**3. Results**

82 Health Management – Different Approaches and Solutions

Straus & Gelles, 1990). Perpetration of IPV by the husband in the year prior to the survey was assessed via 8 items included in the survey given to the women. A positive response to any one of the following behaviors indicated the perpetration of physical IPV: (1) pushing, shaking, or throwing an object; (2) slapping; (3) twisting her arm or pulling her hair; (4) punching or hitting with a fist or something harmful; (5) kicking or dragging; (6) choking or burning; or (7) threatening or attacking with a knife or gun. Perpetration of sexual IPV was indicated by a positive response to 'physically forcing her to have sexual intercourse even when she did not want to'. These assessments were recorded to create a four-level categorical variable reflecting the experiences of three categories of IPV: physical IPV only, sexual IPV only, and both physical and sexual IPV. The fourth category was a referent group of no IPV perpetration of either form. We also created a binary variable measuring whether a mother reported any form of IPV (physical, sexual or both); this was termed "any IPV". Though psychological violence is one of the important indicators of all IPV incidents (Leland & Subramanian, 2009) this information was not available in the current study, as it

We included several socio-demographic, environmental and nutritional variables theoretically and empirically linked to IPV (Uthman, Lawoko,& Moradi T, 2009; Bates et al., 2004) and common childhood illness (Rayhan, Khan, & Shahidullah, 2007; Daniel et al., 2008; Tomkins, Dunn, & Hayes, 1989; Gasana et al., 2002; Cairncross e al., 2010; Barros et al., 2010).These variables included: maternal age (15-24 years, 25-34 years or 35-49 years), maternal education (no education, primary or secondary and higher), maternal decision making autonomy, mother's occupation (unemployed or agriculture/non-manual or manual), mother's BMI (thin, normal or overweight), residence (rural or urban), household members (2-4, 5-6 or 7+), parity (1, 2 or 3+ ), wealth index, type of cooking fuel (biomass/charcoal or LPG/natural gas/biogas), child sex (male or female), child's age (0-11 months, 12-23 months, 24-35 months or 36-59 months), initiation of breastfeeding (early or late), and duration of breastfeeding (0-11 months, 12-23 months or ≥24 months). We used BDHS wealth index as a proxy indicator for socioeconomic position. The BDHS wealth index was constructed from data on household assets, including ownership of durable goods (such as televisions and bicycles) and dwelling characteristics (such as source of drinking water, sanitation facilities, and construction materials). Principal components analysis was used to assign individual household wealth scores. These weighted values were then summed and rescaled to range from 0 to 1, and each household was assigned to

We calculated descriptive statistics for socio-demographic, environmental, IPV, nutritional, and morbidity characteristics for our sample. Demographic and socio-economic differences of any physical or sexual IPV perpetration were assessed by χ2 analyses. The 2-tailed significance level for all analyses was *p* < .05. We created 2 fully adjusted models to analyze the appropriate binary for each morbidity outcome of diarrhea, ARI, fever, and any illness (any vs. no IPV; and the separate effects of physical only, sexual only and both physical and sexual IPV). We entered all covariates simultaneously in the multiple regression models. Adjusted odds rations (AOR) were estimated to understand the strength of the associations

was not collected in the BDHS.

either the poorest, middle, or richest tertials.

**2.5 Statistical analyses** 

**2.4 Covariates** 

#### **3.1 Descriptive statistics**

Nearly half of the women (49.1%) were 15-24 years old, 29.2% were uneducated, and 78.5% lived in rural areas **(Table 1)**. About 11% of the respondents had no decision-making autonomy. Regarding nutritional status, 60.3% women were considered to have normal BMI; 32.0% were undernourished or thin (BMI less than 18.5); and 7.5% were overweight or obese (BMI 25 or higher). From the total sample population, 69.9% of children were below three years of age, nearly half were female and 42.8% of the children were breastfed for 24 months or more, and only 8.8% used LPG/natural gas/biogas as cooking fuel.

