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Knowledge, Attitude, and Practice of Intimate Partner Violence and Its Determinants Among Female Nursing Students in Abakaliki, Southeast Nigeria

Knowledge, Attitude, and Practice of Intimate Partner Violence and Its Determinants Among Female... To assess the knowledge, attitude, practice, and determinants of intimate partner violence (IPV) among nursing female stu- dent in a tertiary hospital in Abakaliki. A cross-sectional descriptive study was done in a tertiary hospital in Abakaliki between 1st March 2018 and 31st August 2018 among 450 nursing female student. They were interviewed using a Composite Abuse Scale (CAS) version 2013. Analysis was done using IBM SPSS Statistic version 20. The prevalence of any type of IPV among respondents was 47.8%. The majority (70.9%) were aware of IPV and the commonest mode of information was mass media (60.0%). Majority of the respondent would resort to prayer following IPV and only 15.5% would report to police. The most common form of abuse reported was emotional &or harassment abuse (26.6%). Student’s age (OR = 0.42; 95% CI [0.41, 0.92]), social class (OR = 0.60; 95% CI [0.40, 0.90]), level of study (OR = 0.45; 95% CI [0.29, 0.68]), and partner’s level of edu- cation (OR = 0.60; 95% CI [0.42, 0.88]) were determinant of respondent experiencing IPV. Less than 50% of the respondent were aware of legislation against IPV. The study shows a high level of IPV among the studied group. Screening for IPV is advo- cated among the students’ population especially among the young adolescent. Efforts should also be made by the government to increase awareness about Nigerian law against IPV. Keywords violence, intimate partner violence, violence, nursing, female students, combined abuse scale the level of ‘‘domestic terrorism’’ that women under go Introduction from their partners. In Nigeria a high prevalence rate of Intimate partner violence is a global health problem. It IPV has been reported (Anzaku et al., 2017; Benebo includes physical violence, sexual violence, stalking, and et al., 2018; O. I. Fawole et al., 2005; Onanubi et al., psychological aggression by a current/former romantic 2017; Umana et al., 2014) among Nigerian women. and/or sexual partner (Breiding et al., 2015). The true These disturbing findings in Nigeria are also seen in burden of IPV is not known. While men can be recipi- other studies in African countries (Burgos-Soto et al., ents of IPV, women experience IPV at higher rates. IPV is estimated to affect 35% of women worldwide (World Health Organization [WHO], 2013). There is a regional 1 Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi variation on the lifetime prevalence of IPV, the highest State, Nigeria Federal Medical Centre, Owerri, Imo State, Nigeria rate is seen in developing world of which African (36.6 95% CI [32.7, 40.5]) region is second to South-East Asia Corresponding Author: (37.7 95% CI [32.8, 42.6]) region on cases of physical Chidebe C. Anikwe, Alex Ekwueme Federal University Teaching Hospital, and/or sexual intimate partner violence (WHO, 2013). Abakaliki, Ebonyi State, Nigeria. Various studies in Africa including Nigeria have shown Email: drchideanikwechristian@gmail.com Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open 2014; Delamou et al., 2015; Malan et al., 2018; Ogum et al., 2016; Hampanda et al., 2017; Onanubi et al., Alangea et al., 2018). 2017). Exposure to IPV can increase women’s risk for The patriarchal nature of African societies which human immunodeficiency virus (HIV) infection encourages male dominance with the subjugation of (Hampanda et al., 2017). It also affects partner disclo- women as a ‘‘tool to a means’’ is an important factor to sure of HIV status and a woman’s adherence to therapy IPV (Bowman, 2003). In Nigeria, for example, the gender with resultant poor performance on antiretroviral equality index is low, Nigeria is estimated to rank 128th medication (Maman et al., 2000). Ignoring the increasing in Global Gender Gap Index with score of 0.635 (World global burden of IPV, therefore, can be a hindrance to Economic Forum, 2019) and this might probably be con- the international community effort in ending the AIDS tributing to IPV. Some women justify IPV against other epidemic by 2030 (WHO, 2017). This becomes particu- women which might ultimately encourage further acts of larly important in sub Saharan countries like Nigeria IPV (Ajah et al., 2014; Esere et al., 2009). The victims’ where the prevalence of HIV/AIDS disease is assuming apparent non-reporting of an assault to appropriate an epidemic proportion. Apart from the above findings, channels for redress and lack of enabling laws in some IPV negatively affects the academics performance of the African countries encourages the perpetration of this victim. bastard act (IPV) to thrive. It is, however, gladding that The majority of women undergo trauma in silence with the passage of Nigerian law against IPV, succor which makes it difficult to intervene and eradicate IPV would be given to victims of domestic violence (Violence (Ibekwe, 2007; WHO, 2012). This ‘‘silence syndrome’’ in Against Persons (Prohibition) Act, 2015). Nigeria constitute an impediment to eradicating the can- The male partner is the common perpetrator of female kerworm called IPV (Ibekwe, 2007). According to a IPV. Some of the risk factors for this behavior among study by Linos et al. less than 40 % of Nigerian women men include drug dependence, jealousy, alcoholism, low that are victims of intimate partner abuse reported ever educational attainment, having multiple sexual partners, seeking help to stop the chain of abuse from the perpe- inability to meet financial needs, childhood abuse, and trator. Help-seeking among the victims were found to be family history of domestic violence (Adebayo, 2014; dependent on the level of Human Development Index of Esere et al., 2009; Matseke et al., 2012; Ntaganira et al., the states (Linos et al., 2014) which calls for a deliberate 2008; Onoh et al., 2013; Shamu et al., 2011). IPV is asso- effort to empower women and develop the girl child in ciated with several negative health problems on the vic- Nigeria as a long term measure in addressing IPV. tims which some of them are: physical injuries, Various reasons adduced for women’s tolerance of an disabilities, substance use problems, suicidal ideation, abused partner include ‘‘fear of retaliation, lack of alter- difficulty in establishing a further relationship with men, native means of economic support, concern for their chil- sleep disturbances, fear, poor academic performance, dren, lack of support from family and friends, stigma or anxiety, and substance abuse (Breiding et al., 2014; fear of losing custody of children associated with divorce Onanubi et al., 2017; Spencer et al., 2016; Wood et al., and love with the hope that the partner will change’’ 2018) huge man-hour lost in production, and health- (WHO, 2012). related cost (National Center for Injury Prevention and In Nigeria, reduction or possible elimination of part- Control, 2003). It could also lead to femicide and Africa ner based violence would involve the education of has been reported to have the highest rate of intimate women on their reproductive and sexual rights. There is femicide (UNODC, 2019). IPV has been argued to occur a need also to address the cultural belief systems that are in three phases which are the tension building phase, cri- not supportive of women’s rights in Nigeria (Ibekwe, sis phase, and the honeymoon phase (Shelter For Help in 2007). It has been advocated that women should have Emergency, 2022). The cycle of abuse tends to increase zero tolerance of domestic violence and every case without intervention and could result in femicide. should be reported to appropriate authorities (Ibekwe, Femicide could occur either in tension or crisis phase. 