Experiences of violence among female and male grade eight learners: baseline findings from the Girls Achieve Power (GAP Year) trial across three South African townships [version 3; peer review: 1 approved, 1 approved with reservations]

Background: South African adolescents experience disproportionally high rates of violence, with lifelong health, social and economic impacts. Few papers present risk factors associated with experiences of adolescent violence. Methods: A baseline cross-sectional survey was done (April 2017 – Sept 2018) with 3432 grade 8 learners in the Girls Achieve Power (GAP Year) trial from 26 high schools in three townships (Soweto and Tembisa, Gauteng and Khayelitsha, Western Cape). Collected data on lifetime experiences of different types of violence, perpetrators, and place of violence. Descriptive statistics and logistic regression were used to enumerate experiences of, and factors associated with violence. Results: A total of 2383 respondents are included. Most (63.1%) were girls, 81.5% aged 12-14. In total 25.9% had ever experienced violence, higher among boys (p=<0.001). Physical violence was most common (35.7%), then psychological (21.8%), sexual (13.1%), neglect (10.6%)


Introduction
Violence is the 'intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or neglect' 1 . Globally, 50% of children aged 2-17 years have experienced physical, sexual or emotional violence in the past year 2 . In South Africa (SA), those under 18 years old experience disproportionally high rates of violence. For example, in the South African 'Birth to twenty cohort', 48% and 49.2% of children experienced exposure of violence in their communities and at home, respectively 3 . Meinck et al. 4 found that 32% of children reported at least one type of frequent monthly abuse. The 2016 Optimus Study, researching the extent of child abuse in SA with over 4000 participants, found that 42.2% had ever experienced some form of maltreatment, whether sexual, physical, emotional or neglect 5 . In the 2012 National School Violence Study, Burton and Leoschut 5 surveyed almost 6000 learners across 121 SA schools. They found that 22.2% of learners aged between 12 -18 years had experienced some form of violence while at school in the past year 6 .
Adolescence is a formative period of development, as individuals transition from childhood to adulthood 7 . It is a period characterized by heightened vulnerabilities to certain risks that can have a substantial impact on future health trajectories 7 . Violence during childhood and adolescence can have lifelong adverse health, social and economic consequences 8 , increasing vulnerability to HIV acquisition 9 due to risky sexual behaviours, poor school performance 10,11 and higher levels of depression and suicide ideation 12 . Sex and gender become increasingly important when assessing vulnerability to violence 13 and the social factors and biological changes that take place during adolescence, as these result in gendered differences in experiences of violence 14 . Current research highlights that girls are at higher risk of sexual violence compared to boys 13,15,16 , however, few papers report on risk factors associated with ever experiencing violence 17 .
The Girls Achieve Power Trial (GAP Year) is a cluster randomised controlled trial (cRCT) testing the effectiveness of a comprehensive sexuality education (CSE) asset-building intervention aiming to reduce school dropout among adolescent girls between grades 8-10 while shifting gender attitudes and encouraging positive behaviour change among adolescent boys 18 . We conducted an analysis of the baseline data to examine sex and geographical differences in the prevalence, patterns, location, time, perpetration, and reporting of violence experienced by adolescents attending school in three townships in two provinces. We present the results of the full cRCT elsewhere (manuscript forthcoming).

Study design and setting
A baseline cross-sectional analysis was conducted in 3432 grade 8 participants enrolled into the GAP Year cRCT, between April 2017 -September 2018. Participants completed a knowledge, attitudes, perceptions, and behaviour survey at baseline. Twenty-six public high schools were selected across three townships (Soweto and Tembisa in Gauteng Province and Khayelitsha in the Western Cape (WC)). Schools were selected using the following inclusion criteria: mixed-sex public high schools in Tembisa, Soweto and Khayelitsha; in quintiles 1-3 1 which had not been exposed to any asset building interventions in the past six months. A one to one (1:1) random stratification scheme was employed, assigning 26 schools to either intervention or control groups.

