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Jacob AE, Mshana G, Mosha N, Hashim R, Sichalwe S, Malibwa D, Kapiga S, Ayieko P, Stöckl H. Healthy lifestyle factors and male perpetration of intimate partner violence: a cross-sectional study in Mwanza, Tanzania. Glob Health Action 2024; 17:2397842. [PMID: 39267545 PMCID: PMC11404367 DOI: 10.1080/16549716.2024.2397842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 08/23/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND In Tanzania, nearly half of ever-married women have experienced some form of intimate partner violence (IPV), yet little knowledge of IPV from the male perspective exists. OBJECTIVE To explore the role of essential healthy lifestyle factors, diet, sleep, and exercise, and their potential role in IPV perpetration. METHODS A cross-sectional survey was conducted with 1,002 young men (ages 18-24), 754 of which were in an intimate relationship in the previous year. The study took place in Mwanza, Tanzania and used multivariable logistic regression models to explore associations between male perpetration of IPV and diet, sleep, and exercise. RESULTS Six types of IPV perpetration were investigated separately and the prevalence of controlling behaviours (79.4%), economic abuse (30.6%), emotional abuse (47.3%), physical violence (16.4%), sexual violence (23.3%), and combined physical and/or sexual violence (32.1%) were obtained. Regular exercise demonstrated a protective effect for economic abuse perpetration; the chance of mildly active individuals perpetrating economic abuse was 38% less than their inactive counterparts (p = 0.003). Associations with sleep were varied and did not show a clear directional relationship. Diet, defined as poor food variety, was positively associated with every IPV type except physical violence and was significant in sexual violence perpetration (aOR:1.57, 95%CI:1.21-2.05). CONCLUSIONS The results from this study indicate that considering healthy lifestyle behaviours - diet, sleep, and exercise - in the design of intervention programmes may be beneficial in reducing IPV perpetration in Tanzania, and that they should be considered alongside previously established evidence-based risk factors.
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Affiliation(s)
- Anna E Jacob
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Gerry Mshana
- National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Neema Mosha
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | | | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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Ajoseh SM, Sifat RI, Whesu JT. Food-based domestic violence and anemia among women in sexual unions in Nigeria: the effect of urbanization. J Public Health Policy 2024; 45:523-536. [PMID: 38992219 PMCID: PMC11315663 DOI: 10.1057/s41271-024-00504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
In 2019, 1.74 billion people worldwide had anemia. In Nigeria, women of reproductive age are the most affected. Domestic violence affects the anemia prevalence, but few studies have examined the influence of urbanization on women in heterosexual unions (currently married, and cohabiting between). Using the social determinants of health framework, we argue that food-based violence and anemia vary among women residing in rural and urban areas. We used the Chi-square test and logistic regression to analyze the 2018 Nigeria Demographic and Health Survey records (n = 10,499). The study showed that anemia occurs more among women in rural (66%) than in urban (34%) areas. In rural areas, anemia was 29% higher among women who approved food-based domestic violence (OR: 1.29, CI 1.15-1.57) than those who did not. In urban areas, food-based domestic violence was not significantly associated with anemia. This study emphasizes the urgent need for culturally sensitive maternal health interventions aimed at re-orienting individuals and families on violence in rural areas.
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Affiliation(s)
- Seun Mauton Ajoseh
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, 32603, USA
| | - Ridwan Islam Sifat
- School of Public Policy, University of Maryland, Baltimore County, Baltimore, MD, 21250, USA.
| | - John Tasheyon Whesu
- Department of Sociology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Gong Q, Ju S. Food Insecurity and Children's Problem Behaviors: The Mediating Role of Parental Relationship Quality and Parenting Stress. J Dev Behav Pediatr 2024; 45:e349-e357. [PMID: 38896566 DOI: 10.1097/dbp.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/01/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Food insecurity, identified as a critical stressor for many families, can directly and indirectly influence children's development through interparental relationships and parenting. This study examines how food insecurity relates to children's problem behaviors and the mediating roles of interparental relationship quality and parenting stress. It also investigates the association between parents' perception of relationship quality and both their own and their partner's parenting stress. METHOD The study included 2095 children from the Future of Families and Child Wellbeing Study. The actor partner interdependence model was used to explore the actor and partner influence of relationship quality on parents' parenting stress. To examine the association pathways from food insecurity to children's problem behaviors, a structural equation model was conducted. RESULTS Results suggest that fathers' perception of couple relationship quality predicted both their own and their partner's parenting stress while mothers' perception of couple relationship quality only predicted their own, but not fathers', parenting stress. In the positive association between food insecurity and children's problem behaviors, there was a serial mediation through mothers' perception of relationship quality and mothers' parenting stress. In addition, food insecurity was negatively correlated with mothers' perception of relationship quality, but not with that of fathers. CONCLUSION This study highlights the pathway from food insecurity to children's problem behaviors through mothers' perceptions of interparental relationship quality and parenting stress. Results provide support for the family stress theory and offer valuable insights for the formulation of potential prevention and intervention programs.
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Affiliation(s)
- Qiujie Gong
- Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, Urbana, IL
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Ujah OI, Ocheke AN, Olagbuji BN. Is household food insecurity associated with social attitudes accepting of physical intimate partner violence against women in Nigeria? A population-level cross-sectional study. BMJ Open 2024; 14:e082760. [PMID: 38866566 PMCID: PMC11177683 DOI: 10.1136/bmjopen-2023-082760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/28/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES Although prior research suggests that household food insecurity (HFI) is associated with intimate partner violence against women (IPVAW), there is a paucity of research regarding its impact on attitudes accepting of IPVAW. We examined whether individuals experiencing HFI are more likely to accept physical IPVAW, whether the association varies by gender and whether it persists when models are adjusted for other confounders. DESIGN Population-level cross-sectional analysis. SETTING This study used the round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria. PARTICIPANTS The sample included 23 200 women and 7087 men, aged 15-49 years, who were currently married or in union and responded to the attitudes towards domestic violence and HFI modules in the MICS. OUTCOME MEASURES AND STATISTICAL ANALYSIS Attitudinal acceptance of physical IPVAW (specific forms and overall). We conducted weighted multivariable logistic regression to estimate the OR and their corresponding 95% CIs of the associations of food insecurity (FI) with attitudinal acceptance of physical IPVAW, adjusting for potential confounders. RESULTS Multivariable results indicate that severe HFI was positively associated with attitudinal acceptance physical IPVAW in at least one of the scenarios presented (aOR=1.11; 95% CI: 1.01 to 1.22). Individuals experiencing severe HFI had higher odds of physical IPVAW acceptance when wife neglects the children (aOR=1.15; 95% CI: 1.02 to 1.31). The likelihood of physical IPVAW acceptance if wife burns the food was lower for women experiencing moderate HFI (aOR=0.86; 95% CI: 0.74 to 0.99). Stratified analyses indicated heterogeneity in the association between HFI and attitudinal acceptance of physical IPVAW by gender. CONCLUSION Our findings indicate that, depending on the severity, FI status may be associated with attitudinal acceptance of physical IPVAW, with potential variations based on gender. The public health implications are discussed.
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Affiliation(s)
- Otobo I Ujah
- Department of Obstetrics and Gynaecology, Federal University of Health Sciences Otukpo, Otukpo, Nigeria
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Amaka N Ocheke
- Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau, Nigeria
| | - Biodun N Olagbuji
- Department of Obstetrics and Gynecology, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
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Amoak D, Antabe R, Sano Y. Toward Ending Violence Against Women: The Association of Intimate Partner Violence With Food Security Status Among Ever-Married Women in Cameroon. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241255731. [PMID: 38808963 DOI: 10.1177/08862605241255731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Despite an extensive body of literature that explores potential mechanisms explaining the factors associated with intimate partner violence (IPV) experienced by women, very few studies have studied the association of food security status with women's experience of IPV in sub-Saharan Africa countries, including Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey (n = 4,690), we explore the association between food security status and three distinct forms of IPV (i.e., emotional, sexual, and physical IPV) among ever-married women in Cameroon. Adjusting for socioeconomic, demographic, and attitudinal and behavioral characteristics, we found that women with severe (odds ratio [OR] = 2.09, p < .01), moderate (OR = 1.88, p < .05), and mild (OR = 1.76, p < .05) food insecurity were more likely to experience sexual IPV, compared to those without any food insecurity, whereas women with severe food insecurity were more likely to experience physical IPV (OR = 1.89, p < .001). Although women with severe (OR = 1.51, p < .01) and moderate (OR = 1.67, p < .001) food insecurity had a higher likelihood of experiencing emotional IPV at a bivariate level, we found that these associations became no longer significant in our adjusted model. These findings suggest that food insecurity is a critical risk factor for IPV among ever-married women in Cameroon. Addressing IPV requires a comprehensive strategy that places special emphasis on households experiencing food insecurity. There is also an urgent need to implement educational programs to increase awareness of the interconnection between food insecurity and IPV and to allocate resources to community-based initiatives that empower women both economically and socially.
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Brown LJ, Mannell J, Washington L, Khaula S, Gibbs A. "Something we can all share": Exploring the social significance of food insecurity for young people in KwaZulu-Natal, South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003137. [PMID: 38805479 PMCID: PMC11132456 DOI: 10.1371/journal.pgph.0003137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/28/2024] [Indexed: 05/30/2024]
Abstract
Food insecurity remains a pressing global issue and South Africa continues to face socioeconomic inequalities that make securing food a challenge for many young people. To address this challenge, we need better understanding of the social context of food and its importance in driving perceptions and behaviours about food and its scarcity. In this study, we examine the meaning of food for young people living in urban informal settlements and rural villages in KwaZulu-Natal, and investigate how they exert agency in the face of food insecurity. We use qualitative data from 17 photo/video elicitation interviews conducted from December 2020-January 2021 with young people experiencing food insecurity. The sample consisted of 9 women and 8 men who were part of the Siyaphambili Youth ("Youth Moving Forward") project. Data were analysed using thematic analysis. Themes included the challenges young people face in securing food and money for food. However, in exploring young people's agency, food also plays a critical role in shaping their identities and social networks. Relevant themes included the use of food as a means of bonding with others; solidifying relationships; and as a signifier of social status and gender roles. Despite the challenges of food insecurity, young people demonstrated resilience and agency, utilising social and gendered coping strategies to secure food and to maintain their social networks. Our study contributes to the understanding of food insecurity amongst young people in South Africa and highlights the need for a comprehensive and culturally sensitive approach to addressing this issue. We argue that interventions aimed at addressing food insecurity should prioritise the empowerment of local communities and consider the sociocultural and gendered context of food in their design and implementation.