2007; Titilayo et al., 2014). This will enable punishment The mechanism of femicide vary and could result from of perpetrators and deter perpetrators from further inci- physical injury, neglect of the victim, the victim being dents, compensate survivors, and provide them with the under tension and unlikely to seek and receive prompt necessary interventions for their rehabilitation. It has medical care when sick as this is likely to be prevented by been argued by Ibekwe (2007) that violence against the perpetrator. women should be made a state affair and with the recent Unintended pregnancy, adverse pregnancy outcome, promulgation of law against IPV in Nigeria (Violence nonuse of condoms, sexually transmitted diseases includ- Against Persons (Prohibition) Act, 2015), it is hoped that ing HIV/AIDS are some of the sexual and reproductive affected women in Nigeria will seek redress when their health problems of IPV (Maman et al., 2000; Bernstein right is infringed by their partner. Anikwe et al. 3 This work is embarked upon to assess the knowledge, of the husband for determination of a woman’s social attitude, and practice of IPV among nursing students in class. The social class of the study participants that were a tertiary hospital in Abakaliki. It will also help to assess not married were based on that of their parents. They their rate of IPV victimization and its determinants. were graded into social classes 1 to 5. Social class 1 and Findings from our study will assist the authority in the 2 were classified as upper social class while social class 3, hospital to proactively put measures in place to assist 4, and 5 were classified as lower social class. ‘‘Intimate and prevent IPV among the students. It will also help to partner violence (IPV) is defined as actual or threatened improve their curriculum toward prevention and man- physical, sexual, psychological, emotional, or stalking agement of IPV after their nursing education. abuse by an intimate partner while an intimate partner is defined as a current or former spouse or non-marital partners, such as a boyfriend or dating partner’’ (Basile Materials and Methods et al., 2007). Knowledge of IPV was assessed using 22 items, correct answer was scored as 1 and incorrect Study Design answer as 0. Overall knowledge scores were calculated To assess the knowledge, attitude, practice, and determi- by adding the individual scores (answers); the highest nants of IPV among nursing female student in a tertiary scores was 22. A score of 10 and above was assessed as hospital in Abakaliki. adequate overall knowledge of IPV while a score less than 10 was assessed as inadequate overall knowledge of IPV. The 22 items instrument was pretested among 30 Methods nursing students on ward posting in AEFUTHA. The Study Setting internal consistency was found to be good (Cronbach’s The study was carried out in nursing and midwifery alpha of 0.70). schools of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Sample Size The sample size was gotten using the formula N = Z Study Population 2 PQ/D . Where N = required sample size. Z = 1.96 at The study population was female nursing students that confidence level at 95%; P = estimated population of met the inclusion criteria. They were consenting females 44.6% (Esere et al., 2009) D; margin of error at 5% and who were not pregnant and are currently in an intimate Q=12 P. The sample size for the study is 460 after the partner relationship for the past 12 months. Study popu- addition of a 20% attrition rate. lation was limited to those who are currently in an inti- mate partner relationship to help reduce recall bias and Ethical Consideration to help us assess the current risk that the students are undergoing. Those who were excluded were those who Ethical approval for this study was obtained from the refused to consent, sick, or are not in an intimate partner ethical committee of the hospital. The ethical approval relationship for the past 12 months. A simple random number is REC APPROVAL NUMBER 14/11/2017-19/ sampling method (ballot method) was used for respon- 12/2017. Approval for the use of CAS was obtained dent’s selection. Consented students were asked to pick a from Kelsey Hegarty of the University of Melbourne. piece of blue paper marked ‘‘Yes’’ and ‘‘No’’ with Informed and written consent was obtained from the replacement from a black polythene bag into which an participant before inclusion into the study. equal number of paper ‘‘Yes’’ and ‘‘No’’ paper were added. Students that picked a paper marked ‘‘Yes’’ were Composite Abuse Scale (CAS) recruited as the study population. They were interviewed between January 2018 and May 2018 in a dedicated ‘‘CAS is an easily administered self-report measure that office using a pre-tested structured questionnaire provides standardized subscale scores on four dimensions (Cronbach’s alpha = .72) and a Composite Abuse Scale of intimate partner abuse consisting of 30 items presented (CAS) version 2013 (Hegarty et al., 2005). The question- in a six-point format requiring respondents to answer naire was filled by the participant after thorough expla- ‘‘never,’’ ‘‘only once,’’ ‘‘several times,’’ ‘‘monthly, nation and understanding of the study instrument. The weekly,’’ or ‘‘daily’’ in twelve months. It assess the follow- social class of the study population was determined ing: Severe Combined Abuse Factor, Emotional Abuse based on the work of Olusanya et al. (1985) which used factor, Physical Abuse factor, and the Harassment factor. the educational level of the women and the occupation The CAS is made up of four subscales: Severe Combined 4 SAGE Open Abuse (SCA; 8 items; possible score 0–40), Physical Abuse ‘‘The subscale score was calculated and was com- (7 items; possible score 0–35), Emotional Abuse (11 items; pared with a predetermined cut-off score for each sub- possible score 0–55), and Harassment (4 items; possible scale (Hegarty et al., 2005) as shown below to score 0–20)’’ (Anikwe et al., 2021; Hegarty et al., 2005). determine whether they have suffered that abuse’’ (Anikwe et al., 2021). A subscale score greater than the The Severe Combined Abuse Factor Represent Severe set score would determine that the respondent had such abuse. Example if a woman has a SCA score of 10, Physical Abuse Items, All Sexual Abuse Items, and Emotional abuse score of 15, Physical abuse score of Physical Isolation Aspects of Emotional Abuse 30, and Harassment abuse score of 20 the total score is ‘‘Raped me; Used a knife or gun or other weapons; 75; each score above is greater than the predetermined Took my wallet and left me stranded; Tried to rape me; cut-off score and the woman will be adjudged to have Kept me from medical care; Locked me in the bedroom; suffered each of the above abuses. Categorization will Refused to let me work outside the home; Put foreign determine the category of composite abuse. An overall objects in my vagina’’ (Anikwe et al., 2021; Hegarty score of 7 and above determines an individual that has et al., 2005) suffered an abuse. The Emotional Abuse Factor Include Verbal, Psychological, Dominance, and Social Isolation Abuse CAS Cut-Off Score Items ‘‘Told me that I was not good enough; Told me that I was stupid; Did not want me to socialize with my female Scale Cut-off score friends; Told me that I was crazy; Became upset if din- ner/housework was not done when they thought it Severe combined abuse 1 should be; Blamed me for causing their violent behavior; Physical abuse 1 Tried to turn my family, friends and children against me; Emotional abuse 3 Told me that no one else would ever want me; Told me Harassment 2 that I was ugly; Tried to keep me from seeing or talking Total 7 to my family; Tried to convince my family, friends and children that I was crazy’’ (Anikwe et al., 2021; Hegarty et al., 2005). Abuse Categorizations ‘‘The type of abuse experienced by each respondent The Physical Abuse Factor Has 7 of the Less Severe was categorized as shown below. SCA took precedence Physical Abuse Items over the other forms of abuse so that any participant ‘‘Pushed, grabbed or shoved me; Hit or tried to hit me who had experienced SCA fell into the SCA category with something; Shook me; Slapped me; Threw me; (Category 1). The second category includes all partici- Kicked me, bit me or hit with a fist; Beat me up’’ pants who had experienced Physical Abuse in combina- (Anikwe et al., 2021; Hegarty et al., 2005). tion with Emotional Abuse and/or Harassment. Participants who have experienced at least one episode of Physical Abuse, but no other forms of abuse, fell The Harassment Factor Represents Actual into the third category, Physical Abuse Alone. The Harassment final category contains all participants who had experi- ‘‘Harassed me over the telephone; followed me; Hung enced Emotional Abuse and/or Harassment, but not around outside my house; Harassed me at work’’ any other form of abuse’’ (Anikwe et al., 2021; Hegarty (Anikwe et al., 2021; Hegarty et al., 2005). et al., 2005). NO Anikwe et al. 5 Abuse Categorizations Sequence Severe combined Does the participant meet the cutoff for YES abuse Severe combined abuse? Does the participant meet the cutoff for Emotional and/or NO Harassment Physical Abuse? Does the participant meet the Physical Abuse cutoff for Emotional and/or NO alone Harassment? Physical, Emotional, and/or Harassment 6 SAGE Open Table 1. Socio - Demographic Characteristics of the Women Table 2. Respondent Knowledge About Intimate Partner (n = 450). Violence. Characteristics Frequency (n) Percentage (%) Variables Frequency Percentage Age (years) Knowledge of IPV <19 61 13.6 Adequate 319 70.9 20–24 258 57.3 Inadequate 131 29.1 ø 25 131 29.1 Source(s) of information Marital status Reading books 81 18.0 Single 344 76.4 Friends 117 26.0 Married 97 21.6 Newspaper 90 20.0 Separated 2 0.5 Radio 63 14.0 Divorced 7 1.5 Television 117 26.0 Residence From school 54 12.0 Rural 145 32.2 Church 27 6.0 Urban 305 67.8 Sibling 27 6.0 Mother’s education Parent 54 12.0 None 84 18.7 Types of IPV known Primary 110 24.4 Sexual violence 180 40.0 Secondary 112 24.9 Physical violence 135 30.0 Tertiary 144 32.0 Emotional violence 171 38.0 Year of study Psychological abuse 144 32.0 Year 1 124 27.6 Stalking 54 12.0 Year 2 162 36.0 Friends with a history of IPV Year 3 164 36.4 Yes 207 46.0 Partner No 243 54.0 Age <19 9 2.0 Multiple answer allowed. 