Prevalence and factors associated with anxiety disorder among married women exposed to violence in rural area, Ismailia, Egypt: A cross-sectional study

Background

Domestic abuse is a widespread health issue that negatively impacts both mental health and quality of life.

Objectives

To determine the prevalence of domestic violence and anxiety among women visiting primary healthcare facilities in the rural Ismailia governorate.

Methods

Between October 2021 and December 2021, a cross-sectional study was conducted. Simple random methods were used to choose the participants from those who attended a clinic. 350 married women were included in the estimated sample size. By using an interview questionnaire, data were gathered including the following parts: The socio-demographic data, designed scale for assessment of violence and anxiety symptoms were assessed by the Hamilton anxiety scale.

Results

The prevalence of domestic violence was 41% and both physical and sexual abuse was 43%. The most predominant sexual abuse was practice without consent (63%). The prevalence of anxiety was 76%, the predominance was mild degree 46% followed by mild to moderate 18%. The significant predictors for anxiety in the total sample were the increase in age of women, rural residence, and exposure to abuse (OR = 11.2 (4.9-25.4). The use of the husband's stimulant drugs was the most predictor factor for women's abuse (OR = 2.3 (1.4-3.9).

Conclusion

forty-one of the women exposed to every form of violence, anxiety was present in more than three-quarters of the studied women. It is essential to screen any wife attending primary health care for the manifestation of domestic violence especially in rural areas and increase the awareness of family physicians towards screening of mental health problems.

Associations between intimate partner violence and adverse birth outcomes during pregnancy: a systematic review and meta-analysis

Background

Intimate partner violence (IPV) has been associated with an elevated risk of multiple adverse birth outcomes, yet little is known about how specific IPV influences adverse birth outcomes. The aim of this study was to examine the association between IPV during pregnancy and adverse birth outcomes (i.e., preterm birth, low birth weight, and stillbirth).

Methods

Systematic searches were conducted using four databases: EMBASE, Web of Science, PubMed, and CINAHL for observational studies published from 1 January 2011 to 31 August 2021. Two reviewers independently carried out the literature search, study selection, data extraction, assessment of the study, and risk of bias assessment; disagreements were resolved by a third reviewer. A random-effect model was used to calculate the odds ratio (OR) with a 95% confidence interval (CI) for preterm birth, low birth weight, and stillbirth. I² statistic accompanied by chi-square p-value was used to assess heterogeneity, and funnel plot and Peter's test were used to assess publication bias.

Results

In total, 23 studies met the inclusion criterion. IPV was associated with preterm birth (OR = 1.84; 95% CI: 1.37-2.49; I² = 88%), low birth weight (OR = 2.73; 95% CI: 1.66-4.48; I² = 95%), and stillbirth (OR = 1.74; 95% CI: 0.86-3.54; I² = 64%). We attained comparable results among all specific IPV including physical, sexual, emotional, and mixed.

Conclusion

Intimate partner violence and specific IPV during pregnancy were significantly associated with adverse birth outcomes, especially for physical IPV. An urgent need for greater action to prevent or intervene in IPV during pregnancy is warranted.

Systematic review registration

CRD42021282936, https://www.crd.york.ac.uk/prospero/.

Determinants of Intimate Partner Violence against Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis

Background. Intimate partner violence (IPV) against pregnant women is a recognized global public health problem affecting all spheres of women and unborn infants. In Ethiopia, although inconsistent, individual studies avail; there is a dearth of systematic reviews and meta-analysis about the prevalence and associated factors of intimate partner violence. Thus, the present study was aimed at determining the pooled prevalence of IPV and its determinant factors during pregnancy. Methods. The report of meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis 20 guideline (PRISMA 20). Databases including PubMed/Medline, CINAHL, SCOPUS, HINARI (research4life), AJOL, IRIS, and AIM were searched. Heterogeneity test was assessed by the Cochrane chi-square ( $\chi 2$ ) and quantified by $I^2$ statistics test. Publication bias was tested by funnel plots and Egger’s test. Sensitivity test and subgroup analysis were also performed. Effect size was calculated by random effects model. Results. A total of 26 studies, including data from 13, 912 participants, were included in the analysis. The prevalence of IPV ranged from 7% to 81% with overall estimated pooled prevalence of 37% (30% -44%, $I^2=96.5$ %, $p\le 0.001$ ). Of this, the prevalence of physical, sexual, and psychological violence was 24% (95% CI; 19%-30%), 21% (95% CI; 16%-26%), and 27% (95% CI; 22%-32%), respectively. Factors such as lack of formal education, childhood violence, rural residency, low decision-making power, family history of violence, attitude, unplanned and unwanted pregnancy by women and partners, late initiation of antenatal care, partner alcohol, and khat use were associated with IPV. Conclusion. More than one-third of pregnant women experienced IPV. The most prevalent form of IPV was psychological violence followed by physical and sexual violence. The identified risk for IPV including victim, pregnancy, and perpetrator-related factors indicated the need of a holistic approach in the promotion, prevention, and treatment of IPV. The finding of this study suggests the need of strengthening women empowerments (capacity building) against traditional beliefs, attitudes, and practices. This study also suggests the need of evaluation and strengthening the collaborative work among different sectors such as policy-makers, service providers, administrative personnel, and community leaders, including the engagement of men partners.