Sample size justification
The sample size was calculated based on the study's primary outcome measures, namely dropout rate and increased reporting of GBV among adolescent girls, computed using cluster-randomized size methodology suggested by Hayes and Bennett 19 . The effect size of dropout was factored from other similar studies to account for a large conservative and representative sample size to measure outcomes. Based on other local studies, we hypothesize a reduction in drop-out rate from 17.8% as reported by Branson, Hofmeyr 20 to less than 14% (estimated effect size of 20%), with an anticipated attrition rate of 5% per year based on a similar local study 21 . This resulted in a conservative sample size of 2730 adolescent girls and 1850 boys to determine the association between intervention and control school's dropout rate and GBV variables. This was the upper limit for the sample size for the cRCT.
For the cross-sectional study, we only included those who consented into the trial.

Study participants
Grade 8 learners were selected for the trial as this grade marks the end of compulsory education in SA. The grade 8 learner age range is approximately 12-14 years; however due to learners repeating grades and other reasons, the age range is commonly wider with older learners enrolled up to 18 years 20,22 . All grade eight learners, at selected schools were eligible to participate in the baseline survey, irrespective of sex, age, or race.

Measures
The baseline interview consisted of an interviewer-administered survey collecting information on demographics, socio-economic status and knowledge and attitudes pertaining to school safety, social support and social networks, sexuality, gender and norms, sexual reproductive health and rights, and care-seeking behaviours. Following completion of this component of the interview, the participant was asked to complete a behavioural audio computer-assisted self-interview (ACASI), allowing learners to hear questions through headphones and respond on a tablet themselves, aiming to reduce social desirability bias. The majority did the interviewer administered survey first, although this was not always the case. The ACASI section, 20-30 minutes in duration, asked sensitive questions regarding the participant's actual practices and behaviour, covering questions on multiple sexual partners, sexual history, substance abuse (alcohol, drugs) and experiences of different types of violence (physical, sexual, psychological, economic, corporal punishment, neglect, and cyberbullying), as well as the perpetrators, and place and time of violence. In the survey 23 , respondents were asked "Please specify the type of violence you have experienced (Select those that apply to you)" and were able to select all those types of violence that they had experienced 23 . Each of the types of violence experienced were then captured as separate variables in the dataset, as presented in Table 2.
For the purposes of this analysis the single item variables were then combined as a multiple response variable, for both boys and girls. Therefore, out of 621 participants that stated they had ever experienced violence, there were 744 responses to the types of violence experienced, -as some participants had experienced more than one type of violence.

Data management and analysis
The data for the baseline interview was collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at Wits Reproductive Health and HIV Institute 24 . REDCap is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources.
The completed surveys were stored on encrypted password-protected tablets and the synced data was stored on Wits RHI secured servers. All data from REDCap and ACASI systems were exported as csv files and then into StataCorp 2017 25 . Descriptive analyses, together with a chi 2 square test of independence, were used to describe provincial and gender differences in the socio-demographics and patterns of violence ever experienced. The outcome ''ever experienced violence'' was used to estimate associations with other variables. A multivariate logistic regression analysis examined the independent association between experiences of violence vs sex and province, controlling for potential confounders. The bivariate risk and factors associated with violence were estimated using crude odds ratios, at 95% confidence interval (CI) and significance reported at alpha less than 5%. Significant p-values less than 20% from the one-way Analysis of Variance (ANOVA) were used to estimate the adjusted odds ratio at the multivariate level, while variables more than 20% were considered collinear variables. Furthermore, n-values of missing data are shown in the tables, but missing values were not included in the calculation of the percentage breakdown for each variable. All variables show the percentage breakdown and the corresponding p-value for recorded responses only. Participants' age was presented in groups (12-14 years and 15-17 years), rather than a continuous variable. It should be noted that the "no" category has been removed for all dichotomous variables [variables with a Yes or No Response] shown in the tables in the Results.

Ethical approval and considerations
The study was granted ethical approval from the University of the Witwatersrand Human Research Ethics Community (#M160940). Provincial research approval was obtained from Western Cape Department of Education and Gauteng Department of Education. Learner's enrolment and participation was voluntary. Only those with written parental/guardian consent and individual assent were recruited into the study. Those who were 18 years and older, did not require parental consent but provided their own written informed consent, enabling them to participate. Initially in English, the survey was translated and back translated into Xhosa, commonly spoken in some study sites. All data collection was supervised by the research team. Interviewer environments were set up to ensure confidentiality. Where feasible, interviewers were the same sex as the participant. Participants could stop the interview process at any time and were free to refuse to respond to any question(s) they felt uncomfortable answering. Social workers were employed to provide psychosocial support to participants during data collection and study intervention and a social harm form was developed to facilitate prompt referrals, where needed. To ensure meaningful participant and stakeholder engagement, the study was guided by the Good Participatory Practice guidelines 18 .