20–24 70 15.5 25–29 147 32.6 30–34 143 31.8 and 5 (lower social class) were reclassified for easy analy- ø 35 81 18.0 sis. The partner’s characteristics were also reclassified Occupation Unemployed 217 48.2 into ł 30 years and .30 years. The odds ratios with their Employed 233 51.8 95% CI were calculated to determine the strength and Education presence of an association. p-Value of \.05 is adjudged Primary 22 4.9 significant. Odds ratio \1 implies decreased likelihood Secondary 197 43.8 of being a victim of IPV, while OR. 1 represented Tertiary 231 51.3 increased probability of suffering from IPV. Validation of CAS Results ‘‘To test the reliability and internal consistency of the A total of 460 questionnaires were shared, out of which CAS, we surveyed 36 female nurses in the Department of 450 (97.8%) students were in intimate partner relation- Obstetrics and Gynaecology of Alex Ekwueme Federal ships and were analyzed. From Table 1, the mean age of University Teaching Hospital, Abakaliki. Respondents the women was 23.0 (95% CI [22.4, 22.6]) years (not in completed the questionnaires twice in 2 weeks and the Table). The majority of the study population were responses were matched and compared for test-retest between 20 and 24 years. More than 40 % of the respon- reliability. The internal consistency for the scale was dent belong to lower socioeconomic class. More than good (Cronbach’s alpha = 0.72)’’ (Anikwe et al., 2021). three-quarters are single. The mean partner’s age was 30.0 (95% CI [29.0, 31.1]) years (not in the Table) with the majority being employed. The highest level of educa- Data Analysis tion attended by the male partner was tertiary education. Data analysis was done using IBM SPSS statistic 20 soft- From Table 2, the majority had adequate knowledge ware. Chi-square (x ) and logistic regression analysis of IPV which they got majorly from friends and watching were used for categorical variables where applicable. The television. Only 12% of women were aware that stalking student’s age (ł 23 or .23 years), marital status (mar- is a form of IPV. When asked whether they have a friend ried or single), year of education (ł3or .3 years), and with a history of IPV, 46% (207) was affirmative in their social class 1 and 2 (upper social class); social class 3, 4, answers. Anikwe et al. 7 RADIO SIBLING PARENT VICTIM CHURCH SCHOOL NEWSPAPER TELEVISION FRIENDS READING BOOKS 020 40 60 80 100 120 Figure 1. Sources of information about Nigerian Law against IPV. commonest type of IPV experienced was Emotional &/ Table 3. Profile of Intimate Partner Violence Among the Study or Harassment abuse. Respondent. As shown in Table 4, more than 50% of the student would report a case of IPV. A majority (167, 37.1%) of Variables Frequency (n) Percentage (%) those that will report said they would report to their par- Intimate partner violence ent while 24% will report to the partner’s parent. Less Yes 215 47.8 than one-fifth of the respondent would report to the No 235 52.2 criminal justice system for redress on experiencing IPV. Afraid of partner Those that would not report attributed their major rea- Yes 170 37.8 No 280 62.2 son for not reporting on fear of further attack (26.0%) Types of IPV and shame (24.0%). The Table also shows that majority Severe combined abuse 63 14.0 of the respondent would resort to prayer (243, 54.0%) Physical, emotional, and/or 25 5.6 while 35.1% (158) would keep quiet on being assaulted. harassment abuse From Table 5, the age of the respondent and history of Physical abuse 7 1.6 Emotional and/or 120 26.6 IPV had a significant association. There is a 58% chance harassment abuse of a student who is more than 23 years being assaulted None 235 52.2 than those that are ł 23 years with true effect size of 35% to 73%. Being in lower socio-economic class is asso- ciated with increased odds of being a victim. Cohort of women who are married were at reduced risk of IPV than Among our study population, only 47% were aware being single (OR = 0.61 95% CI [0.24, 0.48]). of such legislation against IPV. The commonest source of information was reading the newspaper and watching television (Figure 1). Discussion Table 3 below shows the profile of IPV observed in the women. The point prevalence of IPV was 47.8%; IPV is an epidemic which needs to be prevented. This 37.8% including those with and without experience have study is embarked upon to assess the knowledge, atti- a history of being afraid of their partner. The tude, practice, and determinants of intimate partner 8 SAGE Open Table 4. Respondent Reaction and Attitude Toward Intimate Table 5. The Determinant of Intimate Partner Violence Among Partner Violence. the Respondent. Variables Frequency (n) Percentage (%) Intimate partner violence a Variables OR 95% CI Yes (n,%) No (n,%) Reaction to IPV Keeping quiet 158 35.1 Age Crying 97 21.5 <23 years 41 (19.1) 84 (35.7) 0.42 [0.27–0.65] Praying 243 54.0 .23 years 174 (80.9) 151 (64.3) 1 Fight back 88 19.5 Social class Involve third party 95 21.1 Lower 138 (64.2) 176 (74.9) 0.60 [0.40–0.90] Leave house 113 25.1 Upper 77 (35.8) 59 (25.1) 1 Kill me approach 38 8.4 Marital status Begging 70 15.5 Married 68 (31.6) 38 (16.2) 2.39 [1.52–3.76] Reporting IPV 274 60.8 a Single 147 (68.4) 197 (83.8) 1 Whom to report Year of study Police 70 15.5 \3 years 134 (62.3) 185 (78.7) 0.45 [0.29–0.68] Parent 167 37.1 ø 3 years 81 (37.7) 50 (21.3) 1 Sibling 50 11.1 Partner Church 63 14.0 Age Friends 32 7.1 <30 years 134 (62.3) 165 (70.2) 0.70 [0.47–1.04] Health worker 48 10.7 .30 years 81 (37.9) 70 (29.8) 1 Relation of partner 106 23.5 Occupation Counselor 11 2.4 Not employed 95 (44.2) 122 (51.9) 0.73 [ 0.51–1.06] Partner’s parent 36 8.0 Employed 120 (55.8) 113 (48.1) 1 School authority 11 2.4 a Education Reason for not reporting Below tertiary 91 (42.3) 129 (54.9) 0.60 [0.42–0.88] Fear of further attack 115 25.5 Tertiary 124 (57.7) 106 (45.1) 1 Shame 108 24.0 Against my religion 93 20.6 Significant. Against my culture 99 22.0 Multiple answers allowed. provide them with the necessary interventions for their rehabilitation. violence among nursing students in, Abakaliki. Our In our study, the rate of IPV among the study popula- study shows that the majority of the female nursing stu- tion was unacceptably high as almost 50% of the student dents have adequate knowledge of IPV and the common reported being a victim of IPV within 12 months before sources of information are mass media (60%), friends the study. This is in keeping with the high rate of IPV in (26%), and reading books (18%). The most common the study area (Anzaku et al., 2017; Benebo et al., 2018; type of IPV known by the study group was sexual vio- Onanubi et al., 2017; Owoaje & OlaOlorun, 2012; lence which was followed by emotional and psychological Oyediran & Feyisetan, 2017; Tanko et al., 2016; Umana violence. This might be a reflection of the type of assault et al., 2014) and other African nations (Burgos-Soto that has been experienced by themselves, their friend and et al., 2014; Ogum Alangea et al., 2018; Spencer et al., relation. It is quite discomforting that about 53% of the 2016). The two most common forms of IPV observed in students are not aware of a Nigerian law that was the women were Emotional &/or Harassment abuse recently promulgated against intimate partner violence. (26.6%) and SCA (14%). Physical, Emotional &/or Apart from its recent promulgation into law by Nigerian Harassment abuse and physical violence were reported government (Violence Against Persons (Prohibition) Act, in 5.6% and 1.6% of respondents respectively. The rates 2015) being a factor for lack of knowledge among the of different forms of IPV seen in our study, however, dif- study population, the fact that only 15.5% (70) of the fers from a similar study in Kano, Nigeria (Tanko et al., students are willing to report to the Police might not be 2016); difference in the study population might account unconnected to the socio-cultural and religious factors for this observation. (National Population Commission affecting the fight against elimination of violence against Nigeria, 2014). The occurrence of SCA among the women (Ibekwe, 2007). It, therefore, calls for dissemina- female nursing students is highly disturbing as SCA rep- tion of information about this law to the general popu- resents the most severe form of abuse a woman can suf- lace by the Nigerian government. This will help the fer (Hegarty et al., 2005) which can lead to the death of victim seek redress, punish perpetrator, deter perpetra- the victim. IPV