Measuring Sexual and Gender-Based Violence at the University of Cape Coast: Developing and Deploying a Campus Climate Survey.

AIMS: Sexual and gender-based violence (SGBV) is a global public health crisis, impacting university youth around the world. The purpose of this study was twofold: (a) determine the best methodology for conducting a campus climate survey at the University of Cape Coast (UCC) in Ghana and (b) gather data on SGBV knowledge, attitudes, and behaviors from a representative sample of students. METHODS: This descriptive study included three phases: (a) develop a campus climate survey unique to UCC, (b) develop a sampling methodology, and (c) deploy the first ever campus climate survey at UCC. RESULTS: A 71-item survey was developed and then administered via a student portal to 2,000 students. Of those students, 1,381 (69.1%) responded. Although most students (63.2%) know the university has a sexual harassment policy, fewer have seen it (25.9%) or read it (22.3%). Students held generally positive views of how the university would respond to reports of sexual harassment, although 50.2% of participants believed the reporter would be labeled a troublemaker. More participants reported seeking and giving verbal than nonverbal consent, and more men than women reported both seeking and giving verbal consent. More men than women reported they "always" sought verbal consent (61.2% vs. 47.7%, p = 0.001). Most students ( n = 316, 56.5%) sought verbal consent all of the time, and an additional 99 (17.7%) sought it most of the time. CONCLUSIONS: Accurate data about students' knowledge, attitudes, and experiences with SGBV policy, prevention, and response are needed globally to better inform locally appropriate practices. POTENTIAL IMPACT OF CAMPUS INTIMATE PARTNER VIOLENCE AND SEXUAL ASSAULT ON FORENSIC NURSING: Forensic nursing is currently localized in high-income countries. University students' knowledge, attitudes, and experiences with SGBV can support the expansion of forensic nursing research and practice to low- and middle-income countries.

Impact of employer-covered planned oocyte cryopreservation on decision-making for medical training.

PURPOSE: To characterize how employer coverage of planned oocyte cryopreservation (POC) might impact medical career decision-making. METHODS: A cross-sectional survey was distributed to all medical students at two large academic programs in December 2022 to better understand attitudes towards childbearing, POC, and how employer coverage of POC might influence future career decisions. RESULTS: Of the 630/1933 (32.6%) medical students who participated, 71.8% identified as women and 28.1% as men. More women (89.2%) than men (75.1%, P < 0.001) felt pressure to delay childbearing. Regarding childbearing, women more than men were concerned about the physical demand of residency (76.5% vs. 50.8%, P < 0.001), stigma in residency hiring practices (41.2% vs. 9.0%, P < 0.001), and parental leave interfering with team dynamics (49.6% vs. 20.9%, P < 0.001). Respondents were more likely to pursue POC if it were covered by residency employer health insurance (60.0% vs. 11.6%, P < 0.001). Women were more likely than men to state that employer-sponsored POC would influence their residency ranking (46.0% vs. 23.7%, P < 0.001), pursuit of additional degrees (50.9% vs. 30.5%, P < 0.001), and pursuit of fellowship training (50.9% vs. 30.5%, P < 0.001). Additionally, 25.4% of women and 19.8% of men felt their choice in medical specialty would be impacted by employer-sponsored POC. CONCLUSIONS: Medical students, particularly women, feel pressure to delay childbearing during medical training and are concerned about future fertility. Both male and female students were interested in employer-sponsored POC and more likely to pursue it with financial coverage. Further research is needed to determine the full impact of employer-sponsored POC on medical career decision-making.

Norethindrone dosing for adequate menstrual suppression in adolescents.