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Affiliation(s)
- Laura J. Brown
- Institute for Global Health, University College London, London, United Kingdom
| | - Jenevieve Mannell
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | - Andrew Gibbs
- Institute for Global Health, University College London, London, United Kingdom
- Department of Psychology, University of Exeter, Exeter, United Kingdom
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
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Callands TA, Taylor EN, Sileo KM, Gilliam SM, Hansen NB. Understanding the Effects of Trauma Exposure, Life Stress, Intimate Partner Violence, and Depression on Sexually Transmitted Infection Risk in Post-Conflict Liberia. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1519-1530. [PMID: 38167991 DOI: 10.1007/s10508-023-02765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
In sub-Saharan Africa, sexually transmitted infections (STIs) are a public health concern. The impact of STIs are exacerbated in post-conflict low- and middle-income countries, such as Liberia, where exposure to traumatic events is prevalent and access to mental health services are limited. Following a syndemics framework, this study used regression analyses to explore the independent, additive, and multiplicative effects of four psychosocial conditions (exposure to war-related traumatic events, intimate partner violence [IPV], stressful life events, and depressive symptoms) on self-reported STIs. Data were collected from 379 youth aged 18-30 years (n = 170 women; n = 179 men) in Montserrado County, Liberia. Results revealed that psychosocial variables correlated with each other and STI risk. In multivariable analysis, stressful life events, depressive symptoms, and IPV were statistically significant predictors of STI risk. We found support for an additive effect between the number of psychosocial conditions reported and STI risk, as well as a multiplicative effect (interaction) between IPV and depressive symptoms on STI risk. Our results suggest a synergy between experiencing psychosocial conditions and STI risk and point to the potential benefit of multi-level sexual health approaches that simultaneously address mental health and IPV among youth in Liberia.
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Affiliation(s)
- Tamora A Callands
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, 30602, USA.
| | - Erica N Taylor
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | - Katelyn M Sileo
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, 30602, USA
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Waterman EA, McLain M, Zulfiqar H, Ahmar Qadeer T, Ciavoi SM. The Link Between Intimate Partner Violence and Food Insecurity: A Review of Quantitative and Qualitative Studies. TRAUMA, VIOLENCE & ABUSE 2024; 25:1511-1530. [PMID: 37485673 DOI: 10.1177/15248380231186152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Intimate partner violence (IPV) and food insecurity are global health issues that affect millions of people worldwide. Numerous studies show that IPV and food insecurity are linked; however, there is a lack of synthesis of this research. Using a systematic search and review, we examined the international quantitative and qualitative research published on the link between IPV and food insecurity. We searched for peer-reviewed, English-language articles with participants above the age of 16 in 4 large online databases. Fifty-six studies were included from around the world that discussed the link between food insecurity and IPV perpetration and/or victimization. We found evidence in both qualitative and quantitative studies for a meaningful connection between these two global health isues. We also reviewed the literature on moderators and mediators (e.g., mental health). Our findings indicate the importance of implementing IPV prevention strategies which also address household food insecurity, and the potential for food insecurity resources to provide IPV resources. Future research should focus more frequently on IPV perpetration as opposed to victimization, and further examine the moderating and mediating mechanisms that inform the link between IPV and food insecurity.
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De Wet-Billings N, Billings B. Experiences of intimate partner violence (IPV) among females with same-sex partners in South Africa: what is the role of age-disparity? BMC Womens Health 2024; 24:168. [PMID: 38461233 PMCID: PMC10924349 DOI: 10.1186/s12905-024-03005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND South African women have been exposed to epidemic proportions of intimate partner violence (IPV) amongst heterosexual relationships but not much is known about same-sex partnerships. Sexual minorities are excluded from research but are subject to intimate partner violence as much as heteronormative persons. The purpose of this study is to determine the association between age-disparity and IPV outcomes among females with same-sex partners in South Africa. METHODS A cross-sectional study of the nationally representative South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM 2017) is used. A weighted sample of 63,567 female respondents identified as having a same-sex partner are analysed. IPV is measured as ever been physically and/ or sexually abused. Any experience of IPV is included in the dependent variable of this study. Descriptive and inferential statistics are used to estimate the relationship between demographic, socioeconomic, age-disparity and IPV. RESULTS Almost 16% of females in same-sex relationships experienced IPV and about 22% from younger partners. In female same-sex partnerships, partner age-disparity (OR: 1.30, CI: 1.18 - 1.51), type of place of residence (OR: 2.27, CI: 1.79 - 3.79), highest level of education (OR: 1.07, CI: 0.97 - 1.17), marital status (OR: 1.60, CI: 1.37 - 1.88), and race (OR: 1.47, CI: 1.41 - 1.54) are associated with an increased likelihood of violence. CONCLUSION IPV programs that are specifically targeted for non-heteronormative orientations are needed. These programs should promote health equity and safety for non-confirmative sexual identities in the country.
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Affiliation(s)
- Nicole De Wet-Billings
- Demography and Population Studies, Schools of Social Sciences and Public Health, Faculties of Humanities and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Brendon Billings
- Anatomical Sciences, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Zharima C, Singh R, Closson K, Beksinska M, Zulu B, Jesson J, Pakhomova T, Dong E, Dietrich J, Kaida A, Basham CA. Economic hardship and perpetration of intimate partner violence by young men in South Africa during the COVID-19 pandemic (2021-2022): a cross-sectional study. Inj Epidemiol 2024; 11:2. [PMID: 38229136 PMCID: PMC10790426 DOI: 10.1186/s40621-024-00483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Economic hardship is a potential trigger for intimate partner violence (IPV) perpetration. While higher IPV rates have been reported in low-income regions, few African studies have focused on IPV being triggered by economic hardship among young men during the COVID-19 pandemic. We therefore estimated economic hardship's effect on IPV perpetration by young men in eThekwini District, South Africa, during the COVID-19 pandemic. METHODS A cross-sectional survey of COVID-19 pandemic experiences was conducted among youth aged 16-24 years through an anonymous self-administered questionnaire, including questions about economic hardship (increased difficulty accessing food or decreased income) and IPV perpetration. A prespecified statistical analysis plan with a directed acyclic graph of assumed exposure, outcome, and confounder relationships guided our analyses. We measured association of economic hardship and IPV perpetration through odds ratios (ORs) computed from a multivariable logistic regressions adjusted for measured confounders. Secondary outcomes of physical and sexual IPV perpetration were analyzed separately using the same specifications. Propensity score matching weights (PS-MW) were used in sensitivity analyses. Analysis code repository: https://github.com/CAndrewBasham/Economic_Hardship_IPV_perpetration/ RESULTS: Among 592 participants, 12.5% reported perpetrating IPV, 67.6% of whom reported economic hardship, compared with 45.6% of those not reporting IPV perpetration (crude OR = 2.49). Median age was 22 years (interquartile range 20-24). Most (80%) were in a relationship and living together. Three quarters identified as Black, 92.1% were heterosexual, and half had monthly household income < R1600. We estimated an effect of economic hardship on the odds of perpetrating IPV as OR = 1.83 (CI 0.98-3.47) for IPV perpetration overall, OR = 6.99 (CI 1.85-36.59) for sexual IPV perpetration, and OR = 1.34 (CI 0.69-2.63) for physical IPV perpetration. PS-MW-weighted ORs for IPV perpetration by economic hardship were 1.57 (overall), 4.45 (sexual), and 1.26 (physical). CONCLUSION We estimated 83% higher odds of self-reported IPV perpetration by self-reported economic hardship among young South African men during the COVID-19 pandemic. The odds of sexual IPV perpetration were The seven-times higher by economic hardship, although with limited precision. Among young men in South Africa, economic hardship during COVID-19 was associated with IPV perpetration by men. Our findings warrant culturally relevant and youth-oriented interventions among young men to reduce the likelihood of IPV perpetration should they experience economic hardship. Further research into possible causal mechanisms between economic hardship and IPV perpetration could inform public health measures in future pandemic emergencies.
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Affiliation(s)
- Campion Zharima
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rishav Singh
- Vaccine Evaluation Centre, BC Children's Hospital and Research Institute, Vancouver, BC, Canada
| | - Kalysha Closson
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Bongiwe Zulu
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Julie Jesson
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Tatiana Pakhomova
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
| | - Erica Dong
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
| | - Janan Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), A Division of the Wits Health Consortium, Johannesburg, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.
- Women's Health Research Institute, Vancouver, BC, Canada.
| | - C Andrew Basham
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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Shubina O, Mshana G, Sichalwe S, Malibwa D, Mosha N, Hashim R, Nahay F, Ayieko P, Kapiga S, Stöckl H. The association between alcohol consumption and intimate partner violence in young male perpetrators in Mwanza, Tanzania: a cross-sectional study. Glob Health Action 2023; 16:2185967. [PMID: 36927456 PMCID: PMC10026741 DOI: 10.1080/16549716.2023.2185967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Although alcohol consumption is a well-known risk factor for intimate partner violence (IPV) perpetration, few studies have been conducted among young males in low- and middle-income countries. Alcohol consumption and IPV are both complex phenomena, whose association requires more in-depth exploration regarding drinking patterns and the alcohol-related manifestation of five different forms of IPV. OBJECTIVE In this study, we sought to explore the relationship between alcohol use and IPV in young Tanzanian men and to identify differences in the magnitude of past-year IPV perpetration among alcohol drinkers and abstainers. Furthermore, we aimed to assess the association between various drinking patterns with the perpetration of different forms of IPV. METHODS A cross-sectional survey of 1002 young males residing in Mwanza, Tanzania, was conducted in 2021-2022. Data on alcohol consumption were collected using the alcohol use disorder identification test. IPV perpetration was assessed using an index total of 19 items on acts of physical, sexual, economic, emotional abuse, and controlling behaviour. Logistic regression models were conducted to estimate the relationship between alcohol use and the perpetration of each form of IPV. RESULTS Among partnered respondents currently consuming alcohol (n = 189, 18.8%), the most and the least prevalent IPV forms in the past 12 months were controlling behaviour (84.1%) and physical IPV (25.4%), respectively. Those reporting recent alcohol consumption reported higher rates of all forms of past-year IPV perpetration compared to abstainers. While no form of IPV was associated with low-risk consumption versus abstention, all forms of IPV were associated with hazardous drinking. CONCLUSION Young men who drink alcohol, especially those drinking hazardously, are also more likely to report perpetrating IPV. An understanding of the different drinking patterns and manifestations of forms of IPV can contribute to better-tailored alcohol-related interventions and has the potential to improve young adults' health and reduce IPV perpetration.
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Affiliation(s)
- Olena Shubina
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Gerry Mshana
- National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | | | - Neema Mosha
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | - Fauzia Nahay
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
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Oyekunle V, Gibbs A, Tomita A. Assessing the role of depression in reducing intimate partner violence perpetration among young men living in urban informal settlements using a mediation analysis of the Stepping Stones and Creating Futures intervention. Glob Health Action 2023; 16:2188686. [PMID: 36927500 PMCID: PMC10026746 DOI: 10.1080/16549716.2023.2188686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Stepping Stones and Creating Futures (SS/CF) is a gender transformative and economic empowerment intervention that has effectively reduced the perpetration of intimate partner violence (IPV) by young men living in informal settlements in South Africa. OBJECTIVE This study examines whether depression mediated the association between SS/CF intervention and decreased IPV. METHOD Data from a two-arm cluster randomised community-based controlled trial that evaluated the effectiveness of SS/CF in lowering IPV were obtained from 674 young men aged 18-30 within urban informal settlements in South Africa. After being randomly assigned to either the experimental arm (SS/CF) or the control arm, the participants were followed up for 24 months. Logistic regression using mediation analysis was conducted to see whether changes in depressive symptoms mediated the association between the intervention and reduced IPV perpetration. RESULTS Findings from the mediation analysis indicated that those assigned to the SS/CF experimental group reported lower depression (β = -0.42, p < 0.05) at 12 months, and this was subsequently associated with reduced IPV (β = 0.43, p < 0.05) at 24 months. The direct path from SS/CF to IPV was originally (β = -0.46, p < 0.01), but reduced in the mediation model to (β = -0.13, p = 0.50). Depressive symptoms mediated the association between the SS/CF intervention and decreased IPV perpetration. CONCLUSION These findings suggest that one pathway through which SS/CF decreased IPV was through improvement in mental health (i.e. depression). Future IPV prevention interventions may consider incorporating components that focus on improving mental health as a way of also reducing IPV perpetration in disadvantaged settings.
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Affiliation(s)
- Victoria Oyekunle
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Department of Psychology, University of Exeter, Exeter, UK
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Tulem TG, Hordofa MA. Prevalence of food insecurity and associated factors among households in Waliso town, Oromia, Ethiopia. BMC Nutr 2023; 9:139. [PMID: 38012785 PMCID: PMC10683113 DOI: 10.1186/s40795-023-00787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Food insecurity is the underlying cause of malnutrition. In addition, it is a condition where people lack consistent access to enough food for every person in a household to live an active and healthy life. Recently, urban food insecurity has been on the top agenda in Ethiopia, as households prone to food insecurity are rising because of various factors. Hence, we aimed to assess the prevalence of food insecurity and associated factors among households in Waliso town, Oromia, Ethiopia. METHODS A community-based cross-sectional study design was used from December 17, 2021, to January 16, 2022, among 397 randomly selected households in Waliso town. Study participants were selected using a simple random sampling technique. Data collection was performed using a structured questionnaire, and data were entered using Epi Info 7 and exported to SPSS version 20 software for analysis. To identify factors associated with household food insecurity, multivariable binary logistic regression analyses were done. An adjusted odds ratio along with a 95% confidence interval were estimated to measure the strength of the association. In this study, the level of statistical significance was declared at p < 0.05. RESULTS The prevalence of household food insecurity was 63.4%, 95% CI (58.60%, 68.20%). Factors associated with household food insecurity were family sizes 6 + [AOR = 3.06, 95% CI: (1.35, 6.94)], dependents 1-2 [AOR = 2.62, 95% CI: (1.35, 5.10)], dependents 3 + [AOR = 3.07, 95% CI: (1.38, 7.40)], unemployed [AOR = 6.86, 95% CI: (2.76, 17.04)], self-employed [AOR = 3.27, 95% CI: (1.50, 7.14)], wage laborers [AOR = 13.01, 95% CI: (4.93, 34.38)], low wealth index [AOR = 4.08, 95% CI: (2.18, 7.64)], and a medium wealth index [AOR = 2.08, 95% CI: (1.18, 3.69)]. CONCLUSION Nearly two in three households were food insecure in Waliso Town. Large family sizes, a high dependency ratio, unemployment, low wage employment, and a low wealth index were significantly associated with food insecurity. Hence, the implementation of actions to improve household income and livelihoods, minimize dependency rates, by strengthen the use of family planning and encourage urban agriculture is vital to alleviate household food insecurity problems in the town.
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Affiliation(s)
| | - Mulatu Ayana Hordofa
- Department of Public Health, College of Medicine and Health Science, Ambo University, PO.BOX.240, Ambo, Ethiopia.
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14
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Oyekunle V, Tomita A, Gibbs A. Cluster randomized controlled trial of Stepping Stones and Creating Futures to reduce mental health challenges among young men in informal settlements in KwaZulu-Natal Province, South Africa. Int J Soc Psychiatry 2023; 69:1712-1722. [PMID: 37272405 PMCID: PMC10657496 DOI: 10.1177/00207640231174370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Informal settlements are high density areas in and around cities, characterized by a lack of formal planning and basic amenities, being known in South Africa for high levels of mental disorder driven by violence, and complex social and economic challenges. In particular, young men's poor mental health goes untreated, with relatively few evidenced-based interventions available in this setting. AIM This cluster randomized controlled trial investigated the effectiveness of Stepping Stones and Creating Futures (SS/CF), a participatory gender transformative and economic empowerment intervention, on the mental health of young men living in South African informal settlement. METHODS A total of 674 young men ages 18 to 30 years were recruited in 34 clusters in Durban's urban informal settlements. Clusters were randomly allocated (1:1) to either the experimental SS/CF or control arm and participants were followed-up over 24-months. Intention-to-treat analysis based on generalized estimating equations (GEE) were fitted to quantify the impact of SS/CF on the men's anxiety and post-traumatic stress (PTS) symptomatology. RESULTS At end of the 24 months follow-period, anxiety (adjusted odds ratio [aOR]: 0.62, p = .04, 95% CI [0.39, 0.99]) and PTS (aOR = 0.52, p = .03, 95% CI [0.29, 0.93]) were significantly lower for group assigned to the SS/CF compared to the control group. CONCLUSION SS/CF, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges in informal settlements reduced anxiety and PTS among men with mental health challenges living in informal settlements.
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Affiliation(s)
- Victoria Oyekunle
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Psychology, University of Exeter, UK
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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15
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Meyer SR, Mosha NR, Hatcher AM, Hashim R, Ayieko P, Kapiga S, Mshana G, Stöckl H. Food Insecurity and Intimate Partner Violence in Mwanza, Tanzania: A Longitudinal Analysis. Am J Prev Med 2023; 65:932-939. [PMID: 37343708 DOI: 10.1016/j.amepre.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Food insecurity is a potential predictor of intimate partner violence. This study (1) describes the prevalence of food insecurity and various forms of intimate partner violence experience among women in Mwanza, Tanzania; and (2) assesses the effect of food insecurity and hunger on various forms of women's experience of intimate partner violence longitudinally. METHODS Women (aged 18-70 years) who reported being in a relationship in the past 12 months, who had participated in the control arms of two randomized controlled trials conducted as part of the MAISHA study were interviewed at four time points (N=1,004 at baseline in 2017). Analyses were conducted in 2022. Associations between food insecurity exposures and intimate partner violence outcomes were assessed, and univariate random effect logistic models were conducted to identify relevant sociodemographic variables (including age, education level, and SES) that were statistically significant. Multivariable random effects logistic models were conducted, including time as a fixed effect, to calculate odds ratios indicating associations between food insecurity exposures and intimate partner violence outcomes. RESULTS Prevalence of food insecurity was 47.7%, 55.6%, 47.2%, and 50.8% for each of the 4 waves, respectively, with significant difference in proportion of food insecurity between baseline and Wave 2. Multivariable random effects models indicated that food insecurity was associated with increased odds of exposure to all forms of intimate partner violence outcomes, and hunger was significantly associated with increased odds of experience of all intimate partner violence outcomes, apart from controlling behaviors. CONCLUSIONS Results from this longitudinal analysis of food insecurity and women's reports of intimate partner violence experience in a low- and middle-income country setting indicate that food insecurity is significantly associated with all forms of intimate partner violence, apart from controlling behaviors, among women in this sample in Mwanza, Tanzania. Policy and programmatic implications include the need for integrated intimate partner violence prevention programming to take into account household food needs.
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Affiliation(s)
- Sarah R Meyer
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine LMU Munich, München, Germany; Pettenkofer School of Public Health, Munich, Germany
| | - Neema R Mosha
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine LMU Munich, München, Germany; Pettenkofer School of Public Health, Munich, Germany; Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Abigail M Hatcher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania; National Institute for Medical Research, Mwanza, Tanzania
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine LMU Munich, München, Germany; Pettenkofer School of Public Health, Munich, Germany; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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16
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Hartmann M, Giovenco D, Zeebari Z, Itzikowitz G, Ekström AM, Nielsen A, Pettifor A, Bekker LG, Kågesten AE. Associations between psychosocial wellbeing and experience of gender-based violence at community, household, and intimate-partner levels among a cross-sectional cohort of young people living with and without HIV during COVID-19 in Cape Town, South Africa. BMC Public Health 2023; 23:2115. [PMID: 37891509 PMCID: PMC10612288 DOI: 10.1186/s12889-023-16945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Growing evidence indicates that gender-based violence (GBV) increased during COVID-19. We investigated self-reported impact of the pandemic on GBV at community, household and intimate partner (IPV) levels among young people and its associations with psychosocial wellbeing, i.e., COVID-related stressors and mental health. METHODS Cross-sectional data were drawn from a survey with young people ages 13-24 (N = 536) living with HIV (YPLWH) and without HIV (YPLWoH), in peri-urban Cape Town, South Africa. The survey, conducted February-October 2021, examined the impact of the initial lockdown on experience and perceived changes in GBV at each level, and pandemic-related psychosocial wellbeing. Descriptive statistics and binomial and multinomial regression analyses were conducted to illustrate exposure and perceived changes in GBV since lockdown, and their association with COVID-related stress factors (e.g., social isolation, anxiety about COVID), mental health (e.g., depression, anxiety), and other risk factors (e.g., age, gender, socioeconomic status) by HIV status. RESULTS Participants were 70% women with mean age 19 years; 40% were living with HIV. Since lockdown, YPLWoH were significantly more likely than YPLWH to perceive community violence as increasing (45% vs. 28%, p < 0.001), and to report household violence (37% vs. 23%, p = 0.006) and perceive it as increasing (56% vs. 27%, p = 0.002) (ref: decreasing violence). YPLWoH were also more likely to report IPV experience (19% vs. 15%, p = 0.41) and perception of IPV increasing (15% vs. 8%, p = 0.92). In adjusted models, COVID-related stressors and common mental health disorders were only associated with household violence. However, indicators of economic status such as living in informal housing (RRR = 2.07; 95% CI = 1.12-3.83) and food insecurity (Community violence: RRR = 1.79; 95% CI = 1.00-3.20; Household violence: RRR = 1.72; 95% CI = 1.15-2.60) emerged as significant risk factors for exposure to increased GBV particularly among YPLWoH. CONCLUSIONS Findings suggest that for young people in this setting, GBV at community and household levels was more prevalent during COVID-19 compared to IPV, especially for YPLWoH. While we found limited associations between COVID-related stressors and GBV, the perceived increases in GBV since lockdown in a setting where GBV is endemic, and the association of household violence with mental health, is a concern for future pandemic responses and should be longitudinally assessed.
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Affiliation(s)
- Miriam Hartmann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Women's Global Health Imperative, RTI International, Berkely, CA, USA.
| | - Danielle Giovenco
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Zangin Zeebari
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
| | - Gina Itzikowitz
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital, Stockholm, Sweden
| | - Anna Nielsen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Fedina L, Shyrokonis Y, Backes B, Schultz K, Ashwell L, Hafner S, Rosay A. Intimate Partner Violence, Economic Insecurity, and Health Outcomes Among American Indian and Alaska Native Men and Women: Findings From a National Sample. Violence Against Women 2023; 29:2060-2079. [PMID: 36168282 DOI: 10.1177/10778012221127725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Limited data are available on experiences of intimate partner violence (IPV) and sexual violence (SV) and health outcomes among American Indian and Alaska Native (AIAN) populations. This study explores the relationship between IPV and SV, food insecurity, housing insecurity, healthcare access, and self-reported physical and mental health status in a nationally representative sample of AIAN adults (N = 3,634). IPV and SV were associated with poorer physical and mental health at the bivariate level, but not in multivariate analyses. Economic inequalities are a salient predictor of health and may be compounded by demographic and geographic contexts.
