Gender-based violence among female students and implicatons for health intervention programmes in public universities in Eastern Cape, South Africa

Abstract South African institutions of higher education and training are experiencing an increase in the prevalence of gender-based violence committed against female students who are most often victims. This gave rise to this study to investigate the prevalence and underlying factors to gender-based violence among female students in public universities in Eastern Cape, South Africa. A cross-sectional research design was used to conduct a study among 604 female students from Nelson Mandela University, University of Fort Hare, Rhodes University, and Walter Sisulu University in Eastern Cape selected using cluster sampling method. The data were analysed using descriptive statistics and logistic regression. P-values (<0.005) variables were selected based on statistical significance. The adjusted odds ratio was used to illustrate the strength of association with 95% confidence intervals. Results indicate 344 (57.8%) to be the prevalence of gender-based violence. Findings show that 336 (56.5%) of the students experienced emotional or verbal violence, 378 (46.7%) sexual violence and 102 (36.3%) physical violence. The prevalence of attempted rape was 96 (36.7%) while complete rape was 80 (28.9%). Significant underlying factors to gender-based violence reported were living alone in a rented house (AOR = 3.3, 95% CI: 1.80–6.26, P = 0.040), having a sexual partner AOR = 4.42; 95% CI: 2.4–8.05, P = 0.001), monthly allowance ≤ 1000 rand (AOR = 3.4; 95% CI: 1.8–6.0, P = 0.010), age ≤ 19 years (AOR = 3.5; 95% CI: 1.5–5.4, P = 0.030), having a housemate with a boyfriend (AOR = 4; 95% CI: 2.9–7.7, P = 0.001), and being a student in the discipline of medical sciences (AOR = 3.1; 95% CI: 1.2–7.7, P = 0.030). Further, the study revealed that a considerable number of students were survivors of gender-based violence at the university. There is need for universities and interested parties to fight against gender-based violence by devising interventions and developing policies to protect female students, and generate intervention programmes to raise awareness of the prevalence, types of gender-based violence and their underlying factors.


PUBLIC INTEREST STATEMENT
Universities in South Africa are experiencing an increase in the prevalence of gender-based violence committed against female students who are most often the victims. This motivated this study to assess the prevalence and factors associated with gender-based violence among female students in public universities in Eastern Cape, South Africa. Findings show that students experienced verbal or emotional violence, sexual violence, and physical violence. Underlying factors to gender-based violence include ethnicity, living alone in a rented house, having a sexual partner, monthly allowance, age, having a housemate with a boyfriend, and being a student in the discipline of medical sciences. Many students reported to be survivors of gender-based violence at their universities. There is need for universities and interested parties to fight against gender-based violence by devising interventions and developing policies to protect female students, and generate intervention programmes to raise awareness of the prevalence, types of gender-based violence, and their underlying factors.

