Joint effect of maternal depression and intimate partner violence on increased risk of child death in rural Ethiopia.

OBJECTIVES: To assess independent and interaction effect of experience of intimate partner violence and depression on risk of child death. DESIGN: Community-based cohort design. SETTING: The study was conducted within the demographic surveillance site of Butajira Rural Health Program in south central Ethiopia. PARTICIPANTS: Women (n=561) who gave birth to a live child. MAIN OUTCOME MEASURES: Exposure status comprising physical, sexual and emotional violence by intimate partner was based on the WHO multi-country questionnaire on violence against women. Depression status was measured using the Composite International Diagnostic Interview. Risk of child death and its association with maternal exposure to violence and/or being depressed was analysed by incidence, rate ratios and interaction. RESULTS: The child death in the cohort was 42.1 (95% CI, 32.7 to 53.5) children per 1000 person years, and maternal depression is associated with child death. The risk of child death increases when maternal depression is combined with physical and emotional violence (RR=4.0; 95% CI, 1.6 to 10.1) and (RR=3.7; 95% CI, 1.3 to 10.4), showing a synergistic interaction. CONCLUSION: An awareness of the devastating consequences on child survival in low income setting of violence against women and depression is needed among public health workers as well as clinicians, for both community and clinical interventions.

Women's strategic responses to violence in Nicaragua.

STUDY OBJECTIVE: To describe the responses of women in León, Nicaragua to partner abuse and identify contextual factors associated with the use of certain coping mechanisms and the likelihood of permanent separation. DESIGN: Cross sectional population-based survey. SETTING: León, Nicaragua. PARTICIPANTS: 188 women 15-49 years of age who had experienced physical partner abuse, out of 488 women interviewed. MAIN RESULTS: 66% of women defended themselves effectively from abuse either physically or verbally. Forty one per cent of women had left home temporarily because of violence and 20% had sought help outside the home. Women experiencing severe abuse were more likely to leave or seek help, whereas women with less severe abuse were more able to defend themselves effectively. Seventy per cent of women eventually left abusive relationships. Help seeking and temporary separations increased the likelihood of a permanent separation, whereas women who defended themselves and were able to stop the violence, at least temporarily, were more likely to remain in abusive relationships. CONCLUSIONS: Women in Nicaragua use a variety of methods in order to overcome physical partner abuse. Temporary leaving and help seeking are critical steps in the process of leaving a violent relationship. However, many women indicated that they did not receive support for their situation. More interventions are needed to help women recognise and deal with violence, as well as strengthening the community support networks available to abused women.

Wife abuse among women of childbearing age in Nicaragua.

OBJECTIVES: This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua. METHODS: A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age. RESULTS: The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation. CONCLUSIONS: Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims.