A systematic review of African studies on intimate partner violence against pregnant women: prevalence and risk factors

Background

Intimate partner violence (IPV) is very high in Africa. However, information obtained from the increasing number of African studies on IPV among pregnant women has not been scientifically analyzed. This paper presents a systematic review summing up the evidence from African studies on IPV prevalence and risk factors among pregnant women.

Methods

A key-word defined search of various electronic databases, specific journals and reference lists on IPV prevalence and risk factors during pregnancy resulted in 19 peer-reviewed journal articles which matched our inclusion criteria. Quantitative articles about pregnant women from Africa published in English between 2000 and 2010 were reviewed. At least two reviewers assessed each paper for quality and content. We conducted meta-analysis of prevalence data and reported odds ratios of risk factors.

Results

The prevalence of IPV during pregnancy ranges from 2% to 57% (n = 13 studies) with meta-analysis yielding an overall prevalence of 15.23% (95% CI: 14.38 to 16.08%). After adjustment for known confounders, five studies retained significant associations between HIV and IPV during pregnancy (OR1.48–3.10). Five studies demonstrated strong evidence that a history of violence is significantly associated with IPV in pregnancy and alcohol abuse by a partner also increases a woman''s chances of being abused during pregnancy (OR 2.89–11.60). Other risk factors include risky sexual behaviours, low socioeconomic status and young age.

Conclusion

The prevalence of IPV among pregnant women in Africa is one of the highest reported globally. The major risk factors included HIV infection, history of violence and alcohol and drug use. This evidence points to the importance of further research to both better understand IPV during pregnancy and feed into interventions in reproductive health services to prevent and minimize the impact of such violence.     

Rape revisited: sexual violence against women in the former Yugoslavia

This article presents information on the rape of women in the former Yugoslavia, focusing more on Muslim women in Bosnia-Herzegovina, and examines the evolutionary, sociological, psychological, and feminist theories of this form of sexual violence. Using a case study approach, through documentation from newspapers and other media accounts, this paper investigated the sexual violence that featured strongly in the campaign of ethnic cleansing or genocide of Muslims in Bosnia-Herzegovina. It was noted that the variables of power, sex, and aggression in the context of war seem to be linked. This is particularly evident when authority legitimates sexual aggression. Without the backing of authority, some rape is expected, but not of such proportion or brutality. In terms of the theories, the evolutionary perspective appears to have limited applicability in explaining rape as an act of war. However, the feminist and macrosociological multivariate theories that focus on heterogeneity of the population, a cultural foundation of very traditional gender roles, and a historical tradition that legitimates sexual violence by armies in war-time, provide more persuasive insights.     

Physical violence against intimate partners and related exposures to violence among South African men

Background

Despite high rates of intimate partner violence in South Africa, there have been no national studies of men''s perpetration of violence against female partners.

Methods

We analyzed data from the South Africa Stress and Health Study, a cross-sectional, nationally representative study, specifically examining data for men who had ever been married or had ever cohabited with a female partner. We calculated the prevalence of physical violence against intimate female partners and used logistic regression to examine associations with physical abuse during childhood and exposure to parental and community violence.

Results

A total of 834 male participants in the South Africa Stress and Health Study met the study criteria. Of these, 27.5% reported using physical violence against their current or most recent female partner during their current or most recent marriage or cohabiting relationship. Crude odds ratios (ORs) and 95% confidence intervals (CIs) indicated significant associations between perpetration of violence against an intimate partner and witnessing parental violence (OR 3.91, 95% CI 2.66–5.73) or experiencing physical abuse during childhood (OR 3.24, 95% CI 2.27–4.63), but not exposure to community violence (OR 1.29, 95% CI 0.88–1.88). The 2 significant associations persisted in adjusted analyses: OR 3.22 (95% CI 1.94–5.33) for witnessing parental violence and OR 1.73 (95% CI 1.07–2.79) for experiencing physical abuse during childhood.