OBJECTIVES: We sought to study factors predictive of achieving menstrual suppression with norethindrone vs. norethindrone acetate in adolescents, as optimal dosing is unknown. Secondary outcomes included analyzing prescriber practices and patient satisfaction. METHODS: We performed a retrospective chart review of adolescents ages <18 years presenting to an academic medical center from 2010 to 2022. Data collected included demographics, menstrual history, and norethindrone and norethindrone acetate use. Follow-up was measured at one, three, and 12 months. Main outcome measures were starting norethindrone 0.35 mg, continuing norethindrone 0.35 mg, achieving menstrual suppression, and patient satisfaction. Analysis included Chi-square and multivariate logistic regression. RESULTS: Of 262 adolescents initiating norethindrone or norethindrone acetate, 219 completed ≥1 follow-up. Providers less often started norethindrone 0.35 mg for patients with body mass index ≥25 kg/m2, prolonged bleeding, or younger age at menarche, but more often for patients who were younger, had migraines with aura, or were at risk of venous thromboembolism. Those with prolonged bleeding or older age at menarche were less likely to continue norethindrone 0.35 mg. Obesity, heavy menstrual bleeding, and younger age were negatively associated with achieving menstrual suppression. Patients with disabilities reported greater satisfaction. CONCLUSIONS: While younger patients more often received norethindrone 0.35 mg vs. norethindrone acetate, they were less likely to achieve menstrual suppression. Patients with obesity or heavy menstrual bleeding may achieve suppression with higher doses of norethindrone acetate. These results reveal opportunities to improve norethindrone and norethindrone acetate prescribing practices for adolescent menstrual suppression.

Contraceptive counseling in 2 urban cities in Ghana and the extent of shared decision-making.

BACKGROUND: Increased use of contraception is associated with reduced maternal mortality worldwide; however, an unmet need remains high in many places, including Ghana. The quality of care provided by family planning practitioners influences contraceptive use; one way to improve the quality of care is to adopt a client-centered approach to counseling, including engaging in shared decision-making. In Ghana, little is currently known about the extent of shared decision-making between clients and providers in contraceptive counseling encounters. OBJECTIVE: The purpose of this study was to explore the extent of shared decision-making during contraceptive counseling in 2 cities in Ghana. STUDY DESIGN: This was a cross-sectional study across 6 urban family planning clinics in Accra and Kumasi, Ghana. We recorded, transcribed, and analyzed 20 family planning patient-provider interactions using the "Observing PatienT InvOlvemeNt" (OPTION) scale. This scale has 12 domains, which are scored on a 5-point scale, from 0 ("the behavior is not observed") to 4 ("the behavior is observed and executed at a high standard"); the scores of each domain are summed up for a total score ranging from 0 to 48. RESULTS: In these encounters, the mean total scores for each interaction ranged from a low of 9.25/48 to a high of 21.5/48. Although providers were thorough in sharing medical information with clients, they did not actively involve clients in the decision-making process and did not generally elicit client preferences. Across the 12 domains, the mean total score was 34.7%, which is below the 50% that would correspond with a "baseline skill level," suggesting there are very low levels of shared decision-making currently occurring. CONCLUSIONS: In these 20 patient-provider encounters, counseling was mainly a sharing of medical information from the provider with the client, without the provider eliciting information from the client about her preferences for method characteristics, side effects, or method preference. Family planning counseling in these settings would benefit from increased shared decision-making to engage patients in their contraceptive choice.

The Utility of Pelvic Ultrasounds in Adolescents Presenting to the Emergency Department with Abnormal Uterine Bleeding.

