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Chakrabarty M, Singh A, Mohan D, Singh S. Understanding the association between intimate partner violence and sexually transmitted infections among women in India: a propensity score matching approach. Sex Transm Infect 2024; 100:143-149. [PMID: 38355296 DOI: 10.1136/sextrans-2023-055904] [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: 06/22/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Intimate partner violence (IPV) against women can significantly impact their overall health. While numerous studies in developing nations highlight the association between IPV and sexually transmitted infections (STIs), the evidence available within the Indian context remains limited. Therefore, this study aims to fill this knowledge gap by investigating the relationship between exposure to different forms of IPV and the occurrence of STIs, using a quasi-experimental approach. METHODS The study used a sample of 63 851 women aged 15-49 years from the latest National Family Health Survey-5. Propensity score matching (PSM) was employed to assess the 'treatment effect' from exposure to IPV (physical, emotional or sexual) in the past 12 months on STIs. RESULTS About 12.2% of women (95% CI: 11.7% to 12.8%) reported symptoms of STIs at the time of the survey. Approximately 31.9% (95% CI: 31.2% to 32.7%) of women reported experiencing at least one form of IPV-either physical, emotional or sexual IPV. Of all forms of IPV, physical IPV was the most prevalent, reported by 28.6%, followed by emotional IPV (13.2%) and sexual IPV (5.7%). Women who experienced any form of IPV-whether physical, sexual or emotional-reported a higher prevalence of STIs (17.8%) as compared with those who did not experience any IPV (9.5%). The findings from the PSM analysis indicated that among the three forms of IPV, the impact of sexual IPV on STIs was the most pronounced. The average treatment effect on the treated from exposure to sexual IPV on STIs was 0.15 (95% CI 0.13 to 0.17). CONCLUSION This study provides evidence of a significant association between IPV and STIs among women in India and underscores the urgent need for intensified efforts and interventions to address both IPV and STIs, to improve the overall health and well-being of women in India.
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Affiliation(s)
| | - Aditya Singh
- Department of Geography, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Girl Innovation, Research, and Learning (GIRL) Centre, Population Council, New York, New York, USA
| | - Diwakar Mohan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shivani Singh
- Independent Researcher, Lucknow, Uttar Pradesh, India
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Adomako EB, Darkwa Baffour F. Suffering in the Hands of a Loved One: The Endemic to Intimate Partner Violence and Consequences on Migrant Female Head-Load Carriers in Ghana. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP11940-NP11967. [PMID: 31789080 DOI: 10.1177/0886260519888547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The study contributed to filling a knowledge gap in the area of intimate partner violence (IPV). Previous studies conducted in Ghana have investigated the causes and types of IPV, leaving a gap on the consequences the violence had on the victims. Using a population of local economic migrants (hereafter, head-load carriers), a qualitative design with emphasis on phenomenology was employed to investigate the effects of IPV on 20 head-load carriers in two major cities in Ghana (Kumasi and Accra). The analysis performed on the data, using interpretive phenomenological analysis, revealed that IPV affected the head-load carriers' health, employment, and human relationships. Each of the participants spoke of one or more health complications, which they attributed to IPV. Among the health-related effects reported by the head-load carriers were body pains, wounds, depression, suicide ideation, headache, and abdominal pains that resulted from the termination of an unwanted pregnancy. All the head-load carriers recounted the detrimental outcomes of IPV on their job and human relationships. After they had experienced IPV, some of the victims could not go to work due to fear of stigmatization and those who were able to could not work as they usually do due to severe pain. At their workplace, some of the IPV victims became aggressive toward customers and coworkers, whereas others remained isolated. These negatively impacted on their human relationship skills and earnings. Based on the findings, there is the need for policies that seek to address IPV to consider the effects on victims' employment, earning, and behavior.