Introduction
Gender-based violence is violence directed against any person based on gender norms and unequal power relationships. Gender-based violence manifests itself in different types; physical, sexual, and verbal/emotional. In this study, physical violence is understood as when a person hurts a partner by kicking, hitting, or using another type of physical force while sexual violence is understood as forcing or attempting to force a partner to take part in a sex act, sexual touching, or a non-physical sexual event for example, sexting when the partner does not or cannot consent (Adams, Mabusela & Dlamini, 2013). Emotional/verbal abuse is defined as a pattern of behaviour in which the perpetrator insults, humiliates, and generally instils fear in an individual to control them (Gqola, 2015). As a result, an individual's reality may become distorted as a person may internalise the abuse as their own failings (Gqola, 2015). Even though gender-based violence affects both men and women, evidence around the globe shows that violence against women is a most systematic, prevalent, and pervasive problem (Adams, Mabusela & Dlamini, 2013). Scholars (Anitha & Lewis, 2018) agree that genderbased violence against women is a universal scourge affecting every society. Gender-based violence has no geographical boundaries, culture, wealth, street, home, school, workplace or institution, and it is a human rights violation which is a constraint on gender equality and the development of nations" (Belknap & Erez, 2007;Gqola, 2015).
This purpose of this study is to examine the prevalence and factors underlying gender-based violence among female students at public universities in the Eastern Cape. Findings may be used by government, policymakers, and stakeholders to develop policies and intervention programmes to combat gender-based violence among female students on South African campuses. Bloom (2008) shows that globally, one out of three women will be physically or sexually harmed, and one out of five will experience rape or attempted rape in their lifetime. In developing countries, gender-based violence is a serious problem, as the rate of violence is high (between 30% and 76%) and takes place under different circumstances (Centre for the Study of Violence and Reconciliation (CSVR), 2016).
In sub-Saharan Africa (Decker et al., 2015), the risk of experiencing gender-based violence seems to be high (between 46% and 78%) among adolescent girls. The prevalence of forced first sexual intercourse among adolescent girls aged between 12 and 19 years ranges from 15% to 38% (Sandfort, 2013).
While gender-based violence is also sub-Saharan Africa phenomenon (Thobejane et al., 2018), the Human Rights Watch (2010) categorically branded South Africa the "rape capital" of the world. Rape can be complete rape understood as a non-consensual sex act in which the perpetrator penetrates the victim's vagina, anus, or mouth with a penis, hand, finger, or other object or it can be attempted rape which is a trial to have sexual intercourse without consent of the female but without penetration of vagina (Thobejane et al., 2018). Evidence shows that South Africa has one of the highest rates of gender-based violence in the world. Gender-based violence commonly reported in South Africa does not only include rape but intimate partner violence and femicide as well (Matzopoulos et al., 2019). Gqola (2007) further argues that gender-based violence in South Africa is commonplace and omnipresent and has been normalised through the dominant public discourse fed by cultural norms that often dictate that men are aggressive, controlling, and dominant, while women are docile, subservient, and rely on men as providers.
Previous studies show that there are many consequences of gender-based violence which include the risk of getting infected with the human immunodeficiency virus (HIV) and sexually transmitted infections (STIs), unwanted pregnancy, unsafe abortion, and vaginal discharge (Belknap & Erez, 2007;Gqola, 2015). Other consequences of gender-based violence are emotional and psychological trauma, which may result in attempted and completed suicide (Ali, 2018;Zain, 2012).
Though gender-based violence is widespread and has numerous adverse health effects, the social ill is underreported. Barriers to reporting or seeking care from formal sources include shame and stigma, financial barriers, perceived impunity for perpetrators, lack of awareness of available services or access to such services, cultural beliefs, threat of losing children, and fear of getting the offender in trouble (Matzopoulos et al., 2019). In addition, many women are afraid of retaliation, discriminatory and stereotypical attitudes toward victims in courts and law enforcement settings, distrust of health care workers, view that violence is normal or not serious enough to report (De Klerk et al., 2007).
There are many reports of gender-based violence in educational settings worldwide (Beyene et al., 2019). Studies of young women on campuses found that predictors of sexual assault and abuse against female students included the year of study, prior victimisation, consensual sexual activity, religious affiliation, ethnicity, marital status, indigeneship, campus residence, and faculty affiliation (Iliyasu et al., 2011).
While South Africa is becoming more aware of the problem of gender-based violence in institutions of higher education and training, there is lack of provincial or national research to provide a clearer understanding of the nature and extent of gender-based violence in institutions of higher education and training in South Africa. Furthermore, the under-reporting of gender-based violence, particularly sexual violence, makes it difficult to determine the prevalence of the different forms of gender-based violence in institutions of higher education and training. As a result of underreporting, and the consequently low numbers of officially reported incidents of gender-based violence, institutions of higher education and training may perceive that this phenomenon is not a major problem at their institutions and therefore argue that it does not require a concerted institutional response (De Klerk et al., 2007). However, the 2016, 2019, and 2020 protests around the country concerning gender-based violence on South African campuses revealed that the issue of genderbased violence in institutions of higher education and training is a significant issue that needs serious attention. This study is part of the efforts to address the scourge of gender-based violence and will be conducted among female students at public universities in the Eastern Cape. sexual assault, incest, bestiality, statutory rape, and the sexual grooming of children (South Africa's Crime Statistics, 2020/2021). The SAPS report covering the period between March 2020 to March 2021 highlighted that 10, 006 people were raped between April and June 2021. This is an increase of 4, 201 cases, amounting to a 72.4% increase, compared to the previous reporting period. This number drops drastically to 2.8% if comparison was made to the normal period prior to Lockdown. A sample of 5, 439 rape cases revealed that 3, 766 of the rape incidents took place at the home of the victim or the home of the rapist, and 487 rape cases were domestic violence related. The SAPS report also shows an increase of 47.1% in recorded sexual offences when compared to the previous skewed reporting period, this figure is revised to 5.0% if compared to the previous normal period of 2019/2020 financial year (South Africa's Crime Statistics, 2020/ 2021).
The increase in the number of gender-based violence cases reported in the SAPS report suggest that there is an increase in the number of cases of gender-based violence in South Africa. However, because of social stigma and misperceptions associated with gender-based violence, it is logical to argue that there may be many more cases on gender-based violence going unreported. A series of gender-based violence including femicides have been prodding anger and calls from different sections of society to act against the scourge. Calls to decisively fight gender-based violence is not from without because evidence shows that South Africa is experiencing a series of senseless killings, assaults, rapes, and cases of abuse with frightening levels inflicted on women. Many women have been brutally assaulted and murdered at the hands of men in South Africa over the years (South Africa's Crime Statistics, 2020/2021). Some murdered women make the headlines while others are mourned behind closed doors. In a few cases, justice is served while in other perpetrators are walking free on the streets while in some cases are not reported.

