Does resilience moderate the effect of intimate partner violence on signs of depression among Tanzanian pregnant women: A cross-sectional study.

INTRODUCTION: Exposure to intimate partner violence (IPV) has been found to be associated with a multitude of poor health and quality of life outcomes. Among the risks exacerbated by IPV is prenatal depression. Resilience is hypothesized to protect against psychopathology after exposure to a traumatic influence. The present study aims to investigate resilience as a moderator of the effect of exposure to IPV on prenatal depression among pregnant women in Moshi, Tanzania. MATERIAL AND METHODS: In this cross-sectional study, nested within a larger longitudinal study, pregnant women receiving antenatal care were interviewed about exposure to IPV, signs of depression using the Edinburgh Postpartum Depression Scale, and resilience using the abbreviated Connor-Davidson Resilience Scale. Logistic regression was used to test the effect of the interaction term of resilience and exposure to IPV during pregnancy on the risk of high level of signs of depression. RESULTS: In total, 1013 women completed all interviews, 300 women reported exposure to IPV, and 113 had high levels of signs of depression. Mean resilience score was 14.26 (SD 9.45). Exposure to IPV was correlated with signs of depression (adjusted odds ratio 6.49, 95% CI 3.75-11.24). Resilience was not correlated with signs of depression, nor was the interaction term of resilience and exposure to IPV. CONCLUSIONS: The study did not find that resilience acted as a moderator of the effect of exposure to IPV during pregnancy on the risk of prenatal depression. The cross-sectional design of the study may not be well suited to investigate resilience, which could take time to manifest. The abbreviated Connor-Davidson Resilience Scale has not been validated in a Tanzanian setting, or in the Swahili version. Practitioners should take note that all women and families affected by IPV should be afforded relevant assistance from social services, law enforcement, healthcare practitioners, and other relevant services, regardless of their apparent level of resilience.

The Association Between Intimate Partner Violence and Signs of Depression During Pregnancy in Kilimanjaro Region, Northern Tanzania.

Intimate partner violence (IPV) against pregnant women is common with severe health consequences to women and their babies. The aim of the present study is to measure the association between IPV and signs of depression among pregnant women attending antenatal care in a semi-urban setting in northern Tanzania. A cross-sectional study was conducted from March 1, 2014, to May 30, 2015, among pregnant women attending routine antenatal care in Moshi Municipality, Tanzania. During their third trimester, self-reported exposure to IPV was assessed using a validated structured questionnaire adopted from the World Health Organization's (WHO) Multi-Country Study on Women's Health and Domestic Violence. Signs of depression were assessed using Edinburg Postpartum Depression Scale. A total of 1,116 pregnant women were included in the analysis. A total number of 433 (38.8%) reported to be exposed to at least one type of violence during their pregnancy, and 128 (11.5%) presented with signs of depression. The most common type of violence experienced was emotional violence (30.7%), followed by sexual violence (19.0%) and physical violence (10.0%). Exposure to at least one type of violence was the strongest predictor for depression (adjusted odds ratio [AOR] = 5.06; 95% confidence interval [CI] = [3.25, 7.86]), followed by women who reported their primary source of emotional support was individuals not related to their family as compared with support obtained from their male partner/husband (AOR = 2.25; 95% CI = [1.26, 4.02]). Positive HIV/AIDS status (AOR = 2.27; 95% CI = [1.01, 5.14]) and previous history of depression (AOR = 1.62; 95% CI = [1.00, 2.64]). After adjusting for other predictors and types of violence, physical violence was the strongest predictor for signs of depression (AOR = 4.42; 95% CI = [2.65, 7.37]). Signs of depression were commonly observed among pregnant women and strongly associated with exposure to any type of IPV. The present findings indicate an urgent need for screening depression and IPV to mitigate the adverse health outcomes related to both IPV and depression during pregnancy.

Intimate partner violence and subsequent premature termination of exclusive breastfeeding: A cohort study.