increases the odds of negative physical tors from further incidents, compensate survivors and and mental health conditions of the victim (Breiding Anikwe et al. 9 et al., 2014; Spencer et al., 2016) and a significant contri- at risk of intimate partner violence (Breiding et al., 2014; butor to poor academic performances of the victim Onanubi et al., 2017; Sto¨ ckl et al., 2014). Our study pop- (Wood et al., 2018). It can therefore adversely affect the ulation are mostly single and in low socioeconomic strata academic performance of our study population thereby which leaves them prone to monetary manipulations by the opposite sex for their selfish gains. The mean age of impinging on their future development. This finding female partner’s in our study was 30.0 (95% CI [29.0, from our study calls for urgent interventions by the Government and Non-Governmental Organization 31.1]) years and it is the age bracket when most men (NGO) in Nigeria to help address this ‘‘domestic terror- have established a source of livelihood in the study area ism’’ which these unfortunate women are experiencing. and are looking for a life partner. IPV ‘‘cripples’’ and isolates a woman (Follingstad The female nursing student’s age, social class, year of et al., 1990; Sassetti, 1993) and it not surprising from our study, and partner’s level of education are a significant study that a sizable number of the female nursing stu- determinant of IPV among the women studied (p\ .05). In our study, students who are 23 years and below and in dents are afraid of their male partner which might not be low socioeconomic class have an increased odd of been unconnected to the level of violence that they have assaulted by their partner and vice versa. This finding undergone from their partners. It is however encoura- from our study could be explained from the perspective ging from our study that most of the women studied of Right and Feminist theories of IPV in Africa would report a case of IPV although it is disappointing that most would report to their relatives as shown in (Bowman, 2003). The Feminist theory of IPV in Africa attributes women’s subordinate position, passivity, gen- Table 4. This finding from our study negates the think- der inequality, and economic dependence as fundamental ing that for the eradication of violence against women, to the development of domestic violence (Bowman, women should have zero tolerance of it and every case of 2003). Our study population being young and in lower violence should be reported to appropriate authorities class as an extension of feminist thinking, therefore, for redress (Ibekwe, 2007; Onanubi et al., 2017). It high- leaves them unacceptably prone to abuse by their male lighted the need for a clarion call on the need to educate partner who are much older and economically less the women folk on their right and to the ‘‘evil’’ nature of dependent. Apart from this, an explanation of the abuse domestic violence to themselves and her children (O. A. could arise from the influence of cultural dictates of Fawole et al., 2016; National Population Commission domestic violence in Africa and individual psychology Nigeria, 2014; Spencer et al., 2016; Titilayo et al., 2017). and psychopathology of the batterer (Bowman, 2003). More than two-fifth of the women interviewed attrib- The latter argues that the batterer engages in violence uted their reasons of not wanting to report a case of IPV against their partner as a result of personal insecurity to culture and religion while fear and shame accounted for and deep psychological dependence on their victim. In the majority of their reasons which agrees with earlier our study, the male partner being unemployed increases reports (WHO, 2012). Cultural and Feminist theories of the risks by 73% of his partner being assaulted by him IPV in Africa offer a more plausible reason for these (95% CI [0.51, 1.06]); p. .05) and this odd is increased responses among our study population (Bowman, 2003). among male partners with below tertiary education The patriarchal nature of traditional African societies with (OR = 0.60; 95% CI [0.42, 0.88]). Above observations is subordinate positioning of women with its pervasive gen- in tandem with other works on this subject (Onanubi der inequality and interacting with traditional mores and et al., 2017). According to the ecological model of vio- norms supporting wife battering in Africa are plausible lence, relationship level factors predisposing female reasons for this attitudinal rationalization seen among our youth to IPV seen in our study include unemployment study population (Bowman, 2003). Benebo et al. (2018) in and lower levels of education. Other factors include a study showed that community belief system that justify female partners having multiple partners, partner’s exhi- IPV negates the positive influence of women’s status on biting controlling behavior, use of substance abuse and IPV reduction (OR = 1.89; 95% CI [1.26, 2.83]). Programs those who experienced violence when growing up (Krug, should, therefore, be put in place to re-orientate commu- 2002; Uthman et al., 2010). nity members to embrace gender equity, mutual respect, and amicable resolution of family issues as a panacea to partner violence (Oyediran & Feyisetan, 2017). Limitations of the Study The mean age of the women was 23.0 (95% CI [22.4, 22.6]) years with the majority belonging to 20 to 24 age Our study is a cross-sectional study involving only the brackets. This age bracket is the late adolescent stage nursing student in our center and the findings of this when young girls might be trying to start an intimate study could not be a representative of the population of partner relationship, for possible marriage, with the the students in Abakaliki. It, however, opens a window opposite sex. This agree with an earlier report of women to the possible prevalence of IPV in the state and Nigeria 10 SAGE Open in general. It is also limited by the fact that a causal rela- Informed Consent tionship could not be ascertained and there might be Informed written consent was obtained from the study recall and social desirability bias. An effort was however population. made to reduce recall bias and social desirability bias by encouraging recall of IPV in the past 1 year and inform- ORCID iD ing the study population not to write their names, phone Chidebe C. Anikwe https://orcid.org/0000-0002-3730-621X numbers, and that the findings and report would not have anything to do with them. Privacy was also pro- vided for them when answering the questionnaire. The Availability of Data and Material study instrument (CAS) was validated in the study area All data generated or analyzed during this study are included in before applying it to our respondents to ensure its valid- this published article. ity in assessing partner violence in the study area. The questionnaire was pretested before being applied. Our References study was also limited by non-inclusion of women that Adebayo, A. A. (2014). Sociological implications of domestic were not currently in relationships and people who were violence on children’s development in Nigeria. Journal of sick as these women might have suffered from IPV. African Studies and Development, 6(1), 8–13. https://doi.org/ 10.5897/JASD2013.0237 Anikwe, C. C., Umeononihu, O. S., Anikwe, I. F., Ikeoha, C. Conclusion C., Eleje, G. U., Ewah, R. L., Okorochukwu, B. C., Nwo- koe, B. I., Ogah, C. O., & Okoroafor, F. C. (2021). Burden Our study shows a high level of IPV in the studied group of intimate partner violence among nurses and nursing stu- is high. The two most common form of IPV is Emotional dents in a tertiary hospital in Abakaliki, Ebonyi State, &/OR Harassment abuse and SCA. It is however Nigeria. SAGE Open Nursing, 7. https://doi.org/10.1177/ encouraging that the majority of the students believed that IPV should be reported. We recommend appropriate Anzaku, S. A., Shuaibu, A., Dankyau, M., & Chima, G. A. management of such cases and effort made to inform the (2017). Intimate partner violence and associated factors in women and the general populace at large of Nigerian leg- an obstetric population in Jos, North-central Nigeria. Sahel islation against gender-based violence because of poor Medical Journal, 20, 49–54. awareness seen in our study. Enablement should also be Ajah, L. O., Iyoke, C. A., Nkwo, P. O., Nwakoby, B., & Ezeonu, P. (2014). Comparison of domestic violence against provided by the Government and NGOs to assist the vic- women in urban versus rural areas of southeast Nigeria. tim to seek redress. International Journal of Women’s Health, 6, 865–872. Basile, K. C., Hertz, M. F., & Back, S. E. (2007). Intimate part- Author Contributions ner violence and sexual violence victimization assessment instruments for use in healthcare settings: Version 1. 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Knowledge, Attitude, and Practice of Intimate Partner Violence and Its Determinants Among Female Nursing Students in Abakaliki, Southeast Nigeria