Gender-based violence in South African universities
South African institutions of higher education and training have not been spared from the scourge of gender-based violence leading to numerous protests around the country time and again, many of which concerned sexual violence on campuses (Department of Higher Education and Training (Department of Higher Education and Training (DHET), 2019). The anger over gender-based violence on and around university campuses is as a result of the few incidents reported media in the media both local and national. However, only a few cases make into the national news. Thus, just a small portion of the incidents of gender-based violence on and around campuses in the country is reported (Phipps et al., 2018).
One of the challenges of gender-based violence in universities is lack of sufficient information to have a comprehensive picture of the extent of the scourge of gender-based violence. Scholars agree that incidents of gender-based violence are underreported (Swartz et al., 2017). Most incidents that are reported are not followed up and investigated.
The phenomenon of underreporting gender-based violence is complex and gives a hint on the prevalence and normalization of gender-based violence. Evidence shows relationships and interrelations of constructions of what constitutes perpetration and victimhood. In many cases, victims of gender-based violence say that they do not know what to do because of trauma and lack of information where to report the case. This view is supported by Adams, Mabusela & Dlamini (2013) who found that victims of gender-based violence are often not sure where to report and what processes to follow. This seem to suggest that lack of clarity about university procedures to report gender-based violence contribute to underreporting. A study by Mkhize and n.d.imande-Hlongwa (2014) further explained that students do not know where to report gender-based violence because of confusion, and hopelessness. Other studies (Chauke et al., 2015;Ahmed (2015) argue that emotions such as shame; fear of being negatively judged by parents, family, friends and the community; fear of stigmatisation; and fear of reprisal attacks from the perpetrators play a role in underreporting of gender-based violence. The shame and stigma attached to being a victim of gender-based violence are often reinforced by social and institutional discourses and norms that put the onus of preventing gender-based violence on victims not perpetrators (Rentschler, 2015). Ahmed (2015) argues that sometimes victims know what to do but face barriers that hinder them from reporting. A study by Ahmed (2015) found that students are discouraged to report genderbased violence cases for fear of damaging their career as they are often advised. Such advice works as threat that students will lose the very connections that would enable them to progress; or reporting would damage the lecturer; or reporting will ruin the image of the university. As a result, reports on sexual harassment may also not be made public to protect the reputation of the university from damage (Rentschler, 2015).
Evidence shows that in 80-90% of gender-based violence crimes, victims and assailants know each other as friends, acquaintances, or people they go out with (Fisher et al., ;Rennison & Addington, 2014). These factors and abuse of alcohol known for defining socialisation on campuses contribute to the burden experienced by victims and the subsequent unlikelihood to report gender-based violence. Besides, studies have revealed that victims of gender-based violence who are under the influence of alcohol or drugs during gender-based violence are less likely to report their victimisation to law enforcement agencies because their cases may be dismissed especially when there is no physical assault involved (Fisher et al.).
Ahmed (2015) and Rentschler (2015) found that failure to report gender-based violence is one of the key factors contributing to the perpetuation of the scourge which is not helping the cause of fighting this societal disorder. The situation is worsened by institutional barriers and poor reporting procedures hence a perpetuation of gender-based violence. Rennison and Addington (2014) found that some universities often downplay the magnitude of the scourge of gender-based violence on their campuses. This phenomenon is driven by concerns of public image and unwillingness to commit universities to offering the necessary gender-based violence responses (Chauke et al., 2015). This means that universities are contributing to the cover-up of the actual extent of the prevalence of gender-based violence on campuses. Such practices make universities concerned complicit in the continuation of gender-based violence.
Evidence shows that gender-based violence in universities is on the increase (Beyene et al., 2019;Swartz et al., 2017); therefore, there is need for unity of purpose to amplify voices and activism, care, and support needed to transform campuses into a safe places for female students and all people. Research has potential to make universities to have a better understanding of the phenomenon and have the potential of informing responses to the scourge. This study will investigate the prevalence and underlying factors to gender-based violence among female students in public universities in the Eastern Cape, South Africa to help fight against gender-based violence and the discourses and university structures that normalise gender-based violence against female students. The study was guided by research questions and research objectives research approach and there was no hypothesis used in the study.

Research design
A cross-sectional research design was used to guide the study among female students in public universities in Eastern Cape. A cross-sectional research design was used because the design allows studies to collect data to make inferences about a population of interest at one point in time (Creswell, 2014). A cross-sectional research design makes snapshots of the populations about which they gather data. Besides, this design was chosen because it allows studies to collect data from many different individuals at a single point in time. In this case, data were collected from four different public universities in Eastern Cape using quantitative research approach which is the process of collecting and analysing numerical data (Creswell, 2014). Quantitative research approach can be used to find patterns and averages, make predictions, test causal relationships, and generalise results to wider populations. Cluster sampling technique was used to select 604 respondents from four public universities in Eastern Cape: Nelson Mandela University, University of Fort Hare, Rhodes University and Walter Sisulu University in Eastern Cape. Most of the students stay on off campus residences which are self-catering residences and range from commune buildings to apartments, townhouses, freestanding houses, garden cottages or bachelor units. There is a variety of rooms to choose from ranging between standard single rooms to en-suite single rooms. Only students of the similar gender share rooms. The research design used in this study helped to quantify the prevalence and underlying factors to gender-based violence among female students using numerical data transformed into statistics.

