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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.
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