Preparé et Presenté par : Sidikiba SIDIBE Thème: Intimate Partner Violence Against Women: Prevalence and/or Determinants, attitudes, consequences. A systematic Review study of Sub-Saharan Africa countries Memoire Master 2 Presenté en November 2011 à Bordeaux Preparé et Presenté par : Sidikiba SIDIBE

Plan Introduction Purpose/Objective Methods Result Prevalence Determinants Relationship with HIV Attitudes and Consequences Discussion and Conclusion

Intimate partner violence, serious public problem Introduction Intimate partner violence, serious public problem Women reproductive age more vulnerable Lifetime prevalence ranged 15% in Japan to 71% in Ethiopia (WHO 2005) Associated to health negatives outcomes (WHO 2005) Women negatives attitudes contribute to sustain intimate partner violence

Objective Conduct a systematic review on the prevalence of Intimate Partner Violence (domestic violence) against women and/or determinants, atitudes and consequences. The study assessed also the reviewed studies limitations.

Method (1) Search strategy Criteria Medline database supplemented by Google Scholar and hand searching Criteria Studies on domestic violence (Married, Cohabiting women) English Published studies from 2000 to 2011 Prevalence on Intimate partner violence (Sexual, Physical and Emotional) Articles/Abstracts based on quantitative research Women as principle source of information

Method (2) Assessed for Eligibility (n=168) Stage 1: selected (n=116) Excluded for not meeting selection criteria (n=52 ) Stage 2: References Selected (n=56) References Excluded (n=40 ) Eligible but not yielded in the review N=3 Eligible and included in the review N=53

Method (3) Data Collection Items (Variables) Excel Country Article Design (time of follow up) Sample Type of violence (physical, sexual and psychological) Tools Used Prevalence and incidence Determinants, Attitudes and consequences Limitations of studies 7

Method (4) Data analysis No formal meta-analyze was done Descriptive using Excel and Word offices 2003 Prevalence Determinants Attitudes and Consequences Studies limitations Odds Ratios or Risk Ratio (95%) 8

Results

Result (1) Design methodological tool 45 Cross sectional 5 Prospective (cohort) 1 Case control 1 Trial Randomized 1 systematically review methodological tool 49 administered questionnaires 4 conflict tactics scale 3 WHO administered questionnaire 3 Self-Interviewing 10

Result (2) Prevalence 47 reported lifetime or 12 past months prevalence Lifetime prevalence ranged from 14.2% to 99% and reported by 37 studies 12 past months prevalence ranged from 4.5% to 46% Prevalence by types of violence Physical lifetime ranged: 5.3% to 50.4% (n=24) v.s 17.4% to 52.2% in 12 past months Sexual lifetime ranged : 0.6% to 65% (n=18) v.s 3.4% to 13.4% Emotional/psychological lifetime: 9.2% to 67.5% (n=10) vs 10.8% to 51% 11

During Pregnancy (n=8 studies) Result (2) con’t During Pregnancy (n=8 studies) Overall Ranged from 2.3% to 48.6% Physical violence: 16.5% from 1 study Sexual violence : 26.5% one study reporting 12

Result (3) Determinants (n=32 studies) Low education reported by 17 studies Polygamous unions reported by 13 studies Low socio-economic status (n=11 studies) Alcohol consumption (n=11 studies) Young age (n=6 studies) History of violence (n=5 studies) Household size (n=5 studies) Pregnancy and use of contraceptives 13

Result (4) Relationship with HIV OR IC 95% p-value n=10 studies HIV positive women 2.38 1.59-3.57 Perception of HIV status 3.72 2.81-4.92 <.0001 Age younger women (<30years) 9.99 2.67-37.37 Having a HIV negative spouse 3.1 2.4-5.3 Experience of violence before diagnosed HIV+ 44.4 10.3-190.4 Having HIV positive child 9,2 4.5-18.8 14

Result (5) Attitudes (n=17 studies) Reasons (11 studies) - Woman disobeyed husband/elders - Woman’s refusal of sex - Arguments over money - Suspected infidelity woman/husband - Women’s insistence on use of condom - Woman used contraception without permission - Woman suspected to be HIV positive - Husband drunk - Neglects children - Going out without informing husband 15

Result (6) Consequences (n=24 studies) women’s health or illnesses (n=8 studies) Obstetrical complications Depressive symptoms Health risk behaviors : alcohol, smoking (n=3) Infant illnesses or death (n=6 studies) Diarrhea Sexual risks (n=9) HIV, STIs. HSV2 (n=7) Inconstant condom use Non-use female contraceptive 16

Result (7) Limitations (n=46 studies) Cross sectional design Information and selection biases Underreporting of violence Generalization to whole population (n=9 studies) Small size of sample (n=6 studies) 17

Discussion Our Study Past 12 months During pregnancy (n=8) Overall prevalence 4.5% to 46% Physical: 17.4% to 52.2% During pregnancy (n=8) Overall: 2.3% to 48.6% Physical: 16.5% (n=1) Sexual : 26.5% (n=1) Recent systematic review Shamu et al, 2011 Past 12 months Overall prevalence 14.2% to 43.4% Physical: 14% to 41% During Pregnancy (n=13) Overall: 2.7 to 26.5% Physical: 22% to 40% (n=4) Sexual: 2.7% to 35% (n=6)) 18

Conclusion Strong association between intimate partner violence and several determinants as risks factors Demonstrated the strong association between wife beating and health/illnesses outcomes issues (obstetrical complications, negative health behavior issues (Smoking, alcohol drinking) and women’s depression or mental problems. Main reasons justifying wife beating demonstrated Violence against women is sustained by women’s positive attitudes, religious and socio-cultural acceptability Further future research to elucidate the temporal relationship should be undertaken.

Acknowledgements ISPED SIDACTION Tutors 20

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