Data collection instruments
Data were collected using a SurveyMonkey questionnaire was prepared in English language. To achieve the aim of the study and high response rate, students in the first, second, third-and fourth-year level of study were invited to complete the questionnaire through their respective university communication systems. Besides, the questionnaire was made available on university social media platforms including websites and facebook pages. The survey used a questionnaire with several items including demographics, and variables about gender-based violence: sexual and physical violence and psychological abuses. The scales on physical, emotional, and sexual violence were adopted from the violence scale and severity index. The sections in the questionnaire had different Cronbach's alpha value; questionnaires related to demographic characteristics (a = 0.87), questionnaires related to sexual violence (a = 0.77), questionnaires related to physical violence (a = 0.73), and questionnaires related to emotiomal/verbal violence status (a = 0.81). The questionnaire was developed by the researcher in 2021 based on existing questionnaires on the prevalence and underlying factors to gender-based violence among students (Abubeker et al., 2021;Iliyasu et al., 2011). The initial questionnaire was e-mailed to four expert clinicians and researchers in gender-based violence and prevention. The draft was also distributed to gender-based violence prevention and education programme coordinators at the national department of health. The reviewers were asked to comment on the selected scales, indicate if any scales were missing, and indicate whether the included scales could reasonably be used in a university setting. The comments were used to identify new scales and to improve the summary information provided.
A pilot sample (n = 10) was used to improve the wording and clarity of expression of the survey items. Data from the pilot sample was not used in any further analysis. The final version of the questionnaire required an estimated time of 5-15 minutes to complete. The questionnaire was posted online together with the consent form describing the purpose of the study in detail. Six hundred and four (604) questionnaires were collected. The total number of female students expected to complete the survey was 6 000. Using the confidence level 95%, population size 6 000 and margin of error 5% the ideal sample size is 360 but generated 604 questionnaires expressing close to 100% response rate.

Variables
Gender-based violence in this study was the dependent variable, and independent variables included age, year of study, discipline of study, having a partner, living setting, pocket money, having a roommate who has a boyfriend, ethnicity, and religion. Perpetrators of gender-based violence were university friends, strangers, boyfriends, and lecturers, and assessed perpetration tactics of physical violence such as fractures, scratches, bruising, and cuts; perpetration tactics of sexual violence specifically making victims drunk, forcing them to take one or more substances such as cocaine and shisha, using their authority especially lecturers; and perpetration tactics of emotional/ verbal violence that includes being intimidated, subjected to inappropriate comments, insulted, and humiliated. The study also assessed the effects of gender-based violence especially physical, sexual, and emotional/verbal violence on respondents' activities. In addition, the study examined the issue of reporting/non-reporting of gender-based violence and factors that prevent reporting.

Ethical considerations
With adequate knowledge of the study, female students were asked to sign the consent form by ticking on the right side of the questionnaire if they wanted to participate. Respondents were given contacts in case they needed counselling services or other services after participating in the study. The different types of gender-based violence; physical, sexual, rape, and emotional/verbal were defined in the title page. Students were informed that participation in the study was voluntary and were at liberty to withdraw from the study anytime without any consequences. Confidentiality, privacy, and anonymity were upheld. The contact details for Nelson Mandela University Research Office were provided in case students had questions. The four universities under study provided gatekeepers' letters and Nelson Mandela University provided ethical clearance. The questionnaire ran online from July 2021 to August 2021.

Data analysis
The investigator assessed the data for completeness and accuracy and there were no data excluded. The data were entered into EpiData version 3.2 thereafter exported to Statistical Package for Social Science (SPSS) version 25 for analysis. Data were analysed using descriptive statistics that included the computing of percentages and frequencies. Bivariate and multivariable logistic regression analyses were performed, and adjusted odds ratios (AORs) calculated with 95% confidence interval to determine the associations between gender-based violence and independent variables. Gender-based violence screening tool was dichotomised as "yes" and "no" before performing logistic regression analysis. Thus, students who did not experience at least one or more forms of gender-based violence acts; sexual violence, physical violence and emotional or verbal abuse were assigned "no" indicating that students were not victims of gender-based violence and students who reported at least one or more forms of gender-based violence acts were assigned "yes" indicating that they were victims of gender-based violence. All variables with a p = value <.25 in the bivariate analysis were considered for the final multivariable analysis using backward stepwise regression. In addition, in the final multivariable logistic regression analyses, all variables with a p = value <0.05 were treated to be significantly associated with the outcome variable gender-based violence though not presented in this study.