STUDY OBJECTIVE: To analyze what factors influence a provider's decision to order a pelvic ultrasound (PUS) in the emergency department (ED) for adolescents with abnormal uterine bleeding (AUB), to determine if endometrial stripe (EMS) measurements are used in treatment decisions, and to evaluate if treatment outcomes differ based on EMS thicknesses. METHODS: Retrospective chart review of patients aged 11-19 presenting to the ED with AUB from 2006 to 2018. Those receiving a PUS were divided into three EMS groups: ≤5 mm, 6-9 mm, and ≥10 mm. Outcomes were evaluated in admitted patients by progress notes indicating resolution of bleeding. Cross-tab, χ2, and logistic and linear regression analysis were performed. RESULTS: Of 258 adolescents meeting study criteria, 113 (43.8%) had a PUS. None had an abnormality. A PUS was more likely to be performed in patients with lower hemoglobin values (P < .003). Provider decision to order a PUS did not differ by age or bleeding duration (P > .1). Among those with a PUS, 67 (59%) received hormonal therapy (pill, progestin-only, IV estrogen). There were no significant differences in treatment choices based on EMS (P < .061) or, among the 44 admitted patients (17%), in the time it took bleeding to stop after initiating treatment (pill: P = .227, progestin-only: P = .211, IV estrogen: P = .229). CONCLUSION: In adolescents with AUB in the ED, performing a PUS was more common in those with low hemoglobin. EMS thickness did not appear to affect treatment decisions or inpatient outcomes. Larger studies are needed to confirm the current findings and determine if PUS is needed in the evaluation of AUB.

The potential impact of neighboring states' bans on abortion volume in a haven state.

OBJECTIVES: We explored the potential impact of abortion bans in neighboring states on Michigan's abortion volume. STUDY DESIGN: Using ArcGIS mapping software, we determined which counties in neighboring states had their closest out-of-state abortion clinic in Michigan. We estimated the change in abortions in Michigan occurring from neighboring states' residents, assuming complete bans in those states. RESULTS: Complete bans in neighboring states could increase abortion volume in Michigan by approximately 5928 out-of-state patients annually (21% increase). CONCLUSIONS: Complete bans in neighboring states may markedly increase abortions occurring in Michigan, which may strain Michigan facilities' capacity to provide abortion care.

The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche.

OBJECTIVES: We sought to evaluate the impact of estrogen-containing treatment for heavy menstrual bleeding (HMB) on subsequent height compared to progesterone-only or non-hormonal treatment when initiated at menarche. METHODS: We performed a retrospective chart review of adolescent females aged 10-15 years who presented to an institution-affiliated outpatient, inpatient, or emergency setting for management of HMB within three months of menarche. Growth records over a 2 year period starting at menarche were recorded, and comparisons made among patients treated with 1) estrogen, 2) progesterone, and 3) non-hormonal methods (controls). Groups were compared using bivariate analysis with Chi-square or Fisher's exact test and linear regression. RESULTS: In an analysis of 80 patients at 24 months, the mean increase in height from menarche was 6.4 cm among controls (n=54), 7.2 cm among the progesterone-only group (n=10), and 3.8 cm among the estrogen group (n=16). The estrogen group's increase in height was significantly lower than the control group's, by a mean of 1.8 cm (p=0.04). Change in height did not differ significantly between the progesterone and control groups (p=0.87). Additionally, for every year younger at menarche, there was 1 fewer cm of growth (change in height) at 24 months after menarche (p<0.002). CONCLUSIONS: Estrogen-containing treatment for HMB initiated within three months of menarche was associated with reduced growth at 24 months compared to progesterone-only or non-hormonal methods. The clinical applicability of the estrogen group's 1.8 cm absolute reduction in height may have considerable significance for those who are shorter at baseline.

Benefits and barriers of home blood pressure monitoring in pregnancy: perspectives of obstetric doctors from a Ghanaian tertiary hospital.