The prevalence of underweight, stunting, and wasting was 40.8%, 42.0%, and 19.0% respectively, while the prevalence of diarrhea, fever, and ARI was 10.1%, 38.7%, and 13.3% respectively. Overall, 45.6% children were suffering from any type of illness (diarrhea or ARI or fever) two weeks before the survey. Substantial numbers of mothers (29.0%) reported that they had suffered any IPV in the year prior to the survey; 15.5% of mothers indicated that they had experienced only physical IPV, 6.2% indicated that they had experienced only sexual IPV, and 7.3% indicated that they had experienced both types of IPV **(Table 1)**.

In bivariate analysis, several significant differences were observed in the prevalence of IPV perpetration across various socio-demographic groups **(Table 2)**. Specifically, significantly a higher prevalence of perpetration of any form of IPV, physical IPV only and both physical and sexual IPV was identified among younger women (aged 15-24 years) and women who used LPG/natural gas/biogas as cooking fuel compared with older women and women used Biomass/charcoal as cooking fuel. Regarding educational status, significantly a higher prevalence of any form of IPV and past-year perpetration of both physical and sexual IPV was identified among women having no education. Significantly a higher prevalence of any form of IPV and past-year perpetration of both physical and sexual IPV was also identified among women having children suffering from any types of recent illness.

Intimate Partner Physical and Sexual Violence and Childhood Morbidity 85

24.5 (22.1-27.1) 24.4 (22.0-26.9) 21.0 (18.9-23.3) 30.1 (27.6-32.8)

49.9 (47.0-52.8) 50.1 (47.2-53.0)

34.2 (31.6-36.8) 65.8 (63.2-68.4)

27.7 (25.2-30.2) 29.5 (27.0-32.2) 42.8 (40.2-45.5)

89.9 (88.2-91.4) 10.1 (8.6-11.8)

86.7 (84.6-88.4) 13.3 (11.6-15.4)

54.4 (51.3-57.3) 45.6 (42.7-48.9)

58.0 (55.4-61.1) 42.0 (38.8-44.5)

59.2 (56.3-62.2) 40.8 (38.0-43.7)

81.0 (78.4-83.3) 19.0 (16.7-21.6)

71.0 (68.4-73.4) 29.0 (26.6-31.6)

71.0 (68.4-73.4) 15.5 (13.6-17.6) 6.2 (5.0-7.8) 7.3 (5.9-8.9)

64.2) 38.7( 35.8-41.6)

61.3 (58.4-

**Characteristics n\* % (95% CI)†**

931 920

635 1212 4

1665 195

> 592 259

1007 844

1081 770

1099 752

1504 347

1290 559 2

\* Number of decisions in which women could participate: alone or jointly with husband/partner or

Table 1. Socio-demographic, Nutritional, and IPV Characteristics of Currently Married

† Unweighted n's and † weighted percentages (%, 95% CI) presented

¥ Early: initiation of breastfeeding within one hour of birth

Mothers of Under-five Children (n=1851)

 1140 711

**Child age**  0-11 m 12-23 m 24-35 m 36-59 m

**Child sex**  Female Male

> Early Late Missing data

> 0-11 m 12-23 m ≥24 m Missing data

No Yes

No Yes

**Any illness**  No Yes

**Stunting**  No Yes

**Wasting**  No Yes

> No Yes Missing data

**Types of IPV**  None Physical only Sexual only

Missing data

other person

**Underweight**  No Yes

**Any physical or sexual IPV** 

Both physical and sexual

**Symptoms of ARI**  No Yes

**Initiation of breastfeeding¥**

**Duration of breastfeeding** 

**Diarrhea in the past 2 weeks** 

**Fever in the past 2 weeks** 


49.0 (46.2-51.9) 41.2 (38.5-44.1) 9.7 (8.2-11.4)

 29.2 (26.7-31.9) 27.0 (24.6-29.6) 43.8 (41.0-46.6)

11.0 (9.-13.0) 6.9 (5.5-8.4) 11.8 (9.9-14.1) 15.1 (12.9-17.4) 16.3 (14.4-18.5) 38.9 (36.0-41.9)

32.0 (29.3-34.9) 60.4 (57.7-63.2) 7.6 (6.2-9.8)

78.5 (76.3-80.6) 21.5 (19.4-23.7)

30.4 (27.8-33.1) 36.6 (33.8-39.6) 33.0 (30.1-35.9)

