Negussie Deyessa, Tiruwork Kassa, Simegn Terefe REGIONAL WORKSHOP SPIR II Learning Event Co-organized by IFPRI, USAID, CARE, ORDA, and World Vision MAY 16, 2023 - 9:00AM TO MAY 17, 2023 - 5:00PM EAT

1. SPIR II RFSA | 2023 Learning Event
GBV and related mental health
Challenges among women, in Woldia
Negussie Deyessa1, Tiruwork Kassa2, Simegn Terefe1
1 College of health Sciences Addis Ababa University,
2 Milk-way Communication Enterprise

2. Burden and Magnitude of IPV
• IPV is leading risk factor for higher disability-adjusted life years (DALYs)
• It is responsible for 11·0% of Disability Adjusted Life Years
Global Health Metrics, 2020
• Globally, women are expected to live about 4.1 years with IPV, while in
Africa they live about 6 years, and in Ethiopia over 8 years with IPV
(YLIPV),
Gomez-Casillas. et al, 2021
•  27% Globally,  38% East Sub-Saharan [Lifetime]
•  13% Globally,  24% East Sub-Saharan [12 months time]
Sardinha. La, et al., Lancet 2022
•  28.7% in Ethiopia (2016 DHS)
Liyew, et al, 2022 2

3. How would be
IPV and Mental illness during conflict?
• Intimate partner violence (IPV) and mental illness can
become more closely intertwined during times of conflict.
• Conflict, within a relationship or a broader societal conflict,
may create an environment of an increased stress and
tension.
• Conflict often involves exposure to traumatic events, such
as physical violence, forced displacement, or loss of loved
ones.
• Assessing such war related problems on the IPV and
common mental illness is important 3

4. Objectives
General Objective
• To assess the magnitude of current IPV and war-inflicted GBV
and common mental health correlates of the IPVs
Specific objectives
• To assess the magnitude of war-related GBV, current IPV, and
common mental health problems among women of reproductive
age
• To determine the association between war-related GBV,
including IPV with common mental health problems,
4

5. Methods
Study setting
• The study will undertake in Woldia woreda, with ten kebeles,
in Northern Wollo, in Amhara region
• Woldia is a town, having a population of 79,667, of whom
49.4% are women
• The town experienced serious humanitarian crisis due to the
Northern Ethiopia Conflict, for about three months in 2021
5

6. Cont…
Study design
• It used a cross sectional design, Mar.- Apr. 2023
Source/ target population
• Source population were women of reproductive age between 15-49 who
lived in Woldia town during the war time
• Women who were totally not able to communicable were excluded
6

7. Cont…
Sample size
• Based on previous evidence 4.8% of women of reproductive age without
IPV, will have common mental disorders, mainly depression
Deyessa, N, et al. 2009
• Assuming the estimate among women in conflict-affected areas with IPV or
GBV would experience a two-fold increase,
• We took a 95% CI, power of 80%, and a design effect of 1.5, adding 10% to
compensate for non-response, a total of 1492 women,
Sampling.
Multistage sampling,
First, five of the 10 kebeles (clusters),
Second, systematic sampling to find households
Final, simple random sampling of an eligible woman within HH
7
1503 women

8. Cont…
Data collection
• Data was collected using a face-to-face interview by female data
collectors
• IPV was measured using the WHO-multi-country study questionnaire
• GBV was measured by direct questions related to their experience
• GBV was also measured using neighborhood (5 N) and sisterhood
(15yr or more) method
• Common mental illness, including
• Depressive disorder [by PHQ-9],
• Generalized anxiety disorder [GAD-7],
• Post traumatic Stress Disorder (PCL-5),
• WHO-wellbeing [WHO-5]
8

9. Analysis
• Data retrieved and exported
in IBM-SPSS-V-27
• Descriptive analysis
• Analytic analysis
• Regression [logistic regression]
• Bivariate analysis of
determinants
• Multivariable analysis
• Ethical approval from EPHA
[ref: EPHA/06/279/23; Jan 05, 2023]
• WHO-guideline for VAW
• Response in voluntary basis
• Informed Consent
• Privacy, confidentiality
• Women survivors, informed for service
and referral for those who need it
Cont….
Ethical review
9

10. Results
Characteristics Frequency Percent
Age group
18-24 yrs
25-34 yrs
35-44 yrs
45-54 yrs
55 yrs or mor
108
623
418
235
131
7.2
41.4
27.8
15.0
8.7
Marital status
Married
Currently single
Divorced or separated
Widowed
1087
51
215
152
72.2
3.4
14.3
10.1
Educational status
Not educated
Elementary [0-8]
Secondary [9-12]
Tertiary [BSc or more]
375
529
453
148
24.9
35.1
30.1
9.8
Monthly income [eth. Birr]
Below 1500 Birr
1500 to 2999 Birr
3000 Birr or more .
564
373
560
37.5
24.8
37.2
Sociodemographic characteristics
Characteristics frequency Percent
Perceived econo. status
Higher
Moderate
Lower
84
591
830
5.6
39.3
55.1
Perceived social status
Higher
Moderate
Lower
121
768
616
8.0
51.0
40.9
Oslo-social supp. index
Poor
Moderate
Strong
734
547
223
48.8
36.3
14.8
Spousal alcohol-related
No
Yes
1340
165
89.0
11.0
Spousal Khat-related
No
Yes
1444
61
95.9
4.1
Perceived social, economic, status
and spousal substance use
10