Sociodemographics of the respondents
Six hundred and four questionnaires were completed and returned achieving the response rate of 100.0%. The mean (±SD) age of the respondents was 19 (±1.12) years ranging between 18 and 24. Most of the respondents were in their first-year level of study 186 (31.7%), and 218 (36.2%) were from the discipline of health sciences. Five hundred and fifty students (92.0%) reported to be single and 216 (36.0%) were staying alone in rented houses. Almost half of the study respondents reported to be Christian by religion, and 210 (36.0%) of the respondents reported receiving the mean monthly pocket money of ≤1000 rands (Table 1).

The prevalence gender-based violence among students
Results indicate that 344 (57.8%) students had an experience of some form of gender-based violence at their universities. Out of students who had an experience of gender-based violence, 216 (36.1%) experienced physical gender-based, 336 (56.5%) experienced verbal or emotional violence whereas 278 (46.7%) experienced sexual violence.

Physical gender-based violence
Results show that out of 216 (36.3%) female students who indicated that they had an experience of physical violence, 148 (68.6%) revealed that more than two people tried to perpetuate physical gender-based violence on them. Out of students who survived physical gender-based violence, 68 (31.6%) reported that they experienced numerous exploits of physical gender-based violence.
Students reported that most of the physical violence they experienced was perpetrated by university friends 130 (61%). Other perpetrators of physical gender-based violence were boyfriends 44 (21%) tailed by unfamiliar people 32 (16%) and lecturers 10 (6%). Bruising was the most common type of hurt inflicted on students followed by injury through scratches, cuts, and fractures as presented in Figure 1. Students who survived physical gender-based violence reported that the state they were in after physical gender-based violence negatively affected their daily endeavours. For instance, findings show that the aftermath of physical gender-based violence made 124 (57.5%) of the survivors not to attend lectures because of the state they were in at that time whereas 34 (15.8%) were afraid to walk unaccompanied, 4 (2.0%) were scared of visiting the library at night.

Sexual gender-based violence
Findings demonstrate that 378 (46.7%) of the students had experienced sexual violence. Out of students who experienced sexual violence, 102 (36.8%) reported to be victims of attempted rape while 80 (28.9%) recounted having experienced full rape whereas 96 (34.6%) reported having experienced both attempted and full rape. The study found that 46 (57.6%) of the 80 sexual gender-based violence survivors of full rape were violated once while 34 (42.6%) were violated more than twice. The findings indicate that 136 (45.4%) of the committers of sexual gender-based violence were university friends followed by unfamiliar people 60 (21.7%), boyfriends 50 (19%), and lecturers 42 (15.2%).

Rape mechanism
The study indicates that the most common tactic used by perpetrators of sexual gender-based violence was getting their targets drunk with alcohol 92 (33.2%), coercing them to use substances 76 (27.4%), and use their power or authority 42 (15.2%) in order to control their victims.

Consequences of rape
Effects of rape reported by students include perpetrators committing rape without using a condom 50 (27.3%), survivors of rape not able to sit for an examination after being raped 86 (46.8%) and being impregnated and ending into an abortion (26 (14.2%). Out of 344 students who experienced gender-based violence, 272 (79.2%) reported being worried about being raped every time they were walking alone at night.

Verbal or emotional violence
Results revealed that 336 (56.5%) of the students experienced verbal or emotional violence in the past 3 years of being at the university. Findings show that 134 (41%) of the perpetrators of verbal/ emotional violence were university friends, 90 (28%) were unfamiliar people, 78 (23%) were lecturers and 34 (12%) were boyfriends. Psychological exploitation reported included receiving inappropriate remarks, humiliation, insults, and intimidation. Findings indicate that most verbal or emotional survivors experienced this violence more than once 288 (85.8%).
Only 4 (1.4%) of students who experienced gender-based violence were able to report the matter to legal authorities. Students revealed that they were not able to report the matter because they were afraid of their parents or guardians and embarrassed to share what happened to them 132 (39.4%), regarded the issue as negligible 118 (35.2%), sacred that perpetrators would come after them 26 (7.8%), and some had no idea where to report the matter 32 (9.6%).

