Depression, anxiety and associated factors among housemaids working in Addis Ababa Ethiopia

Impact of the COVID-19 pandemic on mental health care and people with mental health conditions in Ethiopia: the MASC mixed-methods study

BACKGROUND

The COVID-19 pandemic has had far-reaching effects on the mental health of populations around the world, but there has been limited focus on the impact on people with existing mental health conditions in low-income countries. The aim of this study was to examine impact of the pandemic on mental health care and people with mental health conditions in Ethiopia.

METHODS

A convergent mixed methods study was conducted. We systematically mapped information from publicly available reports on impacts of the pandemic on mental health care. Monthly service utilisation data were obtained from Amanuel Mental Specialised Hospital, the main psychiatric hospital, and analysed using segmented Poisson regression (2019 vs. 2020). In-depth interviews were conducted with 16 purposively selected key informants. Framework analysis was used for qualitative data. Findings from each data source were integrated.

RESULTS

In the early stages of the pandemic, participants indicated a minimal response towards the mental health aspects of COVID-19. Mental health-related stigma and discrimination was evident. Scarce mental health service settings were diverted to become COVID-19 treatment centres. Mental health care became narrowly biomedical with poorer quality of care due to infrequent follow-up. Households of people with pre-existing mental health conditions in the community reported worsening poverty and decreased access to care due to restricted movement, decreased availability and fear. Lack of reliable medication supplies increased relapse and the chance of becoming chained at home, abandoned or homeless. Caregiver burden was exacerbated. Within mental health facilities, prisons and residential units, infection control procedures did not adequately safeguard those with mental health conditions. Meanwhile, the needs of people with mental health conditions in COVID-19 quarantine and treatment facilities were systematically neglected. Only late in the day were integrated services developed to address both physical and mental health needs.

CONCLUSIONS

The COVID-19 pandemic had substantial negative impacts on the lives of people with mental health conditions in Ethiopia. Future emergency response should prioritise the human rights, health, social and economic needs of people with mental health conditions. Integration of mental and physical health care would both expand access to care and increase resilience of the mental health system.

Highly precarious general and sexual health conditions of young domestic servants: results from a qualitative exploratory study and perspectives for community-based research in Bamako, Mali

Most domestic servants (DS) in Mali are very young female migrants living in precarious conditions. We aimed to understand their living and working conditions in relation to their general and sexual health. Seven focus groups (53 participants) were conducted by the DS community-based organization ADDAD. Narratives were thematically analyzed using an inductive method. The dominant emerging theme was DS' strong dependence on their employers. Employers' attitudes regarding DS workload, the provision of food, water and hygiene products, housing conditions, and healthcare cover, appeared decisive for DS' physical and mental health, and the type of healthcare they used (self-medication, traditional care, healthcare facilities). Psychological, physical and sexual violence in employers' households was frequent. HIV/STI prevention knowledge was poor. These results highlight the serious risks for DS in terms of HIV/STI and unwanted pregnancies. DS were interested in receiving healthcare from ADDAD; this was motivated by the organization's trusting and understanding community-based environment, and DS' fear of discrimination in healthcare facilities. This study highlights the relevance of tackling the defense of rights and sexual health promotion for DS at the community level. Its findings can help identify research questions to evaluate the extent to which DS constitute a key HIV population.

Prevalence and associated factors of sexual violence experienced by housemaids in Ethiopia: a systematic review and meta-analysis

Background

Housemaids often experience different types of sexual violence by different perpetrators. Sexual violence against housemaids remains usually concealed as victims cannot report such offenses. Except for fragmented studies with varying reports, there is no national prevalence studies conducted on sexual violence among housemaids in Ethiopia. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence and associated factors of sexual violence amongst housemaids in Ethiopia.

Methods

A systematic search of PubMed, Embase, Science Direct, HINARI, Scopus, Cochrane Library, and Google Scholar was conducted using relevant search terms. Data were extracted using the Joanna Briggs Institute (JBI) tool. The quality of all selected articles was evaluated using JBI critical appraisal checklist. Data analysis was performed using STATA Version 14 statistical software. Egger’s test and funnel plot were used to evaluate publication bias. Heterogeneity was assessed using Cochran’s chi-squared test and quantified by I² values. A random-effects model was applied during meta-analysis if heterogeneity was exhibited; otherwise, a fixed-effects model was used.

Results

After reviewing 37,849 articles, 8 studies involving 3,324 housemaids were included for this systematic review and meta-analysis. The pooled prevalence of life time sexual violence among housemaids in Ethiopia was 46.26% (95% CI: 24.69, 67.84). The pooled prevalence was 55.43% (95% CI: 26.38, 84.47) for sexual harassment, 39.03% (95% CI: 14.55, 63.52) for attempted rape, and 18.85% (95% CI: 7.51, 30.19) for rape. Sexual violence is more likely among housemaid who previously lived rural residence (AOR = 2.25; 95% CI: 1.41, 3.60), drinks alcohol (AOR = 2.79 95% CI: 1.02, 4.56), and employer alcohol consumption (AOR = 6.01; 95% CI: 1.10, 32.96).

Conclusion

This study revealed that the prevalence of sexual violence against housemaids in Ethiopia is high. Of the forms of sexual violence against housemaids, sexual harassment is high. Male employers are the vast majority of perpetrators of their housemaids. Thus, concerned stakeholders should develop and implement interventions that could empower housemaids in their struggle toward the elimination of sexual violence, create awareness for men, control and monitor the implementation of legislation and policies, and prompt punishment of the perpetrators.

Systematic review and meta-analysis registration PROSPERO CRD42021160511.

Sexual violence is the most common form of gender-based violence and has been a persistent problem in public health. Housemaids are the most vulnerable groups for any of the forms of sexual violence, as they face the greatest obstacles to gaining protection and necessary services. The sexual activity of domestic workers differs from that of the general population. Housemaids are more likely to be coerced into having sex and to have had sex before age 15 as compared to other young women. Housemaids often experience sexual violence by a person unknown to the victim, employers and male members of the household, brokers, or other intermediary persons. Sexual violence against housemaids remains usually concealed as victims cannot report such offenses. The most common reason for not reporting such violence was a lack of awareness of where to and for whom to report, a low level of education, and a fear of losing their work as they have few or no options for other work.

In Ethiopia, the national prevalence of sexual violence among housemaids is not investigated. Also, forms and determinants of sexual violence and identification of perpetrators have not been well described. Thus, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of sexual violence amongst housemaids in Ethiopia. This systematic review and meta-analysis revealed that nearly half of housemaids experienced at least one form of sexual violence by different perpetrators. Of the forms of sexual violence against housemaids, sexual harassment is high. Male employers are the vast majority of perpetrators of their housemaids. Thus, concerned stakeholders should develop and implement interventions that could empower housemaids in their struggle toward the elimination of sexual violence, create awareness for men, and prompt punishment of the perpetrators.