BACKGROUND: Delayed diagnosis of preeclampsia contributes to maternal morbidity and mortality. Patient-performed home blood pressure monitoring facilitates more frequent monitoring and earlier diagnosis. However, challenges may exist to implementation in low- and middle income-countries. METHODS: This cross-sectional mixed methods study evaluated obstetric doctors' perspectives on the benefits of and barriers to the implementation of home blood pressure monitoring among pregnant women in Ghana. Participants were doctors providing obstetric care at Korle Bu Teaching Hospital. Electronic surveys were completed by 75 participants (response rate 49.3%), consisting of demographics and questions on attitudes and perceived benefits and challenges of home BP monitoring. Semi-structured interviews were completed by 22 participants to expand on their perspectives. RESULTS: Quantitative and qualitative results converged to highlight that the current state of blood pressure monitoring among pregnant women in Ghana is inadequate. The majority agreed that delayed diagnosis of preeclampsia leads to poor health outcomes in their patients (90.6%, n = 68) and earlier detection would improve outcomes (98.7%, n = 74). Key qualitative benefits to the adoption of home blood pressure monitoring were patient empowerment and trust of diagnosis, more quantity and quality of blood pressure data, and improvement in systems-level efficiency. The most significant barriers were the cost of monitors, lack of a communication system to convey abnormal values, and low health literacy. Overall, doctors felt that most barriers could be overcome with patient education and counseling, and that benefits far outweighed barriers. The majority of doctors (81.3%, n = 61), would use home BP data to inform their clinical decisions and 89% (n = 67) would take immediate action based on elevated home BP values. 91% (n = 68) would recommend home BP monitoring to their pregnant patients. CONCLUSION: Obstetric doctors in Ghana strongly support the implementation of home blood pressure monitoring, would use values to inform their clinical management, and believe it would improve patient outcomes. Addressing the most significant barriers, including cost of blood pressure monitors, lack of a communication system to convey abnormal values, and need for patient education, is essential for successful implementation.

Give women what they want: contraceptive discontinuation and method preference in urban Ghana.

BACKGROUND: Unmet need for contraception remains high in Ghana. Reducing the number of women who discontinue their contraceptive use is one way to decrease the number of women with an unmet need. In this study, we investigated factors associated with discontinuation among a cohort of Ghanaian women. METHODS: Women who were beginning a new method of contraception at one of six urban clinics in Accra and Kumasi, Ghana were invited to participate in our study. Participants were interviewed before and after their counseling session, and at 3-, 6-, 9-, and 12-months post-enrollment to determine continuation. During follow-up, participants who were no longer using their method were asked why, if they were using any method of contraception, and if so, which method. Logistic regression analysis was performed to identify factors associated with discontinuation for reason other than pregnancy or desired pregnancy. RESULTS: Of the 472 women who reported leaving their counseling session with a method, 440 (93.2%) had at least one follow-up contact. Of the 440 women, 110 (25%) discontinued their method at some point over the 12-month period, and 94 (85.5%) did so for reasons other than pregnancy or desired pregnancy. In the multivariate regression analysis, women who reported they were given their method of choice were 12.0% less likely to discontinue due to a non-pregnancy reason (p=0.005); those who used a long-acting reversible contraceptive (LARC) method were 11.1% less likely (p=.001); and those who reported they would choose to use that method again, one measure of satisfaction, were 23.4% less likely (p<.001). CONCLUSIONS: To our knowledge, the current study is the first to explore method preference and its relation to continuation. Women in our study who reported they were given the contraceptive method of their choice were less likely to discontinue using that method for non-pregnancy-related reasons. Further, those who adopted a LARC method and those who reported they would make the same method choice again were less likely to discontinue. Women should be supported in selecting a contraceptive method of their choice. Providers should work with their clients to find a method which meets their preferences.

Danger and sexuality: exploring negotiations in romantic and sexual relationships among university students in Ghana.

Gender inequalities and social mores normalise gender-based violence in many settings. The goal of this study was to gain a more in-depth understanding of romantic and sexual relationships, consent, and gender-based violence among university students in Ghana. We used focus group discussions to explore individual factors influencing romantic and sexual relationships among students enrolled at a university in the Central Region of the country to inform the development and tailoring of future interventions. During a series of four focus group discussions comprising students recruited via convenience and snowball sampling, participants were asked to reflect on the nature of their romantic and sexual relationships. Demographic data and experiences of gender-based violence were also collected. The focus groups discussions were recorded and transcribed verbatim and analysed thematically. Five themes were developed from the data: (1) traditional gender roles; (2) self-control; (3) relationship-based consent; (4) cheating; and (5) non-verbal communication. This study suggests negative health and social ramifications of violence will continue until there is a resolution of conflicting social norms that result in different expectations about how men and women can address their sexual needs. Future programming and interventions for gender-based violence prevention should reflect on their impact across all ecological levels.