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Intimate partner violence during pregnancy in Vietnam: role of husbands. Arch Womens Ment Health 2021; 24:271-279. [PMID: 32728774 DOI: 10.1007/s00737-020-01056-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Intimate partner violence (IPV) perpetrators are often husbands. Understanding factors pertaining to women's male partners is essential for programming interventions against IPV. The objective of the study was to describe husband-related social and behavioural risk factors and assess how they are associated with IPV during pregnancy. Cross-sectional data were collected among 1309 pregnant women with husbands in Dong Anh district, Vietnam. Information on sociodemographic characteristics of husbands, the husband's behaviour and the husband's involvement in pregnancy care was indirectly collected via women's report at first antenatal care visit. Data on exposure to intimate partner violence during pregnancy were collected when the women returned for antenatal care in 30-34 gestational weeks. Logistic regression analyses were used to measure the relationships between IPV during pregnancy and risk factors from the husband. Pregnant women who had husbands who were younger or blue-collar worker/farmer/unemployed had more likelihood to be exposed to IPV. Women with husbands who drank alcohol before sexual intercourse and gambled were more likely to be exposed to IPV repeated times. Those with husbands who had intentions of having a child had over three times increased OR to be exposed to IPV once (AOR = 3.2, 95% CI 1.1-9.7). If the husband had a preference for sons, the woman had 1.5 times increased OR (AOR = 1.5; 95% CI 1.1-1.9) to be exposed to IPV repeated times during pregnancy. This study highlights significant associations between IPV and maternal perceptions of husbands' behaviours and involvement in pregnancy. Findings may help to identify at-risk pregnant women to IPV and guide the development of targeted interventions to prevent IPV from husbands.
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Steele SJ, Abrahams N, Duncan K, Woollett N, Hwang B, O'Connell L, van Cutsem G, Shroufi A. The epidemiology of rape and sexual violence in the platinum mining district of Rustenburg, South Africa: Prevalence, and factors associated with sexual violence. PLoS One 2019; 14:e0216449. [PMID: 31365536 PMCID: PMC6668777 DOI: 10.1371/journal.pone.0216449] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background Estimates for the prevalence of rape and other forms of sexual violence (SV) vary in South Africa. This survey aimed to provide clarity by quantifying the prevalence of SV (forced sex or sexual acts) by 1) sexual partners, and 2) non-partners, and to describe factors associated with these outcomes among women (18–49 years) living in Rustenburg Municipality. Materials and methods We conducted a cluster-randomized household survey (November—December 2015). Women were asked about their experiences of SV, associated attitudes and behaviours, and access to services. Logistic regression was used to determine factors associated with partner and non-partner SV. Results Of eligible households, 83·1% (1700/2044) participated. Of 966 women invited, 836 participated (86·5%). Average age of participants was 31.6 years (95%CI: 30·9, 32·4) with 45% having completed at least secondary school, and 60% unemployed or looking for work. Lifetime prevalence of SV was 24.9% (95%CI: 21·7–28·5), reaching 9.0% (95% CI: 6·6–12·1) by age 15. Almost one third told no one of their SV experiences. Factors related to financial dependence were associated with SV by a partner. History of termination of pregnancy increased the likelihood of SV by a non-partner as an adult. Women who experienced SV in childhood or as an adult were more likely to experience SV from a different type of perpetrator than those who did not. Conclusions We found a high prevalence of SV, including during childhood, in this setting, with limited access to care. This and the high morbidity attributed to SV calls for increased service provision.