Socio-demographics
Overall, 3432 eligible learners across 26 schools participated in the baseline survey: we included 2383 in the analysis as this was the number who completed both components of the survey. In some cases, due to lack of time for participants to complete both components at the same time, some learners were unable to complete both components.  Overall, school was the most common place (30.7%, n=272) where violence was experienced followed by the park 2 (17.5%, n=155) or at their friends' home (12.9%, n=114). There were statistically significant sex differences in the places of violence, boys were more likely to experience violence at school compared to girls (36.0% vs 26.3% p=0.001). Girls were then more likely to experience violence in the park compared to boys (20.2% vs 14.3% p=0.001). There were no statistical differences across provinces in place violence was experienced.
Most violence took place during the day (57%, n=377), followed by evening/at night (32.4% n=213) and 10.1% (n=66) in the morning. The majority of those who had ever experienced violence knew the perpetrator (66.7%, n=414), while the rest (n=207) preferred not to say. Most violence was perpetrated by peers (38.4%, n=168), followed by strangers (21.1%, n=92), parent/guardians (11.9%, n=52) or siblings (8.9%, n=39). After peers, boys were more likely to experience violence from a stranger (25.8% vs. 15.9% respectively, p=0.001). Table 2 shows the baseline experiences of violence by sex and province. Boys (p<0.001), those aged 15-17 years (P<0.001), those who had ever used substances (p<0.001), ever had sex (p<0.001), those who had ever repeated a grade (p<0.001) and those who felt worthless (p=0.001) were more likely to ever experience violence. There was some evidence that living in WC (p=0.057) was associated with ever experiencing violence. Racial group (p=0.991), household structure (p=0.926), parent/ guardian employment status (p=0.264), government grant recipient (p=0.608), sexual debut (p=0.398) were not found to be statistically associated with ever experiencing violence and therefore they are excluded from Table 3.

Factors associated with experiencing violence
When adjusted, the following five variables remained significant: sex, age, ever used substances, ever had sex and self-worth. The adjusted multivariable analysis showed that the odds of boys ever experiencing violence were increased 1.57 times (aOR 1.68; 95% CI 1.32 -2.14 -p<0.001) than girls. The odds of those aged 15-17 years having ever experienced violence were increased by 41% (aOR 1.41 -95% CI 1.04 -1.89 -p=0.025) compared to those 12-14 years. The odds of those who had ever used substances having ever experienced violence were increased by 92% (aOR 1.90 -95% CI 1.59 -2.28 -p<0.001) compared to those who had not used substances. The odds of those who sometimes felt worthless having ever experienced violence were increased by 35% (aOR 1.33 -95% CI 1.09 -1.63, 0.005) compared to those who thought their life was worthwhile. The odds of those who had ever had sex, having ever experienced violence were icreased by 42% (aOR 1.42 -95% CI 1.1 -1.83 -p=0.008) compared to those who had never had sex.