Interpretation

We found a high prevalence of physical violence perpetrated by men against their intimate partners. Men who experienced physical abuse during childhood or were exposed to parental violence were at the greatest risk.Most research about men''s perpetration of violence against female intimate partners has concentrated on elucidating the factors that put women at risk for experiencing such violence and identifying the related service needs. Less work has been done to investigate the factors affecting men''s risk of perpetrating violence against women. Such work is needed to inform development of empirically based public health programs to reduce men''s use of such violence. Intimate partner violence is of pandemic proportions, with global estimates indicating that 15% to 75% of women have experienced such abuse.^1,2 Such violence may confer grave health consequences, including transmission of HIV/AIDS.³The overwhelming majority of research on violence against intimate partners perpetrated by men has been conducted in Western countries, with the focus on men at high risk for such activity (e.g., prisoners, people enrolled in intervention programs for batterers).^4,5 This work has highlighted the importance of exposure to violence early in life (e.g., witnessing parental violence, experiencing child abuse) in predicting perpetration of violence against a partner during adulthood.⁶ Recently, the potential relations between community violence and men''s perpetration of violence against intimate partners have also been examined.⁷Fewer studies have been done in developing nations, but several notable investigations have recently assessed men''s perpetration of violence against intimate partners in South Africa, specifically in Eastern Cape and Cape Town. Two of these studies have indicated high rates of violence against intimate partners: 31.8% in Eastern Cape⁸ and 42.3% in Cape Town.⁹ The extent to which these findings reflect national rates is unknown. Furthermore, work with both men and women in South Africa has demonstrated strong relations between violence (men''s perpetration and women''s victimization) and higher rates of sexually risky behaviours.^3,8 Associations between women''s experience as victims of intimate partner violence and HIV infection have also been documented.³ These data strongly suggest that men''s perpetration of violence against intimate partners is common in South Africa and that it may play an important role in this nation''s HIV epidemic,^3,8 which currently ranks highest in the world with respect to the number of people living with HIV.¹⁰In the study reported here, we sought to build upon prior work by using a national sample of South African men to examine the prevalence of physical violence perpetrated by men against their female intimate partners and potential violence-related risk factors (i.e., exposure to parental violence, experience of abuse in childhood and exposure to community violence).     

The power laws of violence against women: rescaling research and policies

Background

Violence against Women –despite its perpetuation over centuries and its omnipresence at all social levels– entered into social consciousness and the general agenda of Social Sciences only recently, mainly thanks to feminist research, campaigns, and general social awareness. The present article analyzes in a secondary analysis of German prevalence data on Violence against Women, whether the frequency and severity of Violence against Women can be described with power laws.

Principal Findings

Although the investigated distributions all resemble power-law distributions, a rigorous statistical analysis accepts this hypothesis at a significance level of 0.1 only for 1 of 5 cases of the tested frequency distributions and with some restrictions for the severity of physical violence. Lowering the significance level to 0.01 leads to the acceptance of the power-law hypothesis in 2 of the 5 tested frequency distributions and as well for the severity of domestic violence. The rejections might be mainly due to the noise in the data, with biases caused by self-reporting, errors through rounding, desirability response bias, and selection bias.

Conclusion

Future victimological surveys should be designed explicitly to avoid these deficiencies in the data to be able to clearly answer the question whether Violence against Women follows a power-law pattern. This finding would not only have statistical implications for the processing and presentation of the data, but also groundbreaking consequences on the general understanding of Violence against Women and policy modeling, as the skewed nature of the underlying distributions makes evident that Violence against Women is a highly disparate and unequal social problem. This opens new questions for interdisciplinary research, regarding the interplay between environmental, experimental, and social factors on victimization.     

Biosocial factors influencing women to become prostitutes in India

Abstract

Based on materials collected during a study of risk factors associated with cervix cancer among prostitutes in Domjur, Howrah, West Bengal, this report explores various biosocial factors which may lead women to prostitution. When family and marital ties fail or disintegrate for various reasons, the life situations which a woman encounters may themselves generate a “process” of anchorlessness. The failure of family support along with the lack of ability to provide for themselves due to poverty and illiteracy were key factors why the women in this study had adopted prostitution.     

