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      Domestic violence: a cross-sectional study among pregnant women in different regions of Sri Lanka

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          Abstract

          Objectives

          The aims of this study were to assess the regional differences in domestic violence among pregnant women in the capital district and in the tea plantation sector of Sri Lanka, to explore potential contributory factors and to assess whether healthcare workers addressed domestic violence and disclosure among survivors.

          Design

          A cross-sectional study was carried out using interviewer-administered Abuse Assessment Screen.

          Setting

          Fifty-seven antenatal clinic centres in the capital district and 30 in the tea plantation sector.

          Participants

          Pregnant women between 6 and 40 weeks of gestational age. In the capital district, 1375 women were recruited from antenatal clinic centres in the urban (n=25) and in the rural areas (n=32), and 800 women from 30 centres in the tea plantation sector. The response rate in the capital district was 95.6% and 96.7% in the tea plantation sector.

          Results

          Among the total sample of pregnant women (n=2088), the prevalence of ‘ever abused’ was 38.6%, and the prevalence of ‘currently abused’ was 15.9%. ‘Ever abused’ (31.5% vs 50.8%) and ‘currently abused’ (10% vs 25.8%) were significantly higher (P<0.001) among the women living in the tea plantation sector. ‘Ever abused’ was associated with living in the tea plantation sector, being employed, living far from gender-based violence care centre and of Muslim ethnicity, after adjusting for age, education and family income. Only 38.8% of all participants had been asked by healthcare workers about abuse. Living in the tea plantation sector and lower level of education were associated with not being asked. Among those who reported ‘ever abused’, only 8.7% had disclosed the experience to a healthcare worker.

          Conclusion

          Domestic violence was prevalent and highest among women in the tea plantation sector compared with the capital district. The capacity of healthcare workers in addressing domestic violence should be increased.

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          Most cited references4

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          A simplified general method for cluster-sample surveys of health in developing countries.

          General guidelines are presented for the use of cluster-sample surveys for health surveys in developing countries. The emphasis is on methods which can be used by practitioners with little statistical expertise and no background in sampling. A simple self-weighting design is used, based on that used by the World Health Organization's Expanded Programme on Immunization (EPI). Topics covered include sample design, methods of random selection of areas and households, sample-size calculation and the estimation of proportions, ratios and means with standard errors appropriate to the design. Extensions are discussed, including stratification and multiple stages of selection. Particular attention is paid to allowing for the structure of the survey in estimating sample size, using the design effect and the rate of homogeneity. Guidance is given on possible values for these parameters. A spreadsheet is included for the calculation of standard errors.
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            Health-sector responses to intimate partner violence in low- and middle-income settings: a review of current models, challenges and opportunities.

            There is growing recognition of the public-health burden of intimate partner violence (IPV) and the potential for the health sector to identify and support abused women. Drawing upon models of health-sector integration, this paper reviews current initiatives to integrate responses to IPV into the health sector in low- and middle-income settings. We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives. The findings suggest that a few models of integration are being replicated in many settings. These often focus on service provision at a secondary or tertiary level through accident and emergency or women's health services, or at a primary level through reproductive or family-planning health services. Challenges to integration still exist at all levels, from individual service providers' attitudes and lack of knowledge about violence to managerial and health systems' challenges such as insufficient staff training, no clear policies on IPV, and lack of coordination among various actors and departments involved in planning integrated services. Furthermore, given the variety of locations where women may present and the range and potential severity of presenting health problems, there is an urgent need for coherent, effective referral within the health sector, and the need for strong local partnership to facilitate effective referral to external, non-health services.
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              The prevalence and pattern of wife beating in the Trincomalee district in eastern Sri Lanka.

              A descriptive cross-sectional study was carried out to determine the prevalence and to identify some socio-demographic factors associated with wife beating in the Medical Officer of Health (MOH) area of Kantale in the Trincomalee district of eastern Sri Lanka. A random sample of 417 women in the age category 18-49 years constituted the sample population. Data were obtained by focus group discussions followed by the administration of a structured questionnaire by trained interviewers. The prevalence of reported wife beating among ever-married women was 30% and the prevalence of wife beating in the year preceding the study was 22%. There was no significant association between wife beating and ethnicity of the study population or a particular age group of either the batterer or the victim. Moreover, wife beating was associated with an early age at marriage for women, low-income, a low standard of living index, large families and alcohol consumption by the batterer. A significant inverse relationship between domestic violence and the level of education of both the batterer and the victim was also identified. Contusions, typically distributed in the region of the head, face and neck were found to be the commonest type of injury suffered by battered women. A majority of women, irrespective of their level of education and employment status placed the welfare of their children as the prime reason for continuing to stay in an abusive relationship. The study concludes that wife beating is a serious health and social problem for the women population of Kantale. Intervention is recommended in relation to key issues identified by the study, including alcohol abuse by men, relative lack of education among the population, lack of family planning, societal influences promoting teenage marriages of the girl-child and absence of programs aimed at creating awareness on wife beating.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                20 February 2018
                : 8
                : 2
                : e017745
                Affiliations
                [1 ] departmentDepartment of Community Medicine, Faculty of Medical Sciences , University of Sri Jayawardenapura , Colombo, Sri Lanka
                [2 ] departmentDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim, Norway
                [3 ] departmentDepartment of Obstetrics and Gynecology , St. Olavs Hospital Trondheim University Hospital , Trondheim, Norway
                [4 ] departmentDepartment of Health and Caring Sciences, Faculty of Health and Life Science , Linnaeus University , Kalmar, Sweden
                Author notes
                [Correspondence to ] Dr Munas M Muzrif; muzrif@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-8903-9961
                Article
                bmjopen-2017-017745
                10.1136/bmjopen-2017-017745
                5855343
                29463585
                f7f178f2-6107-4954-b040-7abed0297473
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 14 May 2017
                : 14 December 2017
                : 14 December 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100005416, Norges Forskningsråd;
                Categories
                Public Health
                Research
                1506
                1724
                Custom metadata
                unlocked

                Medicine
                gender based violence,domestic violence,tea plantation sector in sri lanka,violence in pregnency,sri lanka

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