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Affiliation(s)
- Lisa Fedina
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Bethany Backes
- Department of Criminal Justice and School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Katie Schultz
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Louise Ashwell
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Steven Hafner
- Center for Human Identification at the University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Andre Rosay
- College of Health, University of Alaska Anchorage, Anchorage, AK, USA
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18
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Oyekunle V, Tomita A, Gibbs A. High levels of poor mental health among young men in urban informal settlements in South Africa: a community-based study of social determinants. PSYCHOL HEALTH MED 2023; 28:2606-2620. [PMID: 35699350 DOI: 10.1080/13548506.2022.2088816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
Informal settlements (high population density areas at the outskirts of urban areas characterized by lack basic amenities) in South Africa are consequences of apartheid regime's discriminatory migrant labour and spatial policy and continue to grow. Living in informal settlements accompanies a mire of social/health challenges that threatens upward mobility, but few studies exist that document drivers of mental health challenges in these settings. We investigated the prevalence and social determinants of poor mental health for young men in informal settlements adjacent to one of the largest cities that is at the heart of HIV endemic in South Africa. This study involved a cross-sectional study with cluster sampling design of 674 young men aged 18-30 years residing in eThekwini informal settlement communities. We assessed the prevalence, and social determinants, of significant depressive (i.e., depression) and post-traumatic stress (i.e., PTS) symptoms using logistic regression. Given the complex survey design of the study, all analyses were adjusted for clustering. The prevalence of depression and PTS in the sample was 46.8% and 14.4% respectively. Results of the multivariable analyses indicated that severe food insecurity (aOR = 2.98, 95% CI:1.70-5.22), crime perpetration (aOR = 1.51, 95% CI:1.05-3.80), severe adverse childhood event (aOR = 2.00, 95% CI: 1.05-3.80), traumatic event exposures (aOR = 2.43, 95% CI:1.56-3.80) and problematic alcohol use (aOR = 1.73, 95% CI:1.20-2.49) were significantly associated with depression. While incomplete secondary education (aOR = 0.45, 95% CI:0.22-0.92), moderate food insecurity (aOR = 2.51, 95% CI:1.04-6.06), traumatic event exposures (aOR = 2.19, 95% CI:1.32-3.64) and problematic alcohol use (aOR = 2.15, 95% CI: 1.24-3.73) were significantly associated with PTS. Our study highlights the exceedingly high levels of poor mental health among young men in informal settlements, with depression and PTS being driven by economic/social conditions. Multilevel interventions that address the individual, interpersonal, and social variables that contribute to poor mental health are needed.
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Affiliation(s)
- Victoria Oyekunle
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-NatalKwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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19
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Forsythe L. Gender-based violence in food systems. NATURE FOOD 2023:10.1038/s43016-023-00777-y. [PMID: 37308694 DOI: 10.1038/s43016-023-00777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/12/2023] [Indexed: 06/14/2023]
Abstract
Gender-based violence (GBV) is an important and pervasive global health and human rights issue whereby prevalence rates have remained unchanged for a decade. However, the relationship between GBV and food systems - the complex networks of people and activities involved in food, from production to consumption - lacks recognition in food systems research and policy. For both moral and practical reasons, GBV needs to be part of food system conversations, research and policy, so that the food sector can respond to global calls for action to address GBV.
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Affiliation(s)
- Lora Forsythe
- Natural Resources Institute, University of Greenwich, Chatham Maritime, UK.
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20
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Leopold SS. Editor's Spotlight/Take 5: Do Patients Reporting Fractures Experience Food Insecurity More Frequently Than the General Population? Clin Orthop Relat Res 2023; 481:846-848. [PMID: 36995335 PMCID: PMC10097534 DOI: 10.1097/corr.0000000000002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Seth S Leopold
- Editor-in-Chief, Clinical Orthopaedics and Related Research ®, Park Ridge, IL, USA
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Shoko Kori D. The psychosocial impact of climate change among smallholder farmers: a potential threat to sustainable development. Front Psychol 2023; 14:1067879. [PMID: 37179880 PMCID: PMC10169624 DOI: 10.3389/fpsyg.2023.1067879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/05/2023] [Indexed: 05/15/2023] Open
Abstract
Psychosocial impacts of climate change and implications on sustainable development remain unclear. This problem was addressed focusing on smallholder farmers in resettlement areas of Chirumanzu District, Zimbabwe. An Exploratory Descriptive Qualitative research design was adopted. Purposive sampling techniques were used to select 54 farmers who served as main respondents from four representative wards. Data were collected through semi-structured interviews and analyzed using a grounded theory approach. Code groups and codes were established through inductive approaches considering narratives of farmers. Forty psychosocial impacts were established. They were qualitative, intangible, indirect and difficult to measure quantitatively. Farmers agonized over the threat of climate change on farming operations, felt humiliated, and embarrassed over detestable practices they resorted to due to climate change. Some farmers experienced heightened negative feelings, thoughts, and emotions. It was established that psychosocial impacts of climate change have a bearing on sustainable development of emerging rural communities.
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Affiliation(s)
- Dumisani Shoko Kori
- Department of Geography, Environmental Management and Energy Studies, Faculty of Science, University of Johannesburg, Johannesburg, South Africa
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22
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Fledderjohann J, Patterson S, Owino M. Food Insecurity: A Barrier to Reproductive Justice Globally. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:296-311. [PMID: 38595861 PMCID: PMC10903663 DOI: 10.1080/19317611.2023.2201841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2024]
Abstract
Objective: Reproductive Justice identifies three core reproductive rights for all people: (1) the right to not have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. We aim to illustrate that food insecurity infringes upon on all three of these rights and so is a pressing issue for reproductive justice and for sexual and reproductive health more broadly. Methods: Using a phenomenological approach, we outline potential pathways between food insecurity and reproductive justice. Results: There are numerous potential pathways between food insecurity and reproductive justice, including entry into sexual relationships for material support, links to sexually transmitted infections and infertility, structural violence, prioritization and spending tradeoffs between food and other basic necessities, biological impacts of malnutrition, restricted reproductive choices, population control measures, and social stigma and exclusion. Marginalized people are disproportionately impacted by food insecurity and its consequences, with implications for sexual health and pleasure and for reproductive justice. Conclusions:Meaningful and equitable collaboration between people with lived experience of food insecurity, human rights and reproductive justice activists, and academics is critical to sensitively contextualize this work and mobilize broader social change.
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Affiliation(s)
| | - Sophie Patterson
- Faculty of Health and Medicine, Lancaster University, Bailrigg Campus, Lancaster, UK
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maureen Owino
- Faculty of Environmental Studies and Urban Health, York University, Toronto, Canada
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23
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Jewkes R, Chirwa E, Alangea DO, Addo-Lartey A, Christofides N, Dunkle K, Ramsoomar L, Gibbs A. Pooled analysis of the association between food insecurity and violence against women: Evidence from low- and middle-income settings. J Glob Health 2023; 13:04021. [PMID: 36896806 PMCID: PMC9999307 DOI: 10.7189/jogh.13.04021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Background Intimate partner violence impacts relationships across the socioeconomic spectrum, nonetheless its prevalence is reported to be highest in areas that are most socio-economically deprived. Poverty has direct and indirect impacts on intimate partner violence (IPV) risk, however, one of the postulated pathways is through food insecurity. The aim of this paper is to describe the association between food insecurity (household hunger) and women's experiences, and men's perpetration, of intimate partner violence and non-partner sexual violence in data from Africa and Asia. Methods We conducted a pooled analysis of data from baseline interviews with men and women participating in six Violence Against Women prevention intervention evaluations and present a meta-analysis using mixed-effects Poisson regression models. Data were from South Africa (two studies), Ghana, Rwanda (two data sets), and Afghanistan and comprised interviews with 6545 adult women and 8104 adult men. We assessed food insecurity with the Household Hunger Scale. Results Overall, 27.9% of women experienced moderate food insecurity (range from 11.1% to 44.4%), while 28.8% of women reported severe food insecurity (range from 7.1 to 54.7%). Overall food insecurity was associated with an increased likelihood of women experiencing physical intimate partner violence, adjusted incidence rate ratio (aIRR) = 1.40 (95% CI = 1.23 to 1.60) for moderate food insecurity and aIRR = 1.73 (95% CI = 1.41 to 2.12) for severe food insecurity. It was also associated with an increased likelihood of men reporting perpetration of physical IPV, with aIRR = 1.24 (95% CI = 1.11 to 1.39) for moderate food insecurity and aIRR = 1.18 (95% CI = 1.02 to 1.37) for severe food insecurity. Food insecurity was not significantly associated with women's experience of non-partner sexual violence, aIRR = 1.27 (95% CI = 0.93 to 1.74) for moderate or severe food insecurity vs none, nor men's perpetration of non-partner sexual violence aIRR = 1.02 (95% CI = 0.90 to 1.15). Conclusions Food insecurity is associated with increased physical intimate partner violence perpetration and experience reported by men and women. It was not associated with non-partner sexual violence perpetration, although there was some evidence to suggest an elevated risk of non-partner sexual violence among food-insecure women. Prevention programming needs to embrace food insecurity as a driver of intimate partner violence perpetration, however, non-partner sexual violence prevention needs to be shaped around a separate understanding of its drivers.
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Affiliation(s)
- Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | | | | | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health and Health Systems, University of the Pretoria, Pretoria, Gauteng, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Psychology, University of Exeter, Exeter, Devon, UK
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Wand H, Vujovich-Dunn C, Derrick K, Moodley J, Reddy T, Naidoo S. Geospatial variations in socioeconomic conditions and health outcomes in COVID-19 era: insights from South Africa (2020-2022). GEOJOURNAL 2023; 88:1-17. [PMID: 38625344 PMCID: PMC9988606 DOI: 10.1007/s10708-023-10851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/17/2024]
Abstract
South Africa also has the highest burden of coronavirus disease 2019 (COVID-19) related comorbidities in Africa. We aimed to quantify the temporal and geospatial changes in unemployment, food insecurity, and their combined impact on depressive symptoms among South Africans who participated into several rounds of national surveys. We estimated the population-attributable risk percent (P A R % ) for the combinations of the risk factors after accounting for their correlation structure in multifactorial setting. Our study provided compelling evidence for immediate and severe effect of the pandemic where 60% of South Africans reported household food insecurity or household hunger, shortly after the pandemic emerged in 2020. Despite the grants provided by the government, these factors were also identified as the most influential risk factors (adjusted odds ratios (aORs) ranged from 2.06 to 3.10, p < 0.001) for depressive symptoms and collectively associated with 62% and 53% of the mental health symptoms in men and women, respectively. Similar pattern was observed among pregnant women and 41% of the depressive symptoms were exclusively associated with those who reported household hunger. However, aORs associated with the concerns around pandemic and vaccine were mostly not significant and ranged from 1.12 to 1.26 which resulted substantially lower impacts on depressive symptoms (PAR%:7%-and-14%). Our findings suggest that South Africa still has unacceptably high rates of hunger which is accelerated during the pandemic. These results may have significant clinical and epidemiological implications and may also bring partial explanation for the low vaccine coverage in the country, as priorities and concerns are skewed towards economic concerns and food insecurity.