OBJECTIVE: The objective of this study was to examine whether exposure to Intimate Partner Violence (IPV) is associated with premature termination of Exclusive Breastfeeding (EB). Per WHO recommendations, this was defined as ceasing breastfeeding or supplementing with other foods or liquids before the child was 6 months old. METHOD: It is a prospective cohort study set in Moshi, Tanzania consisting of 1128 pregnant women with live singleton births. Women were enrolled during pregnancy and followed up with interviews during pregnancy, after birth and 2-3 years postpartum, using structured questionnaires. Emotional, physical and sexual IPV exerted by the current partner was assessed at 34 weeks gestational age with WHO questionnaires. Months of EB was assessed 2-3 years postpartum. Premature termination of EB was defined as less than 6 months of EB. Analyses were made using a logistic regression model adjusted for maternal age, education, HIV-status, alcohol use during pregnancy and parity. Confounding variables were determined using a theoretical framework approach, i.e. a Directed Acyclic Graph model to minimize bias. RESULTS: Women who were exposed to IPV had more than 50% higher odds of terminating EB before the child was 6 months old compared to women who were not exposed (aOR = 1.62, 95%CI: 1.27-2.06). Women exposed to all three types of IPV had twice the odds of early termination of EB (aOR = 1.95, 1.12; 3.37). Furthermore, the odds were tripled if exposure happened specifically during the index pregnancy (aOR = 2.93 95%CI: 1.3; 6.6). Stratified analyses showed the most severely affected groups were the mothers older than 30 and those who gave birth to girls. CONCLUSIONS: The results indicated that exposure to IPV is associated with increased risk of premature termination of EB. The odds increase with multiple types of the IPV, especially when exposed during the index pregnancy.

Prevalence and causes of blood donor deferrals among clients presenting for blood donation in northern Tanzania.

INTRODUCTION: Blood is an important requirement in different medical and surgical conditions with half of all donations are from developing countries. Lack of eligibility among blood donors who present for blood transfusion, called blood donor deferral is associated with the unsustainable and inadequate amount of blood collected by blood banks worldwide. However, the prevalence and causes of blood donor deferrals are not well known in Tanzania where less than one-third of actual needs of blood is collected, leading to unmet demand of blood for transfusion, and causing unwanted morbidity and mortality. MATERIALS AND METHODS: This was a retrospective analysis of blood donors at northern zone blood transfusion center, Tanzania from January to December. 2016. Donor's data were transferred to Statistical Package for Social Studies (SPSS) program version 20.0 for analysis. Descriptive statistics was used to summarize data and comparisons made by type of donor and deferrals using Chi-square test. RESULTS: A total of 14377 participants were studied whereby 12775 (88.9%) were voluntary non-remunerated blood donors. The blood donor deferral rate was 12.7% and deferral was significantly more likely in females, with increasing age above 31 years, who came from nearby regions from where the blood bank is located and/or a family replacement donor (P value <0.01). Overall, infections contributed to 62% of all deferrals and low hemoglobin was the leading cause of temporary deferrals while Hepatitis B lead the permanent deferral causes. CONCLUSIONS: Blood donor deferral is a significant problem in northern Tanzania and accounts for more than one-tenth of all prospective blood donors. Latent and active infections are the leading cause of blood donor deferrals, a picture that mirrors other low income countries especially those located in sub-Saharan Africa. Results of this study calls for appropriate preventive interventions to address prevalent causes of deferrals such as infections with HIV and HBV to tackle low hemoglobin.

"Staying for the children": The role of natal relatives in supporting women experiencing intimate partner violence during pregnancy in northern Tanzania - A qualitative study.

INTRODUCTION: Intimate partner violence (IPV) is a global health and human rights problem. In Tanzania, national studies have shown that half of all women experience partner violence in their lifetime, 38% reported being abused during a period of 12 months and 30% during pregnancy. Despite the benefits of social support to women victims of violence during pregnancy, a majority of women hesitate to seek help and, if they do, they mainly turn to their natal relatives for support. However, this process of help-seeking and the type of support received is not well documented and needs to be explored with a view to future interventions. This article investigates women's own perspectives on the support they receive from natal relatives when experiencing IPV during pregnancy. MATERIALS AND METHODS: Eighteen participants who experienced physical IPV during pregnancy were purposively selected from a cohort of 1,116 pregnant women enrolled in a project that aimed at assessing the impact of intimate partner violence on reproductive health. In-depth interviews were used to explore the social support received from the natal family among women who experienced partner violence during pregnancy. All interviews were audio recorded, transcribed, coded and analyzed. RESULTS: Women who experienced severe IPV during pregnancy were more likely to seek help from natal relatives. Severe violence was defined by the women as acts that occurred frequently and/or resulted in injury. The women's natal relatives were willing to provide the support; however, they strongly encouraged women to maintain their marriage so that they could continue caring for their children jointly with their partners. Emotional support was the commonest form of support and included showing love and empathy and praying. Information provided to victims aimed mainly at advising them to maintain their marriage. Practical support included direct financial support and building their economic base to reduce dependency on their partners. When the couple was on the verge of separation, mediation was provided to save the marriage. CONCLUSION: Women who experienced partner violence preferred to seek help from their natal relatives. The support provided by natal relatives was beneficial; however, maintaining the marriage for the care of children and family was given the highest priority, over separation. As a consequence, many women continued to live with violence. Stakeholders supporting victims of violence need to understand the priorities of victims of violence and structure intervention to address their needs.

