Gunilla Krantz

Intimate partner violence against women in rural Vietnam--different socio-demographic factors are associated with different forms of violence: need for new intervention guidelines?

BackgroundThis population-based study investigated the different forms, magnitude and risk factors of mens violence against women in intimate relationships in a rural part of northern Vietnam and whether a difference in risk factors were at hand for the different forms of violence. Vietnam has undergone a rapid transition in the last 20 years, moving towards a more equal situation for men and women however, Confucian doctrine is still strong and little is known about mens violence against women within the Vietnamese family.MethodsThis is a cross-sectional population-based study that used a questionnaire developed by the World Health Organisation for investigating womens health and violence against women in different settings. Face-to face structured interviewing was performed and 883 married women, aged 17 to 60 participated. Bi- and multivariate analyses was used for risk factor assessment.ResultsThe lifetime prevalence of physical violence was 30.9 percent and past year prevalence was 8.3 per cent, while the corresponding figures for physical and sexual violence combined was 32.7 and 9.2 percent. The lifetime prevalence was highest for psychological abuse (27.9 percent) as a single entity. In most cases the violence was of a severe nature and exercised as repeated acts over time. Womans low educational level, husbands low education, low household income and the husband having more than one wife/partner were risk factors for lifetime and past year physical/sexual violence. The pattern of factors associated with psychological abuse alone was however different. Husbands low professional status and womens intermediate level of education appeared as risk factors.ConclusionMens violence against women in intimate relationships is commonly occurring in rural Vietnam. There is an obvious need of preventive and treatment activities. Our findings point at that pure psychological abuse is different from physical/sexual violence in terms of differing characteristics of the perpetrators and it might be that also different strategies are needed to reduce and prevent this violence.

Intimate partner violence against women, health effects and health care seeking in rural Vietnam

BACKGROUNDnHealth effects and health care seeking were investigated among women in rural Vietnam exposed to physical and/or sexual violence from their partner in the past year. The study was conducted within the framework of the demographic surveillance site in Bavi District, Ha Tay Province in northern Vietnam.nnnMETHODSnFace-to-face interviews based on a questionnaire developed by the WHO for use in violence research were conducted with 883 randomly selected women. Past-year violence and health effects were investigated in bi and multivariate analyses.nnnRESULTSnThe prevalence of past-year physical and/or sexual violence was 9.2% (n = 81). Women exposed to violence ran a considerably elevated risk of memory loss (OR 3.7; 1.8-7.5), pain or discomfort (OR 3.8; 2.3-6.3), sadness or depression (OR 4.5; 2.7-7.5) and having suicidal thoughts (OR 2.8; 1.04-7.3) compared with those with no violence experience in the past year, when adjusted for socio-demographic factors. Almost 50% (n = 40) of the women exposed to violence reported injuries and, of those, 58% had to seek health care.nnnCONCLUSIONSnPhysical and/or sexual violence are common occurrences in Vietnam, associated with pain, injuries and mental health problems in exposed women. These results point to the need for a reliable health surveillance system, along with health care and support activities for victimised women, and policy initiatives to prevent this violence.

2The role of controlling behaviour in intimate partner violence and its health effects: a population based study from rural Vietnam

BackgroundStudies in North America and other high-income regions support the distinction between extreme intimate terrorism and occasional situational couple violence, defined conceptually in terms of the presence or absence of controlling behaviour in the violent member of the couple. Relatively little research has been conducted on the different forms intimate partner violence may take in low-income countries. The aim of this study was to investigate whether these expressions of intimate partner violence in one low-income country, Vietnam, adhere to patterns observed in western industrialised countries as well as to investigate the resulting health effects.MethodsThis cross-sectional study collected structured interview data from 883 married women aged 17–60, using the Womens Health and Life Experiences questionnaire developed by WHO. Intimate partner violence was assessed by past-year experience of physical or sexual violence and control tactics were assessed using six items combined into a scale. Three different health parameters constituted the dependent variables. Bi- and multivariate analyses, including effect modification analyses, were performed.ResultsOf the participants, 81 (9.2%) had been exposed to physical or sexual violence during the past 12 months; of these, 26 (32.1%) had been subjected to one or more controlling behaviours by their partners. The risk of ill health associated with combined exposure was elevated eight to 15 times, compared to a two-fourfold risk increase after exposure to only one of the behaviours, i.e. violent acts or control tactics.ConclusionPhysical or sexual violence combined with control tactics acted synergistically to worsen health in rural Vietnamese women. The occurrence of such violence calls for altered policies, increased research and implementation of preventive and curative strategies. The unacceptability of intimate partner violence as a part of normal Vietnamese family life must be recognised in the general debate.

Coping with patients with medically unexplained symptoms: work-related strategies of physicians in primary health care.