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Abstract

To assess the knowledge, attitude, practice, and determinants of intimate partner violence (IPV) among nursing female stu- dent in a tertiary hospital in Abakaliki. A cross-sectional descriptive study was done in a tertiary hospital in Abakaliki between 1st March 2018 and 31st August 2018 among 450 nursing female student. They were interviewed using a Composite Abuse Scale (CAS) version 2013. Analysis was done using IBM SPSS Statistic version 20. The prevalence of any type of IPV among respondents was 47.8%. The majority (70.9%) were aware of IPV and the commonest mode of information was mass media (60.0%). Majority of the respondent would resort to prayer following IPV and only 15.5% would report to police. The most common form of abuse reported was emotional &or harassment abuse (26.6%). Student’s age (OR = 0.42; 95% CI [0.41, 0.92]), social class (OR = 0.60; 95% CI [0.40, 0.90]), level of study (OR = 0.45; 95% CI [0.29, 0.68]), and partner’s level of edu- cation (OR = 0.60; 95% CI [0.42, 0.88]) were determinant of respondent experiencing IPV. Less than 50% of the respondent were aware of legislation against IPV. The study shows a high level of IPV among the studied group. Screening for IPV is advo- cated among the students’ population especially among the young adolescent. Efforts should also be made by the government to increase awareness about Nigerian law against IPV. Keywords violence, intimate partner violence, violence, nursing, female students, combined abuse scale the level of ‘‘domestic terrorism’’ that women under go Introduction from their partners. In Nigeria a high prevalence rate of Intimate partner violence is a global health problem. It IPV has been reported (Anzaku et al., 2017; Benebo includes physical violence, sexual violence, stalking, and et al., 2018; O. I. Fawole et al., 2005; Onanubi et al., psychological aggression by a current/former romantic 2017; Umana et al., 2014) among Nigerian women. and/or sexual partner (Breiding et al., 2015). The true These disturbing findings in Nigeria are also seen in burden of IPV is not known. While men can be recipi- other studies in African countries (Burgos-Soto et al., ents of IPV, women experience IPV at higher rates. IPV is estimated to affect 35% of women worldwide (World Health Organization [WHO], 2013). There is a regional 1 Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi variation on the lifetime prevalence of IPV, the highest State, Nigeria Federal Medical Centre, Owerri, Imo State, Nigeria rate is seen in developing world of which African (36.6 95% CI [32.7, 40.5]) region is second to South-East Asia Corresponding Author: (37.7 95% CI [32.8, 42.6]) region on cases of physical Chidebe C. Anikwe, Alex Ekwueme Federal University Teaching Hospital, and/or sexual intimate partner violence (WHO, 2013). Abakaliki, Ebonyi State, Nigeria. Various studies in Africa including Nigeria have shown Email: drchideanikwechristian@gmail.com Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open 2014; Delamou et al., 2015; Malan et al., 2018; Ogum et al., 2016; Hampanda et al., 2017; Onanubi et al., Alangea et al., 2018). 2017). Exposure to IPV can increase women’s risk for The patriarchal nature of African societies which human immunodeficiency virus (HIV) infection encourages male dominance with the subjugation of (Hampanda et al., 2017). It also affects partner disclo- women as a ‘‘tool to a means’’ is an important factor to sure of HIV status and a woman’s adherence to therapy IPV (Bowman, 2003). In Nigeria, for example, the gender with resultant poor performance on antiretroviral equality index is low, Nigeria is estimated to rank 128th medication (Maman et al., 2000). Ignoring the increasing in Global Gender Gap Index with score of 0.635 (World global burden of IPV, therefore, can be a hindrance to Economic Forum, 2019) and this might probably be con- the international community effort in ending the AIDS tributing to IPV. Some women justify IPV against other epidemic by 2030 (WHO, 2017). This becomes particu- women which might ultimately encourage further acts of larly important in sub Saharan countries like Nigeria IPV (Ajah et al., 2014; Esere et al., 2009). The victims’ where the prevalence of HIV/AIDS disease is assuming apparent non-reporting of an assault to appropriate an epidemic proportion. Apart from the above findings, channels for redress and lack of enabling laws in some IPV negatively affects the academics performance of the African countries encourages the perpetration of this victim. bastard act (IPV) to thrive. It is, however, gladding that The majority of women undergo trauma in silence with the passage of Nigerian law against IPV, succor which makes it difficult to intervene and eradicate IPV would be given to victims of domestic violence (Violence (Ibekwe, 2007; WHO, 2012). This ‘‘silence syndrome’’ in Against Persons (Prohibition) Act, 2015). Nigeria constitute an impediment to eradicating the can- The male partner is the common perpetrator of female kerworm called IPV (Ibekwe, 2007). According to a IPV. Some of the risk factors for this behavior among study by Linos et al. less than 40 % of Nigerian women men include drug dependence, jealousy, alcoholism, low that are victims of intimate partner abuse reported ever educational attainment, having multiple sexual partners, seeking help to stop the chain of abuse from the perpe- inability to meet financial needs, childhood abuse, and trator. Help-seeking among the victims were found to be family history of domestic violence (Adebayo, 2014; dependent on the level of Human Development Index of Esere et al., 2009; Matseke et al., 2012; Ntaganira et al., the states (Linos et al., 2014) which calls for a deliberate 2008; Onoh et al., 2013; Shamu et al., 2011). IPV is asso- effort to empower women and develop the girl child in ciated with several negative health problems on the vic- Nigeria as a long term measure in addressing IPV. tims which some of them are: physical injuries, Various reasons adduced for women’s tolerance of an disabilities, substance use problems, suicidal ideation, abused partner include ‘‘fear of retaliation, lack of alter- difficulty in establishing a further relationship with men, native means of economic support, concern for their chil- sleep disturbances, fear, poor academic performance, dren, lack of support from family and friends, stigma or anxiety, and substance abuse (Breiding et al., 2014; fear of losing custody of children associated with divorce Onanubi et al., 2017; Spencer et al., 2016; Wood et al., and love with the hope that the partner will change’’ 2018) huge man-hour lost in production, and health- (WHO, 2012). related cost (National Center for Injury Prevention and In Nigeria, reduction or possible elimination of part- Control, 2003). It could also lead to femicide and Africa ner based violence would involve the education of has been reported to have the highest rate of intimate women on their reproductive and sexual rights. There is femicide (UNODC, 2019). IPV has been argued to occur a need also to address the cultural belief systems that are in three phases which are the tension building phase, cri- not supportive of women’s rights in Nigeria (Ibekwe, sis phase, and the honeymoon phase (Shelter For Help in 2007). It has been advocated that women should have Emergency, 2022). The cycle of abuse tends to increase zero tolerance of domestic violence and every case without intervention and could result in femicide. should be reported to appropriate authorities (Ibekwe, Femicide could occur either in tension or crisis phase. 