Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda: findings from a population based study

Women's exposure to intimate partner violence and its association with child stunting: findings from a population-based study in rural Rwanda

BACKGROUND

Child stunting is a significant challenge for most districts in Rwanda and much of sub-Saharan Africa and persists despite multisectoral efforts. There is a notable lack of population-based studies examining the correlation between violence against women and child stunting in Rwanda.

OBJECTIVE

We aimed to investigate the association between Rwandan women's exposure to intimate partner violence (IPV) and child stunting in children under 3 years of age.

METHODS

In December 2021, a population-based cross-sectional study was conducted in the Northern Province of Rwanda, including 601 women and their children <3 years of age. The World Health Organization (WHO) Women's Health and Life Experiences Questionnaire for IPV research was utilized. Child stunting was assessed using the WHO criteria for low height for age. Multivariable logistic regression was used to examine the association between IPV and child stunting before and during pregnancy.

RESULTS

Of 601 women, 47.4% (n = 285) experienced any form of IPV during pregnancy. The prevalence rates of the types of IPV associated with child stunting varied: 33% for psychological, 31.4% for sexual, and 25.7% for physical violence. Exposure to physical violence before pregnancy and sexual violence during pregnancy was associated with higher odds of child stunting; the adjusted odds ratios were 1.29 (95% CI, 1.01-2.03) and 1.25 (95% CI, 1.04-2.01), respectively.

CONCLUSION

Women's exposure to physical and psychological violence is associated with an increased risk of child stunting. Urgent targeted interventions and support systems are needed to address the complex relationship between women's exposure to IPV and adverse effects on child growth.

Mental health outcomes of offspring exposed to parental intimate partner violence in Rwanda

BACKGROUND

Children who witness parental intimate partner violence (IPV) are more likely to develop mental health issues compared to those who do not witness such violence.

OBJECTIVE

The main objective of this study is to assess the association between parental intimate partner violence and child mental health outcomes.

METHODOLOGY

This cross-sectional study involved 548 participants divided into two groups: parents (N = 304) and offspring (N = 244). The participants were recruited from Mageragere Sector in the City of Kigali (urban), as well as Mbazi and Ruhashya sectors in Huye District (rural). To assess the difference about mental difficulties reported by the offspring, a Mann-Whitney U test was employed to compare the responses of parents and their children on mental health outcomes. Additionally, multiple linear regression analysis was conducted to explore the association between parental intimate partner violence (IPV) and the mental health outcomes of their offspring.

RESULTS

The results highlighted significant levels of mental and emotional challenges in children, as reported by both parents and the children themselves. Depression and youth conduct problems were more prevalent among the children compared to their parents, whereas anxiety and irritability were more commonly reported by parents than by their children. Intimate partner violence showed to be a predictor of irritability and anxiety symptoms in offspring. In terms of irritability, depression, and youth conduct problems they were identified as predictors of anxiety symptoms. Particularly, anxiety and irritability were revealed to predict youth conduct problems.

CONCLUSION

The study indicates that parental intimate partner violence (IPV) has an impact on the mental well-being of their offspring. Furthermore, it was observed that there is not only a correlation between IPV and poor mental health outcomes, but also a connection between different mental conditions, implying that children exposed to IPV are more prone to experiencing a range of mental issues. As a result, intervention programs should place emphasis on addressing the mental disorders of both parents and children.

Association Between Intimate Partner Violence and Suicidal Ideation Among Female and Male Adults in South Korea: A Nationally Representative Longitudinal Study

This study sought to assess the prevalence of intimate partner violence (IPV) victimization and to examine the sex-stratified associations between IPV and suicidal ideation in South Korea. This study used nationally representative longitudinal survey data from 2011 to 2020 of the Korean Welfare Panel Study of 9732 married adults at baseline. Participants were annually asked about IPV experiences of verbal abuse, physical threat, or physical assault over the past year in 2011-2019. Suicidal ideation in the past year was assessed in the following year 2012-2020 of IPV experiences. Using multilevel logistic regression models, we examined the associations between IPV and suicidal ideation among married adults. The prevalence of verbal abuse, physical threat, and physical assault was respectively 19.8%, 3.0%, and 1.4% in females (n = 5056); and 18.8%, 2.7%, and 1.0% in males (n = 4676). After adjusting for potential confounders (e.g., lifetime suicidal ideation and random effects of individuals and households) in the same year when participants had IPV experiences, all types of IPV experiences were statistically associated with suicidal ideation in the following year among both females and males, except for physical threat among males. We found a statistically significant association between physical threat and suicidal ideation among females (adjusted odds ratio: 2.22, 95% confidence interval: 1.62, 3.04), whereas no association was observed among males. Our findings suggest that public health interventions related to suicidal behaviors that can be attributable to experiencing IPV are necessary among both females and males in South Korea.