Domestic violence in Mozambique: from policy to practice

BACKGROUND

To reduce the impact of domestic violence (DV), Mozambican governmental and non-governmental entities are making efforts to strengthen the legislative framework and to improve the accessibility of care services for survivors of violence. Despite this remarkable commitment, the translation of policies and legislation into actions remains a considerable challenge. Therefore, this paper aims to identify gaps in the implementation of existing national policies and laws for DV in the services providing care for survivors of DV.

METHODS

This qualitative study comprised of two approaches. The first consisted of content analysis of guidelines and protocols for DV care provision. The second consisted of in-depth interviews with institutional gender focal points (Professionals with experience in dealing with aspects related to DV). The analysis of the document content was based on a framework developed according to key elements recommended by international agencies (PAHO and UN) for design of DV policies and strategies. Data from the in-depth interviews, where analysed in accordance with the study objectives.

RESULTS

Eleven (11) guidelines/protocols of care provision and innumerable brochures and pamphlets were identified and analysed. There is a standardised form which contains fields for police and the health sector staff to complete, but not for Civil Society Organisations. However, there is no specific national DV database. Although the seventeen (17) focal points interviewed recognised the relevance of the reviewed documents, many identified gaps in their implementation. This was related to the weaknesses of the offender's penalisation and to the scarcity of care providers who often lack appropriate training. The focal points also recognised their performance is negatively influenced by socio-cultural factors.

CONCLUSION

Within services providing care to survivors of DV, a scarcity of guidelines and protocols exist, compromising the quality and standardisation of care. The existence of guidelines and protocols was regarded as a strength, however its implementation is still problematic. There was also recognition for the need to strengthening by governmental and non-governmental entities the defined policies and strategies for DV prevention and control into practice.

Physical Violence and Associated Factors among Housemaids Living in Debre-Tabor Town, Northwest Ethiopia: Does Employer Alcohol Intake Increase Housemaid Violence?

Background

Violence against women and girls continues to be a global epidemic, including Ethiopia. Housemaids are a neglected segment of the population, and there are no sufficient findings in our country. This study aimed to assess the magnitude of physical violence and associated factors among housemaids aged 15 years and above living in Debre Tabor town, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in Debre Tabor town, northwest Ethiopia from April 1 to 30, 2018. A total of 634 housemaids were selected using cluster sampling method. Data were entered into Epi info version 7.2.2.6 and analyzed with SPSS version 20 using descriptive and analytic statistics. Binary logistic regression analysis was carried out to identify independent significant factors. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to report the strength of associations.

Results

From 634 housemaids that participated in the study, 235 (37.1%, 95% CI: 33.1−41.0) of them experienced at least one type of physical violence in their lifetime. Housemaids who previously lived in rural areas (AOR = 2.82, 95% CI: 1.61, 4.94), had high working experience (AOR = 2.17, 95% CI: 1.27, 3.71), not having parents (AOR = 2.02, 95% CI: 1.18, 3.46), being divorced (AOR = 2.23, 95% CI: 1.31, 4.20), employer alcohol consumption (AOR = 4.97, 95% CI: 2.81, 8.79), and presence of extended family with employers (AOR = 2.26, 95% CI: 1.42, 3.59) were independently associated with the probability of housemaid physical violence.

Conclusion

High prevalence of housemaid physical violence has been reported. Socio-demographic characteristics of both employers and employees and the behavioral characteristics of employers contributed to physical violence. It is important to give special attention to housemaids who came from rural areas and do not have parents. It is also important to make work experience of housemaids as short as possible.

The prevalence and predictors of domestic violence among pregnant women in Southeast Oromia, Ethiopia

Introduction

Domestic violence is a common global health problem and relatively hidden and ignored form of violence against pregnant women. The magnitude of domestic violence among pregnant women is higher in low and middle-income countries including Ethiopia as compared with developed countries. Domestic violence is a violation of human right and associated with numerous adverse outcomes for mothers and the offspring. However, research on domestic violence and predictors against pregnant women is limited in Ethiopia. Therefore, the aim of this study was to assess the magnitude and predictors of domestic violence among pregnant women in southeast Oromia, Ethiopia.

Methods

Cross-sectional study design was utilized among 299 pregnant women selected by systematic sampling technique. A structured World Health Organization (WHO) multi-country study questionnaire on women health and domestic violence was used to measure domestic violence. Binary and multivariable logistic regression models were fitted. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI)) was computed to assess the strength of association.

