Avid Reza

Epidemiology of violent deaths in the world

Objective—This study describes epidemiologic patterns of mortality due to suicide, homicide, and war for the world in order to serve as a benchmark against which to measure future progress and to raise awareness about violence as a global public health problem. Setting—The world and its eight major regions. Method—Data were derived from The Global Burden of Disease series and the US National Center for Health Statistics to estimate crude rates, age adjusted rates, sex rate ratios, and the health burden for suicide, homicide, and war related deaths for the world and its eight major regions in 1990. Results—In 1990, an estimated 1 851 000 people died from violence (35.3 per 100 000) in the world. There were an estimated 786 000 suicides. Overall suicide rates ranged from 3.4 per 100 000 in Sub-Saharan Africa to 30.4 per 100 000 in China. There were an estimated 563 000 homicides. Overall homicide rates ranged from 1.0 per 100 000 in established market economies to 44.8 per 100 000 in Sub-Saharan Africa with peaks among males aged 15–24 years old, and among females aged 0–4 years old. There were an estimated 502 000 war related deaths with peaks in rates for both sexes among people aged 0–4, 15–29, and 60–69 years old. Conclusion—The number of violence related deaths in the world is unacceptably high. Coordinated prevention and control efforts are urgently needed.

Sexual violence and its health consequences for female children in Swaziland: a cluster survey study

BACKGROUND Despite concern, few studies have been done about sexual violence against girls younger than 18 years of age in sub-Saharan Africa. We report the prevalence and circumstances of sexual violence in girls in Swaziland, and assess the negative health consequences. METHODS We obtained data from a nationally representative sample of girls and women aged 13-24 years from selected households in Swaziland between May 15, 2007, and June 16, 2007, with a two-stage cluster design. The questionnaire examined demographics, type of sexual violence that took place before the respondent was 18 years of age, circumstances of the incident, and health-related conditions. Information was gathered from 1244 women and girls (response rate 96.3%), of whom 1242 provided retrospective responses to questions about sexual violence. We used regression models adjusted for relevant demographics to estimate the odds ratios for the associations between sexual violence and health-related conditions. FINDINGS 33.2% (95% CI 29.9-36.7) of respondents reported an incident of sexual violence before they reached 18 years of age. The most common perpetrators of the first incident were men or boys from the respondents neighbourhood (32.3% [28.8-36.1]) and boyfriends or husbands (26.2% [22.2-30.7]). The first incident most often took place in the respondents own home (26.1% [21.6-31.2]). Sexual violence was associated with reported lifetime experience of sexually transmitted diseases (adjusted OR 3.69 [95% CI 1.78-7.66]), pregnancy complications or miscarriages (3.54 [1.47-8.55]), unwanted pregnancy (2.92 [1.87-4.55]), and self-report of feeling depressed (2.30 [1.70-3.11]). INTERPRETATION Knowledge of the high prevalence of sexual violence against girls in Swaziland and its associated serious health-related conditions and behaviours should be used to develop effective prevention strategies. FUNDING UNICEF.

Risk factors associated with sexual violence towards girls in Swaziland

OBJECTIVE To explore risk factors for sexual violence in childhood in a nationally representative sample of females aged 13 to 24 years in Swaziland. METHODS During a household survey respondents were asked to report any experiences of sexual violence before the age of 18 years. The association between childhood sexual violence and several potential demographic and social risk factors was explored through bivariate and multivariate logistic regression. FINDINGS Participants totalled 1244. Compared with respondents who had been close to their biological mothers as children, those who had not been close to her had higher odds of having experienced sexual violence (crude odds ratio, COR: 1.89; 95% CI: 1.14-3.14), as did those who had had no relationship with her at all (COR: 1.93; 95% CI: 1.34-2.80). In addition, greater odds of childhood sexual violence were noted among respondents who were not attending school at the time of the survey (COR: 2.26; 95% CI: 1.70-3.01); who were emotionally abused as children (COR: 2.04; 95% CI: 1.50-2.79); and who knew of another child who had been sexually assaulted (COR: 1.77; 95% CI: 1.31-2.40) or was having sex with a teacher (COR: 2.07; 95% CI: 1.59-2.69). Childhood sexual violence was positively associated with the number of people the respondent had lived with at any one time (COR: 1.03; 95% CI: 1.01-1.06). CONCLUSION Inadequate supervision or guidance and an unstable environment put girls at risk of sexual violence. Greater educational opportunities and an improved mother-daughter relationship could help prevent it.

A national survey of childhood physical abuse among females in Swaziland.

Objective: This study describes the scope and characteristics of childhood physical abuse in a nationally representative sample of 13–24 year-old females in Swaziland. The current study also examined health consequences and risk factors of childhood physical abuse. Methods: The study utilized a two-stage cluster sampling design in order to conduct the household survey. Retrospective reports of childhood physical abuse and relevant risk factors were collected from 1292 females. Bivariate and multivariate logistic regression models examined associations between childhood physical abuse and both health consequences and risk factors. Results: Nearly 1 in 5 females in Swaziland has experienced childhood physical abuse in their lifetime, with nearly 1 in 20 having experienced abuse that was so severe that it required medical attention. A number of risk factors for lifetime childhood physical abuse were identified including: maternal death prior to age 13; having lived with three or more families during their childhood; and having experienced emotional abuse prior to age 13. Conclusions: Preventing childhood physical abuse in Swaziland may be addressed through: promoting safe, stable, and nurturing relationships between children and their caretakers; addressing social norms that contribute to harsh physical punishment; and addressing underlying stressors associated with severe social and economic disadvantage.

Retrospective determination of whether famine existed in Niger, 2005: two stage cluster survey

Objective To apply the famine scale by Howe and Devereux to the situation in Niger, west Africa, in 2005 to retrospectively determine whether famine existed. Design Two stage cluster survey. Setting Survey of households in each of Niger’s eight regions. Participants 4003 households. Main outcome measures Crude mortality, mortality in children under 5, and the proportion of caregivers both nationally and regionally adopting coping strategies to deal with insufficient food needs. Results The estimated national crude mortality rate was 0.4 (0.4 to 0.5) deaths per 10 000 per day and under 5 mortality rate was 1.7 (1.4 to 1.9) deaths per 10 000 per day. Nationally, 22.3% (95% confidence interval 19.9% to 24.8%) of caregivers of under 5s did not resort to any coping strategies to deal with insufficient food needs. Reversible coping strategies were, however, used by 5.8% (4.7% to 7.0%) of caregivers, whereas 49.4% (46.9% to 51.8%) relied on irreversible coping strategies and 22.6% (20.0% to 25.4%) on survival strategies. Conclusion On the basis of the famine scale proposed by Howe and Devereux, most regions in Niger experienced food crisis conditions and some areas approached famine proportions.