Association Between Girl-child Marriage and Intimate Partner Violence in Sub-Saharan Africa: Insights From a Multicountry Analysis of Demographic and Health Surveys

While considerable attention has been given to the health consequences of child marriage in Sub-Saharan Africa (SSA), limited studies exist on its impact on intimate partner violence (IPV) in the region. We address this gap by examining the link between child marriage and IPV. We tested our study hypothesis using demographic and health survey data of 28,206 young women aged 20-24 years from 16 SSA countries with recent surveys (2015-2019). Binary logistic regression models were used to examine the effect of child marriage on IPV. Child marriage prevalence ranged from 13.5% in Rwanda, in East Africa, to 77% in Chad, in Central Africa, while IPV ranged from 17.5% in Mozambique in Southern Africa to 42% in Uganda, in East Africa. Past year experience of IPV was higher among young women who married or begun cohabiting before the age of 18 (36.9%) than those who did at age 18 or more (32.5%). This result was consistent for all forms of violence: physical violence (22.7% vs 19.7%), emotional violence (25.3% vs 21.9%), and sexual violence (12% vs 10.4%). After controlling for covariates, we found that young women in SSA who married before 18 years were more likely to experience IPV than those who married as adults (AOR: 1.20; 95% CI [1.12, 1.29]). Significant heterogeneity was observed in the country-level results, with a higher likelihood of IPV found in 14 of the 16 countries and lower in Angola and Chad. Child marriage is associated with a higher likelihood of IPV in most SSA countries, suggesting that ending child marriage will result in a substantial reduction in IPV. There is a need to institute policies to support and protect women who marry as children from abusive relationships in SSA.

The prevalence of mental disorders among intimate partner violence exposed and non-exposed Rwandans: Findings from a national cross-sectional survey

Despite mounting evidence indicating an increased risk of long-term mental disorders in Rwanda's general population, little is still known about the national prevalence of mental disorders among victims of intimate partner violence (IPV) in a post-conflict setting. The aim of this study was to compare the prevalence of mental disorders among IPV exposed and non-exposed individuals in Rwanda. This was a cross-sectional study based on secondary data from the 2018 Rwanda Mental Health Survey. The sample consisted 20,381 participants selected nationwide, from 7,124 households (age range: 14-65 years), of which 3,759 Rwandans were exposed to IPV (18.4%) and 16,622 were non-exposed to IPV (81.6%). Participants were screened for IPV exposure and common mental disorders, and data was analyzed using the SPSS version 25 software. The results showed that the rate of any mental disorder was substantially higher in the group exposed to IPV than the non-exposed, at 32.4% and 11.7% respectively. These results highlight that among Rwandans diagnosed with severe mental disorders, participants with a history of IPV exposure present with increased odds of mental disorders prevalence and severity. Therefore, people seeking mental health care should also be screened for their IPV exposure and offered appropriate interventions.

Association between experiences of intimate partner sexual violence and cigarette smoking among women in union in Papua New Guinea: evidence from a nationally representative survey

Background

Intimate partner sexual violence (IPSV) is a prevalent public health problem affecting millions of people each year globally, particularly in developing countries like Papua New Guinea (PNG). Although over two-thirds of women in PNG are estimated to experience some form of sexual violence in their lifetime, empirical evidence is limited on the association between IPSV and cigarette smoking. Thus, the present study aims to examine the prevalence of IPSV and its association with cigarette smoking among women in union  in PNG.

Methods

This cross-sectional study used data from the first demographic and health survey of PNG conducted between 2016 and 2018. A total of 9,943 women aged 15–49 years in intimate unions were included in this study. We estimated the relative risk of smoking cigarette using modified Poisson regression models with a robust variance and 95% confidence intervals.