Discussion
We assessed learners' experiences of different types of violence and found that there were sex differences: boys have higher odds of ever experiencing violence compared to girls. This is confirmed by other recent South African studies 3,5,26 , indicating that boys were more likely to report some form of abuse in their lifetimes, although those forms tend to be different, compared to girls. Among those who did experience violence, we found that both boys and girls experienced similar rates of physical, psychological and sexual violence: these findings are confirmed by other studies 5,13 . Interestingly, girls experienced almost double the economic abuse as their male counterparts. Given the higher odds of males experiencing violence overall, primary violence prevention interventions are needed to tackle harmful cultural norms that perpetuate violence among boys and decrease tolerance of violence overall 27,28 . Stepping Stones 29,30 , Family Matters 3 31 and SASA! 32 are interventions that could be implemented, targeting both boys and girls, men and women, as adults play a key role in the reduction of violence against children and adolescents. These programs should target both boys and girls, men and women, as parents play a key role in the reduction of violence against children and teens 17 .
Violence most often took place at school, during the day, with the majority knowing the perpetrator, as a peer. This is supported by findings from the National School Safety Framework survey conducted in 15 government funded high schools in the same schools 33 . Kutywayo et al., found that the poor enforcement of discipline at school experienced by male learners, correlated with and is confirmed by the high rates of peer provocation and relational aggression experienced at a school level 33 . Kutywayo et al., provide several strategies for tackling school peer violence in their recent manuscript 33 . Despite being banned through the National Education Policy Act of 1996, corporal punishment 4 , is still experienced by this cohort of learners as well as across many SA schools 34,35 . Given the sensitivity of this question and the emotional implications of disclosure, it is understandable that some learners did not wish to disclose the perpetrator. In light of the fact that the perpetrator may well be the educator, schools need to strengthen the implementation of protocols 36 that guide the reporting of violence at school level and frameworks to create a safer school environment 37 . Secondary violence prevention interventions should also be strengthened to improve the immediate response to those who have experienced violence. This could be done by adopting survivor-centred first line support using the World Health Organisation's LIVES 5 framework 38 and strengthening the referral pathways into post violence care.
We also found statistically significant associations between substance use, ever had sex and experiences of violence, confirmed by existing South African research 39-42 and other research on the continent [43][44][45] . Attention should therefore be on the scale up of behavioural interventions, focusing on CSE and increasing risk perception to reduce the likelihood that adolescents will engage in potentially harmful behaviours such as substance use and early sexual debut 46 . It is also important to note that these variables have the potential to be outcomes as well as risk factors for experiencing violence. Further research needs to be conducted to determine the temporal relationship between these variables as this has the potential to change the response required for these results.
Of concern is the fact that those who thought their life was worthless were more likely to ever experience violence which is confirmed by South African literature 39 . This strong association between experiencing violence and low self-worth reinforces the need for empowerment interventions: increasing self-esteem and self-efficacy could be critical to reducing their risk of experiencing violence 47 but could also support them following their experience of violence. Structural interventions such as DREAMS 6,7 48 and the She Conquers campaign 49 are also critical structural interventions to support girl empowerment and work with boys to end violence.
With almost a quarter of our participants having ever experienced violence (25.9%), the majority of those aged 15-17 years, and the link between childhood experiences of violence, high risk of adverse mental health outcomes, substance abuse, harmful gender attitudes 50-54 and increased perpetration of violence later in life 55-57 , it is key that violence prevention interventions start from a young age to limit childhood exposure to violence and break the cycle of violence. We recommend that all violence prevention strategies adopt an ecological approach, encompassing children, young adolescents, parents, educators, community members, local organisations and politicians to ensure a wide range of stakeholders are involved 42 . Improved surveillance of the range of types, locations, and perpetrators of violence against children, as well as of access to key prevention interventions, is essential to target prevention and monitor progress.

Strengths and limitations
When reviewing these findings, the following strengths and limitations should be considered. A strength of this study is that it was conducted in 26 schools in three highly populated diverse townships of South Africa and is therefore generalisable to other South African settings. Another strength is that it provides data on a variety of different types of violence, often excluded in other manuscripts. We also provide updated school violence data, building on previous studies conducted in 2016 5 and 2012 6 .
Whilst the final sample size was substantially less than originally planned, the results maintain power to draw these conclusions. Data collection relied upon retrospective recollections 3 The Families Matter! Program (FMP) is an evidence-based, parent-focused intervention designed to promote positive parenting and effective parentchild communication about sexuality and sexual risk reduction, including risk for child sexual abuse and gender-based violence, for parents or caregivers of 9-12 year olds in Africa 4 Defined as any kind of violent action inflicted on children by teachers or school administrators as punishment for disciplinary purposes which may result in an under-reporting of violence 58 . The study was cross-sectional therefore only representing one point in time. There were no questions in the survey to establish recency of violence making it difficult to establish individual incidence of violence or if it was ongoing. The time of day when violence was experienced was not clearly defined and therefore left up to each participant's interpretation. In addition, there was insufficient power to determine different factors associated with different experiences of violence.
There were many participants who did not complete both components of the survey and were therefore excluded from this analysis. This was linked to the time of data collection: data collection typically took place after school leaving a short period of time for data collection. Some learners did not have sufficient time to complete both components afterschool and were requested to return the following day to complete the second component. In these instances, we experienced challenges in getting the participants back to complete the second component, possibly due to lack of interest or lack of time. To overcome this, we have only included those who completed both components of the survey in the analysis.
These limitations are unlikely to alter our primary findings.