2007; Titilayo et al., 2014). This will enable punishment The mechanism of femicide vary and could result from of perpetrators and deter perpetrators from further inci- physical injury, neglect of the victim, the victim being dents, compensate survivors, and provide them with the under tension and unlikely to seek and receive prompt necessary interventions for their rehabilitation. It has medical care when sick as this is likely to be prevented by been argued by Ibekwe (2007) that violence against the perpetrator. women should be made a state affair and with the recent Unintended pregnancy, adverse pregnancy outcome, promulgation of law against IPV in Nigeria (Violence nonuse of condoms, sexually transmitted diseases includ- Against Persons (Prohibition) Act, 2015), it is hoped that ing HIV/AIDS are some of the sexual and reproductive affected women in Nigeria will seek redress when their health problems of IPV (Maman et al., 2000; Bernstein right is infringed by their partner. Anikwe et al. 3 This work is embarked upon to assess the knowledge, of the husband for determination of a woman’s social attitude, and practice of IPV among nursing students in class. The social class of the study participants that were a tertiary hospital in Abakaliki. It will also help to assess not married were based on that of their parents. They their rate of IPV victimization and its determinants. were graded into social classes 1 to 5. Social class 1 and Findings from our study will assist the authority in the 2 were classified as upper social class while social class 3, hospital to proactively put measures in place to assist 4, and 5 were classified as lower social class. ‘‘Intimate and prevent IPV among the students. It will also help to partner violence (IPV) is defined as actual or threatened improve their curriculum toward prevention and man- physical, sexual, psychological, emotional, or stalking agement of IPV after their nursing education. abuse by an intimate partner while an intimate partner is defined as a current or former spouse or non-marital partners, such as a boyfriend or dating partner’’ (Basile Materials and Methods et al., 2007). Knowledge of IPV was assessed using 22 items, correct answer was scored as 1 and incorrect Study Design answer as 0. Overall knowledge scores were calculated To assess the knowledge, attitude, practice, and determi- by adding the individual scores (answers); the highest nants of IPV among nursing female student in a tertiary scores was 22. A score of 10 and above was assessed as hospital in Abakaliki. adequate overall knowledge of IPV while a score less than 10 was assessed as inadequate overall knowledge of IPV. The 22 items instrument was pretested among 30 Methods nursing students on ward posting in AEFUTHA. The Study Setting internal consistency was found to be good (Cronbach’s The study was carried out in nursing and midwifery alpha of 0.70). schools of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Sample Size The sample size was gotten using the formula N = Z Study Population 2 PQ/D . Where N = required sample size. Z = 1.96 at The study population was female nursing students that confidence level at 95%; P = estimated population of met the inclusion criteria. They were consenting females 44.6% (Esere et al., 2009) D; margin of error at 5% and who were not pregnant and are currently in an intimate Q=12 P. The sample size for the study is 460 after the partner relationship for the past 12 months. Study popu- addition of a 20% attrition rate. lation was limited to those who are currently in an inti- mate partner relationship to help reduce recall bias and Ethical Consideration to help us assess the current risk that the students are undergoing. Those who were excluded were those who Ethical approval for this study was obtained from the refused to consent, sick, or are not in an intimate partner ethical committee of the hospital. The ethical approval relationship for the past 12 months. A simple random number is REC APPROVAL NUMBER 14/11/2017-19/ sampling method (ballot method) was used for respon- 12/2017. Approval for the use of CAS was obtained dent’s selection. Consented students were asked to pick a from Kelsey Hegarty of the University of Melbourne. piece of blue paper marked ‘‘Yes’’ and ‘‘No’’ with Informed and written consent was obtained from the replacement from a black polythene bag into which an participant before inclusion into the study. equal number of paper ‘‘Yes’’ and ‘‘No’’ paper were added. Students that picked a paper marked ‘‘Yes’’ were Composite Abuse Scale (CAS) recruited as the study population. They were interviewed between January 2018 and May 2018 in a dedicated ‘‘CAS is an easily administered self-report measure that office using a pre-tested structured questionnaire provides standardized subscale scores on four dimensions (Cronbach’s alpha = .72) and a Composite Abuse Scale of intimate partner abuse consisting of 30 items presented (CAS) version 2013 (Hegarty et al., 2005). The question- in a six-point format requiring respondents to answer naire was filled by the participant after thorough expla- ‘‘never,’’ ‘‘only once,’’ ‘‘several times,’’ ‘‘monthly, nation and understanding of the study instrument. The weekly,’’ or ‘‘daily’’ in twelve months. It assess the follow- social class of the study population was determined ing: Severe Combined Abuse Factor, Emotional Abuse based on the work of Olusanya et al. (1985) which used factor, Physical Abuse factor, and the Harassment factor. the educational level of the women and the occupation The CAS is made up of four subscales: Severe Combined 4 SAGE Open Abuse (SCA; 8 items; possible score 0–40), Physical Abuse ‘‘The subscale score was calculated and was com- (7 items; possible score 0–35), Emotional Abuse (11 items; pared with a predetermined cut-off score for each sub- possible score 0–55), and Harassment (4 items; possible scale (Hegarty et al., 2005) as shown below to score 0–20)’’ (Anikwe et al., 2021; Hegarty et al., 2005). determine whether they have suffered that abuse’’ (Anikwe et al., 2021). A subscale score greater than the The Severe Combined Abuse Factor Represent Severe set score would determine that the respondent had such abuse. Example if a woman has a SCA score of 10, Physical Abuse Items, All Sexual Abuse Items, and Emotional abuse score of 15, Physical abuse score of Physical Isolation Aspects of Emotional Abuse 30, and Harassment abuse score of 20 the total score is ‘‘Raped me; Used a knife or gun or other weapons; 75; each score above is greater than the predetermined Took my wallet and left me stranded; Tried to rape me; cut-off score and the woman will be adjudged to have Kept me from medical care; Locked me in the bedroom; suffered each of the above abuses. Categorization will Refused to let me work outside the home; Put foreign determine the category of composite abuse. An overall objects in my vagina’’ (Anikwe et al., 2021; Hegarty score of 7 and above determines an individual that has et al., 2005) suffered an abuse. The Emotional Abuse Factor Include Verbal, Psychological, Dominance, and Social Isolation Abuse CAS Cut-Off Score Items ‘‘Told me that I was not good enough; Told me that I was stupid; Did not want me to socialize with my female Scale Cut-off score friends; Told me that I was crazy; Became upset if din- ner/housework was not done when they thought it Severe combined abuse 1 should be; Blamed me for causing their violent behavior; Physical abuse 1 Tried to turn my family, friends and children against me; Emotional abuse 3 Told me that no one else would ever want me; Told me Harassment 2 that I was ugly; Tried to keep me from seeing or talking Total 7 to my family; Tried to convince my family, friends and children that I was crazy’’ (Anikwe et al., 2021; Hegarty et al., 2005). Abuse Categorizations ‘‘The type of abuse experienced by each respondent The Physical Abuse Factor Has 7 of the Less Severe was categorized as shown below. SCA took precedence Physical Abuse Items over the other forms of abuse so that any participant ‘‘Pushed, grabbed or shoved me; Hit or tried to hit me who had experienced SCA fell into the SCA category with something; Shook me; Slapped me; Threw me; (Category 1). The second category includes all partici- Kicked me, bit me or hit with a fist; Beat me up’’ pants who had experienced Physical Abuse in combina- (Anikwe et al., 2021; Hegarty et al., 2005). tion with Emotional Abuse and/or Harassment. Participants who have experienced at least one episode of Physical Abuse, but no other forms of abuse, fell The Harassment Factor Represents Actual into the third category, Physical Abuse Alone. The Harassment final category contains all participants who had experi- ‘‘Harassed me over the telephone; followed me; Hung enced Emotional Abuse and/or Harassment, but not around outside my house; Harassed me at work’’ any other form of abuse’’ (Anikwe et al., 2021; Hegarty (Anikwe et al., 2021; Hegarty et al., 2005). et al., 2005). NO Anikwe et al. 5 Abuse Categorizations Sequence Severe combined Does the participant meet the cutoff for YES abuse Severe combined abuse? Does the participant meet the cutoff for Emotional and/or NO Harassment Physical Abuse? Does the participant meet the Physical Abuse cutoff for Emotional and/or NO alone Harassment? Physical, Emotional, and/or Harassment 6 SAGE Open Table 1. Socio - Demographic Characteristics of the Women Table 2. Respondent Knowledge About Intimate Partner (n = 450). Violence. Characteristics Frequency (n) Percentage (%) Variables Frequency Percentage Age (years) Knowledge of IPV <19 61 13.6 Adequate 319 70.9 20–24 258 57.3 Inadequate 131 29.1 ø 25 131 29.1 Source(s) of information Marital status Reading books 81 18.0 Single 344 76.4 Friends 117 26.0 Married 97 21.6 Newspaper 90 20.0 Separated 2 0.5 Radio 63 14.0 Divorced 7 1.5 Television 117 26.0 Residence From school 54 12.0 Rural 145 32.2 Church 27 6.0 Urban 305 67.8 Sibling 27 6.0 Mother’s education Parent 54 12.0 None 84 18.7 Types of IPV known Primary 110 24.4 Sexual violence 180 40.0 Secondary 112 24.9 Physical violence 135 30.0 Tertiary 144 32.0 Emotional violence 171 38.0 Year of study Psychological abuse 144 32.0 Year 1 124 27.6 Stalking 54 12.0 Year 2 162 36.0 Friends with a history of IPV Year 3 164 36.4 Yes 207 46.0 Partner No 243 54.0 Age <19 9 2.0 Multiple answer allowed. 