11. Characteristics Freq. Prevalence (95% CI)
WHO-wellbeing [lower score] 917 60.9 (53.0, 33.7)
PHQ-9 based scoring
Mild depression [5-9]
Moderate [10-19]
Severe depression [20 or more]
448
484
75
29.8 (25.9, 33.7)
32.2 (28.0, 36.4)
5.0 (4.3, 5.7)
Generalized anxiety disorder
Mild anxiety
Moderate anxiety
Severe anxiety
487
341
158
32.4 (28.2, 36.6)
22.7 (19.7, 25.7)
10.5 (9.1, 11.9)
Presence of PTSD
Present 508 33.8 (23.4, 38.2)
Magnitude of mental health
11
Vs
15-20%

12. 12
Type of IPV Frequen
cy
Percent
In lifetime
Emotional
Physical
Sexual
Physical or sexual
267
187
67
199
17.7 (15.4, 20.0)
12.3 (10.7, 13.9)
4.5 (3.91, 5.08)
13.2 (11.5, 14.9)
In the last 12 months
Emotional
Physical
Sexual
Physical or sexual
212
145
46
157
14.1 (12.3, 15.9)
9.6 (8.3, 10.8)
3.1 (2.7, 3.5)
10.4 (9.0, 11.8)
Magnitude of IPV

13. Self reported GBV by strangers
Characteristics Freq. Percent (95% CI)
GBV on themselves (percent)
Attempted rape
Completed rape
Gang (two or more) rape
Rape in front of a family member
Physical violence
Emotional violence
43
27
11
23
132
315
2.9 (2.5, 3.3)
1.8 (1.6, 2.0)
0.7 (0.6, 0.8)
1.5 (1.3, 1.7)
8.8 (7.7, 9.9)
20.9 (18.2, 23.6)
13

14. Magnitude of GBV by strangers
using neighborhood [adult /child] and sisters method
Characteristics frequency Percent (Proportion)
GBV on five adult neighbors (n=7525)
Sexual violence
Physical violence
Emotional violence
45
289
591
5.98 per 1000
38.40 per1000
78.54 per1000
GBV on five under18 yrs neighbor (n=7525)
Sexual violence
Physical violence
Emotional violence
11
109
240
1.46 per1000
14.49 per1000
31.89 per1000
GBV on their sisters (above 15 yrs) (n=804)
Attempted rape
Sexual violence
Physical violence
Emotional violence
20
6
92
131
24.86 per1000
7.46 per1000
114.43 per1000
162.93 per1000 14

15. Association of
IPV and common mental health problems
Characteristics Depression
OR (95% CI)
Anxiety Dis.
OR (95% CI)
PTSD
OR (95% CI)
In lifetime
Physical 3.08 (2.24, 4.22) 2.52 (1.84, 3.48) 2.91 (2.13, 3.98)
Sexual 4.25 (2.49, 7.25) 3.16 (1.92, 5.21) 3.50 (2.11, 5.82)
Physical or sexual 3.07 (2.26, 4.18) 2.47 (1.82, 3.34) 2.69 (1.99, 3.64)
In 12 months
Physical 3.21 (2.25, 4.58) 2.52 (1.78, 3.56) 2.77 (1.95, 3.91)
Sexual 5.68 (2.86, 11.3) 3.26 (1.79, 5.96) 3.49 (1.90, 6.41)
Physical or sexual 3.30 (2.34, 4.64) 2.51 (1.80, 3.51) 2.58 (1.85, 3.61)
15

16. Characteristics Depression
OR (95% CI)
Anxiety Dis.
OR (95% CI)
PTSD
OR (95% CI)
War-related sexual GBV
No
Yes
1.00
2.02 (1.25, 3.26)
1.00
1.70 (1.05, 2.75)
1.00
2.23 (1.38, 3.59)
War-related physical GBV
No
Yes
1.00
1.85 (1.29, 2.64)
1.00
1.96 (1.37, 2.81)
1.00
2.33 (1.63, 3.34)
War-related emotion GBV
No
Yes
1.00
2.37 (1.85, 3.06)
1.00
2.64 (2.04, 3.40)
1.00
3.16 (2.45, 4.08)
16
Association of GBV
by stranger and common mental health problems

17. Conclusion
• IPV was as similar as in other places
• War-inflicted GBV by strangers was high although it may
be underestimated
• Common mental illness was much higher in Woldia town,
and is associated with all forms of IPV and GBV.
17

18. Recommendation
• Raise Awareness and Address war-inflicted gender-based violence
(GBV) may be significantly higher than reported.
• Develop comprehensive strategies to prevent and respond to GBV in
war-affected areas
• Recognize the high prevalence of common mental illness in Woldia
town and ensure the availability of accessible and culturally
appropriate mental health services.
• Focus on survivor-centered approaches that promote
empowerment, healing, and recovery.
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19. Acknowledgement
• I would like to acknowledge the International Food Policy
Research Institute for sponsoring the project
• I would also thank Lucy Billings, Melissa Hidrobo, Parthu Kalva,
D.GILLIGAN, and Jessica Leight, for participating in
commenting the proposal
• I would like to acknowledge women who participated in the
research and the data collectors
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