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Affiliation(s)
- Sarah Jane Steele
- Médecins Sans Frontières (MSF) South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | - Naeemah Abrahams
- South African Medical Research Council, Gender and Health Division, Cape Town, South Africa
| | - Kristal Duncan
- Médecins Sans Frontières (MSF) South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | - Nataly Woollett
- University of the Witwatersrand, School of Clinical Medicine, School of Public Health, Johannesburg, South Africa
| | - Bella Hwang
- Médecins Sans Frontières (MSF) South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | - Lucy O'Connell
- Médecins Sans Frontières (MSF), Southern African Medical Unit, Cape Town, South Africa
| | - Gilles van Cutsem
- Médecins Sans Frontières (MSF), Southern African Medical Unit, Cape Town, South Africa.,University of Cape Town, Centre for Infection Disease and Epidemiology Research, Cape Town, South Africa
| | - Amir Shroufi
- Médecins Sans Frontières (MSF) South Africa, Operational Control Centre Brussels, Cape Town, South Africa
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Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Are interventions focused on gender-norms effective in preventing domestic violence against women in low and lower-middle income countries? A systematic review and meta-analysis. Reprod Health 2019; 16:93. [PMID: 31262331 PMCID: PMC6604322 DOI: 10.1186/s12978-019-0726-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background One in three women experience intimate partner violence worldwide, according to many primary studies. However, systematic review and meta-analysis of intimate partner violence is very limited. Therefore, we set to summarize the findings of existing primary studies to generate evidence for informed decisions to tackle domestic violence against women in low and lower-middle income countries. Methods Studies were searched from main databases (Medline via PubMed, EMBASE, CINAHL, PopLine and Web of Science), Google scholar and other relevant sources using electronic and manual techniques. Published and unpublished studies written in English and conducted among women aged (15–49 years) from 1994 to 2017 were eligible. Data were extracted independently by two authors, and recorded in Microsoft Excel sheet. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of funnel plot. Statistical analysis was carried out to determine the pooled prevalence using Comprehensive Meta-Analysis software. In addition, sub-group analysis was carried out by study-setting and types of intimate partner violence. Results Fifty two studies were included in the systematic review. Of these, 33 studies were included in the meta-analysis. The pooled prevalence of lifetime intimate partner violence was 55% (95% CI: 52, 59%). Of these, main categories were lifetime physical violence [39% (95% CI: 33, 45%); psychological violence [45% (95% CI: 40, 52%)] and sexual violence [20% (95% CI: 17, 23%)]. Furthermore, the pooled prevalence of current intimate partner violence was 38% (95% CI: 34, 43%). Of these, physical violence [25% (95% CI: 21, 28%)]; psychological violence [30% (95% CI: 24, 36%)] and sexual violence [7.0% (95% CI: 6.6, 7.5%)] were the pooled prevalence for the major types of intimate partner violence. In addition, concurrent intimate partner violence was 13% (95% CI: 12, 15%). Individual, relationship, community and societal level factors were associated with intimate partner violence. Traditional community gender-norm transformation, stakeholders’ engagement, women’s empowerment, intervention integration and policy/legal framework were highly recommended interventions to prevent intimate partner violence. Conclusion Lifetime and current intimate partner violence is common and unacceptably high. Therefore, concerned bodies will need to design and implement strategies to transform traditional gender norms, engage stakeholders, empower women and integrate service to prevent violence against women. Protocol registration PROSPERO: 2017: CRD42017079977. Electronic supplementary material The online version of this article (10.1186/s12978-019-0726-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agumasie Semahegn
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana. .,College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia.
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Abubakar Manu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia
| | - Gezahegn Tesfaye
- College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia
| | - Augustine Ankomah
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana.,Population Council/Ghana, Yiyiwa Drive, Accra, Ghana
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Intimate Partner Violence in Relation to Husband Characteristics and Women Empowerment: Evidence from Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050709. [PMID: 30818838 PMCID: PMC6427227 DOI: 10.3390/ijerph16050709] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to assess the magnitude of intimate partner violence (IPV) and associated factors among women in Nepal. The secondary data from the Nepal Demographic and Health Survey (NDHS) 2016 was used. This study was confined to the respondents selected for the domestic violence module. The association between experience of IPV 'ever' and 'in the past year' with selected factors were examined by using Chi-square test, followed by multivariate logistic regression. Complex sample analysis procedure was adopted to adjust for multi-stage sampling design, cluster weight, and sample weight. The result revealed that 26.3% of ever-married women experienced any form of IPV at some point in their lives, while only 13.7% has experienced any form of IPV in the past year. The factors associated with both 'lifetime' and 'past year' experience of IPV includes women witnessing parental violence during their childhood, the husband being drunk frequently, women being afraid of their husband most of the times, and women whose husbands shows marital control behavior. Women's experiencing IPV was associated more with husband related factors than with women's empowerment indicators. Reducing IPV requires a commitment to changing the norms that promote the husband's behavior of controlling his wives and beating her.