COVID-19 and Decision-Making for Pregnant Women: Taking or Relinquishing Control in Response to a Pandemic.

COVID-19 has uniquely impacted pregnant women. From the initial unknowns about its virulence during pregnancy, to frequent and rapidly changing hospital guidelines for prenatal care and delivery, pregnant women have felt intense uncertainty and, based on recent research, increased anxiety. This study sought to determine the impact COVID-19 had on women's birth plans. Open-ended qualitative responses from an anonymous, online survey of pregnant women in the United States, conducted on April 3-24, 2020, were analyzed using the Attride-Stirling qualitative framework. A conceptual framework for understanding the impact of COVID-19 on women's birth plans was generated. 2,320 pregnant women (mean age 32.7 years, mean weeks pregnant 24.6 weeks) responded to the open-ended prompts, reflecting the following themes: the impact(s) of COVID-19 on pregnant women (including unanticipated changes and uncertainty), the effect of COVID-19 on decision-making (including emotional reactions and subsequent questioning of the healthcare system), and how both of those things led women to either exercise or relinquish their agency related to their birth plan. These findings indicate that the changes and uncertainty surrounding COVID-19 are causing significant challenges for pregnant women, and absent more clarity and more provider-driven support, women seeking to cope are considering changes to their birth plans. Health systems and providers should heed this warning and work to provide pregnant women and their families with more information, support, and collaborative planning to ensure a positive, healthy birth experience, even during a pandemic.

Attitudes, experiences, and training on comprehensive abortion care: A nationwide survey of trainee physicians in Ghana.

This cross-sectional study assessed attitudes and experiences with abortion care among physician trainees in Ghana. Participants were 27 Obstetrics/Gynecology (OBGYN) residents and 138 house officers. An electronic survey evaluated attitudes, training, clinical experience, and technical skills with abortion care. The majority of participants believe that women should have access to safe abortion. However, only 51.6% of OBGYN residents and 40.9% of house officers want to currently perform abortions as a trainee, primarily due to religious or ethical beliefs. Among house officers, increased likelihood of performing abortions in their future practice is associated with greater exposure to abortion training, (OR 1.40, p=0.032), fewer years practicing medicine (OR 0.26, p=0.010), and believing abortion laws should be liberalized (OR 3.62, p=0.03). Overall, we demonstrate that only two-thirds of physician trainees in Ghana are likely to perform abortion care after completing training, and greater exposure to abortion training is associated with an increased likelihood of performing abortions.

Understanding Stalking Among University Students in Ghana: A Mixed-Methods Study.

The purpose of this study is to explore experiences of stalking behaviors among midwifery students at one Ghanaian university, as well as their association with mental health disorders. Specifically, this study had the following three aims: (a) to identify the frequency of stalking experiences in this population; (b) to explore mental health symptoms, such as depression and anxiety, within this population; and (c) to better understand intervention opportunities related to stalking, including bystander intervention and use of available resources. The study utilized an exploratory mixed-methods design with surveys (n = 118) and focus group discussions (n = 2 with 16 participants) with midwifery students recruited from a centrally located Ghanaian university campus in July of 2018 using convenience sampling. Results indicate a large percentage (80.3%) of participants have experienced stalking behavior(s) within the last six months. Multiple regression analyses demonstrate a statistically significant relationship between any stalking behaviors and depressive symptomatology as well as between unwanted monitoring/following and anxiety. This was reinforced by focus group discussions in which participants discussed the themes of: (a) types of stalking, with a heavy emphasis on using technology for unwanted following/monitoring; (b) positive versus negative perceptions of stalking intentions, where some types of monitoring and following could be seen as forms of flattery or interest; and (c) barriers to seeking help that focused on stigma, cultural barriers, systemic barriers, and personal barriers. Future research should delve more deeply into barriers to existing resources to identify ways to increase accessibility for stalking survivors in connection with mental health services. This study also highlights the need for additional research to more clearly understand stalking in Ghana so that interventions can begin to address mental health services, healthy relationships, communication, and consent.