Conclusions
Ever experiencing violence is strongly associated with being a boy, being aged 15-17 years, used substances, never having had sex and lower self-esteem. With a quarter of our adolescent participants having ever experienced violence (physical, sexual, psychological, economic, corporal punishment, neglect, and cyberbullying), there is an urgent need for wider adoption, scaling, and sustaining of evidence-based primary violence prevention interventions as well as structural interventions to reduce the high burden of violence against adolescent boys and girls. Interventions must target stakeholders across the ecological model, including very young adolescents, to tackle the harmful cultural norms that perpetuate violence.

Consent
Written informed consent for publication of the participants details obtained from the participants and their parents/ guardian. rewording, as it is the odds of violence were increased by 35%, which is different to a crude 35% and is misleading (Davies et al., 1998 1 ); please edit these points.

Data availability
Statement: "With almost a third of our participants having ever experienced violence (25.9%)," needs rephrasing to a quarter.

2.
I still can't see how the authors dealt with the clustered nature of the data in analysis -this will change the standard errors and confidence intervals -and make them wider. As schools were the clusters, some form of adjustment in the model is needed.

3.
Response : We have run separate regression tables for table 3, disaggregating for  males and females. The results don't show vast differences between the two, from  the combined table. Therefore we have only presented the combined table in the main text. We can add the separate tables as appendices if needed.
○ PG: Results/Discussion: On the basis of the above, it also might be useful to highlight in the discussion that there was insufficient power to determine different factors associated with different experiences of violence. It is likely that the factors associated with experience of sexual violence (for example) are different from those associated with experience of corporal punishment.
Response: This has been added as a limitation ○ PG: Results/Discussion: The problem of temporality is touched on within the discussion, but I think this needs to be developed further. There are a number of variables associated with violence exposure that could equally be an outcome as a risk factor, in particular, using substances, repeating a grade, feeling worthless, early sexual experience. Indeed, for those who have experienced sexual violence, their first sexual encounter may have been forced. Understanding these variables as having the potential to be outcomes as well as risk factors for violence experience might change our approach to people who carry these experiences or characteristics. Response: Restructured this paragraph to include this reflection measures, we do not get any detail provided on the measures used to assess the different forms of violence, whether they were single or multiple items and how they were asked and coded etc. Without this sort of detail it is hard to interpret the findings of the paper. Including a table with the outcome measures clearly specified would be great.
Linked to this is the statistical analysis section of the paper needs further work to make it clearer for readers to follow. It needs to read more like a step-by-step set of work. So overall sample, then described by Province, then overall experience of violence and then among those who experience violence etc. As I read it, it skipped around and made for a tricky interpretation.
In the literature cited there needs to be greater details provided. For two papers the Birth to 20 cohort, for instance they have cited both experienced and witnessed violence, leading to a massive percentage, while the other studies are about experience. Similarly with the Burton paper, one needs to know where it was done, and sampling strategy. A key paper has been missed out, by Burton and colleagues: http://www.ci.uct.ac.za/overview-violence/research-bulletin/optimusstudy-on-child-abuse-violence-neglect-in-SA which provides an excellent estimate.
In the conclusions I am concerned that the findings do not adequately link to the recommendations. First, there is a sentence: "We found that both boys and girls experienced similar rates of physical, psychological and sexual violence: these findings are confirmed by other" this is not correct as the multivariable logistic regression shows boys are more likely to experience violence. Assume this is meant to be among those who experience violence.
The statement that interventions such as Stepping Stones etc. should tackle the norms of violence -is this not exactly what many of these interventions do? I think they are trying to make the point they tend to focus on violence from men to women and need to extend to include all forms of violence (which as far as I know, no one has measured).
The paragraph beginning: "Violence most often took place at school, during the day, with the majority knowing the perpetrator, as a peer" has two issues. First, this is an important statement and suggests we should be doing much more around school peer violence than is currently being done. Discussing this would be really important. Second, the rest of the paragraph is about the low reporting of violence from teachers -the authors are correct and they need to show this is the case (e.g. by citing other work) and then reflect on why they may have seen very low reporting of teacher violence and what can be done.
In the paragraph beginning: "We also found statistically significant associations between substance use, ever had sex and experiences of violence" the solutions are a bit unclear. I think the authors need to think what can be done to address violence, alcohol use is certainly a clear driver of violence, so interventions such as CSE need to address alcohol as well. But why may having had sex be a risk factor for violence? And therefore what could be done to address this.
There is a paragraph on grants. While I don't disagree with what is being said, it feels off topic.
A few more minor issues: In the statistical analysis, did the authors account for study design in their analysis?
Results -please provide clarity on the percentage who refused to participate and the percentage who did not complete the whole questionnaire, so we can understand refusal rate. Results -when reporting the results, please be consistent e.g. if comparing two statistics (e.g. percent of boys and girls) please put both percentages in and consistently provide a p-value.
Table 2 -please could we get overall prevalence of each type of violence first, before the prevalence among those who experience violence. Please make it clear where the sample size is different. Also, there is an implication people could have chosen multiple forms of violence, but the columns seem to add up to 100%, so did people only chose 1? Table 3: please could we get all unadjusted ORs provided, and then exclude in the multivariable analysis -much easier to see how the analysis was done, and not just provide those which are significant in unadjusted analysis.
Overall, this paper provides a nice analysis of risk factors and the patterns of violence, but requires more clarity on a range of steps. Once this is done it will be much easier for readers to understand.