Results

The rates of IPSV and current cigarette smoking were 25.9% and 26.8%, respectively. The modified Poisson regression results showed that IPSV was significantly associated with an elevated risk for cigarette smoking. Women with IPSV history were more likely to smoke cigarette relative to their counterparts with no IPSV history (RR: 1.33, 95% CI: 1.18–1.50) in the absence of covariates. After controlling for demographic, social and economic factors, the association between IPSV and cigarette smoking remained statistically significant (RR: 1.24, 95% CI: 1.08–1.42).

Conclusions

The rates of IPSV and cigarette smoking among women in union in PNG in the current study were relatively high. Irrespective of diverse demographic, social and economic factors, IPSV was still significantly associated with cigarette smoking among women in union in PNG. The findings presented call the attention of policy-makers and relevant authorities in PNG to an important association that needs to be addressed. Counseling, awareness creation, service provision and program design on IPSV are urgently required to minimize cigarette smoking and IPSV among women in union in PNG.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13003-4.

Married Women's Attitude toward Intimate Partner Violence Is Influenced by Exposure to Media: A Population-Based Spatial Study in Bangladesh

This study estimated the attitudes of women toward accepting IPV at district level in Bangladesh and examined its relationship with sociodemographic predictors including exposure to media (e.g., newspaper, radio and television) using the Multiple Indicator Cluster Survey-2019 with a sample of 63,689 women. Around 25.6% women accepted IPV that geographically varied from 1.78% (Pirojpur) to 57.14% (Kurigram). Women regularly exposed to media were 17% less likely to accept IPV. Attitude toward accepting IPV was found to be higher among the illiterate women in disadvantaged circumstances, patriotically from poorer households living in remote areas, which suggest that planned interventions are needed for this vulnerable group of women to improve their living status by providing access to education and media. Further research is necessary to assess the impact of women's empowerment on their attitude toward acceptance of IPV.

Psychological Trauma in the Context of Intimate Partner Violence: A Concept Analysis

A comprehensive understanding of psychological trauma in the context of intimate partner violence (IPV) is relevant for nurses and other healthcare providers to provide better care for individuals and families confronting this issue. A concept analysis based on Walker and Avant was conducted to fully understand this concept and its impact on physical and mental health. This concept analysis demonstrates that psychological trauma in the IPV context is an intricate multi-faceted concept that can have a significant long-term effect on individuals who have experienced IPV. The concept's attributes, antecedents, and consequences identified in this concept analysis will contribute to guiding practice, research, education, and policy development aimed to address the trauma affecting individuals and families in the context of IPV.

Intimate partner violence as a predictor of antenatal care services utilization in Rwanda

Background

Although compelling evidence shows that exposure to intimate partner violence (IPV) during pregnancy is detrimental to both physical and mental health of the victims and their fetuses, studies on negative impact of IPV on antenatal care (ANC) services utilization are scarce.

Methods

The aim of the current study was to determine the impact of IPV exposure on ANC services utilization indicators such as (i) initiation of care within the first 3 months of pregnancy, (ii) receipt of at least four ANC visits and (iii) receipt of care from skilled providers among reproductive age women in Rwanda. This study used the data from the 2014–15 Rwanda Demographic and Health Survey. Multiple logistic regression was used to estimate the effects of physical and sexual IPV on the ANC services utilization indicators.

Results

Among married women living with their partners with at least one child aged 5 years or under (N = 5116), 17% of them reported physical violence, 22.8% reported psychological violence and 9.2% reported sexual violence. We found that there was a significant negative relationship between physical IPV and both early ANC and sufficient ANC. Women who had experienced physical violence by their partners during the preceding 12 months were less likely to receive more than four ANC visits, (O.R = 0.61, CI = 0.417–0.908) and they were less likely to attend the first ANC visits within the first 3 months (O.R = 0.656, CI = 0.445–0.967).

Conclusion

In this study, the prevalence of IPV still remains high and there is evidence that it does have significant impact on ANC. Therefore, the results provide support for continued efforts to reduce intimate partner violence, through the improvement of screening for IPV during ANC visits.