The impact of COVID-19 on prenatal care in the United States: Qualitative analysis from a survey of 2519 pregnant women.

OBJECTIVE: To explore if and how women perceived their prenatal care to have changed as a result of COVID-19 and the impact of those changes on pregnant women. DESIGN: Qualitative analysis of open-ended prompts included as part of an anonymous, online, cross-sectional survey of pregnant women in the United States. SETTING: Online survey with participants from 47 states within the U.S. PARTICIPANTS: Self-identified pregnant women recruited through Facebook, Twitter, and other online sources. MEASUREMENTS AND FINDINGS: An anonymous, online survey of pregnant women (distributed April 3 - 24, 2020) included an open-ended prompt asking women to tell us how COVID-19 had affected their prenatal care. Open-ended narrative responses were downloaded into Excel and coded using the Attride-Sterling Framework. 2519 pregnant women from 47 states responded to the survey, 88.4% of whom had at least one previous birth. Mean age was 32.7 years, mean weeks pregnant was 24.3 weeks, and mean number of prenatal visits at the point of the survey was 6.5. Predominant themes of the open narratives included COVID-19's role in creating structural changes within the healthcare system (reported spontaneously by 2075 respondents), behavioral changes among both pregnant women and their providers (reported by 429 respondents), and emotional consequences for women who were pregnant (reported by 503 respondents) during the pandemic. Changes resulting from COVID-19 varied widely by provider, and women's perceptions of the impact on quality of care ranged from perceiving care as extremely compromised to perceiving it to be improved as a result of the pandemic. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women who are pregnant during the COVID-19 pandemic have faced enormous upheaval as hospitals and healthcare providers have struggled to meet the simultaneous and often competing demands of infection prevention, pandemic preparedness, high patient volumes of extremely sick patients, and the needs of 'non-urgent' pregnant patients. In some settings, women described very few changes, whereas others reported radical changes implemented seemingly overnight. While infection rates may drive variable responses, these inconsistencies raise important questions regarding the need for local, state, national, or even global recommendations for the care of pregnant women during a global pandemic such as COVID-19.

Post-abortion contraceptive adoption in Ethiopia.

OBJECTIVE: To assess the effect of couple counseling on modern contraception adoption among women receiving abortions. METHODS: A cross-sectional study was conducted between October 2019 and May 2020 at the abortion clinic of Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Women receiving abortion care were interviewed using Open Data Kit. Logistic regression was used to assess predictors of modern contraception adoption. RESULTS: During the study period, a total of 326 women receiving abortion care were interviewed and 112 (34.4%) received couple counseling. Of the 112, 89 (79.5%) adopted modern contraception. The odds of using a modern contraceptive method were 2.34 times higher among women whose partner approved (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.05-5.22) compared with those without partner approval. The odds of using a modern contraceptive method was 1.78 times higher among women who believed they had partner support (aOR 1.78; 95% CI 1.03-3.10) compared with women without support. CONCLUSION: Few women received couple counseling for contraception. Partner approval and a woman's belief that her partner supports her contraception decision were associated with contraception adoption.

Preferences and perspectives on vaginal breech delivery in Ghana.

