Background Global studies indicate that sexual gender based violence (SGBV) may increase during pandemics including the COVID-19. The Mid-Eastern region in Uganda was of a concern due to high prevalence of intimate partner sexual violence among adolescent girls and young women (AGYW) (13% in 2016). Due to limited data, we investigated factors associated with SGBV among AGYW during the COVID-19 pandemic in Eastern Uganda, April 2022. Methods We line listed all AGYW 10-24 years who obtained SGBV services at ten high-volume health facilities from March 2020 to December 2021, the main COVID-19 period in Uganda. We conducted a case-control study among these AGYW. A case was ≥1 SGBV episode experienced by an AGYW aged 10-24 years residing in Tororo and Busia Districts. For every randomly-selected case from the health facility line list, we identified two neighbourhood-matched AGYW controls who reported no SGBV. We interviewed 108 and 216 controls on socio-demographics, socio-economics, and SGBV experiences during COVID-19. We conducted logistic regression to obtain adjusted odds ratios and confidence intervals. Results Among 389 SGBV cases, the mean age was 16.4 (SD± 1.6: range 10-24) years, and 350 (90%) were 15-19 years. Among 108 cases interviewed, 79 (73%) reported forced sex. Most (73; 68%) knew the perpetrator. In multivariate analysis, self-reported SGBV before the COVID-19 period [aOR=5.8, 95%CI: 2.8-12] and having older siblings [aOR=1.9, 95%:CI 1.1-3.4] were associated with SGBV during the period. Living with a family that provided all the basic needs was protective [aOR=0.42, 95%: CI 0.23-0.78]. Conclusion Previous SGBV experiences and family dynamics, such as having older siblings, increased the odds of SGBV during the COVID-19 pandemic in Uganda. Conversely, a supportive family environment was protective. Identifying, supporting, and enacting protective interventions for existing SGBV victims and socioeconomically vulnerable AGYW could reduce the burden of SGBV during similar events.

The authors have declared no competing interest.

Our training program (Field Epidemiology Training Program, or Public Health Fellowship Program in Uganda) does not receive publication support from the US Government, the fieldwork itself is funded by US Government funds. This work was funded by the Cooperative Agreement-Provision of Comprehensive HIV/AIDS services and Developing National Capacity to manage HIV/AIDS Programs in the Republic of Uganda under the President's Emergency Plan for AIDS Relief (Cooperative Agreement number U2GGH001353-04) through the United States Centers for Disease Control and Prevention to Uganda Ministry of Health through Makerere University School of Public Health. The funder had no role in the study's design, data collection, or decision to publish the work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Ministry of Health Uganda gave the directive and approval to evaluate the factors associated with the increased numbers of Sexual Gender-based Violence during COVID-19 in the country. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. All experimental protocols were approved by the US CDC human subjects review board and the Uganda Ministry of Health and have been performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from the participants before the start of each interview including the health care workers and the interviewed AGYW. We obtained written informed consent from the parents and guardians of the AGYW that were below the age of 18 years before interviews and assent from these girls. We also sought permission from the district health officials and heads of the health facilities. During data collection, respondents were assigned unique identifiers instead of names to protect their confidentiality.

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The datasets upon which our findings are based belong to the Uganda Public Health Fellowship Program, Ministry of Health, Uganda. For confidentiality reasons, the datasets are not publicly available. However, the data sets can be made available upon reasonable request from the corresponding author (pmwine@musph.ac.ug) and with permission from the Uganda Public Health Fellowship Program.