Prevalence and correlates of intimate partner violence, before and during pregnancy among attendees of maternal and child health services, Enugu, Nigeria: mixed method approach, January 2015

The Pan African medical journal, Volume 32, Year 2019

Interprétation

Introduction: Intimate Partner Violence (IPV) is an under-reported public health problem. This study determined the prevalence of IPV and types of IPV, complications and factors associated with IPV among women accessing health services. Methods: we conducted a cross-sectional survey of 702 women accessing maternal and child health services in Enugu State, Nigeria using multi-stage sampling technique. Quantitative data was collected using semi-structured questionnaire, qualitative data by key informant interview (KII). We analysed data using descriptive statistics, bivariate and multivariate logistic regression analysis. The level of statistical significance was set at p-value < 0.05. Qualitative data was analysed using thematic content analysis. Results: mean age of respondents was 27.71 ± 5.14 years and 654 (93.2%) were married. Prevalence of IPV, a year before last pregnancy, was 307 (43.7%) and during last pregnancy was 261 (37.2%). Frequent involvement in physical fights with other men, controlling behaviour and younger aged partners (< 40 years) were independent predictors of IPV experience both before and during pregnancy. Independent predictors of IPV experience before and during pregnancy were younger aged partners (< 40 years). [Adjusted Odds Ratio AOR 1.72; 95% confidence interval (CI) = 1.17, 2.53], partner having controlling behaviour AOR 2.24; 95% C.I=1.51-3.32) and Partner's frequent involvement in physical fights (AOR 2.29; 95% C.I = 1.43-3.66). Having a male child and married/cohabiting were protective against violence. KII revealed poverty, lack of education and infidelity as common triggers of IPV. Conclusion: the prevalence of IPV and types of IPV was high and the predisposing factors of IPV in Enugu were multifactorial. Couple counselling sessions that focus on non-violence conflict resolution techniques is crucial to end IPV. Study area: the study was conducted in Enugu State, in the South Eastern region of Nigeria. Economically, the state is predominantly rural with a large proportion of the working population being farmers. However in the urban areas trading is the dominant occupation. The state is made up of three Senatorial Zones, seven health districts and 17 Local Government Areas. Study design: we conducted a health facility based on a cross-sectional study from January to December 2015 to determine the prevalence and correlates of IPV before and during pregnancy among attendees of maternal and child health services, Enugu State. Study population: the study population were women attending postnatal or child immunization clinics for care. The eligibility criteria were mothers from those who had just delivered to three months postpartum. Sample size: using the formula for calculating sample size of a cross sectional survey assuming a prevalence of IPV against women during pregnancy in Edo state, Nigeria of 28.3% [9]; confidence level of 95%; power of 80%; precision of 0.05, sample size of 636 was calculated which was increased to 700 to adjust for 10% non-response rate, however 702 questionnaires were completely filled and returned. Sampling technique: we employed a four-staged sampling technique for collection of the quantitative data. We randomly selected by balloting one of the three senatorial zones in the state. The selected senatorial zone has three health districts that are covering 5 local government areas (LGAs). There are 20 secondary health facilities and 136 primary health facilities distributed within the five LGAs. Two health districts were randomly selected by balloting from the selected senatorial zone. Two health facilities were purposively selected from each LGA, to make a total of 10 health facilities. The number of women to be interviewed was proportionately allocated to the health facilities. The total number of women registered in each health facility were divided by the total number of women in all the 10 health facilities that was sampled and this fraction was multiplied by the sample size.. All consecutive women accessing the immunization and post-natal services were interviewed in each health facility until the desired sample size was reached. For the qualitative method, we adopted a purposive sampling technique and selected four non-governmental organizations that manage cases of intimate partner violence. Data collection: we used a mixed-method for data collection. An 86-item interviewer administered semi-structured questionnaire was used to collect quantitative data. Six trained research assistants and the investigators collected data. The questionnaire collected data on respondents and their partners' socio-demographic characteristics, respondents' experience of IPV, types of IPV experienced, health problems arising from IPV and potential risk factors associated with IPV before and during pregnancy. Data was collected between June to September 2015. Qualitative data were collected by the principal investigator and two research assistants using a key informant guide, and the respondents were two key representatives (project coordinators, legal advisers, field coordinators, chairpersons and project assistants ) each of five non-governmental in Enugu State that deal on issues of domestic violence KII interviews were conducted to better understand and explore in greater depth, the triggers of IPV, coping strategies of the victims, complications arising from IPV and suggested solutions to end violence. Operational definitions: IPV was defined as physical, sexual, psychological or economic abuse by a current or former partner or spouse. It includes both spouses and dating partners, in current and former relationships [10]. Physical violence was defined as the intentional use of physical force with the potential for causing death, disability, injury or harm. The physical violence included, but not limited to scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, slapping, punching, burning, use of a weapon and use of restraint or one's body, size, or strength against another [11]. Sexual violence was defined as the use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed. It is an attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act, e.g., because of illness or disability [11]. Psychological also called emotional violence was defined as trauma to the victim caused by acts, threats of the act, or coercive tactics. Psychological violence can include, but is not limited to, humiliating the victim, controlling what the victim can and cannot do, withholding information from the victim, deliberating doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family [11]. Economic violence was defined as denying the victim access to money or other basic resources, controlling the victim's finances to prevent them from accessing resources, working or maintaining control of earnings, achieving self-sufficiency and gaining financial independence [12]. Controlling behavior was defined as trying to keep her from seeing friends or family, got angry if he speaks with another man, suspects her of unfaithfulness or monitors her movement. Perceived negative attitude of the mother-in-law was defined as involvement in decision making that may be detrimental to the respondents. Frequent physical fighting was defined as having been involved in fights with other men of ≥ 12 times per year. Study variables: the main outcome variable was any experience of IPV 12 months before pregnancy and also during the current pregnancy. This included physical, sexual, psychological or economic violence. Independent variables were socio-demographic characteristics of the respondents and partner: age, religion, marital status, family type (polygamous and monogamous), educational level and occupation. Data analysis: we reviewed all completed questionnaires before electronic data entry. We conducted univariate analysis to obtain frequencies and proportions, bivariate and multivariate logistic regression analysis to identify associations and independent predictors of IPV before and during pregnancy. P value set at < 0.05. Data analysis was performed using SPSS version 20. Qualitative data from key informant interview were thematically analyzed. Ethical considerations: we obtained ethical clearance for the study from Enugu State Ministry of Health Ethical Review Board with Ref Number -MH/MSD/EC/0173. Written informed consent was obtained from each respondent. We also obtained verbal and written informed consent from an adult related to mothers below 15 years of age. Confidentiality of the respondents was assured and maintained during and after the study.