Mental health of women and children experiencing family violence in conflict settings: a mixed methods systematic review

BACKGROUND

Armed conflict has significant impacts on individuals and families living in conflict-affected settings globally. Scholars working to prevent violence within families have hypothesised that experiencing armed conflict leads to an increase in family violence and mental health problems. In this review, we assessed the prevalence of family violence in conflict settings, its association with the mental health of survivors, moderating factors, and the importance of gender relations.

METHODS

Following PRISMA guidelines, we systematically reviewed quantitative and qualitative studies that assessed the prevalence of family violence and the association between family violence and mental health problems, within conflict settings (PROSPERO reference CRD42018114443).

RESULTS

We identified 2605 records, from which 174 full text articles were screened. Twenty-nine studies that reported family violence during or up to 10 years after conflict were eligible for inclusion. Twenty one studies were quantitative, measuring prevalence and association between family violence and mental health problems. The studies were generally of high quality and all reported high prevalence of violence. The prevalence of violence against women was mostly in the range of 30-40%, the highest reported prevalence of physical abuse being 78.9% in Bosnia and Herzegovina. For violence against children, over three-quarters had ever experienced violence, the highest prevalence being 95.6% in Sri Lanka. Associations were found with a number of mental health problems, particularly post-traumatic stress disorder. The risk varied in different locations. Eight qualitative studies showed how men's experience of conflict, including financial stresses, contributes to their perpetration of family violence.

CONCLUSIONS

Family violence was common in conflict settings and was associated with mental health outcomes, but the studies were too heterogenous to determine whether prevalence or risk was greater than in non-conflict settings. The review highlights an urgent need for more robust data on perpetrators, forms of family violence, and mental health outcomes in conflict-affected settings in order to help understand the magnitude of the problem and identify potential solutions to address it.

The epidemiology of psychiatric disorders in Africa: a scoping review

This scoping review of population-based epidemiological studies was done to provide background information on the prevalences and distribution of psychiatric disorders in Africa for calls to broaden diversity in psychiatric genetic studies. We searched PubMed, EMBASE, and Web of Science to retrieve relevant literature in English, French, and Portuguese from Jan 1, 1984, to Aug 18, 2020. In 36 studies from 12 African countries, the lifetime prevalence ranged from 3·3% to 9·8% for mood disorders, from 5·7% to 15·8% for anxiety disorders, from 3·7% to 13·3% for substance use disorders, and from 1·0% to 4·4% for psychotic disorders. Although the prevalence of mood and anxiety disorders appears to be lower than that observed in research outside the continent, we identified similar distributions by gender, although not by age or urbanicity. This review reveals gaps in epidemiological research on psychiatric disorders and opportunities to leverage existing epidemiological and genetic research within Africa to advance our understanding of psychiatric disorders. Studies that are methodologically comparable but diverse in geographical context are needed to advance psychiatric epidemiology and provide a foundation for understanding environmental risk in genetic studies of diverse populations globally.

Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence

IMPORTANCE

Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking.

OBJECTIVE

To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019).

EXPOSURES

Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State.

MAIN OUTCOMES AND MEASURES

Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale-Revised.

RESULTS

A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale-Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = -0.206, P = .05) and in social relationships (β = -0.221, P = .03) were associated with a reduction in PTSD symptoms.

CONCLUSIONS AND RELEVANCE

These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.

Contribution of community-based sociotherapy interventions for the psychological well-being of Rwandan youths born to genocide perpetrators and survivors: analysis of the stories telling of a sociotherapy approach

BACKGROUND

Psychological well-being (PWB) refers to inter- and intra-individual levels of positive functioning that include one's relatedness with others and self-referent attitudes that include one's sense of mastery and personal growth. PWB consists of hedonism and eudaimonia building on thoughts, feelings, and behaviors. Sociotherapy is a community-based health intervention that contributes to the promotion of PWB worldwide. Starting from an analysis of trauma transmitted from the perpetrators and survivors of the Rwandan genocide to their descendants, this article is aimed at exploring the contribution of therapeutic sessions to PWB among youth.

METHOD

A qualitative study design based on shared testimonies was carried out. Field reports from the sociotherapists, written texts, and testimonies of changes presented in the conviviality meetings were analyzed using transactional analysis. We included 24 reflexive texts upon completion of 8 months of the therapeutic program.