Physical abuse during pregnancy: prevalence and risk factors

BACKGROUND: Violence during pregnancy is a health and social problem that poses particular risks to the woman and her fetus. To address the lack of Canadian information on this issue, the authors studied the prevalence and predictors of physical abuse in a sample of pregnant women in Saskatoon. METHODS: Of 728 women receiving prenatal services through the Saskatoon District public health system between Apr. 1, 1993, and Mar. 31, 1994, 605 gave informed consent to participate in the study and were interviewed in the second trimester. Of these, 543 were interviewed again late in the third trimester. During the initial interview, information was collected on the women''s sociodemographic characteristics, the current pregnancy, health practices and psychosocial variables. The second interview focused on the women''s experience of physical abuse during the pregnancy and during the preceding year, the demographic characteristics and the use of alcohol or illicit drugs by their male partner. RESULTS: In all, 31 (5.7%) of the women reported experiencing physical abuse during pregnancy; 46 (8.5%) reported experiencing it within the 12 months preceding the second interview. Of the 31 women 20 (63.3%) reported that the perpetrator was her husband, boyfriend or ex-husband. Although all ethnic groups of women suffered abuse, aboriginal women were at greater risk than nonaboriginal women (adjusted odds ratio 2.8, 95% confidence interval [CI] 1.0-7.8). Women whose partner had a drinking problem were 3.4 times (95% CI 1.2-9.9) more likely to have been abused than women whose partner did not have a drinking problem. Perceived stress and number of negative life events in the preceding year were also predictors of abuse. Abused women tended to report having fewer people with whom they could talk about personal issues or get together; however, they reported socializing with a larger number of people in the month before the second interview than did the women who were not abused. INTERPRETATION: Physical abuse affects a significant minority of pregnant women and is associated with stress, lack of perceived support and a partner with a drinking problem.     

Review of cardiovascular risk factors in women

Background: Although cardiovascular disease (CVD) is the leading cause of death in women in the United States, a knowledge gap persists regarding the mechanisms and management of CVD in women. Before treatment can be optimized, the role of cardiovascular risk factors must be elucidated.Objective: This review provides an updated assessment of cardiovascular risk factors in women, with a focus on cardiometabolic risk.Methods: MEDLINE and Cochrane Library databases, and statistics from the National Health and Nutrition Examination Survey and the American Heart Association, were searched from 1990 to September 2008 using the following terms: cardiovascular risk factors, women, gender, cardiometabolic risk, abdominal obesity, and metabolic syndrome. Publications were classified as English-only original data, reviews, and clinical guidelines. Nonpublished data were excluded. Data were extracted by 2 reviewers independently.Results: Investigators performing multivariable predictive models have estimated that traditional risk factors account for ~70% of the variance in estimating cardiovascular events. However, substantial sex differences exist in the prevalence of traditional risk factors as well as in cardiovascular outcomes. Hypertension is more prevalent in men until the age of 59 years, but then contributes to greater morbidity in older women. Low levels of high-density lipoprotein and elevated triglyceride levels pose more of a threat to women, yet high levels of low-density lipoprotein pose equal risk for women and men. The CVD mortality rate is -3 times greater in people with diabetes than in those without diabetes. Among diabetic individuals, CVD mortality is slightly higher in women compared with men.Conclusions: Increased knowledge of gender-specific risks for CVD has led to national campaigns to educate women. In addition to traditional risk factors, cardiometabolic risk is an important consideration in women. Controversy exists regarding the exact definitions and usefulness of the term metabolic syndrome, but it is clear that the presence of certain factors contributes to increased morbidity and mortality in affected individuals. Abdominal obesity links insulin resistance, dyslipidemia, and hypertension through complex endocrine pathways. Current research is identifying gene × gender interactions, and continued research is necessary to explore the relationship of sex steroids and cardiovascular risk in both men and women.     