General practitioners (GPs) often meet patients with medically unexplained symptoms (MUS). From a patient perspective, MUS is a well-acknowledged problem within the primary health care services today, but less is known about the GPs’ perceptions. This study aims to elucidate GPs’ perceptions of patients with MUS, focusing on stressing situations, emotional reactions and coping strategies. Twenty-seven physicians participated in focus-group discussions. In the analysis, where a phenomenographic approach was used, six situations were identified as being especially stressful in the encounter with these patients. The GPs described how they used both problem-focused and emotion-focused strategies, but with emotion-focused strategies slightly dominating, indicating that the GPs had difficulties in managing their own stress when working with patients with MUS.

What do young adults know about the HIV/AIDS epidemic? Findings from a population based study in Karachi, Pakistan.

BackgroundHIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of this epidemic. This study investigated Pakistani young adults (male and female) knowledge and awareness of the HIV/AIDS disease.MethodsA population-based, cross-sectional study of 1,650 male and female adults aged 17–21 years living in Karachi was conducted using a structured questionnaire. A multi-stage cluster sampling design was used to collect data representative of the general population in an urban area. Bivariate and multivariate analyses were performed separately for males and females.ResultsOf 1,650 subjects, 24 per cent (n = 390) reported that they had not heard of HIV/AIDS. Among the males, those with a poor knowledge were younger (AOR = 2.20; 95 per cent CI, 1.38, 3.49), with less than six years of schooling (AOR = 2.46; 1.29 4.68) and no computer at home (AOR = 1.88; 1.06 3.34). Among the females, the risk factors for poor knowledge were young age (AOR = 1.74; 1.22, 2.50), low socio-economic status (AOR = 1.54; 1.06, 2.22), lack of enrolment at school/college (AOR = 1.61; 1.09, 2.39) and being unmarried (AOR = 1.85; 1.05, 3.26).ConclusionAlarming gaps in knowledge relating to HIV/AIDS were detected. The study emphasises the need to educate young adults and equip them with the appropriate information and skills to enable them to protect themselves from HIV/AIDS. However, taboos surrounding public discussions of sexuality remain a key constraint to preventive activities.

Assessing Reasons for School/College Dropout Among Young Adults and Implications for Awareness about STDs and HIV/AIDS: Findings from a Population-Based Study in Karachi, Pakistan

BackgroundDropping out of school/college not only impedes economic prosperity but may also result in poor knowledge and awareness about sexually transmitted diseases (STDs).PurposeThis study investigated, among young adults in Karachi, Pakistan, the risk factors associated with involuntary school/college dropout and the implications for awareness about HIV/AIDS and STDs.MethodA population-based, cross-sectional study of 1,650 young males and females, aged 17–21xa0years and living in Karachi, was conducted using a structured questionnaire. Bivariate and multivariate analyses were performed separately for males and females.ResultsFemales were twice as likely to drop out of school/college as males. Furthermore, migrant residential status, living in an extended family and lower socio-economic status were identified as risk factors for school/college dropout both for males and females. In the total sample, only 17% of males and 13% of females had heard of STDs (pu2009=u20090.020). Furthermore, 26.8% of males and 20.5% of females had not heard of HIV/AIDS (pu2009=u20090.003). The females exhibited a higher level of awareness on these matters than the males, irrespective of whether they had dropped out of school or not. While the males who dropped out were considerably less aware than those who remained at school, there was no such difference among females.ConclusionYoung adults from poor families are at increased risk of dropping out of school/college. Among the dropouts, males were clearly at risk of ignorance about STDs while females were somewhat better informed.

The Panorama and Outcomes of Pregnancies Within a Well-Defined Population in Rural Vietnam 1999–2004

BackgroundPregnancy outcomes in the general population are important public health indicators.PurposeThe overall aim of this study was to investigate the outcomes of reported pregnancies within a well-defined population, to identify risk groups for adverse pregnancy outcomes, and to suggest preventive measures.MethodA prospective population-based cohort study of pregnant women in Bavi district, Vietnam between 1 January 1999 and 30 June 2004.ResultsPregnancy outcome was reported for 5,259 cases; 4,152 (79%) resulted in a live birth, 67 (1.3%) in a stillbirth, 733 (14%) in an induced abortion, and 282 (5.4%) in a spontaneous abortion. There was an increased risk of home delivery for women from ethnic minorities (ORu2009=u20091.85; 95%CIu2009=u20091.06–3.24) or with less than 6xa0years of schooling (ORu2009=u20097.36; 95%CIu2009=u20093.54–15.30). The risk of stillbirth was increased for ethnic minorities (ORu2009=u20096.34; 95%CIu2009=u20091.33–30.29) and women delivering at home (ORu2009=u20096.81; 95%CIu2009=u20092.40–19.30). The risk of induced abortion increased with maternal age.ConclusionOur findings emphasize the public health significance of access to adequate family planning, counselling, and maternal health care for all women. Policies should specifically target women from high-risk groups.