Underlying factors to gender-based violence
The multivariate logistic regression analysis results indicate that students aged ≤ 19 years (AOR = 3.5; 95% CI: 1.5-5.4, P = 0.030) were more susceptible to gender-based violence compared to students equal to or older than 20 years of age. Students with monthly allowances (AOR = 3.4; 95% CI: 1.8-6.0, P = 0.010) were more susceptible to gender-based violence compared to students without monthly allowances. Students in the discipline of health sciences (AOR = 3.1; 95% CI: 1.2-7.7, P = 0.030), and students with a sexual partner (AOR = 4.42; 95% CI: 2.4-8.05, P = 0.001) were more likely to experience gender-based violence. Besides, findings reveal that students staying alone in rented houses off campus (AOR = 3.3, 95% CI: 1.80-6.26, P = 0.040), and students staying in a rented house off campus with housemates who had boyfriends (AOR = 4; 95% CI: 2.9-7.7, P = 0.001) were more prone to gender-based violence as shown in Table 2.

Discussion
The study found that 57.8% of the female students at public universities in the Eastern Cape had an experience of some form of gender-based violence in the two to 3 years of their campus life. The prevalence of gender-based violence among female students is in agreement with some previous studies conducted in South Africa and the collective projected prevalence of gender-based violence among youth attending university education and training in sub-Saharan African countries (Jewkes et al., 2002). This finding is reinforced by a cross-sectional study conducted on the prevalence and factors associated with gender-based violence among students in Botswana that found that 62.2% had an experience of gender-based violence (Arnold et al., 2008). In addition, a systematic literature review that investigated the prevalence of gender-based violence among female students in sub-Saharan Africa also reported similar results (Beyene et al., 2019). On the other hand, the prevalence of gender-based violence in this study was higher than in the study conducted in South Africa that reported 33% (Adams, Mabusela & Dlamini, 2013) and results of a systematic literature review conducted in Ethiopia (Arnold et al., 2008). The variance in the findings may be attributed to differences in the social and cultural environments of the populations studied. The current study was conducted among female students at universities that are mostly located in urban areas; therefore, students have easy access to substances such as alcohol, nicotine, marijuana/dagga, heroin/morphine, mandrax, and cocaine reported as some of the underlying factors to the higher prevalence of gender-based violence (Beyene et al., 2019;Collins et al., 2011).
Findings show that 36.3% of the female students had an experience of physical violence. The findings of this current study are lower than findings reported in Uganda showing that 98% of female students had an experience of physical violence (Mirembe & Davies, 2001). However, findings in this current study agree with the findings reported by Abubeker et al. (2021) in Ethiopia, which found that 32.3% of female students had an experience of more than two types of physical violence during their campus life.
The study reported bruising 120 (55.7%), cuts 56 (25.8%), scratches 28 (12.9%), and fractures 12 (5.6%) in this order as the most prevalent physical violence committed against female students. These findings are supported by Patel and Andrew (2001) who found that beating, burning, and kicking to be the physical violence committed against female students. In agreement, Iliyasu et al. (2011) found punching, maiming, kkilling,and the use of objects or weapons to be the physical violence committed against female students.
This study revealed that 378 (46.7%) of the female students had an experience of being sexually abused from the time they joined the university. The finding is supported by studies reporting that female students had an experience of being sexually abused in Sierra Leone (23%; Alexander, 2017), India (33%; Patel & Andrew, 2001), Cameroon (15%; Menick, 2002), Nigeria (22.2%;Iliyasu et al., 2011), United States (25%; Heise et al., 1995), and Ethiopia (4%; Gebreyohannes, 2007). Findings from a study in Zimbabwe reported a higher (65.6%) level of sexual abuse is experienced among female students (Shumba, 2001). The prevalence of attempted rape in this current study was 96 (36.7%). The finding agrees with the Ethiopian study that found that 37% of students were raped (Gebreyohannes, 2007). The current finding is, however, lower than the finding reported in Botswana where 46% reported attempted rape (Rivers, 2000). The cause of this variation in the findings is not known but may be attributed to the different immediate physical and social settings in which students live or in which rape happens. This means that the culture in which a student is educated or lives, and the people and institutions with whom they interact can influence rape in that the physical setting enables victims to fight off the attempt successfully before any sexual penetration occurs or the perpetrator may withdraw from the attempt after changing his or her mind (Collins, 2014).
Findings show that 80 (28.9%) of the female students reported complete rape. The current finding is high when compared to the study conducted in South Africa that reported complete rape to be 6.9% (Swartz et al., 2017). The variance in the findings may be attributed to the trends and developments in changes in behaviour, attitudes, and values in the two societies where the studies were conducted. The finding is supported by Collins et al. (2011) who found that populations, lifestyles, cultures, customs, and traditions play a role in sexual intercourse accomplished against the consent of the victim. In addition, the differences can be attributed to the finding that 162 (80%) of female students in the current study were staying in rented houses outside campus either with other students or alone compared to students reported by in a study conducted by Swartz et al. (2017) in which only 10% of female students were staying off campus.
Sexual violence was committed by boyfriends, students, strangers, and lecturers. The findings above did not come as a surprise because several studies have reported similar results. For instance, a study in Zimbabwe (Shumba, 2001), Sierra Leone (Menick, 2002) and Cameroon (Alexander, 2017) reported that lecturers, strangers, and friends, respectively, were the main perpetrators of sexual violence.
Findings show that 336 (56.5%) of the students reported verbal or emotional violence as the most prevalent form of gender-based violence. Verbal or emotional is often minimised as not being "that bad," because it does not cause physical harm. In fact, verbal or emotional abuse is substantially more prevalent than physical abuse but not as often identified and addressed. Verbal or emotional abuse that does not cause physical injury includes overprotection, gaslighting, name-calling, gradual isolation, cold-shouldering, guilt-tripping, stalking, body shaming, and financial abuse. However, studies conducted in Botswana (Rivers, 2000) and in Uganda (Mirembe &  Students aged ≤ 19 years were three times more prone to experience gender-based violence than their older counterparts. This finding is supported by a study in Ethiopia that found similar results where younger students were more susceptible to gender-based violence than older students. However, it remains unknown why younger students are more positioned to genderbased violence than older students. The finding may be attributed to the finding that younger students lack knowledge and experience on how to decipher situations quickly that would lead to gender-based violence. In agreement, Valentine et al. (2009) found that younger students lack knowledge of the impact of gender-based violence to fight the scourge.
Health sciences students were three times more prone to experience gender-based violence compared to students from other disciplines. The underlying factor to this finding is not known as there are no studies that have investigated the relationship between students' disciplines of study and gender-based violence. The possible explanation to this finding is that most of the medical sciences disciplines studied are dominated by male students who are the main perpetrators of gender-based violence. The finding is supported by a study in South Africa that found that men in continue to dominate the medical profession, representing 59.4% of medical doctors registered with the Health Professions Council of South Africa (HPCSA) with females representing 40.6%, resulting in a male-to-female ratio of 1:0.7 (Tiwari et al. (2021).
This study revealed that students with sexual partners were four times likely to have experienced gender-based violence when compared to those who had no sexual partners when the study was conducted. Sexual partners are people who engage in sexual activity together. The sexual partners can be of any number, gender, sex, or sexual orientation. This finding is supported by a study in South Africa, which found that having a sexual partner was associated with genderbased violence (Department of Higher Education and Training (DHET), 2017). Furthermore, findings show that students staying alone in rented houses off campus and students staying in shared rented houses with boyfriends were three times more likely to experience gender-based violence than students staying with others in rented houses off campus and students staying in shared rented houses without boyfriends, respectively.
Having little or no monthly allowance was associated with the likelihood of experiencing genderbased violence. The finding is supported by Abubeker et al. (2021) found that having little or no monthly allowance was a predictor of gender-based violence. This may incline female students with little or no monthly allowance to engage in sexual relationship for economic benefits where they have very little control of what happens in the relationship, exposing them to gender-based violence. The view above agrees with Gouws and Kritzinger (2007) who found that economic disparities and intimate partner violence in relationships often hinder a female student's ability to stand against gender-based violence in fear of losing their economic support.