33.7 (30.9-36.6) 28.7 (26.4-31.3) 37.5 (35.1-40.1)

69.6 (66.9-72.3) 22.7 (20.4-25.2) 7.7 (6.2-9.1)

91.2 (0.89-92.7) 8.8 (7.3-10.6)

46.0 (43.1-49.0) 16.7 (14.8-18.8) 37.3 (34.4-40.2)

**Characteristics n\* % (95% CI)†**

816 840 195

565 511 775

1200 651

> 627 716 508

> 546 556 749

1621 224 6

> 812 317 722

**Maternal age**  15-24 y 25-34 y 35-49 y

**Maternal education**  No education Primary

Secondary and higher

**Maternal decision making autonomy (aspects)\*** 0 1 2 3 4 5

Missing data

**Mother's BMI**  Thin (BMI<18.5) Normal (BMI 18.5-24.9) Overweight/obese (BMI≥25) Missing data

**Residence**  Rural Urban

> 2-4 5-6 7+

labor Manual works Missing data

**Type of cooking fuel**  Biomass/charcoal LPG/natural gas/biogas

Missing data

**Wealth index**  Poor Middle Rich

**Parity**  1 2 3+

**Household members (tertiles)** 

**Occupation of respondents**  Unemployed

Agriculture/non-manual


† Unweighted n's and † weighted percentages (%, 95% CI) presented

\* Number of decisions in which women could participate: alone or jointly with husband/partner or other person

¥ Early: initiation of breastfeeding within one hour of birth

Table 1. Socio-demographic, Nutritional, and IPV Characteristics of Currently Married Mothers of Under-five Children (n=1851)

**Physical IPV only % (95% CI)**

> 18.5 (15.8-21.5) 15.6 (11.6-20.7) 11.8 (9.1-15.3) 0.007

17.3 (15.1-19.7) 7.9 (4.8-12.7) 0.001

14.7 (12.2-17.7) 16.3 (13.4-19.6) 0.478

13.4 (10.3-17.2) 18.1 (14.1-22.9) 17.8 (13.8-22.7) 13.6 (10.3-17.7) 0.177

15.8 (12.5-19.7) 15.3 (13.1-17.8) 0.833

12.8 (9.9-16.3) 16.6 (13.2-20.7) 16.6 (13.6-20.1) 0.227

**Total** 29.0 (26.6-31.6) 15.5 (13.6-17.6) 6.2 (5.0-7.8) 7.3 (5.9-8.9)

Maternal experience of any physical or sexual IPV (AOR: 1.50; 95% CI: 1.04–2.27) was associated childhood diarrheal morbidity; as were physical IPV only (AOR: 1.35; 95% CI:

Maternal experience of any physical or sexual IPV (AOR: 1.46; 95% CI: 1.02–2.12) was associated with ARI morbidity; as were physical IPV only (AOR: 1.72; 95% CI: 1.13-2.64) and

Maternal experience of any physical or sexual IPV (AOR: 1.30; 95% CI: 1.00–1.72) and both physical and sexual IPV (AOR: 1.90; 95% CI: 1.19-3.03) were associated with fever among

1.01–2.30) and both physical and sexual IPV (AOR: 2.38; 95% CI: 1.32-4.31) **(Table 3).**

both physical and sexual IPV (AOR: 1.83; 95% CI: 1.03-3.37) **(Table 3)**.

Table 2. Descriptive Statistics According to Different Forms of IPV of Currently Married

**Sexual IPV only % (95% CI)**

> 7.8 (5.9-10.4) 4.1 (2.2-7.8) 5.2 (3.3-8.1) 0.049

 5.2 (4.6-6.7) 6.5 (2.9-14.2) 0.589

> 5.5 (3.9-7.7) 7.0 (5.1-9.4) 0.303

8.0 (5.0.3-12.5) 6.7 (4.1-10.8) 3.2 (1.7-6.0) 6.6 (4.7-9.2) 0.162

> 7.1 (5.1-9.8) 5.8 (4.3-7.8) 0.348

7.4 (4.7-11.5) 5.4 (3.3-8.7) 5.8 (4.3-7.9) 0.579 **Both physical and sexual % (95% CI)** 