Résumé de l’IA

Study Justification:

– Intimate Partner Violence (IPV) is a significant public health problem that is often under-reported.
– This study aimed to determine the prevalence of IPV and the factors associated with it among women accessing maternal and child health services in Enugu, Nigeria.
– By understanding the prevalence and correlates of IPV, policymakers and healthcare providers can develop targeted interventions to address this issue.

Study Highlights:

– The study found that the prevalence of IPV before and during pregnancy was high, with 43.7% of women experiencing IPV before their last pregnancy and 37.2% experiencing it during their last pregnancy.
– Factors associated with IPV included younger aged partners, partner’s controlling behavior, and partner’s frequent involvement in physical fights.
– Having a male child and being married/cohabiting were protective factors against violence.
– Qualitative interviews revealed poverty, lack of education, and infidelity as common triggers of IPV.

Study Recommendations for Lay Reader:

– Couple counseling sessions that focus on non-violence conflict resolution techniques are crucial to ending IPV.
– It is important to address the underlying factors associated with IPV, such as poverty and lack of education.
– Healthcare providers should be trained to identify and support women experiencing IPV, providing them with appropriate resources and referrals.

Study Recommendations for Policy Maker:

– Develop and implement comprehensive programs that address the prevalence of IPV, focusing on prevention, early detection, and support for victims.
– Allocate resources for training healthcare providers on identifying and responding to IPV.
– Collaborate with non-governmental organizations that manage cases of intimate partner violence to provide comprehensive support services.
– Promote gender equality and women’s empowerment to address the root causes of IPV.

Key Role Players:

– Healthcare providers: They play a crucial role in identifying and supporting women experiencing IPV.
– Non-governmental organizations: They provide support services for victims of IPV and can collaborate with policymakers to develop comprehensive programs.
– Policymakers: They are responsible for developing and implementing policies and programs to address IPV.
– Community leaders: They can raise awareness about IPV and promote community-based interventions.

Cost Items for Planning Recommendations:

– Training programs for healthcare providers on identifying and responding to IPV.
– Development and implementation of comprehensive programs to address IPV.
– Collaboration with non-governmental organizations to provide support services.
– Awareness campaigns and community-based interventions.
– Research and evaluation of interventions to assess their effectiveness.
Please note that the cost items provided are general categories and not actual cost estimates. The actual costs will depend on the specific context and resources available.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional survey, which provides a snapshot of the prevalence and correlates of intimate partner violence (IPV) before and during pregnancy among attendees of maternal and child health services in Enugu, Nigeria. The study population was adequately described, and a multi-stage sampling technique was used to select participants. Quantitative data was collected using a semi-structured questionnaire, and qualitative data was collected through key informant interviews. The data analysis included descriptive statistics, bivariate and multivariate logistic regression analysis, and thematic content analysis. The study found a high prevalence of IPV and identified several factors associated with IPV, such as younger aged partners, controlling behavior, and frequent involvement in physical fights. The study also highlighted poverty, lack of education, and infidelity as common triggers of IPV. The conclusions drawn from the study are supported by the findings. To improve the strength of the evidence, future studies could consider using a longitudinal design to establish causal relationships between risk factors and IPV. Additionally, the study could have included a larger sample size to increase the generalizability of the findings.