Recovery after shift work: Relation to coronary risk factors in women

Shift work increases the risk for developing cardiovascular disease. There is, however, little knowledge of what aspects of shift scheduling that are detrimental and what characteristics promote good health. The aim of the present study was to evaluate whether coronary risk factors deteriorate after a hard work period and whether recovery, in the form of a week off, was sufficient to improve them. A total of 19 women worked an extremely rapidly rotating and clockwise shift schedule at a paper and pulp factory. They underwent two health examinations, one at the end of the work period and one after the week off. In addition, the women were divided into a tolerant and a vulnerable group, depending on their satisfaction with their work hours. Most risk factors did not change, but total cholesterol and low-density lipoprotein (LDL)-cholesterol were lower after the working period than after the week-off. In addition, vulnerable women had higher levels of total cholesterol and a higher ratio of total cholesterol/high-density lipoprotein (HDL) than tolerant ones. In conclusion, the finding that a week-off worsens cholesterol levels was against our hypothesis and suggests further studies on how activities/responsibilities outside the workplace affect shift-working women. It was also shown that susceptible shift workers had worse lipid profiles.     

Physical activity and risk of rheumatoid arthritis in women: a population-based prospective study

IntroductionOnly one study has analysed the association between exercise and development of rheumatoid arthritis (RA), showing no association. Aim of this paper was to evaluate the association of physical activity in all its aspect with RA.MethodsTo examine this association, middle age and elderly women from the Swedish Mammography Cohort, a population-based prospective study, were analysed. Data on physical activity were collected in 1997 by self-administrated food-frequency questionnaire. Risk of RA associated with physical activity was estimated using Cox proportional hazard regression models.ResultsAmong 30,112 women born between 1914 and 1948 followed-up from January 1, 2003 to December 31, 2010, 201 RA cases were identified (226,477 person-years). There was a statistically significant 35% lower risk of RA (relative risk (RR), 0.65; 95% confidence interval (CI), 0.43-0.96) among women in the highest category of leisure-time activity (combining more than 20 minute per day of walking/bicycling (median 40–60 minute per day) and more than 1 hour per week of exercise (median 2–3 hours per week)) as compared to women in the lowest category (less than 20 minute per day of walking/bicycling and less than 1 hour per week of exercise). A non-statistically significant decreased risk was observed for household work (−32%) and work/occupation (−15%), while an increased risk was observed for leisure-time physical inactivity (+27%). Daily energy expenditure was not associated with risk of RA.ConclusionsThis prospective population-based cohort study of women supports the hypothesis that physical activity can be a protective factor in the etiology of rheumatoid arthritis. Our results add to accumulated evidence on benefits of modifiable leisure-time physical activity for prevention of many other chronic diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-015-0560-2) contains supplementary material, which is available to authorized users.     

Magnitude and correlates of intimate partner violence against women and its outcome in Southwest Ethiopia

Background

Intimate Partner Violence (IPV) is a major public health problem with serious consequences. This study was conducted to assess the magnitude of IPV in Southwest Ethiopia in predominantly rural community.

Methods

This community based cross-sectional study was conducted in May, 2009 in Southwest Ethiopia using the World Health Organization core questionnaire to measure violence against women. Trained data collectors interviewed 851 ever-married women. Stata version 10.1 software and SPSS version 12.0.1 for windows were used for data analysis.

Result

In this study the life time prevalence of sexual or physical partner violence, or both was 64.7% (95%CI: 61.4%–67.9%). The lifetime sexual violence [50.1% (95% CI: 46.7%–53.4%)] was considerably more prevalent than physical violence [41.1% (95%:37.8–44.5)]. A sizable proportion [41.5%(95%CI: 38.2%–44.8%)] of women reported physical or sexual violence, or both, in the past year. Men who were controlling were more likely to be violent against their partner.

Conclusion

Physical and sexual violence is common among ever-married women in Southwest Ethiopia. Interventions targeting controlling men might help in reducing IPV. Further prospective longitudinal studies among ever-married women are important to identify predictors and to study the dynamics of violence over time.     

Fetal and infant growth and cardiovascular risk factors in women.