> 9.3 (7.0-12.2) 7.6 (4.7-12.3) 4.6 (2.9-7.2) 0.025

> 8.3 (6.7-10.2) 0.57 (0.08-3.9) <0.001

6.7 (5.0-9.0) 7.8 (5.8-10.6) 0.485

6.0 (3.7-9.4) 8.8 (5.7-13.4) 5.6 (3.7-8.4) 8.2 (5.8-11.5) 0.333

> 7.1 (5.0-9.9) 7.4 (5.7-9.6) 0.816

6.1 (3.9-9.4) 8.9 (6.1-12.7) 6.9 (5.0-9.5) 0.398

**Characteristics Any form of IPV** 

**Wealth index**  Poor Middle Rich *p* value

**Child sex**  Female Male *p* value

**Child age**  0-11 m 12-23 m 24-35 m 36-49 m *p* value

> Early Late *p* value

0-11 m 12-23 m ≥24 m *p* value

**Type of cooking fuel**  Biomass/charcoal LPG/natural gas/biogas  *p* value

**Initiation of breastfeeding** 

**Duration of breastfeeding** 

Mothers of Under-five Children (n=1851)

**4.1 IPV and diarrheal morbidity** 

**4.2 IPV and symptoms of ARI** 

**4.3 IPV and childhood fever** 

children **(Table 3)**.

**4. Association between IPV and child morbidity** 

**% (95% CI)**

35.6 (31.9-39.5) 27.4 (22.1-33.4) 21.7 (17.9-26.1) <0.001

30.8 (28.0-33.6) 15.0 (9.7-22.5) <0.001

26.9 (23.7-30.4) 31.1 (27.5-35.0) 0.105

27.3 (22.3-33.0) 33.6 (28.3-39.4) 26.6 (21.8-32.1) 28.4 (23.8-33.6) 0.274

28.6 (25.6-31.7) 30.0 (25.9-34.4) 0.594

26.2 (21.6-31.5) 30.9 (26.2-36.0) 29.3 (25.5-33.4) 0.429

Across wealth categories, wealthier married women were less likely to report past-year perpetration of any form of IPV, physical IPV alone, sexual IPV alone, and past-year perpetration of both physical and sexual IPV. Significantly, a higher prevalence of any form of IPV and physical IPV alone was observed among women considered to have thin BMI and mothers with household"s member size 2-4. In addition, lower proportion of experiencing any form of IPV and sexual IPV alone was observed among unemployed women. A higher prevalence of perpetration of any form of IPV in the past year was identified among women having five aspects of decision-making autonomy, but these differences were not significant for the three mutually exclusive categories of violence assessed **(Table 2)**.


86 Health Management – Different Approaches and Solutions

Across wealth categories, wealthier married women were less likely to report past-year perpetration of any form of IPV, physical IPV alone, sexual IPV alone, and past-year perpetration of both physical and sexual IPV. Significantly, a higher prevalence of any form of IPV and physical IPV alone was observed among women considered to have thin BMI and mothers with household"s member size 2-4. In addition, lower proportion of experiencing any form of IPV and sexual IPV alone was observed among unemployed women. A higher prevalence of perpetration of any form of IPV in the past year was identified among women having five aspects of decision-making autonomy, but these differences were not significant

> **Physical IPV only % (95% CI)**

> > 18.0 (14.9-21.6) 14.0 (11.5-16.9) 9.5 (5.9-15.0) 0.018

> > 18.4 (15.1-22.2) 15.2 (11.6-19.7) 13.8 (11.0-17.1) 0.17

> > 13.8 (8.6-21.3) 17.8 (10.9-27.7) 16.7 (10.5-25.6) 15.6 (11.3-21.1) 18.9 (14.6-24.0) 13.8 (11.2-16.9) 0.617

> > 18.5 (15.4-22.0) 14.9 (12.3-17.9) 8.4 (4.4-15.3)