RESULTS

Results indicated that before sociotherapy sessions, youth born to genocide survivors and perpetrators had psychosocial distress, including low self-esteem, hopelessness, anxiety, stigma, thoughts of revenge, shame, depression, and antisocial behaviors. Sociotherapy significantly contributed to the reduction of these psychosocial problems. Participating youth reported feeling safe, trusted, respected, and healthier than before the sociotherapy. This intervention created inner healing, social cohesion, alleviated their sufferings of trauma, restored their families and contributed to community resilience. Results revealed that youth developed PWB, helping them to what appeared to be psychosocial problems as being potentially healthy, enhancing self-acceptance, and respecting humanity. Youth also became the vector for the reconciliation and reconstruction of their humanity.

CONCLUSION

Sociotherapy is a community health intervention that has an effective outcome on the personal well-being of of youth. This therapy impacted the individual, social, and familial resilience of youth who developed their capacity to regain and maintain health. The intervention restored their PWB, characterized by increased positive functioning specifically in the areas of autonomy, ecological mastery, individual growth, purpose in life, good relationships with others, and improved self-esteem.

Prevalence of and Risk Factors for Intimate Partner Violence in the First 6 Months Following HIV Diagnosis Among a Population-Based Sample in Rural Uganda

Research in Uganda examining HIV-positive status disclosure and IPV victimization is scarce, and existing findings may not generalize to community-based samples of men and women newly diagnosed with HIV in Uganda. We investigated the prevalence of lifetime IPV, IPV experienced between HIV diagnosis and 6 months following diagnosis (recent IPV), and IPV specifically related to a partner learning one's HIV-positive status among a sample of men and women newly diagnosed with HIV in a population-based study in rural Uganda. We also examined correlates of recent IPV, including HIV-positive status disclosure. The sample included 337 participants followed for 6 months after HIV diagnosis. Lifetime IPV findings showed that over half of the sample reported experiencing emotional IPV (62.81% of men, 70.37% of women), followed by physical IPV (21.49% of men, 26.39% of women) then sexual IPV (7.44% of men, 17.59% of women). For recent IPV, men and women reported similar rates of physical (4.63% and 8.29%, respectively) and emotional (19.44% and 25.91%, respectively) IPV. Women were more likely than men to report recent sexual IPV (8.29% vs. 1.85%); however, this relationship was no longer significant after controlling for other risk factors associated with sexual IPV (AOR = 3.47, 95% CI [0.65, 18.42]). Participants who disclosed their HIV-positive status to their partner had 59% lower odds of reporting emotional IPV (AOR = 0.41, 95% CI [0.21, 0.81]) than participants who did not disclose their HIV-positive status. Younger age, non-polygamous marriage, lower social support, and greater acceptance for violence against women were also significantly associated with experience of recent IPV. Overall, 12.20% of participants who experienced recent IPV reported that the IPV was related to their partner learning their HIV-positive status. Findings highlight the need for IPV screening and intervention integrated into HIV diagnosis, care, and treatment services.

Intimate partner violence among HIV-positive women in Nairobi, Kenya

Purpose

This study was conducted to identify the prevalence and sociodemographic factors associated with four forms of intimate partner violence (IPV) among HIV-positive women attending the Comprehensive Care Centre at the Kenyatta National Hospital in Nairobi, Kenya.

Methods

A cross-sectional study was conducted among 600 sexually active HIV-positive women aged 18–69 years from May to August of 2012. A structured questionnaire including questions pertaining to sociodemographic characteristics, health care decisions, and forms of IPV (controlling behavior, emotional abuse, physical violence, and sexual violence) was administered to each woman.

Results

All women reported experiencing emotional abuse; 20%, 17%, and 15% experienced controlling behavior, physical violence, and sexual violence, respectively. Women who reported low/below average socioeconomic status (SES) had a greater likelihood of experiencing controlling behavior than women with high/average SES (adjusted odds ratio [aOR] =1.62, 95% CI 1.05–2.51). Women who were unemployed had greater odds of experiencing physical violence than those who were employed (aOR =2.35, 95% CI 1.31–4.23). Non-Christian women had higher odds of experiencing controlling behavior, physical violence, and sexual violence than Christian women (aOR =4.41, 95% CI 1.81–10.76 and aOR =3.33, 95% CI 1.43–7.80).