20–24 70 15.5 25–29 147 32.6 30–34 143 31.8 and 5 (lower social class) were reclassified for easy analy- ø 35 81 18.0 sis. The partner’s characteristics were also reclassified Occupation Unemployed 217 48.2 into ł 30 years and .30 years. The odds ratios with their Employed 233 51.8 95% CI were calculated to determine the strength and Education presence of an association. p-Value of \.05 is adjudged Primary 22 4.9 significant. Odds ratio \1 implies decreased likelihood Secondary 197 43.8 of being a victim of IPV, while OR. 1 represented Tertiary 231 51.3 increased probability of suffering from IPV. Validation of CAS Results ‘‘To test the reliability and internal consistency of the A total of 460 questionnaires were shared, out of which CAS, we surveyed 36 female nurses in the Department of 450 (97.8%) students were in intimate partner relation- Obstetrics and Gynaecology of Alex Ekwueme Federal ships and were analyzed. From Table 1, the mean age of University Teaching Hospital, Abakaliki. Respondents the women was 23.0 (95% CI [22.4, 22.6]) years (not in completed the questionnaires twice in 2 weeks and the Table). The majority of the study population were responses were matched and compared for test-retest between 20 and 24 years. More than 40 % of the respon- reliability. The internal consistency for the scale was dent belong to lower socioeconomic class. More than good (Cronbach’s alpha = 0.72)’’ (Anikwe et al., 2021). three-quarters are single. The mean partner’s age was 30.0 (95% CI [29.0, 31.1]) years (not in the Table) with the majority being employed. The highest level of educa- Data Analysis tion attended by the male partner was tertiary education. Data analysis was done using IBM SPSS statistic 20 soft- From Table 2, the majority had adequate knowledge ware. Chi-square (x ) and logistic regression analysis of IPV which they got majorly from friends and watching were used for categorical variables where applicable. The television. Only 12% of women were aware that stalking student’s age (ł 23 or .23 years), marital status (mar- is a form of IPV. When asked whether they have a friend ried or single), year of education (ł3or .3 years), and with a history of IPV, 46% (207) was affirmative in their social class 1 and 2 (upper social class); social class 3, 4, answers. Anikwe et al. 7 RADIO SIBLING PARENT VICTIM CHURCH SCHOOL NEWSPAPER TELEVISION FRIENDS READING BOOKS 020 40 60 80 100 120 Figure 1. Sources of information about Nigerian Law against IPV. commonest type of IPV experienced was Emotional &/ Table 3. Profile of Intimate Partner Violence Among the Study or Harassment abuse. Respondent. As shown in Table 4, more than 50% of the student would report a case of IPV. A majority (167, 37.1%) of Variables Frequency (n) Percentage (%) those that will report said they would report to their par- Intimate partner violence ent while 24% will report to the partner’s parent. Less Yes 215 47.8 than one-fifth of the respondent would report to the No 235 52.2 criminal justice system for redress on experiencing IPV. Afraid of partner Those that would not report attributed their major rea- Yes 170 37.8 No 280 62.2 son for not reporting on fear of further attack (26.0%) Types of IPV and shame (24.0%). The Table also shows that majority Severe combined abuse 63 14.0 of the respondent would resort to prayer (243, 54.0%) Physical, emotional, and/or 25 5.6 while 35.1% (158) would keep quiet on being assaulted. harassment abuse From Table 5, the age of the respondent and history of Physical abuse 7 1.6 Emotional and/or 120 26.6 IPV had a significant association. There is a 58% chance harassment abuse of a student who is more than 23 years being assaulted None 235 52.2 than those that are ł 23 years with true effect size of 35% to 73%. Being in lower socio-economic class is asso- ciated with increased odds of being a victim. Cohort of women who are married were at reduced risk of IPV than Among our study population, only 47% were aware being single (OR = 0.61 95% CI [0.24, 0.48]). of such legislation against IPV. The commonest source of information was reading the newspaper and watching television (Figure 1). Discussion Table 3 below shows the profile of IPV observed in the women. The point prevalence of IPV was 47.8%; IPV is an epidemic which needs to be prevented. This 37.8% including those with and without experience have study is embarked upon to assess the knowledge, atti- a history of being afraid of their partner. The tude, practice, and determinants of intimate partner 8 SAGE Open Table 4. Respondent Reaction and Attitude Toward Intimate Table 5. The Determinant of Intimate Partner Violence Among Partner Violence. the Respondent. Variables Frequency (n) Percentage (%) Intimate partner violence a Variables OR 95% CI Yes (n,%) No (n,%) Reaction to IPV Keeping quiet 158 35.1 Age Crying 97 21.5 <23 years 41 (19.1) 84 (35.7) 0.42 [0.27–0.65] Praying 243 54.0 .23 years 174 (80.9) 151 (64.3) 1 Fight back 88 19.5 Social class Involve third party 95 21.1 Lower 138 (64.2) 176 (74.9) 0.60 [0.40–0.90] Leave house 113 25.1 Upper 77 (35.8) 59 (25.1) 1 Kill me approach 38 8.4 Marital status Begging 70 15.5 Married 68 (31.6) 38 (16.2) 2.39 [1.52–3.76] Reporting IPV 274 60.8 a Single 147 (68.4) 197 (83.8) 1 Whom to report Year of study Police 70 15.5 \3 years 134 (62.3) 185 (78.7) 0.45 [0.29–0.68] Parent 167 37.1 ø 3 years 81 (37.7) 50 (21.3) 1 Sibling 50 11.1 Partner Church 63 14.0 Age Friends 32 7.1 <30 years 134 (62.3) 165 (70.2) 0.70 [0.47–1.04] Health worker 48 10.7 .30 years 81 (37.9) 70 (29.8) 1 Relation of partner 106 23.5 Occupation Counselor 11 2.4 Not employed 95 (44.2) 122 (51.9) 0.73 [ 0.51–1.06] Partner’s parent 36 8.0 Employed 120 (55.8) 113 (48.1) 1 School authority 11 2.4 a Education Reason for not reporting Below tertiary 91 (42.3) 129 (54.9) 0.60 [0.42–0.88] Fear of further attack 115 25.5 Tertiary 124 (57.7) 106 (45.1) 1 Shame 108 24.0 Against my religion 93 20.6 Significant. Against my culture 99 22.0 Multiple answers allowed. provide them with the necessary interventions for their rehabilitation. violence among nursing students in, Abakaliki. Our In our study, the rate of IPV among the study popula- study shows that the majority of the female nursing stu- tion was unacceptably high as almost 50% of the student dents have adequate knowledge of IPV and the common reported being a victim of IPV within 12 months before sources of information are mass media (60%), friends the study. This is in keeping with the high rate of IPV in (26%), and reading books (18%). The most common the study area (Anzaku et al., 2017; Benebo et al., 2018; type of IPV known by the study group was sexual vio- Onanubi et al., 2017; Owoaje & OlaOlorun, 2012; lence which was followed by emotional and psychological Oyediran & Feyisetan, 2017; Tanko et al., 2016; Umana violence. This might be a reflection of the type of assault et al., 2014) and other African nations (Burgos-Soto that has been experienced by themselves, their friend and et al., 2014; Ogum Alangea et al., 2018; Spencer et al., relation. It is quite discomforting that about 53% of the 2016). The two most common forms of IPV observed in students are not aware of a Nigerian law that was the women were Emotional &/or Harassment abuse recently promulgated against intimate partner violence. (26.6%) and SCA (14%). Physical, Emotional &/or Apart from its recent promulgation into law by Nigerian Harassment abuse and physical violence were reported government (Violence Against Persons (Prohibition) Act, in 5.6% and 1.6% of respondents respectively. The rates 2015) being a factor for lack of knowledge among the of different forms of IPV seen in our study, however, dif- study population, the fact that only 15.5% (70) of the fers from a similar study in Kano, Nigeria (Tanko et al., students are willing to report to the Police might not be 2016); difference in the study population might account unconnected to the socio-cultural and religious factors for this observation. (National Population Commission affecting the fight against elimination of violence against Nigeria, 2014). The occurrence of SCA among the women (Ibekwe, 2007). It, therefore, calls for dissemina- female nursing students is highly disturbing as SCA rep- tion of information about this law to the general popu- resents the most severe form of abuse a woman can suf- lace by the Nigerian government. This will help the fer (Hegarty et al., 2005) which can lead to the death of victim seek redress, punish perpetrator, deter perpetra- the victim. IPV increases the odds of negative physical tors from further incidents, compensate survivors and and mental health conditions of the victim (Breiding Anikwe