16.0 (13.8-18.4) 13.8 (11.0-17.3) 0.266

23.1 (19.1-27.5) 15.1 (12.4-18.4) 8.9 (6.4-12.4) <0.001

17.8 (14.0-22.4) 15.2 (12.0-19.1) 13.6 (11.1-16.7) 0.235

15.1 (12.8-17.7) 18.6 (14.5-23.5) 10.4 (6.6-15.8) 0.083

0.030

**Sexual IPV only % (95% CI)**

> 6.9 (4.9-9.7) 5.6 (4.0-7.6) 5.8 (2.7-12.0) 0.652

6.8 (4.6-9.9) 5.1 (3.2-8.1) 6.6 (4.6-9.4) 0.635

8.0 (4.1-15.0) 11.7 (6.4-20.7) 2.9 (12.9-6.5) 6.4 (3.6-11.1) 8.3 (4.8-14.1) 4.9 (3.2-7.3) 0.081

7.6 (5.3-10.7) 5.8 (4.2-7.9) 4.7 (1.8-11.6)

0.421

6.7 (5.2-8.7) 4.4 (2.9-6.8) 0.104

4.9 (3.2-7.5) 5.7 (4.0-8.0) 8.0 (5.3-12.1) 0.208

6.6 (4.2-10.3) 5.7 (3.8-8.5) 6.3 (4.5-8.8) 0.885

4.5 (3.2-6.2) 9.7 (6.6-14.1) 11.4 (6.4-19.7) 0.001 **Both physical and sexual % (95% CI)** 

> 8.9 (6.6-11.8) 5.1 (3.6-7.9) 8.7 (5.1-14.6) 0.031

> 9.6 (6.9-13.2) 7.7 (5.3-11.2) 5.4 (3.6-8.1) 0.048

> 8.1 (4.7-13.7) 9.4 (4.2-19.7) 8.3 (4.4-15.1) 9.1 (5.4-14.9) 7.5 (4.4-12.3) 5.6 (3.9-7.9) 0.621

> 7.3 (5.2-10.2) 7.9 (6.0-10.3) 2.1 (0.9-4.8)

> > 0.062

7.4 (5.8-9.4) 6.8 (4.6-9.9) 0.701

8.7 (6.3-12.0) 7.4 (5.3-10.4) 5.8 (3.6-9.1) 0.336

7.9 (5.6-10.9) 7.8 (5.1-11.6) 6.4 (4.6-8.8) 0.642

7..3 (5.7-9.2) 7.5 (4.5-12.1) 6.7 (2.3-14.6) 0.970

for the three mutually exclusive categories of violence assessed **(Table 2)**.

**% (95% CI)**

33.8 (29.7-38.1) 24.6 (21.5-27.9) 24.1 (17.6-31.9) 0.001

 34.8 (30.5-39.4) 28.1 (23.5-33.2) 25.8 (22.0-30.0) 0.014

29.9 (22.6-38.5) 38.9 (28.7-50.2) 28.0 (20.4-37.1) 31.2 (24.5-38.7) 34.6 (28.7-41.2) 24.2 (20.8-28.1) 0.038

33.4 (29.1-37.9) 28.5 (25.1-32.2) 15.1 (9.5-23.2)

> 30.1 (27.4-33.0) 25.1 (21.0-29.6) 0.050

> 36.7 (31.9-41.8) 28.3 (24.5-32.3) 22.8 (18.3-27.9) <0.001

 32.2 (27.3-37.6) 28.9 (24.6-33.6) 26.3 (22.8-30.1) 0.169

> 26.8 (24.1-29.7) 35.8 (29.9-42.3) 28.4 (20.1-37.9) 0.018

0.002

**Characteristics Any form of IPV** 

**Maternal age**  15-24 y 25-34 y 35-49 y *p* value

*p* value

**Mother's BMI**  Thin (BMI<18.5) Normal (BMI 18.5-24.9) Overweight/obese (BMI≥25) *p* value

**Residence**  Rural Urban *p* value

**(tertiles)**  2-4 5-6 7+ *p* value

**Parity** 1 2 3+ *p* value

> labor Manual works *p* value

**Household members** 

**Occupation of respondents** Unemployed

Agriculture/non-manual

**Maternal education**  No education Primary

Secondary and higher

**Maternal decision making autonomy (aspects)**


Table 2. Descriptive Statistics According to Different Forms of IPV of Currently Married Mothers of Under-five Children (n=1851)