If applicable, is the statistical analysis and its interpretation appropriate? Partly
Are all the source data underlying the results available to ensure full reproducibility? Yes

Alison Kutywayo
AG: In terms of methods and specific measures, we do not get any detail provided on the measures used to assess the different forms of violence, whether they were single or multiple items and how they were asked and coded etc. Without this sort of detail it is hard to interpret the findings of the paper. Including a table with the outcome measures clearly specified would be great. Response: Included as an additional paragraph under "Measures" ○ AG: Linked to this is the statistical analysis section of the paper needs further work to make it clearer for readers to follow. It needs to read more like a step-by-step set of work. So overall sample, then described by Province, then overall experience of violence and then among those who experience violence etc. As I read it, it skipped around and made for a tricky interpretation. Response: Unclear which section this refers to but have tried to ensure that the results flow logically, as per the tables. ○ AG: In the conclusions I am concerned that the findings do not adequately link to the recommendations. First, there is a sentence: "We found that both boys and girls experienced similar rates of physical, psychological and sexual violence: these findings are confirmed by other" this is not correct as the multivariable logistic regression shows boys are more likely to experience violence. Assume this is meant to be among those who experience violence. Response: Clarity added. This sentence is in terms of the types of violence they experienced, among those who did experience violence ○ AG: conclusion: The statement that interventions such as Stepping Stones etc. should tackle the norms of violence -is this not exactly what many of these interventions do? I think they are trying to make the point they tend to focus on violence from men to women and need to extend to include all forms of violence (which as far as I know, no one has measured). Response: The interventions listed do tackle gender norms and have been named as suggested interventions to address this point. The sentence has been re-worded to make more clear.
○ AG: The paragraph beginning: "Violence most often took place at school, during the day, with the majority knowing the perpetrator, as a peer" has two issues. First, this is an important statement and suggests we should be doing much more around school peer violence than is currently being done. Discussing this would be really important. Response: added a reference to a recent manuscript that outlines a variety of ○ than once. AG: Table 3: please could we get all unadjusted ORs provided, and then exclude in the multivariable analysis -much easier to see how the analysis was done, and not just provide those which are significant in unadjusted analysis.
Response: We only kept those that were significant it the bivariate level [so don't have a regression for the unadjusted variables that were not significant], do you want to then include ALL factors in the unadjusted, and then keep only these in the adjusted?

Alison Kutywayo
Before uploading the revised edition of this manuscript, we please require clarity on the following three comments: Linked to this is the statistical analysis section of the paper needs further work to make it clearer for readers to follow. It needs to read more like a step-by-step set of work. So overall sample, then described by Province, then overall experience of violence and then among those who experience violence etc. As I read it, it skipped around and made for a tricky interpretation.
Response: Unclear which section this refers to but have tried to ensure that the results flow logically, as per the tables. ○ 1.
In the statistical analysis, did the authors account for study design in their analysis Response: Unclear what the reviewer is referring to. This study only presents cross sectional baseline findings and therefore the CrCT methodology does not apply here. Does this respond to your query? ○ 2.

Andrew Gibbs
Thanks for the queries, sorry I should have been clearer.
For clarity: It would refer to the methods section, but as long as it is clearer that is fine. 1.