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Semahegn A, Torpey K, Manu A, Assefa N, Ankomah A. Community based intervention to prevent domestic violence against women in the reproductive age in Northwestern Ethiopia: a protocol for quasi-experimental study. Reprod Health 2017; 14:155. [PMID: 29162117 PMCID: PMC5698924 DOI: 10.1186/s12978-017-0414-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Violence against women is a well understood devastating global pandemic, and human right violation. One in three women experienced intimate partner violence worldwide. In Ethiopia, the level of domestic violence against women is one of the highest in the world. However, Ethiopia is signatory for various conventions and incorporated in legal frameworks. Nevertheless, effective implementation of the existing policy documents, and engaging different stakeholders is very limited. Therefore, we aimed to pilot feasibility of implementing available research evidence and policy documents at community level to prevent domestic violence against women in Awi zone, northwestern Ethiopia. Methods A community-based quasi-experimental study design will be employed using mixed method. Multistage stratified systematic sampling and purposive sampling will be used to recruit quantitative and qualitative study participants, respectively. A total of 1,269 women will be participated in the intervention, active comparator and control groups. Pre and post-test quantitative data will be collected using face-to-face interview. Qualitative data will be collected through in-depth, key informant interview and focus group discussions. Intervention: advocacy meeting will be held to persuade local politicians and sustain the implementation of community based intervention to prevent domestic violence against women. Community representatives will be trained to enhance peer education to promote community awareness and engage stakeholders to transform the traditional gender norm within local context. Awareness creation and husband involvement will be made through integrating the intervention with community health extension program. Only husband involvement will not be promoted in the active comparator to test the role of husband involvement on the domestic violence prevention activities. Intervention progress will be monitored regularly. Gathered data will be entered in Epidata and exported to SPSS (23.0) software for analysis. Descriptive statistics, logistic regressions, intention to treat analysis and difference in differences will be computed. Qualitative data will be transcribed, color coded, thematically analyzed and arranged using Nvivo. Discussion This interventional study is aimed to design, pilot and translate proven research evidence, agreed conventions and country policy document to real setting implementation. We are expecting to initiate implementation of culturally acceptable intervention through engaging stakeholders. Policy makers, planners and any concerned bodies will be benefited. Trial registration ClinicalTrials.gov ID: NCT03265626
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Affiliation(s)
- Agumasie Semahegn
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana. .,College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia.
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Abubakar Manu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia
| | - Augustine Ankomah
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
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Vyas S. Marital violence and sexually transmitted infections among women in post-revolution Egypt. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:68-74. [PMID: 28844360 DOI: 10.1016/j.srhc.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/15/2017] [Accepted: 06/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the relationship between past year physical or sexual partner violence against women and women's self-report of sexually transmitted infection (STI) symptoms in post-revolution Egypt; and to examine the effects of men's and women's risky sexual behavioural characteristics and structural dimensions of poverty and gender inequality on this relationship. STUDY DESIGN This study uses the nationally representative cross-sectional demographic and health survey data conducted in 2014. Multivariate logistic regression was used to assess the relationship between past year partner violence and self-report of STI symptoms among currently married women. MAIN OUTCOME MEASURES women's self-report of STI was based on their responses to three questions; whether in the past year they had: got a disease through sexual contact?, a genital sore or ulcer?, or a bad smelling abnormal genital discharge? Women who gave an affirmative response to one or more of these questions were assumed to self-report STI. RESULTS Almost one-third of women self-reported symptoms of STI. Fourteen percent of women reported they had experienced physical or sexual violence by a male partner in the past 12months. Abused women had a 2.76 times higher odds of self-reported STI symptoms (95% CI 2.25-3.38). The significant relationship between self-reported STI and past year partner violence against women did not alter when adjusting for men's and women's behavioural characteristics and factors related to poverty and gender inequality. CONCLUSIONS Public health interventions that address women's sexual and reproductive health need to consider violence response and prevention strategies.