Conclusion

Based on the prevalence of IPV and the sociodemographic factors identified to be associated with IPV among women in this study it may be beneficial to include IPV screening as part of routine clinic visits for HIV-positive and other women. Furthermore, women who report emotional abuse or controlling behavior from spouse should not be overlooked, as these two forms of IPV may precede or accompany physical and sexual IPV. Women who report experiencing IPV during clinic visits may be referred to organizations and resources available to battered women in Kenya. Increased funding for anti-IPV programs and changes in policy may also contribute to a reduction in IPV among HIV-positive and other women in Kenya.

Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide

BACKGROUND

In August 2014, the Islamic State of Iraq and Syria (ISIS), a terrorist organization, attacked the Yazidi's ancestral homeland in northwestern Iraq. Among other atrocities, they abducted thousands of women and girls and traded many of them into sexual slavery. The aim of this study is to determine the mental health of women and girl survivors of these events in relation to enslavement and experiences with genocide-related events, as well as perceived social rejection in their community.

METHODS

Between February and July 2017, trained local assessors interviewed a sample of 416 Yazidi women and girls (65 of whom had survived sexual enslavement), aged between 17 and 75 years, and living in internally displaced person camps in the Kurdistan Region of Iraq. Post-traumatic stress disorder (PTSD) and depression symptoms were assessed using validated Kurdish versions of standard instruments. Scales for trauma exposure and perceived rejection were developed for the purpose of this study.

RESULTS

Participants reported a high number of traumatic events. More than 80% of girls and women, and almost all participants who were formerly enslaved, met criteria for a probable DSM-5 PTSD diagnosis. Trauma exposure and enslavement predicted poor mental health. In addition, among formerly enslaved girls and women, perceived social rejection in their community mediated the relationship between traumatic enslavement events and depression symptoms.

CONCLUSIONS

In a context of maximum adversity, enslavement and war-related events contribute to high levels of PTSD and depression. Perceived social rejection seems to play a role in the relationship between trauma exposure and mental health among abducted genocide survivors. Providing psychosocial support and treatment for Yazidi people is essential and urgently required.

Intimate partner violence during pregnancy in relation to non-psychotic mental health disorders in Rwanda: a cross-sectional population-based study

OBJECTIVES

To investigate the prevalence of non-psychotic mental health disorders (MHDs) and the association between exposure to all forms of intimate partner violence (IPV) during pregnancy and MHDs.

DESIGN

Cross-sectional population-based study conducted in the Northern Province of Rwanda and Kigali city.

PARTICIPANTS AND SETTINGS

Totally, 921 women who gave birth ≤13 months before being interviewed were included. Simple random sampling was done to select villages, households and participants. Community health workers helped to identify eligible participants and clinical psychologists, nurses or midwives conducted face-to-face interviews. The collected data were analysed using descriptive statistics and bivariable and multivariable logistic regression modelling RESULTS: The prevalence rates of generalised anxiety disorder, suicide ideation and post-traumatic stress disorder (PTSD) were 19.7%, 10.8% and 8.0%, respectively. Exposure to the four forms of IPV during pregnancy was highly associated with the likelihood of meeting diagnostic criteria for each of the non-psychotic MHDs investigated. Physical, psychological and sexual violence, showed the strongest association with PTSD, with adjusted ORs (aORs) of 4.5, 6.2 and 6.3, respectively. Controlling behaviour had the strongest association with major depressive episode in earlier periods with an aOR of 9.2.

CONCLUSION

IPV and MHDs should be integrated into guidelines for perinatal care. Moreover, community-based services aimed at increasing awareness and early identification of violence and MHDs should be instituted in all villages and health centres in Rwanda. Finally, healthcare providers need to be educated and trained in a consistent manner to manage the most challenging cases quickly, discreetly and efficiently.

Types of non-psychotic mental disorders in adult women who suffered intimate partner violence: an integrative review

OBJECTIVE

Identifying the types of non-psychotic mental disorders in adult women who suffered intimate partner violence in the literature.

METHOD

An integrative review carried out in the MEDLINE, CINAHL, LILACS, Web of Science and SCOPUS databases.

RESULTS

We selected 19 articles published in international journals in English, with a predominance of cross-sectional study studies (78.9%). The most common types of non-psychotic mental disorders were: depression (73.7%) and post-traumatic stress disorder (52.6%). It was observed that 78.9% of the articles presented a 2C level of evidence.