Postpartum depression among women who have experienced intimate partner violence: A prospective cohort study at Moshi, Tanzania.

BACKGROUND: Post-partum depression (PPD) in many low-income countries, including Tanzania, is not well recognized, and the underlying predictors and causes of PPD remain unclear. Results from previous studies suggest that PPD is associated with intimate partner violence (IPV) experienced during the perinatal period. In the present study, we assessed the relationship between IPV and PPD among women attending antenatal services in Tanzania. METHODS: We conducted a prospective cohort study from March 1, 2014 to May 30, 2015, in Kilimanjaro Region, Tanzania, among pregnant women of less than 24 weeks gestation attending antenatal clinics in two primary level health facilities. Women were interviewed at four time points: 1) Socio-demographic and reproductive health characteristics were assessed at recruitment; 2) At 34 weeks gestational age we screened for depression using the Edinburgh Postpartum Depression Scale (EPDS) and self-reported IPV experiences were assessed using structured questions adopted from the WHO's Multi-country Study on Women's Health and Domestic Violence; 3) Assessment for postpartum depression using EPDS was repeated at 40 days post-partum. Data were analyzed using bivariate and multivariate analyses. RESULTS: A total of 1013 women were interviewed, of whom 304 (30.0%) reported being exposed to at least one type of IPV during their pregnancy and 122 (12.0%) had EPDS scores of 13 and more. Exposure to at least one type of IPV increased the odds of PPD more than three times (AOR=3.10; 95% CI: 2.04-4.40) as compared to those women who were not exposed to IPV during their pregnancy. Stratified analyses showed that this risk of PPD was highest among younger women (aged 18-24 years) who were exposed to physical violence (AOR=3.75; 95% CI: 1.21-11.67). Among women exposed to emotional violence, women with no previous history of depression were also at higher risk of developing postpartum depression as compared to women who were having previous history of depression (AOR=2.79; 95% CI: 1.76-4.42) and (AOR=0.89; 95% CI: 0.38-2.08). CONCLUSIONS: One out of every three pregnant women in the study population was exposed to IPV during pregnancy and these events were strongly associated with development of postpartum depression. Younger women and women with no prior history of depression were specifically prone to develop PPD when being exposed to IPV. These findings should help to inform targeted screening for PPD in the postnatal setting in Tanzania and other low-income countries in order to minimize complications suffered by mothers and their babies.

Social support and intimate partner violence during pregnancy among women attending antenatal care in Moshi Municipality, Northern Tanzania.

BACKGROUND: Intimate Partner Violence (IPV) is a significant public health problem with negative health consequences for women and their pregnancies. While social support has a protective effect against IPV and reduces health consequences of violence, its association with experiencing IPV during pregnancy remain less explored. In our study we aimed to determine the effect of social support on IPV during pregnancy among women attending antenatal care in Moshi, Tanzania METHODS: The study was part of a prospective cohort study that assessed the impact of violence on reproductive health of 1,116 participants. Pregnant women were enrolled below 24 weeks of gestation and followed until delivery. The experiences of social support and IPV during pregnancy were assessed at the 34th week of gestation. Logistic regression analysis was performed to assess the relationship between social support and IPV, with adjustment for potential confounders. RESULTS: The prevalence of IPV during pregnancy was 30.3% where the majority (29.0%) experienced repeated episodes of abuse. Regarding practical social support, having no one to help financially was associated with increased odds of IPV and repeated episodes of abuse during pregnancy, AOR 3.57, (95% CI 1.85 - 6.90) and AOR 3.21, (95% CI 1.69 - 6.11) respectively. For social support in terms of communication, talking to a member of the family of origin at least monthly was associated with decreased odds of IPV and repeated episodes of IPV during pregnancy, AOR 0.46 (95% CI 0.26 - 0.82) and AOR 0.41 (95% CI 0.23 - 0.73) respectively. Perceiving that family of origin will not offer support was associated with a increased odds of IPV and repeated episodes of IPV, AOR 2.29, (95% CI 1.31 - 3.99) and AOR 2.14, (95% CI 1.23 - 3.74) respectively. CONCLUSIONS: Nearly one third of women experienced IPV during pregnancy. Social support to women is associated with decreased odds of experiencing IPV during pregnancy. The family of origin plays an important role in providing social support to women who experience abuse during pregnancy; however, their true involvement in mitigating the impact of violence in the African setting needs further research.