Result

The prevalence of domestic violence was 64.6% (CI: 58.5, 69.9%). Physical violence was reported as the commonest type of violence (44.1%) followed by psychological (39.1%) and sexual (23.7%) violence. In the multivariable analysis, being illiterate (OR = 6.3; 95%CI: 2.23, 11.65), Husband’s alcohol consumption (OR = 5.726; 95% CI 1.873, 11.51), husband history of arrest (OR = 2.59; 95% CI: 1.15, 5.88) and occupation of husband (farmer) (OR = 3.26; 95% CI: 1.29, 8.25) were significantly associated with domestic violence against pregnant women.

Conclusion

This study revealed that a remarkable proportion of pregnant women had experienced domestic violence in their lifetime (64.6%). Being illiterate, husband’s alcohol consumption, occupation (farmer and self-employed), and history of arrest were significantly associated with domestic violence among pregnant women. The findings suggest screening for domestic violence among pregnant women visiting antenatal care clinic and early intervention based on the findings. Integrating health education program on domestic violence with the existing maternal health program is warranted.

'I should not feed such a weak woman'. Intimate partner violence among women living with podoconiosis: A qualitative study in northern Ethiopia

BACKGROUND

Intimate Partner Violence (IPV) is a serious, preventable public health problem that affects millions of people worldwide. Research indicates that adults suffering from long term, disabling conditions are more likely to be victims of IPV due to the intersection of disease-associated stigma and discrimination. IPV in turn is known to worsen the overall health and wellbeing of those affected by it. Little research however explores the relationship between neglected tropical diseases such as podoconiosis and IPV. This study explores the relationship between IPV and podoconiosis in northern Ethiopia with the aim of identifying new avenues for limiting disability and promoting the wellbeing of people affected by this neglected tropical disease.

METHODS

The study was conducted in East and West Gojjam zones, located in the Amhara Regional State of Ethiopia. Research participants were first screened using the domestic violence screening tool Hurt-Insult-Threaten-Scream (HITS). Data were collected by native speakers of the local language (Amharic) in the form of semi-structured interviews during January and February 2016. Thematic and content data analysis was carried out, using the Open Code 3.4 qualitative data analysis software for coding.

RESULTS

A total of 15 women living with podoconiosis and experiencing IPV were interviewed (aged 31 to 75). Women experienced different forms of IPV, including beatings (with or without an object), insults, name calling, undermining, denial of equal rights over common assets, movement monitoring, cheating, abandonment, forced divorce, obstruction of health care access, inhibition of decision-making and sexual coercion. Podoconiosis increases the frequency and severity of IPV and in occasions shapes a change from physical to psychological and financial violence. In turn, frequent episodes of IPV worsen disease outcomes and contribute to disease persistence in the region, in that these impede women's ability to manage the disease and help perpetuate the conditions of poverty that influence disease onset.

CONCLUSIONS

Women living with podoconiosis are victims of various, overlapping forms of IPV that negatively impact their health and wellbeing. Poverty, scarce IPV prevention services in the area together with a social acceptance of IPV and these women's decreased ability to work due to the debilitating effects of podoconiosis and childcare responsibilities frequently prompt these women to tolerate IPV and remain in abusive relationships. Tackling disease-associated taboo and stigma, developing accessible IPV interventions, working towards greater gender equality at the household and societal levels and developing sustainable strategies for improving the socio-economic assets of women affected by podoconiosis are all necessary to both prevent IPV and to improve disease outcome.

Disparities in Intimate Partner Violence among Currently Married Women from Food Secure and Insecure Urban Households in South Ethiopia: A Community Based Comparative Cross-Sectional Study

Intimate partner violence (IPV) against women and food insecurity are an ever growing public health concerns in Ethiopia. However, the connection between the two is not yet well investigated. Therefore, this study compares IPV by household food security status and examines the association between IPV and food insecurity and among currently married women in childbearing age in Arba Minch town, South Ethiopia. A community based comparative cross-sectional study was conducted among 696 currently married women (15-49). A quantitative data was collected using a pretested and structured questionnaire on randomly selected women. Logistic regression was done using IBM SPSS version 20. Statistical significance was declared at p-value of less than 0.05 and odds ratio with its 95% confidence interval was used to show the degree of association. Lifetime and current IPV were 62.4% and 50%, respectively. Sixty-three (23.6%) and 285 (66.4%) women who experienced current IPV were from food secured and insecure households, respectively (P-value<0.001). The odds of experiencing current IPV were higher among women from food insecure households (AOR=6.59,95% CI(4.54,9.57)) and who were in the age range of 30-39 (AOR=2.16, 95% CI(1.34,3.56)) and it was lower among women with 10 and more years age difference with their husband (AOR=0.52, 95% CI (0.31,0.88)) and with high decision-making power (AOR=0.61, 95% CI (0.38.0.96)) than their reference groups. The prevalence of current IPV was significantly higher among women from food insecure households as compared to their counterparts. The odds of experiencing current IPV were higher among women from food insecure households. Policy makers and programme planners should consider improving urban women's household food security status in order to improve gender inequality and empower women. Multisectorial effort is needed to improve women education and other behavioral factors.