OBJECTIVE--To examine whether cardiovascular risk factors in women are related to fetal and infant growth. DESIGN--Follow up study of women born 1923-30 whose birth weights and weights at one year were recorded. SETTING--Hertfordshire. SUBJECTS--297 women born and still living in East Hertfordshire. MAIN OUTCOME MEASURES--Plasma glucose and insulin concentrations during a standard oral glucose tolerance test; fasting plasma proinsulin and 32-33 split proinsulin concentrations; blood pressure; fasting serum total, low density lipoprotein and high density lipoprotein cholesterol, triglyceride, and apolipoprotein A I and B concentrations; and plasma fibrinogen and factor VII concentrations. RESULTS--Fasting plasma concentrations of glucose, insulin, and 32-33 split proinsulin fell with increasing birth weight (P = 0.04, P = 0.002, and P = 0.0002 respectively, when current body mass index was allowed for). Glucose and insulin concentrations 120 minutes after an oral glucose load showed similar trends (P = 0.03 and P = 0.02). Systolic blood pressure, waist:hip ratio, and serum triglyceride concentrations also fell with increasing birth weight (P = 0.08, P = 0.07, and P = 0.07 respectively), while serum high density lipoprotein cholesterol concentrations rose (P = 0.04). At each birth weight women who currently had a higher body mass index had higher levels of risk factors. CONCLUSION--In women, as in men, reduced fetal growth leads to insulin resistance and the associated disorders: raised blood pressure and high serum triglyceride and low serum high density lipoprotein cholesterol concentrations. The highest values of these coronary risk factors occur in people who were small at birth and became obese. In contrast with men, low rates of infant growth did not predict levels of risk factors in women.     

Factors associated with sexual violence against men who have sex with men and transgendered individuals in Karnataka, India

Objectives

There is a lack of information on sexual violence (SV) among men who have sex with men and transgendered individuals (MSM-T) in southern India. As SV has been associated with HIV vulnerability, this study examined health related behaviours and practices associated with SV among MSM-T.

Design

Data were from cross-sectional surveys from four districts in Karnataka, India.

Methods

Multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV.

Results

A total of 543 MSM-T were included in the study. Prevalence of SV was 18% in the past year. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV (p = .104). In multivariable models, and among sex workers, those reporting SV were more likely to report anal sex with 5+ casual sex partners in the past week (AOR: 4.1; 95%CI: 1.2–14.3, p = .029). Increased physician visits among those reporting SV was reported only for those involved in sex work (ARR: 1.7; 95%CI: 1.1–2.7, p = .012).

Conclusions

These results demonstrate high levels of SV among MSM-T populations, highlighting the importance of integrating interventions to reduce violence as part of HIV prevention programs and health services.     

Lateral wedges decrease biomechanical risk factors for knee osteoarthritis in obese women

Obesity is the primary risk factor for the development and progression of medial compartment knee osteoarthritis. Laterally wedged insoles can reduce many of the biomechanical risk factors for disease development in osteoarthritis patients and lean individuals but their efficacy is unknown for at-risk, obese women. The purpose was to determine how an 8° laterally wedged insole influenced kinetic and kinematic gait parameters in obese women. Gait analysis was performed on fourteen obese (average 29.3 years; BMI 37.2kg/m(2)) and 14 lean control women (average 26.1 years; BMI 22.4kg/m(2)) with and without a full-length, wedged insole. Peak joint angles, the external knee adduction moment and its angular impulse were calculated during preferred and standard 1.24m/s walking speeds. Statistical significance was assessed using a 2-way ANOVA (α=0.05). The insole significantly reduced the peak external knee adduction moment (mean decrease of 3.6±3.9Nm for obese and 1.9±1.8Nm for controls) and its angular impulse in both groups. The wedged insoles also produced small changes in ankle dorsiflexion (obese: 1.2±1.4° increase; control: 1.5±1.4° increase) and eversion range of motion (obese: 1.3±1.9° decrease; control: 1.5±1.2° decrease) but did not alter peak angles of superior joints. Although the majority of obese women may develop knee osteoarthritis during their lifetime, a prophylactic insole intervention could allow obese women with no severe knee malalignments to be active while preventing or delaying disease onset. However, the long-term effects of the insole have not yet been examined.     