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Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Kate Derrick
- Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
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A Descriptive Systematic Review of Food Insecurity and Intimate Partner Violence in Southern Africa. WOMEN 2022. [DOI: 10.3390/women2040036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Food insecurity and intimate partner violence are important determinants of health and wellbeing in southern Africa. However, very little research has attempted to investigate the association between them even though food insecurity is anticipated to increase in the region, mostly owing to climate change. The objective of this paper was to descriptively review peer reviewed studies that investigated the relationship between food insecurity and intimate partner violence in southern Africa. Literature searches were carried out in Scopus, Web of Science and PubMed databases without any time restriction. A total of five studies that investigated the association between food insecurity and intimate partner violence were identified in South Africa and Swaziland. Of these four studies used a cross-sectional design, and one employed a longitudinal design. Samples varied from 406 to 2479 individuals. No empirical studies were found for the remaining southern African countries of Angola, Botswana, Malawi, Namibia, Zambia, Zimbabwe, Lesotho, and Mozambique. Moreover, the reported findings indicated that there was an association between food insecurity and interpersonal violence (i.e., physical, psychological, and emotional) in the sub-region regardless the fact that the five studies used diverse measurements of both food insecurity and intimate partner violence.
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Multiple aspects of energy poverty are associated with lower mental health-related quality of life: A modelling study in three peri-urban African communities. SSM - MENTAL HEALTH 2022; 2:100103. [PMID: 36688234 PMCID: PMC9792378 DOI: 10.1016/j.ssmmh.2022.100103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 02/01/2023] Open
Abstract
Objective Over 900 million people in sub-Saharan Africa (SSA) live in energy poverty, relying on cooking polluting fuels (e.g. wood, charcoal). The association between energy poverty and mental/physical health-related quality of life (HRQoL) among women in SSA, who are primarily tasked with cooking, is unknown. Methods Females (n = 1,150) from peri-urban Cameroon, Kenya and Ghana were surveyed on their household energy use and mental/physical health status using the standardized Short-Form 36 (SF-36) questionnaire. Random effects linear regression linked household energy factors to SF-36 mental (MCS) and physical component summary (PCS) scores. A binary outcome of 'likely depression' was derived based on participants' MCS score. Random effects Poisson regression with robust error variance assessed the relationship between household energy factors and odds of likely depression. Results The prevalence of likely depression varied by a factor of four among communities (36%-Mbalmayo, Cameroon; 20%-Eldoret, Kenya; 9%-Obuasi, Ghana). In the Poisson model (coefficient of determination (R2) = 0.28), females sustaining 2 or more cooking-related burns during the previous year had 2.7 (95%CI:[1.8,4.1]) times the odds of likely depression as those not burned. Females cooking primarily with charcoal and wood had 1.6 times (95%CI:[0.9,2.7]) and 1.5 times (95%CI:[0.8,3.0]) the odds of likely depression, respectively, as those primarily using liquefied petroleum gas. Women without electricity access had 1.4 (95%CI:[1.1,1.9]) times the odds of likely depression as those with access. In the MCS model (R2 = 0.23), longer time spent cooking was associated with a lower average MCS score in a monotonically increasing manner. In the PCS model (R2 = 0.32), women injured during cooking fuel collection had significantly lower (-4.8 95%CI:[-8.1,-1.4]) PCS scores. Conclusion The burden of energy poverty in peri-urban communities in SSA extends beyond physical conditions. Experiencing cooking-related burns, using polluting fuels for cooking or lighting and spending more time cooking are potential risk factors for lower mental HRQoL among women.
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Bloom BE, Wagman JA, Dunkle K, Fielding-Miller R. Exploring intimate partner violence among pregnant Eswatini women seeking antenatal care: How agency and food security impact violence-related outcomes. Glob Public Health 2022; 17:3465-3475. [PMID: 33242387 PMCID: PMC10484090 DOI: 10.1080/17441692.2020.1849347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
Women with agency (i.e. the ability to make choices and act on them) may experience reduced food insecurity (FI) and intimate partner violence (IPV). Reducing FI and IPV among women are global goals; however, research focused on agency among Eswatini women has been overlooked, though they experience high rates of FI and IPV. We analysed cross-sectional data from 406 Swazi women who sought care at one rural and one urban-public antenatal clinic in 2013-2014 to understand how FI and agency, our independent variables, are associated with IPV. We assessed the incidence rate ratio (IRR) of number of violent events (including emotional, physical and sexual IPV) in the previous 12 months using Poisson regressions. We found significant relationships between FI and IPV, where higher levels of FI were associated with IPV risk (weekly: IRR = 2.18, 95% CI = 1.82-2.61; Daily: IRR = 3.53, 95% CI = 2.89-4.32) and constrained agency increased women's risk of IPV (IRR = 1.44; 95% CI = 1.22-1.70). Our findings suggest that FI and agency independently impact women's experience(s) of IPV. Interventions focused on women simultaneously experiencing severe FI and constrained agency may have the highest impact; however, providing focused and moderate FI relief (e.g. reducing FI daily to monthly) could potentially reduce women's risk of experiencing violence.
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Affiliation(s)
- Brittnie E. Bloom
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
- Department of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego, CA, USA
| | - Jennifer A. Wagman
- Fielding School of Public Health, Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
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Reyes HLM, Maman S, Kajula L, Mulawa M. Intimate partner violence perpetration and sexual risk behaviour: Identifying shared determinants among young men in Tanzania. Glob Public Health 2022; 17:2792-2806. [PMID: 35129086 PMCID: PMC9356116 DOI: 10.1080/17441692.2022.2032257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
In this study we examined factors that predict involvement in different patterns of sexual risk behavior and IPV perpetration among young men in Tanzania (n = 979), with a focus on identifying factors that distinguish men who engage in both behaviours from those who do not. Risk factors were drawn from three domains thought to be upstream drivers of both IPV and sexual risk: poverty, adverse childhood experiences, and inequitable gender norms. A three-step latent class analysis was used to assess whether and how factors from each domain distinguished subgroups of men whose behaviour patterns were characterised as comorbid (involvement in IPV and sexual risk behaviour), IPV-only, sexual risk only, and normative (low risk). Consistent with expectations, greater food insecurity, adverse childhood experiences, and inequitable gender norms related to violence and sexual behaviour predicted increased risk of membership in the comorbid group compared to other sub-groups. Findings support the promise of integrated prevention programmes targeting the common causes of IPV perpetration and sexual risk behaviour.
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Affiliation(s)
- H. Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440
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Hatcher AM, Page S, Aletta van Eck L, Pearson I, Fielding-Miller R, Mazars C, Stöckl H. Systematic review of food insecurity and violence against women and girls: Mixed methods findings from low- and middle-income settings. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000479. [PMID: 36962559 PMCID: PMC10021293 DOI: 10.1371/journal.pgph.0000479] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022]
Abstract
Violence against women and girls (VAWG) is a global human rights and public health concern. Food insecurity is a sign of severe poverty, and likely to heighten women's vulnerability to VAWG and men's perpetration of it. However, the extent of the association and the multiple pathways between food insecurity and VAWG are not well understood. We systematically assessed peer reviewed quantitative and qualitative literature to explore this in low- and middle-income countries. Fixed effects meta-analysis was used to synthesize quantitative evidence. Qualitative data was analyzed using thematic analysis. From a search of 732 titles, we identified 23 quantitative and 19 qualitative or mixed-methods peer-reviewed manuscripts. In a meta-analysis of 21 cross-sectional studies with 20,378 participants, food insecurity was associated with doubled odds of reported VAWG (odds ratio [OR] = 2.38, 95% confidence interval [CI] = 1.82-3.10). This finding was consistent for both women's experience or male perpetration of VAWG. Qualitative and mixed-methods papers offered insight that underlying conditions of inequitable gender norms, economic deprivation, and social isolation frame both food insecurity and VAWG. Food insecurity may trigger survival behaviors due to household stress and lack of meeting expected gender roles, which leads to VAWG. VAWG exposure may lead to food insecurity if women are more impoverished after leaving a violent household. Potential protective factors include financial stability, the involvement of men in VAWG programming, transformation of gender norms, and supporting women to develop new networks and social ties. Strong evidence exists for a relationship between food security and VAWG. Future funding should target causal directions and preventive options through longitudinal and interventional research. Strategies to ensure households have access to sufficient food and safe relationships are urgently needed to prevent VAWG.
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Affiliation(s)
- Abigail M. Hatcher
- Galling’s School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, United States of America
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sabrina Page
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lele Aletta van Eck
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isabelle Pearson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, California, United States of America
| | | | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mahlangu P, Gibbs A, Shai N, Machisa M, Nunze N, Sikweyiya Y. Impact of COVID-19 lockdown and link to women and children's experiences of violence in the home in South Africa. BMC Public Health 2022; 22:1029. [PMID: 35597933 PMCID: PMC9123923 DOI: 10.1186/s12889-022-13422-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence on the impact of COVID-19 and lockdown remains at an early stage. There is limited research about the impact of hard lockdown restrictions on families, specifically how these restrictions impact on women and children's experiences of domestic violence, including intimate partner violence (IPV) and child abuse in South Africa. We conducted research among men and women in Gauteng province, South Africa to understand their experiences of the COVID-19 national lockdown and its impact and link to women and children's experiences of domestic violence. METHODS We conducted a qualitative study, using social media to recruit men and women who were 18 years and older, living with a spouse and/or children in Gauteng province, South Africa during the lockdown. To collect the data, we conducted telephone interviews, and analyzed data using the thematic approach. RESULTS The lockdown had unprecedented negative economic impacts on families, and exacerbated some of the risk factors for violence against women and children in the home in South Africa. Some women reported experiences of emotional violence. Experiences of physical violence were mostly amongst children. The risk factors for women and children's experiences of violence in the home differed by socio-economic class. Job losses and reduction in earnings resulted to food insecurity which was a key driver of violence in most low socio-economic status (SES) families. Confinement in the home with spouses was an unfamiliar and difficult experience, associated with conflict and perpetration of violence by men in high SES families. Participants across socio-economic groups reported high levels of stress with limited psychosocial support available during the lockdown. CONCLUSIONS Our finding showing a link between low-socio-economic status and increased risk for domestic violence during the lockdown in South Africa suggests the need for socio-economic interventions to mitigate these risks. Structural and social relief measures need to be strengthened to reduce the loss of jobs and income and to address food insecurity during pandemics. Psychosocial support should be provided to men and women to mitigate the mental health impacts of the pandemics and lockdown.
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Affiliation(s)
- P Mahlangu
- Gender & Health Research Unit, South African Medical Research Council, Private Bag X385, 0001, Pretoria, South Africa.
