa, few are evidence-based. This lack of evaluation makes it impossible to know whether programmes are helpful or harmful and whether they use resources efficiently. This article outlines a process for gaugi...

Objective: In a context of disturbing rates of violent crime, this pilot study initiated examination of the association between empathy and aggressive behaviour in young Western Cape children. Establishing which empathy measures are appropriate for our context was a primary concern. Method: To capture various aspects of empathy in young children...

High levels of violence affect every family in South Africa. Exposure to violence starts early, in both the home and community. There are high levels of physical abuse of children and the national under-five homicide rate is more than double that of other low- and middle-income countries. Rates of violence are particularly high in poorer communitie...

Parenting has a considerable impact on children’s behaviour and mental health. Improving child health and behaviour requires an understanding of the relationship between parenting practices; contexual factors such as parental mental health, intimate partner violence, substance abuse and poverty; and children’s behaviour. In this article the authors...

Globally, randomised controlled trials (RCTs) are increasingly seen as the gold standard of programme evaluation, representing the best way to determine whether new interventions are effective - but they are not without limitations. In this article, we discuss the phases of scientific discovery and the research standards that are necessary before s...

High levels of violence affect every family in South Africa. Exposure to violence starts early, in both the home and community. There are high levels of physical abuse of children, and the national under-five homicide rate is more than double that of other low- and middle-income countries. Rates of violence are particularly high in poorer communiti...

Parenting has a considerable impact on children’s behaviour and mental health. Improving child health and behaviour requires an understanding of the relationship between parenting practices; contexual factors such asparental mental health, intimate partner violence, substance abuse and poverty; and children’s behaviour. In this article the authors...