et al. 9 et al., 2014; Spencer et al., 2016) and a significant contri- at risk of intimate partner violence (Breiding et al., 2014; butor to poor academic performances of the victim Onanubi et al., 2017; Sto¨ ckl et al., 2014). Our study pop- (Wood et al., 2018). It can therefore adversely affect the ulation are mostly single and in low socioeconomic strata academic performance of our study population thereby which leaves them prone to monetary manipulations by the opposite sex for their selfish gains. The mean age of impinging on their future development. This finding female partner’s in our study was 30.0 (95% CI [29.0, from our study calls for urgent interventions by the Government and Non-Governmental Organization 31.1]) years and it is the age bracket when most men (NGO) in Nigeria to help address this ‘‘domestic terror- have established a source of livelihood in the study area ism’’ which these unfortunate women are experiencing. and are looking for a life partner. IPV ‘‘cripples’’ and isolates a woman (Follingstad The female nursing student’s age, social class, year of et al., 1990; Sassetti, 1993) and it not surprising from our study, and partner’s level of education are a significant study that a sizable number of the female nursing stu- determinant of IPV among the women studied (p\ .05). In our study, students who are 23 years and below and in dents are afraid of their male partner which might not be low socioeconomic class have an increased odd of been unconnected to the level of violence that they have assaulted by their partner and vice versa. This finding undergone from their partners. It is however encoura- from our study could be explained from the perspective ging from our study that most of the women studied of Right and Feminist theories of IPV in Africa would report a case of IPV although it is disappointing that most would report to their relatives as shown in (Bowman, 2003). The Feminist theory of IPV in Africa attributes women’s subordinate position, passivity, gen- Table 4. This finding from our study negates the think- der inequality, and economic dependence as fundamental ing that for the eradication of violence against women, to the development of domestic violence (Bowman, women should have zero tolerance of it and every case of 2003). Our study population being young and in lower violence should be reported to appropriate authorities class as an extension of feminist thinking, therefore, for redress (Ibekwe, 2007; Onanubi et al., 2017). It high- leaves them unacceptably prone to abuse by their male lighted the need for a clarion call on the need to educate partner who are much older and economically less the women folk on their right and to the ‘‘evil’’ nature of dependent. Apart from this, an explanation of the abuse domestic violence to themselves and her children (O. A. could arise from the influence of cultural dictates of Fawole et al., 2016; National Population Commission domestic violence in Africa and individual psychology Nigeria, 2014; Spencer et al., 2016; Titilayo et al., 2017). and psychopathology of the batterer (Bowman, 2003). More than two-fifth of the women interviewed attrib- The latter argues that the batterer engages in violence uted their reasons of not wanting to report a case of IPV against their partner as a result of personal insecurity to culture and religion while fear and shame accounted for and deep psychological dependence on their victim. In the majority of their reasons which agrees with earlier our study, the male partner being unemployed increases reports (WHO, 2012). Cultural and Feminist theories of the risks by 73% of his partner being assaulted by him IPV in Africa offer a more plausible reason for these (95% CI [0.51, 1.06]); p. .05) and this odd is increased responses among our study population (Bowman, 2003). among male partners with below tertiary education The patriarchal nature of traditional African societies with (OR = 0.60; 95% CI [0.42, 0.88]). Above observations is subordinate positioning of women with its pervasive gen- in tandem with other works on this subject (Onanubi der inequality and interacting with traditional mores and et al., 2017). According to the ecological model of vio- norms supporting wife battering in Africa are plausible lence, relationship level factors predisposing female reasons for this attitudinal rationalization seen among our youth to IPV seen in our study include unemployment study population (Bowman, 2003). Benebo et al. (2018) in and lower levels of education. Other factors include a study showed that community belief system that justify female partners having multiple partners, partner’s exhi- IPV negates the positive influence of women’s status on biting controlling behavior, use of substance abuse and IPV reduction (OR = 1.89; 95% CI [1.26, 2.83]). Programs those who experienced violence when growing up (Krug, should, therefore, be put in place to re-orientate commu- 2002; Uthman et al., 2010). nity members to embrace gender equity, mutual respect, and amicable resolution of family issues as a panacea to partner violence (Oyediran & Feyisetan, 2017). Limitations of the Study The mean age of the women was 23.0 (95% CI [22.4, 22.6]) years with the majority belonging to 20 to 24 age Our study is a cross-sectional study involving only the brackets. This age bracket is the late adolescent stage nursing student in our center and the findings of this when young girls might be trying to start an intimate study could not be a representative of the population of partner relationship, for possible marriage, with the the students in Abakaliki. It, however, opens a window opposite sex. This agree with an earlier report of women to the possible prevalence of IPV in the state and Nigeria 10 SAGE Open in general. It is also limited by the fact that a causal rela- Informed Consent tionship could not be ascertained and there might be Informed written consent was obtained from the study recall and social desirability bias. An effort was however population. made to reduce recall bias and social desirability bias by encouraging recall of IPV in the past 1 year and inform- ORCID iD ing the study population not to write their names, phone Chidebe C. Anikwe https://orcid.org/0000-0002-3730-621X numbers, and that the findings and report would not have anything to do with them. Privacy was also pro- vided for them when answering the questionnaire. The Availability of Data and Material study instrument (CAS) was validated in the study area All data generated or analyzed during this study are included in before applying it to our respondents to ensure its valid- this published article. ity in assessing partner violence in the study area. The questionnaire was pretested before being applied. Our References study was also limited by non-inclusion of women that Adebayo, A. A. (2014). Sociological implications of domestic were not currently in relationships and people who were violence on children’s development in Nigeria. Journal of sick as these women might have suffered from IPV. African Studies and Development, 6(1), 8–13. https://doi.org/ 10.5897/JASD2013.0237 Anikwe, C. C., Umeononihu, O. S., Anikwe, I. F., Ikeoha, C. Conclusion C., Eleje, G. U., Ewah, R. L., Okorochukwu, B. C., Nwo- koe, B. I., Ogah, C. O., & Okoroafor, F. C. (2021). Burden Our study shows a high level of IPV in the studied group of intimate partner violence among nurses and nursing stu- is high. The two most common form of IPV is Emotional dents in a tertiary hospital in Abakaliki, Ebonyi State, &/OR Harassment abuse and SCA. It is however Nigeria. SAGE Open Nursing, 7. https://doi.org/10.1177/ encouraging that the majority of the students believed that IPV should be reported. 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Centers CCA and IHA: study design, data collection/analysis, and for Disease Control and Prevention, National Center for interpretation of findings and drafting of the manuscript. BCO Injury Prevention and Control. and ACI: interpretation of findings and drafting of the manu- Benebo, F. O., Schumann, B., & Vaezghasemi, M. (2018). Inti- script. RLE and JNE, CCI: data analysis and the interpretation mate partner violence against women in Nigeria: A multile- of findings and drafting of the manuscript. All participated in vel study investigating the effect of women’s status and the review of the final manuscript. All the authors approved community norms. BMC Women’s Health, 18, 136. https:// the manuscript. doi.org/10.1186/s12905-018-0628-7 Bernstein, M., Phillips, T., Zerbe, A., McIntyre, J. A., Brittain, Declaration of Conflicting Interests K., Petro, G., Abrams, E. J., & Myer, L. (2016). 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Journal

SAGE Open – SAGE

Published: Feb 1, 2023

Keywords: violence; intimate partner violence; violence; nursing; female students; combined abuse scale

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