Implications for intervention programmes against gender-based violence
The relatively high prevalence of gender-based violence reported in this study is a call for intervention programmes to address gender-based violence among students. The scourge of genderbased violence should be addressed from different levels. First, at point prevalence, by focusing on the proportion of the female students' population who have experienced gender-based violence at a specific point in time. Second, at period prevalence, by focusing on students with experience of gender-based violence at any point during a given period of interest, such as every 12 months. Third, at lifetime prevalence, by focusing on the proportion of students who, at some point in their life have ever had the experience of gender-based violence. This approach may help to support victims of gender-based violence and to determine the likelihood of female students being exposed to gender-based violence.
The study reported different types of gender-based violence committed against female students. Intervention programmes should focus on all types of gender-based violence underscoring their gendered nature because this study shows that almost all types of gender-based violence reported are gendered in nature. This means that intervention programmes should also educate students about how gendered power inequalities are entrenched in society, to reduce and prevent gender-based violence.
The study revealed that gender-based violence experienced includes physical, sexual, emotional and verbal violence. Intervention programmes should therefore educate students about the different types of gender-based violence to help influence the integral health development of students. In addition, education about the different types of gender-based violence can be a source of health benefits for a fuller and better individual life for a student, and for the betterment of university campuses and society.
Gender-based violence is mainly perpetrated by university friends, strangers, boyfriends, and lectures as found in this current study and studies within sub-Saharan African (Rivers, 2000;Tiwari, Wildschut-February, Nkonki et al., 2021). There is a need for intervention programmes to split the perpetrators of gender-based violence up into groups such as university friends, strangers, boyfriend, and lectures. Splitting up an audience of perpetrators of gender-based violence can allow for intervention programmes that are more precisely targeted and for personalised gender-based violence content.
The study found several underlying factors to gender-based violence among students. Intervention programmes should highlight these factors because prevention of gender-based violence requires understanding of the factors that influence this scourge. Intervention programmes should consider addressing the complex interplay between individual, relationships, community, and societal factors to help in the understanding of the range of factors that put students at risk for gender-based violence or to protect them from experiencing or perpetrating gender-based violence. This will help in understanding how overlapping factors at one level influence factors at other levels.
In addition to devising intervention programmes to help to clarify factors underlying genderbased violence, intervention programmes should use these factors as entry points for genderbased violence prevention strategies acting across multiple levels of factors at the same time. This approach is more likely to sustain gender-based violence prevention efforts over time and to achieve campus population-level impact.
Intervention programs can use factors underlying gender-based violence as a logical starting point for addressing the construction of gendered roles. However, it is important that discussions within these intervention programmes address the root causes of gender oppression, in addition to providing alternative and respectful communication strategies. Intervention programmes could, at a minimum, engage students in a dialogue about gender-based violence, its origins, manifestations, and potential impact on overall health and well-being. Actively engaging male and female students in analysing their own constructions of each other and critically examining the patriarchal beliefs of male, heterosexual dominance and the devaluation of girls and women that fuel genderbased violence could provide useful insights and promote critical thinking, which is often a necessary precursor to creating attitudinal and behavioural change.
It is also important that intervention programs underscore the need for policy formulation and implementation, which is vital in addressing gender-based violence. At the national policy level, there have been many positive developments in the South African context. The South African Constitution, the Gender Commission, and the Domestic Violence Act of 1988 are examples of significant policy attempts to address gender violence. However, at university level, the reported incidence of gender violence in this study, as well as in other studies (Gouws & Kritzinger, 2007), points to the need for policy formulation and implementation in institutions of higher education and training, and to the need for multiple mechanisms to help realise policy intentions. To help bridge the gap between policy formulation and implementation, the State should have a wellfunctioning judiciary and law enforcement agency system. At the university level, there is a need for more social development resources, such as centres to report gender-based violence and counselling facilities, and the foregrounding of gender rights in areas such as university syllabuses. Civil society participation should be invited to complement the State by creating greater awareness of gender rights.
The finding that female students staying in rented houses were more susceptible to genderbased violence is an indication that rented housing arrangements are fertile grounds for genderbased violence or unsafe spaces signifying the lack of secure facilities to protect students from gender-based violence. Engaging rented house owners and security personnel as part of advisory teams in intervention programmes could contribute to raising awareness about the importance of creating safe environments free from gender-based violence. The scourge of gender-based violence in rented houses also speaks to the absence of neighbourhood cohesion and the importance of developing social capital to create safe communities. This finding also points to the need to build campus residences for easy implementation of intervention programmes focused on genderbased violence prevention.
The indication that female students with low monthly allowance are more prone to genderbased violence than their counterparts is a call to the Department of Higher Education and Training to revisit the National Student Financial Aid Scheme (NSFAS) to provide adequate financial aid to students.
Gender-based violence is a changing dynamic; therefore, there is a need for social capital to help develop informal social controls and for facilitating university development and empowerment. This can be done by partnering with both internal and external research organizations or units or institutions or councils to conduct research on gender-based violence towards developing interventions that promote safety on campus and in neighbourhoods where the rented house of students are located. Research should also inform campaigns on gender-based violence. In these campaigns, communities can participate in formulating and implementing activities that illuminate the reality of gender-based violence among female students.