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - A Gibbs
- Gender & Health Research Unit, South African Medical Research Council, Private Bag X385, 0001, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - N Shai
- Gender & Health Research Unit, South African Medical Research Council, Private Bag X385, 0001, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - M Machisa
- Gender & Health Research Unit, South African Medical Research Council, Private Bag X385, 0001, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - N Nunze
- Gender & Health Research Unit, South African Medical Research Council, Private Bag X385, 0001, Pretoria, South Africa
| | - Y Sikweyiya
- Gender & Health Research Unit, South African Medical Research Council, Private Bag X385, 0001, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Shepherd DL. Food insecurity, depressive symptoms, and the salience of gendered family roles during the COVID-19 pandemic in South Africa. Soc Sci Med 2022; 301:114830. [PMID: 35367907 PMCID: PMC8882481 DOI: 10.1016/j.socscimed.2022.114830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/22/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Abstract
Extensive research has indicated food insecurity to be associated with depressive symptoms, both of which have been indicated to increase globally during the COVID-19 pandemic. Few studies, however, have made use of nationally representative and longitudinal data to investigate this relationship, making causal claims difficult. In South Africa (SA), as with other low- and middle-income contexts, population-based studies have generally focused on mothers during the perinatal period and other vulnerable groups. This study made use of Cross-Lagged Dynamic Panel Models to examine the relationship between household food insecurity and the depressive symptoms of adults across three waves of the National Income Dynamics Survey–Coronavirus Rapid Mobile Survey (NIDS-CRAM) study collected in 2020 and 2021, a dataset nationally representative of all adults in SA in 2017. Stratification of the sample by gender, parenthood and marital statuses allowed for the assessment of gender differences in family roles that might account for differential impacts of food insecurity on mental health outcomes. The findings of this study indicated a significant impact of food insecurity on the depressive symptoms of adults. Controlling for stable trait-like individual differences eliminated much of this relationship, indicating partial or full mediation by unobserved factors. Gender differences in food security's association with depressive symptoms amongst cohabitating parents following the inclusion of individual effects provided support for a gendered role response. These findings provide further evidence of the complex interactions between sex, gender and health.
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Affiliation(s)
- Debra L Shepherd
- Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
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Sexual relationship power equity is associated with consistent condom use and fewer experiences of recent violence among women living with HIV in Canada. J Acquir Immune Defic Syndr 2022; 90:482-493. [PMID: 35499522 DOI: 10.1097/qai.0000000000003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sexual relationship power (SRP) inequities, including having a controlling partner, have not been widely examined among women living with HIV (WLWH). We measured prevalence, and key outcomes of relationship control among WLWH in Canada. METHODS Baseline data from WLWH (≥16 years), reporting consensual sex in the last month enrolled in a Canadian community-collaborative cohort study in British Columbia, Ontario, and Quebec, included Pulerwitz's (2000) SRP relationship control sub-scale. Scale scores were dichotomized into medium/low [score=1-2.82] vs. high relationship control [score=2.82-4], high scores=greater SRP equity. Cronbach's alpha assessed scale reliability. Bivariate analyses compared women with high vs. medium/low relationship control. Crude and adjusted multinomial regression examined associations between relationship control and condom use (consistent [ref], inconsistent, never), any sexual, physical and/or emotional violence, and physical and/or sexual violence (never [ref], recent [≤3 months ago], and previous [>3 months ago]). RESULTS Overall, 473 sexually active WLWH (33% of cohort), median age=39 (IQR=33-46), 81% on antiretroviral therapy and 78% with viral loads <50copies/mL were included. The sub-scale demonstrated good reliability (Cronbach's alpha=0.92). WLWH with high relationship control (80%) were more likely (p<0.05) to: be in a relationship; have no children; have greater resilience; and report less socio-structural inequities. In adjusted models, high relationship control was associated with lower odds of: inconsistent vs. consistent condom use (aOR:0.39[95%CI:0.18-0.85]); any recent (aOR:0.14[0.04-0.47]); as well as recent physical and/or sexual (aOR=0.05[0.02,0.17]) but not previous violence (vs. never). DISCUSSION Prioritizing relationship equity and support for WLWH is critical for addressing violence and promoting positive health outcomes.
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Militao EMA, Salvador EM, Uthman OA, Vinberg S, Macassa G. Food Insecurity and Health Outcomes Other than Malnutrition in Southern Africa: A Descriptive Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5082. [PMID: 35564477 PMCID: PMC9100282 DOI: 10.3390/ijerph19095082] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
Food insecurity (FI) is one of the major causes of malnutrition and is associated with a range of negative health outcomes in low and middle-income countries. The burden of FI in southern Africa is unknown, although FI continues to be a major public health problem across sub-Saharan Africa as a whole. Therefore, this review sought to identify empirical studies that related FI to health outcomes among adults in southern Africa. Altogether, 14 publications using diverse measures of FI were reviewed. The majority of the studies measured FI using modified versions of the United States Department of Agriculture Household Food Security Survey Module. A wide range in prevalence and severity of FI was reported (18-91%), depending on the measurement tool and population under investigation. Furthermore, FI was mostly associated with hypertension, diabetes, anxiety, depression and increased risk of human immunodeficiency virus (HIV) acquisition. Based on the findings, future research is needed, especially in countries with as yet no empirical studies on the subject, to identify and standardize measures of FI suitable for the southern African context and to inform public health policies and appropriate interventions aiming to alleviate FI and potentially improve health outcomes in the region.
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Affiliation(s)
- Elias M. A. Militao
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden; (S.V.); (G.M.)
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 801 76 Gävle, Sweden
- Department of Biological Sciences, Faculty of Science, Eduardo Mondlane University, 3453 Julius Nyerere Avenue, Maputo 257, Mozambique;
| | - Elsa M. Salvador
- Department of Biological Sciences, Faculty of Science, Eduardo Mondlane University, 3453 Julius Nyerere Avenue, Maputo 257, Mozambique;
| | - Olalekan A. Uthman
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Stig Vinberg
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden; (S.V.); (G.M.)
| | - Gloria Macassa
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden; (S.V.); (G.M.)
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 801 76 Gävle, Sweden
- EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
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Sikweyiya Y, Stern E, Hanass-Hancock J, van der Heijden I, Myrttinen H, Addo-Lartey AA, Dunkle K. Intersections between disability, masculinities, and violence: experiences and insights from men with physical disabilities from three African countries. BMC Public Health 2022; 22:705. [PMID: 35399064 PMCID: PMC8994917 DOI: 10.1186/s12889-022-13137-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Gender-transformative work in the Global South often focuses on transforming ‘toxic masculinities’ to prevent intimate partner violence (IPV), but there has been little research on whether and how constructions of masculinities by men with disabilities shape their experiences and perpetration of violence. Methods We used repeated in-depth interviews and content analysis to understand whether and how physical disability intersects with the construction of masculinities and experience/perpetration of violence among 15 adult men with physical disabilities participating in interventions to prevent IPV in Ghana, Rwanda, and South Africa. Results Societal expectations and participants’ aspirations around masculinity impacted their vulnerability to violence mainly by men without disabilities. Participants reported experiences of disrespect and social exclusion in their communities and felt incapable of protecting themselves when being violated. Most participants felt they were not providing for their families and perceived themselves as having lost decision-making and positions of power in their homes. They expressed their disappointment with having reduced stamina, virility, and sexual prowess in intimate partnerships as a result of their disability. While participants reported that they could not attain key markers of idealized masculinity, placed upon and often internalized by themselves, they longed to achieve these markers to facilitate their inclusion and acceptance in their communities. Conclusions Programmers addressing violence need to engage with men with physical disabilities and consider the intersectionality of masculinities and disability, how these reinforce patriarchal norms and how men with disabilities can be included and enabled to overcome their conflict between disability and masculinities.
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Getinet W, Azale T, Getie E, Salelaw E, Amare T, Demilew D, Lemma A, Kibret D, Aklilu A, Tensae T, Srahbzu M, Shumet S. Intimate partner violence among reproductive-age women in central Gondar zone, Northwest, Ethiopia: a population-based study. BMC Womens Health 2022; 22:109. [PMID: 35397559 PMCID: PMC8994176 DOI: 10.1186/s12905-022-01685-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Violence against women is the most widespread kind of human rights violation, and it has been linked to a wide range of consequences. The most prominent psychosocial and mental health concern that has serious effects for women's physical and mental well-being. This study assessed the prevalence and associated factors of women's violence by intimate partner among women in the reproductive age group (15-49). METHODS Multistage community-based cross-sectional study was conducted among reproductive age group women in the central Gondar zone. We recruited 845 participants and interviewed by health extension workers using face-to-face interviews. We used a Women's Abuse Screening test to outcome variable; it has a total score ranges 0-16, a score > 1 indicates positive for the presence of intimate partner violence within a year. Variables were coded and entered to Epi data version 3.1 and exported to SPSS version 21 for analysis. Descriptive statistics and multivariate logistic regression analysis was run for data analysis. Adjusted odds ratios (AOR) with a 95% confidence level (CI) were declared significant. RESULT Among a total of 845 participants 804 responded to the interviews with a response rate of 95%. The prevalence rate of intimate partner violence is 391(48.6%). From multivariate logistic regression analysis women being married [AOR:3.85; 95% CI (2.38, 6.22)], high school and above educational status [(AOR: 0.43; 95% CI (0.30, 0.61), women's having > 3children [(AOR: 1.82, 95% CI (1.0, 3.1)], having a household food insecurity[(AOR: 2.09, 95% CI (1.51, 2.91)], having life threatening events [(AOR: 2.09; 95% CI (1.51, 2.91)], moderate social support [(AOR: 0.60; 95% CI (0.41, 0.83)], depression [(AOR: 3.12; 95% CI (1.60, 6.07) were significantly associated with violence by intimate partner at 95% CI . CONCLUSION Intimate partner violence is common among reproductive-age women. Married, women with several children, food insecurity, life-threatening events, and depression were all found to be significant predictors of violence. Measures should be taken to raise community awareness, particularly among intimate partners, their families, and government officials.
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Affiliation(s)
- Wondale Getinet
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Telake Azale
- Institute of Public Health College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eskedar Getie
- Institute of Public Health College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Endalamaw Salelaw
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Demeke Demilew
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Alemu Lemma
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Destaw Kibret
- Central Gondar Zonal Health Office, Gondar, Ethiopia
| | - Abayneh Aklilu
- School of Midwifery College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Techalo Tensae
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mengesha Srahbzu
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Conroy AA, Jain JP, Sheira L, Frongillo EA, Neilands TB, Cohen MH, Wilson TE, Chandran A, Adimora AA, Kassaye S, Sheth AN, Fischl MA, Adedimeji A, Turan JM, Tien PC, Weiser SD. Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women. J Acquir Immune Defic Syndr 2022; 89:151-158. [PMID: 34723926 PMCID: PMC8752473 DOI: 10.1097/qai.0000000000002848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gender-based violence (GBV) is associated with poorer engagement in HIV care and treatment. However, there is a dearth of research on the psychological (eg, mental health) and structural (eg, food insecurity) factors that mediate and moderate this association. GBV could lead to poor mental health, which in turn affects adherence, whereas food insecurity could worsen the effect of GBV on engagement in care. This study uses data from the Women's Interagency HIV Study to address these gaps. METHODS Women completed 6 assessments from 2013 to 2016 on GBV, mental health, food insecurity, adherence to antiretroviral therapy, and missed HIV care appointments in the past 6 months. Multilevel logistic regression models estimated associations between GBV and engagement in care and whether associations were mediated by depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) and moderated by food insecurity. RESULTS GBV was associated with higher odds of suboptimal adherence (adjusted odds ratio: 1.88; 95% confidence interval: 1.24 to 2.87) and missed appointments (adjusted odds ratio: 1.76; 95% confidence interval: 1.16 to 2.67). The association between GBV and adherence was mediated by depressive symptoms, GAD, and PTSD, accounting for 29.7%, 15.0%, and 16.5%, respectively, of the total association. The association between GBV and missed appointments was mediated by depression and GAD, but not PTSD, with corresponding figures of 25.2% and 19.7%. Associations did not differ by food insecurity. CONCLUSIONS GBV is associated with suboptimal engagement in care, which may be explained by mental health. Interventions should address women's mental health needs, regardless of food insecurity, when improving engagement in HIV care.