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Affiliation(s)
- Seema Vyas
- London School of Hygiene and Tropical Medicine, Department of Population Health, Keppel Street, London WC1E 7HT, United Kingdom.
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Shrestha R, Copenhaver MM. Association Between Intimate Partner Violence Against Women and HIV-Risk Behaviors: Findings From the Nepal Demographic Health Survey. Violence Against Women 2016; 22:1621-1641. [PMID: 26912296 DOI: 10.1177/1077801216628690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intimate partner violence (IPV) is a significant global health issue and has been associated with an increased HIV-related risk and vulnerability to HIV infection. This study examined the potential relationship between IPV and HIV-risk behaviors among women in Nepal. Our findings revealed that IPV against women was associated with the presence of HIV-risk behaviors, such as history of sexually transmitted infections (STIs), multiple sex partners, inconsistent condom use, partner with known HIV risks, and inability to negotiate safer sexual practices. This highlights a need to develop effective interventions aimed at eliminating IPV to decrease the disproportionate burden of adverse health outcomes, including STIs/HIV among women.
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Affiliation(s)
- Roman Shrestha
- University of Connecticut Health Center, Farmington, USA
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Sigbeku O, Fawole O, Ogunniyan T. EXPERIENCE OF INTIMATE PARTNER VIOLENCE AS A PREDICTOR OF SEXUALLY TRANSMITTED INFECTIONS AMONG MARRIED WOMEN IN NIGERIA. Ann Ib Postgrad Med 2015; 13:6-16. [PMID: 26807081 PMCID: PMC4715374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is an important public health issue that is associated with adverse sexual and reproductive health outcomes including sexually transmitted infections (STIs). STIs have recently gained more recognition worldwide because they increase the risk for HIVinfection. However, there is dearth of information on the association between IPV and STIs particularly among married women in Nigeria. OBJECTIVE To determine the association between IPV and STIs among married women in Nigeria. METHOD This was a secondary data analysis of the 2008 Nigeria Demographic and Health Survey (NDHS) dataset. A total of 18,402 married women aged between 15 and 49 years were included. Questions about intimate partner violence were adapted from the Conflict Tactic Scale (CTS). Multiple logistic regression models were used to determine relationship between IPV and self-reported STIs. RESULTS The prevalence of IPV among married women in Nigeria was 29.3%. Majority of the women experienced emotional violence (22.1%), 17.3% of the women experienced physical violence while the least experienced form of violence was sexual IPV (4.4%). Majority (60.1%) of the women experienced just one type of IPV, 30.0% two types, 9.9% all three types. The prevalence of self-reported sexually transmitted infections was 7.2%. Logistic regression demonstrated that after controlling for other covariates, women who experienced any form of IPV were found to be more likely to report STI than women who did not [OR 1.357 (95% CI 1.188-1.551)]. In addition, experience of physical and sexual IPV was significantly associated with history of STIs [OR 1.699 (95% CI 1.420-2.034); OR 1.414 (95% CI 1.085-1.843) respectively]. Experiencing two or more types of IPV was significantly associated with history of STIs [OR 1.759 (95% CI 1.446-2.139); OR 2.193 (95% CI 1.636-2.941) respectively]. CONCLUSION There is a need to incorporate IPV screening and services in STI clinics. Also, it is important to screen for STIs among women who present with IPV particularly those with multiple types of violence.
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Affiliation(s)
- O.A. Sigbeku
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - O.I. Fawole
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - T.B. Ogunniyan
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
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