OBJECTIVE: To evaluate obstetrician/gynecologist and midwife perspectives and experiences with vaginal breech deliveries in Ghana. METHODS: Respondents completed a survey on their experiences, training, comfort levels, and decision making about vaginal breech deliveries. Comparisons were made across obstetricians/gynecologists and midwives. Multiple logistic regression explored predictors of comfort performing vaginal breech deliveries. RESULTS: Respondents comprised 93 (36.5%) obstetricians/gynecologists and 162 (63.5%) midwives. Most believed that some breech fetuses should be delivered vaginally, with higher agreement from obstetricians/gynecologists than from midwives (n = 86, 97.7% versus n = 207, 80.8%, P = 0.001). Midwives were more likely to strongly agree that training was adequate for obstetricians/gynecologists (n = 65, 55.6% versus n = 8, 9.8%, P < 0.001) and midwives (n = 60, 49.6% versus n = 6, 7.4%, P < 0.001). Most (n = 192, 94%) respondents wanted more experience and/or training. Despite most providers performing only one ot five breech vaginal deliveries yearly, 77.4% (n = 199) were comfortable performing them and 79.5% (n = 202) were comfortable supervising them. Significant predictors of comfort performing vaginal breech delivery were perceived adequacy of training (odds ratio 8.74, 95% CI 3.39-22.52) and belief that vaginal breech deliveries should be performed (odds ratio 4.28, 95% CI 1.33-13.72). CONCLUSION: Respondents were more likely to feel comfortable performing breech vaginal deliveries if they felt that their training was adequate. Vaginal breech deliveries can only be offered as safe alternatives to cesarean delivery if training and experience are maintained in low-resource settings.

Intimate partner violence among prenatal care attendees amidst the COVID-19 crisis: The incidence in Ethiopia.

OBJECTIVE: To assess the incidence and predictors of intimate partner violence (IPV) during pregnancy amidst the coronavirus disease 2019 pandemic. METHODS: This cross-sectional study was conducted at the prenatal care clinic of St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, among pregnant women from 31 August to 2 November 2020. Participants were interviewed using Open Data Kit. Logistic regression was used to assess predictors. RESULTS: Among the 464 pregnant women, 33 (7.1%) reported IPV during pregnancy, and among these 24 (72.7%) reported emotional violence, 16 (48.5%) reported sexual violence, and 10 (30.3%) reported physical violence. Among the study participants, only 8 (1.7%) were screened for IPV. IPV was reported 3.27 times more often by women who reported that their partner chewed Khat compared with those women whose partner did not (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.45-7.38), and 1.52 times more often women who reported that their partner drank alcohol compared with those women whose partner did not (aOR 1.52; 95% CI 1.01-2.28). CONCLUSION: Very few women were screened for IPV. Partners drinking alcohol and chewing Khat are significantly positively associated with IPV during pregnancy. IPV screening should be included in the national management protocol of obstetric cases of Ethiopia.

Building Master Trainers to Facilitate Sexual Violence Prevention: A Pilot Study in Ghana.

Background: Sexual violence is a widespread human rights violation that affects women and girls throughout the world, with particularly high rates among college-age youth. In the United States, many universities have developed primary prevention education programs to comply with federal mandates; however, these programs are limited in sub-Saharan Africa. Objectives: The purpose of this pilot study is to describe and evaluate the training of peer facilitators for a sexual violence prevention program at two universities in Ghana; the University of Cape Coast and Kwame Nkrumah University of Science and Technology. Methods: A three-day "master trainer" training was held focusing on sexual violence, sexual health, bias, healthy relationships, and facilitation skills. Participants completed pre- and post-test evaluations on knowledge, attitudes, and skills related to the topics and participants from the University of Cape Coast also participated in a focus group about bias and self-care. Findings: Participants (n = 23) at both universities demonstrated significant changes in the domains of: self-care knowledge, sexual violence knowledge, rape myth acceptance, and facilitation skills. Conclusions: This study provides early evidence about training methods for primary prevention programs aimed at students on university campuses in sub-Saharan Africa. Further research is needed on peer-facilitation, training, and primary prevention programs related to sexual violence for university students in sub-Saharan Africa.