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Affiliation(s)
- Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA
| | - Jennifer P Jain
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Lila Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA
| | | | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY
| | - Aruna Chandran
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Seble Kassaye
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Anandi N Sheth
- School of Medicine, Emory University, Grady Health System, Atlanta, GA
| | | | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL; and
| | - Phyllis C Tien
- Department of Medicine, Department of Veteran Affairs Medical Center, UCSF and Medical Service, San Francisco, CA
| | - Sheri D Weiser
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA
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Stern E, Batista M, Shannon G, Heise L, Mannell J. A case study comparison of engaging community activists to prevent gender-based violence in Peru and Rwanda. Glob Public Health 2021; 17:2300-2315. [PMID: 34932917 DOI: 10.1080/17441692.2021.2018010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Community mobilisation is recognised as an important strategy to shift inequitable gender norms and ensure an enabling environment to prevent gender-based violence (GBV). Yet there is a need to better understand the factors that facilitate effective community activism in particular contexts. Although fundamental to the success of mobilisation programmes, there is also limited appreciation of the experiences and agency of engaged community activists. This paper draws on qualitative evaluations from two community mobilisation GBV prevention programmes: the Gender Violence in the Amazon of Peru (GAP) Project and the Indashyikirwa programme in Rwanda. In Peru, participatory data was collected, in addition to baseline and endline interviews with 8 activists. In Rwanda, baseline and endline interviews and observations were conducted with 12 activists, and interviews were conducted with 8 staff members. The data was thematically analysed, and a comparative case study approach was applied to both data sets. The comparative study identified similar programmatic aspects that could hinder or enable activist's engagement and development, and how these are embedded within contextual social and structural factors. We discuss these insights in reference to the current emphasis in public health on individualistic programming, with insufficient attention to how wider environments influence violence prevention programming.
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Affiliation(s)
- Erin Stern
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Murylo Batista
- London School of Hygiene and Tropical Medicine, London, UK
| | - Geordan Shannon
- Institute for Global Health, University of College London, London, UK
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Jenevieve Mannell
- Institute for Global Health, University of College London, London, UK
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Meinck F, Orkin M, Cluver L. Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis. BMC Med 2021; 19:263. [PMID: 34758838 PMCID: PMC8580740 DOI: 10.1186/s12916-021-02137-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets ("accelerators") within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. METHODS Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. RESULTS Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. CONCLUSION Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.
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Affiliation(s)
- Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD UK
- OPTENTIA, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Orkin
- MRC-Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Visser J, Wangu J. Women's dual centrality in food security solutions: The need for a stronger gender lens in food systems' transformation. CURRENT RESEARCH IN ENVIRONMENTAL SUSTAINABILITY 2021; 3:100094. [PMID: 36570859 PMCID: PMC9767400 DOI: 10.1016/j.crsust.2021.100094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 06/17/2023]
Abstract
Food insecurity remains a critical issue worldwide. The current COVID-19 crisis has exposed how vulnerable the global food systems are and that urgent measures need to be taken, especially in the Global South. Despite increased recognition that women are among the most food insecure yet major contributors to local and global food security over the recent years, there has not been a systemic change needed in the current food security paradigm. This paper argues that, in developing countries, a stronger gender lens ought to be at the center to the food systems' debate as women are critical to agriculture and food systems' sustainability and resilience. Women are central to food systems, both as primary food producers and as primary caretakers of the household. Three key recommendations are put forward in this article for establishing inclusive, sustainable and resilient food systems: One, ensuring a stronger gender lens in food systems and food security paradigms; by working with accurate sex-disaggregated data and beyond on individuals' level. Two, promoting and supporting alternative strategies to agriculture as a means of livelihood for women. Three, ensuring that women are central in food security solutions by not only listening to their concerns and needs, but also building on their resilience, knowledge, and practices.
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Affiliation(s)
| | - James Wangu
- Utrecht University, Department of Human Geography & Spatial Planning, Vening Meineszgebouw A Princetonlaan, 3584 CB Utrecht, the Netherlands
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40
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Logie CH, Toccalino D, Reed AC, Malama K, Newman PA, Weiser S, Harris O, Berry I, Adedimeji A. Exploring linkages between climate change and sexual health: a scoping review protocol. BMJ Open 2021; 11:e054720. [PMID: 34663670 PMCID: PMC8524293 DOI: 10.1136/bmjopen-2021-054720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health. METHODS AND ANALYSIS Five electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the inception of each database to May 2021. Grey literature and unpublished reports will be searched using a comprehensive search strategy, including from the WHO, World Bank eLibrary, and the Centers for Disease Control and Prevention. The scoping review will consider studies that explore: (a) climate change and EWEs including droughts, heat waves, wildfires, dust storms, hurricanes, flooding rains, coastal flooding and storm surges; alongside (b) sexual health, including: comprehensive sexual health education, sexual health counselling, and HIV/STI acquisition, prevention and/or care, and/or SGBV, including intimate partner violence, sexual assault and rape. Searches will not be limited by language, publication year or geographical location. We will consider quantitative, qualitative, mixed-methods and review articles for inclusion. We will conduct thematic analysis of findings. Data will be presented in narrative and tabular forms. ETHICS AND DISSEMINATION There are no formal ethics requirements as we are not collecting primary data. Results will be published in a peer-reviewed journal and shared at international conferences.
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Affiliation(s)
- Carmen H Logie
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Toccalino
- Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Anna Cooper Reed
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Sheri Weiser
- Department of Medicine, University of California, San Francisco, California, USA
| | - Orlando Harris
- Department of Community Health Systems, University of California, San Francisco, California, USA
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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Tarantino N, Matthews C, Sun S, Orchowski L, Harrison A, Abrahams N, Berkowitz A, Akande M, Kuo C. Unique and Shared Correlates of Sexual Violence Perpetration and Sexual Risk Behavior Among South African Adolescent Boys. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:424-438. [PMID: 34596432 PMCID: PMC9161560 DOI: 10.1521/aeap.2021.33.5.424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Associations between sexual risk behavior (SRB) and sexual violence perpetration (SVP) contribute to the intersecting HIV and sexual violence epidemics in South Africa. We examined SVP and SRB, and their potential correlates among South African boys (N = 80; ages 15-17). Fifty-one percent endorsed SVP in the past year; 61% engaged in past-3-month SRB. Whereas most unique correlates were socio-structural, family, or community factors, correlates shared across behaviors were behavior-specific social norm perceptions and cognitive factors. In final multivariate models, food insecurity and positive attitudes toward delaying sex were associated with SVP (odds ratios [ORs] = 3.05 and 0.37, respectively), and community violence exposure, gender equitable social norm perceptions, positive attitudes toward delaying sex, and intentions to obtain sexual consent were associated with SRBs (ORs = 1.56-1.57, 0.90-0.38, 0.58-0.60, respectively). Interventions to address HIV/sexual violence risk among adolescents in South Africa should be integrated and multilevel.
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Affiliation(s)
- Nicholas Tarantino
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - Catherine Matthews
- South African Medical Research Council, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Shufang Sun
- School of Public Health, Brown University, Providence, Rhode Island
| | - Lindsay Orchowski
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - Abigail Harrison
- University of Cape Town, Cape Town, South Africa
- School of Public Health, Brown University, Providence, Rhode Island
| | | | | | - Morayo Akande
- School of Public Health, Brown University, Providence, Rhode Island
| | - Caroline Kuo
- University of Cape Town, Cape Town, South Africa
- School of Public Health, Brown University, Providence, Rhode Island
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Economic empowerment and intimate partner violence: a secondary data analysis of the cross-sectional Demographic Health Surveys in Sub-Saharan Africa. BMC WOMENS HEALTH 2021; 21:241. [PMID: 34118922 PMCID: PMC8199805 DOI: 10.1186/s12905-021-01363-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) has been recognized as a defining human rights, development and public health issue of our time. Economic empowerment is one of the most promising interventions to reduce IPV in sub-Saharan Africa, yet the evidence around economic factors that are key to ensure a reduction in IPV are still mixed. Furthermore, there is a lack of clarity on what kinds of economic empowerment works for which population group. This paper seeks a more nuanced understanding, by investigating whether the associations between indicators of economic empowerment and physical and/or sexual IPV are similar between the general population of women and among urban versus rural and young, or middle aged women versus older women. METHODS Using couples data from 25 DHS surveys across 15 countries (n = 70,993 women and men aged 15 and above at time of survey), we analyse how household wealth, men's and women's education and employment status, decision making on women's income, differences in education and employment of women and their partners and women's cash income are associated with physical and/or sexual IPV. We also provide sub-analyses for both urban and rural areas and for women aged, 15 to 24 25 to 34 and 35 to 49. RESULTS Across all surveys, 20% of women reported physical and/or sexual IPV in the last 12 months. On the one hand, our findings reinforced certain well-established patterns between women's economic empowerment and IPV, with women's and men's higher levels of education and increased household wealth associated with a decrease in IPV, and women's employment, especially if only the woman worked, and women earning more than her partner associated with an increase in IPV. Most patterns did not differ across urban and rural settings and age groups, but notable differences emerged regarding household wealth, women's and men's employment in the last 12 months and relative employment and education. CONCLUSIONS Factors relating to women's economic empowerment are vital in understanding and addressing IPV. Our analysis indicate however that future interventions need to consider the differing needs of urban and rural areas as well as be targeted to different age groups.