Abstrait

Study area: the study was conducted in Enugu State, in the South Eastern region of Nigeria. Economically, the state is predominantly rural with a large proportion of the working population being farmers. However in the urban areas trading is the dominant occupation. The state is made up of three Senatorial Zones, seven health districts and 17 Local Government Areas. Study design: we conducted a health facility based on a cross-sectional study from January to December 2015 to determine the prevalence and correlates of IPV before and during pregnancy among attendees of maternal and child health services, Enugu State. Study population: the study population were women attending postnatal or child immunization clinics for care. The eligibility criteria were mothers from those who had just delivered to three months postpartum. Sample size: using the formula for calculating sample size of a cross sectional survey assuming a prevalence of IPV against women during pregnancy in Edo state, Nigeria of 28.3% [9]; confidence level of 95%; power of 80%; precision of 0.05, sample size of 636 was calculated which was increased to 700 to adjust for 10% non-response rate, however 702 questionnaires were completely filled and returned. Sampling technique: we employed a four-staged sampling technique for collection of the quantitative data. We randomly selected by balloting one of the three senatorial zones in the state. The selected senatorial zone has three health districts that are covering 5 local government areas (LGAs). There are 20 secondary health facilities and 136 primary health facilities distributed within the five LGAs. Two health districts were randomly selected by balloting from the selected senatorial zone. Two health facilities were purposively selected from each LGA, to make a total of 10 health facilities. The number of women to be interviewed was proportionately allocated to the health facilities. The total number of women registered in each health facility were divided by the total number of women in all the 10 health facilities that was sampled and this fraction was multiplied by the sample size.. All consecutive women accessing the immunization and post-natal services were interviewed in each health facility until the desired sample size was reached. For the qualitative method, we adopted a purposive sampling technique and selected four non-governmental organizations that manage cases of intimate partner violence. Data collection: we used a mixed-method for data collection. An 86-item interviewer administered semi-structured questionnaire was used to collect quantitative data. Six trained research assistants and the investigators collected data. The questionnaire collected data on respondents and their partners' socio-demographic characteristics, respondents' experience of IPV, types of IPV experienced, health problems arising from IPV and potential risk factors associated with IPV before and during pregnancy. Data was collected between June to September 2015. Qualitative data were collected by the principal investigator and two research assistants using a key informant guide, and the respondents were two key representatives (project coordinators, legal advisers, field coordinators, chairpersons and project assistants ) each of five non-governmental in Enugu State that deal on issues of domestic violence KII interviews were conducted to better understand and explore in greater depth, the triggers of IPV, coping strategies of the victims, complications arising from IPV and suggested solutions to end violence. Operational definitions: IPV was defined as physical, sexual, psychological or economic abuse by a current or former partner or spouse. It includes both spouses and dating partners, in current and former relationships [10]. Physical violence was defined as the intentional use of physical force with the potential for causing death, disability, injury or harm. The physical violence included, but not limited to scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, slapping, punching, burning, use of a weapon and use of restraint or one's body, size, or strength against another [11]. Sexual violence was defined as the use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed. It is an attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act, e.g., because of illness or disability [11]. Psychological also called emotional violence was defined as trauma to the victim caused by acts, threats of the act, or coercive tactics. Psychological violence can include, but is not limited to, humiliating the victim, controlling what the victim can and cannot do, withholding information from the victim, deliberating doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family [11]. Economic violence was defined as denying the victim access to money or other basic resources, controlling the victim's finances to prevent them from accessing resources, working or maintaining control of earnings, achieving self-sufficiency and gaining financial independence [12]. Controlling behavior was defined as trying to keep her from seeing friends or family, got angry if he speaks with another man, suspects her of unfaithfulness or monitors her movement. Perceived negative attitude of the mother-in-law was defined as involvement in decision making that may be detrimental to the respondents. Frequent physical fighting was defined as having been involved in fights with other men of ≥ 12 times per year. Study variables: the main outcome variable was any experience of IPV 12 months before pregnancy and also during the current pregnancy. This included physical, sexual, psychological or economic violence. Independent variables were socio-demographic characteristics of the respondents and partner: age, religion, marital status, family type (polygamous and monogamous), educational level and occupation. Data analysis: we reviewed all completed questionnaires before electronic data entry. We conducted univariate analysis to obtain frequencies and proportions, bivariate and multivariate logistic regression analysis to identify associations and independent predictors of IPV before and during pregnancy. P value set at < 0.05. Data analysis was performed using SPSS version 20. Qualitative data from key informant interview were thematically analyzed. Ethical considerations: we obtained ethical clearance for the study from Enugu State Ministry of Health Ethical Review Board with Ref Number -MH/MSD/EC/0173. Written informed consent was obtained from each respondent. We also obtained verbal and written informed consent from an adult related to mothers below 15 years of age. Confidentiality of the respondents was assured and maintained during and after the study.