CONCLUSION

Studies have shown that adult women who are victims of intimate partner violence mostly suffer from depression and post-traumatic stress disorder, as well as other morbidities; a fact that highlights how devastating violence by an intimate partner can impact on the mental health of those who experience it.

Depression in Intimate Partner Violence Victims in Slovenia: A Crippling Pattern of Factors Identified in Family Practice Attendees

This multi-centre cross-sectional study explored associations between prevalence of depression and exposure to intimate partner violence (IPV) at any time in patients' adult life in 471 participants of a previous IPV study. In 2016, 174 interviews were performed, using the Short Form Domestic Violence Exposure Questionnaire, the Zung Scale and questions about behavioural patterns of exposure to IPV. Family doctors reviewed patients' medical charts for period from 2012 to 2016, using the Domestic Violence Exposure Medical Chart Check List, for conditions which persisted for at least three years. Depression was found to be associated with any exposure to IPV in adult life and was more likely to affect women. In multivariable logistic regression modelling, factors associated with self-rated depression were identified (p < 0.05). Exposure to emotional and physical violence was identified as a risk factor in the first model, explaining 23% of the variance. The second model explained 66% of the variance; past divorce, dysfunctional family relationships and a history of incapacity to work increased the likelihood of depression in patients. Family doctors should consider IPV exposure when detecting depression, since lifetime IPV exposure was found to be 40.4% and 36.9% of depressed revealed it.

Prevalence of pregnancy-related complications and course of labour of surviving women who gave birth in selected health facilities in Rwanda: a health facility-based, cross-sectional study

OBJECTIVES

This study estimated health facility-based prevalence for pre-eclampsia/eclampsia, postpartum haemorrhage and caesarean section (CS) due to prolonged labour/dystocia. The background characteristics of Rwandan pregnant women, the course of labour and the level of healthcare were investigated in relation to pregnancy and delivery outcomes.

METHODS

This is health facility-based study and data were collected in 2014-2015 through structured interviews and medical records (n=817) in Kigali and Northern Province, Rwanda. Frequencies and prevalence were used to describe participants' background factors, labour and delivery-related characteristics. Bivariable and multivariable logistic regression models were performed for different background factors and pregnancy/delivery outcomes.

RESULTS

Pre-eclampsia/eclampsia, postpartum haemorrhage and CS due to prolonged labour/dystocia represented 1%, 2.7% and 5.4% of all participants, respectively. In total, 56.4% of the participants were transferred from facilities with low levels to those with higher levels of healthcare, and the majority were transferred from health centres to district hospitals, with CS as the main reason for transfer. Participants who arrived at the health facility with cervical dilation grade of ≤3 cm spent more hours in maternity ward than those who arrived with cervical dilatation grade of ≥4 cm. Risk factors for CS due to prolonged labour or dystocia were poor households, nulliparity and residence far from health facility.

CONCLUSIONS

The estimated health facility-based prevalence of pregnancy-related complications was relatively low in this sample from Rwanda. CS was the main reason for the transfer of pregnant women from health centres to district hospitals. Upgrading the capacity of health centres in the management of pregnant women in Rwanda may improve maternal and fetal health.

Determinants of poor utilization of antenatal care services among recently delivered women in Rwanda; a population based study

Background

In Rwanda, a majority of pregnant women visit antenatal care (ANC) services, however not to the extent that is recommended. Association between socio-demographic or psychosocial factors and poor utilization of antenatal care services (≤2 visits during the course of pregnancy irrespective of the timing) among recently pregnant women in Rwanda were investigated.

Methods

This population-based, cross sectional study included 921 women who gave birth within the past 13 months. Data was obtained using an interviewer-administered questionnaire. For the analyses, bi-and multivariable logistic regression was used and odds ratios were presented with their 95% confidence intervals.

Results

About 54% of pregnant women did not make the recommended four visits to ANC during pregnancy. The risk of poor utilization of ANC services was higher among women aged 31 years or older (AOR, 1.78; 95% CI: 1.14, 2.78), among single women (AOR, 2.99; 95% CI: 1.83, 4.75) and women with poor social support (AOR, 1.71; 95% CI: 1.09, 2.67). No significant associations were found for school attendance or household assets (proxy for socio-economic status) with poor utilization of ANC services.