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Leddy AM, Zakaras JM, Shieh J, Conroy AA, Ofotokun I, Tien PC, Weiser SD. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention. PLoS One 2021; 16:e0252338. [PMID: 34038490 PMCID: PMC8153505 DOI: 10.1371/journal.pone.0252338] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States. Methods We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach. Results A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence. Conclusions Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jennifer M Zakaras
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jacqueline Shieh
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Amy A Conroy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA, United States of America
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America.,Department of Veteran Affairs Medical Center, San Francisco, CA, United States of America
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
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Muluneh MD, Francis L, Agho K, Stulz V. A Systematic Review and Meta-Analysis of Associated Factors of Gender-Based Violence against Women in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4407. [PMID: 33919171 PMCID: PMC8122481 DOI: 10.3390/ijerph18094407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 11/22/2022]
Abstract
A systematic review and meta-analysis were employed to address the associated factors of gender-based violence (GBV) in sub-Saharan African (SSA) countries. The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. A total of 4931 studies were found and 50 studies met the inclusion criteria. Pooled meta-analyses revealed that low educational attainment, higher alcohol consumption, substance use, history of child and family abuse, limited decision-making skills, experiencing depression, males having multiple sexual partners, and younger age were found to be individual- and family-associated factors that increase the experiences of GBV. Community tolerant attitudes to violence, women's unemployment, being Muslim, lower socioeconomic class, food and social insecurity were found to be community- and societal-associated factors of GBV. Alcohol consumption, low educational attainment, experiencing depression, being younger, a history of child and family abuse, tolerant attitudes to violence, and low socioeconomic status were poignant factors associated with GBV amongst women in SSA countries. The need to develop a multipronged approach of intervention is a top priority in SSA to reach the Sustainable Development Goals' (SDGs) target of 2030 to eliminate all forms of violence. Socio-behavioural change communication interventions at individual and community levels need to be introduced, and interventions need to address the prevention of child and family abuse and increase women's feelings of empowerment in order to prevent GBV in SSA.
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Affiliation(s)
- Muluken Dessalegn Muluneh
- School of Nursing and Midwifery, Parramatta South Campus, Western Sydney University, Sydney, NSW 2151, Australia;
- Amref Health Africa in Ethiopia, Addis Ababa P.O. Box 20855, Ethiopia
| | - Lyn Francis
- School of Nursing and Midwifery, Parramatta South Campus, Western Sydney University, Sydney, NSW 2151, Australia;
| | - Kingsley Agho
- School of Science and Health, Western Sydney University, Locked Bag 1797, Perth, NSW 2571, Australia;
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban 4041, South Africa
| | - Virginia Stulz
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia;
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Wamoyi J, Ranganathan M, Stöckl H. COVID-19 social distancing measures and informal urban settlements. Bull World Health Organ 2021; 99:475-476. [PMID: 34108759 PMCID: PMC8164183 DOI: 10.2471/blt.20.265942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/11/2020] [Accepted: 01/21/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, 255 Mwanza, United Republic of Tanzania
| | - Meghna Ranganathan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England
| | - Heidi Stöckl
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England
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Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, Wekesa P, Sheira L, Frongillo EA, Bukusi EA. Food Insecurity and Intimate Partner Violence Among HIV-Positive Individuals in Rural Kenya. Am J Prev Med 2021; 60:563-568. [PMID: 33012622 PMCID: PMC7987870 DOI: 10.1016/j.amepre.2020.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Intimate partner violence and food insecurity are both structural drivers of HIV acquisition, care, and treatment, but little is known about how the 2 conditions intersect in the lives of those already living with HIV. METHODS This study examined cross-sectional baseline data (collected in January 2016-December 2017) from an ongoing trial in southwestern Kenya. Trained interviewers asked enrolled participants living with HIV aged 18-60 years about household food insecurity (using the Household Food Insecurity Access Scale), intimate partner violence (using an adapted WHO multicountry study instrument), and sociodemographics. Negative binomial regression was used to examine the association between food insecurity and partner violence victimization (among women) or perpetration (among men). Secondary data were analyzed in August 2019-March 2020. RESULTS Of 720 participants, more than half of women reported experiencing intimate partner violence (57.6%) and most men reported perpetrating it (58.4%). Participants reporting any partner violence had higher Household Food Insecurity Access Scale scores (21.8) compared with those reporting no violence (21.3, p=0.02). Each categorical change in food insecurity (mild, moderate, severe) was associated with a 41% increased risk of an additional partner violence episode. In models controlling for relationship status, wealth, season of interview (lean versus not lean), and baseline physical health, each 1-point increase in food insecurity was associated with a 6% higher risk of violence victimization among women and 4% greater risk of men perpetrating partner violence. CONCLUSIONS This study highlights the interconnected nature of intimate partner violence and food insecurity among women and men living with HIV. This relationship suggests that enhancing food security may be a useful intervention strategy to prevent intimate partner violence and improve HIV-related health outcomes.
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Affiliation(s)
- Abigail M Hatcher
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California; Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Jill Hagey
- Department of Medicine, Duke University, Durham, North Carolina
| | - Elly Weke
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Pauline Wekesa
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California; Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, Washington; Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
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Awungafac G, Mugamba S, Nalugoda F, Sjöland CF, Kigozi G, Rautiainen S, Malyabe RB, Ziegel L, Nakigozi G, Nalwoga GK, Kyasanku E, Nkale J, Watya S, Ekström AM, Kågesten A. Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda. BMJ Open 2021; 11:e045427. [PMID: 33789856 PMCID: PMC8016075 DOI: 10.1136/bmjopen-2020-045427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns. DESIGN Population-based, cross-sectional household survey. SETTING Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda. PARTICIPANTS A total of N=2014 males aged 13-80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314). MEASURES Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as 'no physical and/or sexual IPV', 'physical' versus 'sexual violence only', and 'physical and sexual violence'. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into 'none', 'low' and 'high'. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours. RESULTS The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion. CONCLUSION This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic.
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Affiliation(s)
- George Awungafac
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Stephen Mugamba
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | | | - Godfrey Kigozi
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Susanne Rautiainen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Leo Ziegel
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Gertrude Nakigozi
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | | | - Emmanuel Kyasanku
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - James Nkale
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Stephen Watya
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Anna Kågesten
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Jesson J, Dietrich J, Beksinska M, Closson K, Nduna M, Smit J, Brockman M, Ndung'u T, Gray G, Kaida A. Food insecurity and depression: a cross-sectional study of a multi-site urban youth cohort in Durban and Soweto, South Africa. Trop Med Int Health 2021; 26:687-700. [PMID: 33666301 DOI: 10.1111/tmi.13572] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the prevalence of food insecurity and the independent association between depression and food insecurity among youth living in two urban settings in South Africa. METHODS Baseline cross-sectional survey data was analysed from a prospective cohort study conducted between 2014 and 2016 among youth (aged 16-24 years) in Soweto and Durban. Interviewer-administered questionnaires collecting socio-demographic, sexual and reproductive health and mental health data were conducted. Household food insecurity was measured using the 3-item Household Hunger Scale, with food insecure participants defined as having 'moderate' or 'severe hunger' compared to 'no hunger'. Depression was assessed using the 10-item Center for Epidemiological Studies Depression (CES-D 10) Scale (range 0-30, probable depression ≥ 10). Multivariable logistic regression models were used to estimate the association between depression and food insecurity. RESULTS There were 422 participants. Median age was 19 years (interquartile range [IQR] 18-21) and 60% were women. Overall, 18% were food insecure and 42% had probable depression. After adjustment for socio-demographic variables (age, gender, female-headed household, household size and school enrolment), participants with probable depression had higher odds of being food insecure than non-depressed participants (2.79, 95%CI 1.57-4.94). CONCLUSION Nearly one-fifth of youth in this study were food insecure. Those with probable depression had increased odds of food insecurity. Interventions are needed to address food insecurity among urban youth in South Africa, combining nutritional support and better access to quality food with mental health support.
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Affiliation(s)
- Julie Jesson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Janan Dietrich
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mags Beksinska
- Maternal Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mzikazi Nduna
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Jenni Smit
- Maternal Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Mark Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thumbi Ndung'u
- HIV Pathogenesis Programme and Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa.,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA.,Max Planck Institute for Infection Biology, Berlin, Germany.,Division of Infection and Immunity, University College London, London, UK
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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The roles of housing, financial, and food insecurities in understanding the relationship between childhood neglect and violence in adulthood. PLoS One 2021; 16:e0246682. [PMID: 33657121 PMCID: PMC7928485 DOI: 10.1371/journal.pone.0246682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/23/2021] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to determine whether basic housing, financial, and food insecurities in part explain the relationship between childhood neglect and violence as documented in the “cycle of violence” literature. Using a prospective cohort design, neglected children (under the age of 12) with court substantiated histories (1967–1971) in one metropolitan Midwest area and demographically matched non-neglected children were followed into adulthood. Housing, financial, and food insecurities were assessed in 2003–2005 interviews at mean age 41. Official arrest data were used to measure violence ever and from 2003 through 2013. Mediation was tested using probit structural equation modeling. Controlling for age, sex, and race, childhood neglect predicted violent arrests and housing, financial, and food insecurities in middle adulthood. Housing and financial securities predicted violent arrests ever and after 2003, whereas food insecurity only predicted any violent arrest ever. Housing and financial insecurities partially mediated the relationship between childhood neglect and violent criminal behavior. Greater attention and efforts need to focus on providing basic housing, financial, and food support for neglected children to reduce their risk for violent criminal behavior.
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Pinchoff J, Austrian K, Rajshekhar N, Abuya T, Kangwana B, Ochako R, Tidwell JB, Mwanga D, Muluve E, Mbushi F, Nzioki M, Ngo TD. Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements. BMJ Open 2021; 11:e042749. [PMID: 33658260 PMCID: PMC7931215 DOI: 10.1136/bmjopen-2020-042749] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES COVID-19 may spread rapidly in densely populated urban informal settlements. Kenya swiftly implemented mitigation policies; we assess the economic, social and health-related harm disproportionately impacting women. DESIGN A prospective longitudinal cohort study with repeated mobile phone surveys in April, May and June 2020. PARTICIPANTS AND SETTING 2009 households across five informal settlements in Nairobi, sampled from two previously interviewed cohorts. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes include food insecurity, risk of household violence and forgoing necessary health services due to the pandemic. Gender-stratified linear probability regression models were constructed to determine the factors associated with these outcomes. RESULTS By May, more women than men reported adverse effects of COVID-19 mitigation policies on their lives. Women were 6 percentage points more likely to skip a meal versus men (coefficient: 0.055; 95% CI 0.016 to 0.094), and those who had completely lost their income were 15 percentage points more likely versus those employed (coefficient: 0.154; 95% CI 0.125 to 0.184) to skip a meal. Compared with men, women were 8 percentage points more likely to report increased risk of household violence (coefficient: 0.079; 95% CI 0.028 to 0.130) and 6 percentage points more likely to forgo necessary healthcare (coefficient: 0.056; 95% CI 0.037 to 0.076). CONCLUSIONS The pandemic rapidly and disproportionately impacted the lives of women. As Kenya reopens, policymakers must deploy assistance to ensure women in urban informal settlements are able to return to work, and get healthcare and services they need to not lose progress on gender equity made to date.
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Affiliation(s)
- Jessie Pinchoff
- Poverty, Gender and Youth, Population Council, New York City, New York, USA
| | - Karen Austrian
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | | | - Timothy Abuya
- Reproductive Health, Population Council, Nairobi, Kenya
| | - Beth Kangwana
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Rhoune Ochako
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | | | - Daniel Mwanga
- Reproductive Health, Population Council, Nairobi, Kenya
| | - Eva Muluve
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Faith Mbushi
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Mercy Nzioki
- Poverty, Gender and Youth, Population Council, Nairobi, Kenya
| | - Thoai D Ngo
- Poverty, Gender and Youth, Population Council, New York City, New York, USA
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