Limitations of the study
The study has limitations. First, the study assessed a few socio-demographic factors that may not reflect the key underlying factors to gender-based violence. Second, a cross-sectional research design was used that did not ascertain a cause-and-effect relationship between gender-based violence and independent variables studied. Third, a self-administered SurveyMonkey questionnaire used to collect data might influence the social desirability bias and non-response rate, which has potential to influence the underestimation of the prevalence of gender-based violence.

Conclusion
The investigation into the prevalence and underlying factors to gender-based violence among students in this study found a reasonably high prevalence of the scourge. The study revealed that gender-based violence was predominantly committed by male students, people unfamiliar to students, boyfriends, and lecturers. Underlying factors to gender-based violence include students' sociodemographic variables, discipline of study, being in a sexual relationship, accommodation circumstances and having little monthly allowance. There is a need for the department of the South African higher education and training, universities, families, and nongovernment organisations to work together to prevent gender-based violence and administer pragmatic actions needed. It is high time universities put in place awareness programmes and counselling centres not only for female students but perpetrators as well to help both male and female students to build their awareness to fight gender-based violence. Victims and perpetrators of gender-based violence should be given post-gender-based violence services including counselling. There is also need for governments and policymakers to support universities to put in place risk reduction and health promotion programmes by creating favourable university environments including building students' residences within campuses to reduce off-campus rented houses arrangements. Taken as a whole, the department of higher education and training and other interested parties should use underlying factors to gender-based violence identified in this study as reliable knowledge to inform prevention programs especially among female students.