Assessment of hemolytic activity of bee venom against some physicochemical factors

Bee venom (BV) is a biotoxin with biologically active peptides which have cell lysis and hemolytic activity properties. These properties can be affected under different storage conditions or during the production process. In present study, we investigated effects of a number of physicochemical factors, including temperature, pH, UV radiation, ultrasound waves and storage time on hemolytic activity of BV. Maximum absorption and melting temperature of BV solution were obtained as 280 nm and ~70 °C, respectively. Cell hemolysis 50 (CH₅₀) -concentration of BV that can lyse 50% of red blood cells- was determined as 0.94 μg/ml at ambient temperature. CH₅₀ was shown not to be importantly varied at temperature up to 60 °C, pH value 2 to 13 and under UV/ ultrasound radiation. Storage at ?20, 6 and 25 °C for 6 months made about 2.5, 35 and 1000 times increase in CH₅₀. From the results, it may be concluded that BV is a relatively resistant hemolytic agent and can be used in a variety of laboratory research and product manufacturing methods.     

Incidence of and risk factors for Motor Neurone Disease in UK women: a prospective study

ABSTRACT: BACKGROUND: Motor neuron disease (MND) is a severe neurodegenerative disease with largely unknown etiology. Most epidemiological studies are hampered by small sample sizes and/or the retrospective collection of information on behavioural and lifestyle factors. METHODS: 1.3 million women from the UK Million Women Study, aged 56 years on average at recruitment, were followed up for incident and/or fatal MND using NHS hospital admission and mortality data. Adjusted relative risks were calculated using Cox regression models. FINDINGS: During follow-up for an average of 9.2 years, 752 women had a new diagnosis of MND. Age-specific rates increased with age, from 1.9 (95% CI 1.3 - 2.7) to 12.5 (95% CI 10.2 - 15.3) per 100,000 women aged 50-54 to 70-74, respectively, giving a cumulative risk of diagnosis with the disease of 1. 74 per 1000 women between the ages of 50 and 75 years. There was no significant variation in risk of MND with region of residence, socio-economic status, education, height, alcohol use, parity, use of oral contraceptives or hormone replacement therapy. Ever-smokers had about a 20% greater risk than never smokers (RR 1.19 95% CI 1.02 to 1.38, p=0.03). There was a statistically significant reduction in risk of MND with increasing body mass index (pfor trend=0.009): obese women (body mass index, 30 kg/m2 or more) had a 20% lower risk than women of normal body mass index (20 to <25 Kg/m2)(RR 0.78 95% CI 0.65-0.94; p=0.03). This effect persisted after exclusion of the first three years of follow-up. Interpretation. MND incidence in UK women rises rapidly with age, and an estimated 1 in 575 women are likely to be affected between the ages of 50 and 75 years. Smoking slightly increases the risk of MND, and adiposity in middle age is associated with a lower risk of the disease.     

Antifungal activity of some marine organisms from India,against food spoilage Aspergillus strains

Crude aqueous methanol extracts obtained from 31 species of various marine organisms (including flora land faunal), were screened for their antifungal activity against food poisoning strains of Aspergillus. Seventeen species exhibited mild (+ =zone of inhibition 1–2 mm) to significant (+++ =zone of inhibition 3–5 mm) activity against one or the other strain under experiment. However, extracts of 12 species were active against all the three strains. Organisms like Salicornia brachiata(obligate halophyte), Sinularia leptocladus(Soft coral), Elysia grandifolia (Mollusks),Gorgonian sp. 2 and Haliclona sp. exhibited significant (inhibition zone of 3–5 mm) antifungal activity against one or the other strains. However,extracts of A. ilicifolius, Amphiroa sp.,Poryphyra sp., Unidentified sponge, Suberites vestigium, Sinularia compressa,Sunularia sp., Sinularia maxima, Subergorgia suberosa, Echinogorgia pseudorassopo and Sabellaria cementifera were mild (inhibition zone of 1–2 mm) to moderate(inhibition zone of 2–3 mm) active against the respective strains. The growth of A. japonicuswas significantly inhibited by the extracts ofS. leptocladus (r = 0.992, p < 0.0001)and E. grandifolia (r = 0.989, p < 0.0001).This revised version was published online in October 2005 with corrections to the Cover Date.