Intimate partner violence during pregnancy and its association with preterm birth and low birth weight in Tanzania: A prospective cohort study.

INTRODUCTION: Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide. The role of violence as an underlying factor in poor birth outcomes remains an area where strong evidence is lacking. The aim of this study was to determine the association between intimate partner violence (IPV) and preterm delivery (PTB) and low birth weight (LBW). MATERIALS AND METHODS: A prospective cohort study was conducted among 1112 pregnant women attending antenatal care in Moshi-Tanzania. The women were enrolled before 24 weeks gestation, followed-up at week 34 to determine exposure to violence during pregnancy, and after delivery to estimate gestation age at delivery and birth weight. Logistic regression analysis was performed to assess the association between exposure to IPV during pregnancy and PTB and LBW while adjusting for possible confounders. In addition, stratified analysis based on previous history of adverse pregnancy outcome was performed. RESULTS: One-third of the women experienced IPV during pregnancy, 22.3% reported emotional, 15.4% sexual and 6.3% physical violence. Women exposed to physical IPV were three times more likely to experience PTB (AOR = 2.9; CI 95%: 1.3-6.5) and LBW (AOR = 3.2; CI 95%: 1.3-7.7). Women with previous adverse pregnancy outcomes and exposure to physical IPV had a further increased risk of PTB (AOR = 4.5; CI 95%: 1.5-13.7) and LBW (AOR = 4.8; CI 95%: 1.6-14.8) compared to those without previous history of adverse outcome. CONCLUSION: Women who are exposed to IPV during pregnancy are at increased risk of PTB and LBW. The risk is even stronger if the women additionally have suffered a previous adverse pregnancy outcome. Interventions addressing IPV are urgently needed to prevent occurrence and reoccurrence of PTB and LBW.

Factors influencing disclosure among women experiencing intimate partner violence during pregnancy in Moshi Municipality, Tanzania.

BACKGROUND: Intimate Partner Violence (IPV) has serious negative health effects to millions of women around the globe. While disclosing IPV could open doors for support and eventually prevent partner abuse, the factors associated with IPV disclosure during pregnancy are not well known. The aim of this study was to examine factors influencing IPV disclosure to any person of interest or organization supporting women during pregnancy in Moshi Municipality, Tanzania. METHODS: Data were from a prospective cohort study of 1123 pregnant women followed-up by the project aiming to assess the impact of violence in the reproductive health conducted in Moshi Municipality, Tanzania from March 2014 to May 2015. Inclusion criteria to the current analysis were all 339 pregnant women who reported to have experienced physical, sexual and/or emotional violence during the index pregnancy. Data analysis used SPSS Version 20. Odds ratio with 95 % Confidence Interval (CI) for factors associated with IPV disclosure was estimated using multivariate logistic regression models while controlling for age, education and parity. A p-value of less than 0.05 was considered for a statistically significant difference. RESULTS: IPV disclosure was found to be 23.3 % (n = 79). Disclosure of IPV was less likely among unemployed (OR = 0.5, 95 % CI 0.30-0.90) and women whose index pregnancy was unplanned (OR = 0.53, 95 % CI 0.29-0.98). Women who regularly participated in women's or community groups, religious groups or political associations at least once a month had 2 times higher odds of IPV disclosure compared to those who did not attend regularly (OR = 2.12, 95 % CI 1.13-3.95). Most of the abused women during pregnancy who disclosed their experience of IPV (69 %) disclosed to a member of the family of birth followed by friends (14 %) and a member of family of the partner (11 %). CONCLUSIONS: Most of the women who experienced IPV during pregnancy kept suffering in silence while less than a quarter of all the abused (23.3 %) disclosed their experience to someone. Identification of the women experiencing IPV during pregnancy should be done as a starting point for supporting victim of IPV. Women empowerment in economical and reproductive health will reduce their vulnerability and facilitate disclosure of IPV for support. Key individuals who informally support victims of IPV should be targeted in interventions.