Matériaux

N/A

Innovations

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and resources related to maternal health, including information on intimate partner violence (IPV) and available support services. These apps can be easily accessible to women in Enugu State, Nigeria, and can provide them with important information and resources to address IPV and other maternal health concerns.

2. Telemedicine Services: Establish telemedicine services that allow women in rural areas to consult with healthcare professionals remotely. This can help overcome geographical barriers and ensure that women have access to timely and appropriate care, including support for IPV.

3. Community-Based Interventions: Implement community-based interventions that raise awareness about IPV and provide support to women experiencing violence. These interventions can involve training community health workers and other community members to identify signs of IPV, provide counseling and support, and refer women to appropriate services.

4. Strengthening Health Systems: Improve the capacity of health systems in Enugu State to address IPV and other maternal health concerns. This can include training healthcare providers on how to identify and respond to IPV, ensuring the availability of necessary resources and equipment, and establishing referral pathways to support services.

5. Collaborations with Non-Governmental Organizations (NGOs): Collaborate with NGOs that specialize in addressing IPV and maternal health issues. These partnerships can help leverage existing expertise and resources to provide comprehensive support to women in need.

It is important to note that these recommendations are based on the information provided and may need to be further tailored and adapted to the specific context and needs of Enugu State, Nigeria.

AI Innovations Description

Based on the study, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Implement Couple Counselling Sessions: The study found that IPV was prevalent among women accessing maternal and child health services in Enugu, Nigeria. One of the factors associated with IPV was younger aged partners. To address this issue and improve access to maternal health, it is recommended to implement couple counselling sessions that focus on non-violence conflict resolution techniques. These sessions can provide a safe space for couples to discuss and address any issues related to violence, and promote healthier relationships. By addressing the underlying causes of IPV, such as poverty, lack of education, and infidelity, these counselling sessions can contribute to ending IPV and improving access to maternal health services.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive public health campaigns to raise awareness about maternal health issues, including intimate partner violence (IPV). This can be done through various channels such as community outreach programs, social media campaigns, and educational workshops.

2. Strengthen healthcare infrastructure: Improve the availability and accessibility of maternal and child health services in rural areas by investing in healthcare infrastructure. This includes building and upgrading healthcare facilities, ensuring the availability of skilled healthcare providers, and providing necessary medical equipment and supplies.

3. Enhance training for healthcare providers: Provide specialized training for healthcare providers on identifying and addressing IPV among pregnant women. This can help healthcare providers to effectively screen for IPV, provide appropriate support and referrals, and ensure the safety of pregnant women.

4. Implement integrated care models: Establish integrated care models that combine maternal health services with IPV screening and support. This can involve integrating IPV screening into routine antenatal care visits and providing comprehensive support services for women experiencing IPV, including counseling, legal assistance, and referrals to support organizations.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the percentage increase in awareness about maternal health issues, the number of healthcare facilities upgraded or built, the percentage of healthcare providers trained on IPV, and the number of integrated care models implemented.

2. Collect baseline data: Gather baseline data on the current status of maternal health access, including the prevalence of IPV, the availability of healthcare facilities, and the level of awareness among the target population.

3. Develop a simulation model: Create a simulation model that incorporates the identified indicators and their interdependencies. This model should consider factors such as population demographics, healthcare infrastructure, and the effectiveness of the recommendations.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to assess the potential impact of the recommendations. This can involve adjusting different variables, such as the level of awareness, the number of healthcare facilities, and the training coverage of healthcare providers.

5. Analyze results: Analyze the simulation results to determine the projected impact of the recommendations on improving access to maternal health. This can include assessing changes in key indicators, identifying potential bottlenecks or challenges, and evaluating the cost-effectiveness of the recommendations.

6. Refine and validate the model: Refine the simulation model based on the analysis of the results and validate it using real-world data. This can involve comparing the simulated outcomes with actual data from pilot projects or similar interventions.

7. Develop an implementation plan: Based on the simulation results, develop an implementation plan that outlines the specific actions needed to achieve the desired improvements in access to maternal health. This plan should consider factors such as resource allocation, stakeholder engagement, and monitoring and evaluation mechanisms.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health and make informed decisions on the most effective strategies to implement.

Auteur

Dima Health

Statistics:

Citations: 8

Identifiers:

DOI: 10.11604/pamj.supp.2019.32.1.13287

Research Areas:

Disability, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Violence and Injury

Study Countries:

Nigeria

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Male & Female

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