Conclusion

Older age, being single, divorced or widowed and poor social support were associated with poor utilization of ANC services. General awareness in communities should be raised on the importance of the number and timing of ANC visits. ANC clinics should further be easier to access, transport should be available, costs minimized and opening hours may be extended to facilitate visits for pregnant women.

Magnitude and factors associated with intimate partner violence in mainland Tanzania

BACKGROUND

In Tanzania like in many sub-Saharan countries the data about Intimate Partner Violence (IPV) are scarce and diverse. This study aims to determine the magnitude of IPV and associated factors among ever partnered women in urban mainland Tanzania.

METHODS

Data for this report were extracted from a big quasi-experimental survey that was used to evaluate MAP (MAP - Men as Partners) project. Data were collected using standard questions as those in big surveys like Demographic and Health Surveys. Data analyses involved descriptive statistics to characterize IPV. Associations between IPV and selected variables were based on Chi-square test and we used binary logistic regression to assess factors associated with women's perpetration to physical IPV and Odds Ratio (OR) as outcome measures with their 95 % confidence intervals (CI).

RESULTS

The lifetime exposure to IPV was 65 % among ever-married or ever-partnered women with 34, 18 and 21 % reporting current emotional, physical and sexual violence respectively. Seven percent of women reported having ever physically abused partners. The prevalence of women perpetration to physical IPV was above 10 % regardless to their exposure to emotional, physical or sexual IPV.

CONCLUSIONS

IPV towards women in this study was high. Although rates are low, there is some evidence to suggest that women may also perpetrate IPV against their partners. Based on hypothesis of IPV and HIV co-existence, there should be strategies to address the problem of IPV especially among women.

Gender Inequality Prevents Abused Women from Seeking Care Despite Protection Given in Gender-Based Violence Legislation: A Qualitative Study from Rwanda

Objective

Despite its burden on a person’s life, Intimate Partner Violence (IPV) is known to be poorly recognised and managed in most countries and communities. This study aimed to explore health care professionals’ experiences of the health care seeking processes of women exposed to intimate partner violence in Rwanda.

Methods

Six focus group discussions were conducted in three district hospitals and three mental health units in Rwanda. A sample of 43 health care professionals with various professions and length of work experience, who regularly took care of patients subjected to IPV, was selected for focus group discussions. The analysis was performed using qualitative content analysis.

Results

The theme “Gendered norms and values defeat the violence legislation in women’s health care seeking when women are abused” expressed the health care professionals’ experiences of the double-faced situation which women exposed to IPV met in their help seeking process. Positive initiatives to protect women were identified, but the potential for abused women to seek help and support was reduced because of poverty, gender inequality with prevailing strong norms of male superiority, and the tendency to keep abuse as a private family matter.

Conclusion

Legislative measures have been instituted to protect women from abuse. Still many Rwandan women do not benefit from these efforts. The role of the health care services needs to be reinforced as an important and available resource for help and support for abused women but further legislative changes are also needed. Initiatives to further improve gender equality, and institutionalised collaboration between different sectors in society would contribute to protecting women from IPV.

Determinants of Intimate Partner Violence in Sub-Saharan Africa: A Review of Prevention and Intervention Programs

Intimate partner violence (IPV) in sub-Saharan Africa affects 36% of the population. Several African countries rank among the highest globally. In this article, we present evidence on the prevalence, determinants, and impact of IPV across several sub-Saharan African countries interpreted against the backdrop of social ecological theory. We also describe prevention or intervention programs tested in different regions of Africa, selecting only those programs which were published in a journal outlet and which met a high criteria of implementation and methodology (n = 7). Based on our review of the empirical literature, some risk factors for violence documented in Western societies are the same in Africa, including poverty, drinking, a past history of child abuse or posttraumatic stress disorder, and highly traditional gender role beliefs. Low education is also associated with IPV for both women and men. In Africa, partner abuse intersects with the HIV pandemic, making violence prevention especially urgent. African programs to prevent IPV are often incorporated with HIV prevention; community building and community engagement are emphasized more in Africa than in North America or Europe, which invoke more individually focused approaches. Some programs we review lowered HIV exposure in women; others contributed to reduced violence perpetration among men. The programs show sufficient promise to recommend replication and dissemination in sub-Saharan Africa.