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      A cluster randomized controlled trial to assess the impact of SAFE on spousal violence against women and girls in slums of Dhaka, Bangladesh

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          Abstract

          Background

          Bangladesh reports one of the highest rates of intimate partner violence (IPV) in the world. Despite wide recognition of IPV as an important public health and human rights issue, evidence for IPV prevention is still inadequate. Lack of guidance on effective IPV prevention in Bangladesh resulted in targeting only women in most of the programmes.

          Methods

          This paper assesses impact of SAFE, a 20-month intervention (March 2012 to October 2013) in slums of Dhaka on IPV and tests effectiveness of female only groups vs. no groups; and female + male groups vs. female only groups on IPV in the community using a three-arm cluster randomized controlled trial. SAFE’s core activities included interactive group sessions, community mobilisation, and services. The last two activities were common across arms.

          Findings

          Regression analyses (female survey: baseline n = 2,666; endline n = 2,670) showed no effect of SAFE on IPV against women aged 15–29. However, sub-group analyses demonstrated 21% risk reduction of physical IPV against adolescent girls aged 15–19 in the female + male group intervention arm. A consistent reduction in sexual violence was observed in both female and female + male arms for both groups of women, but the results were not statistically significant.

          Interpretation

          The findings emphasise the importance of combining male and female interventions for reducing physical IPV against adolescent girls. Implications for future research have been discussed.

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          Most cited references19

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          Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial.

          HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum. Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence--either physical or sexual--in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00242957. In cohort one, experience of intimate-partner violence was reduced by 55% (adjusted risk ratio [aRR] 0.45, 95% CI 0.23-0.91; adjusted risk difference -7.3%, -16.2 to 1.5). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (aRR 1.02, 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (0.89, 0.66-1.19) or HIV incidence (1.06, 0.66-1.69) in cohort three. A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.
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            Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort.

            Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda.
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              Individual and contextual determinants of domestic violence in North India.

              We examined individual- and community-level influences on domestic violence in Uttar Pradesh, North India. Multilevel modeling was used to explore domestic violence outcomes among a sample of 4520 married men. Recent physical and sexual domestic violence was associated with the individual-level variables of childlessness, economic pressure, and intergenerational transmission of violence. A community environment of violent crime was associated with elevated risks of both physical and sexual violence. Community-level norms concerning wife beating were significantly related only to physical violence. Important similarities as well as differences were evident in risk factors for physical and sexual domestic violence. Higher socioeconomic status was found to be protective against physical but not sexual violence. Our results provide additional support for the importance of contextual factors in shaping women's risks of physical and sexual violence.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 June 2018
                2018
                : 13
                : 6
                : e0198926
                Affiliations
                [001]Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
                University of Westminster, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0363-5648
                Article
                PONE-D-18-05065
                10.1371/journal.pone.0198926
                6001962
                29902217
                af2984e9-f0b5-478d-a68f-afb2dd688ecf
                © 2018 Naved et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 February 2018
                : 29 May 2018
                Page count
                Figures: 2, Tables: 5, Pages: 17
                Funding
                Funded by: The Embassy of the Kingdom of Netherlands
                Award ID: ACTIVITY#PIR 21338
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001322, South African Medical Research Council;
                Award ID: SA-MRC; GNR 345
                Award Recipient :
                The Embassy of the Kingdom of Netherlands funded the SAFE study (Grant#00811, Ruchira, http://www.netherlandsembassydhaka.org/). Data analysis and writing up of the results have been supported by the Sexual Violence Research Initiative hosted by the South African Medical Research Council (SAMRC) (Grant#01310, Ruchira, http://www.svri.org/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Age Groups
                Children
                Adolescents
                People and Places
                Population Groupings
                Families
                Children
                Adolescents
                Medicine and Health Sciences
                Public and Occupational Health
                Traumatic Injury Risk Factors
                Violent Crime
                Intimate Partner Violence
                Social Sciences
                Sociology
                Criminology
                Crime
                Violent Crime
                Intimate Partner Violence
                People and Places
                Geographical Locations
                Asia
                Bangladesh
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Trials
                Randomized Controlled Trials
                Medicine and Health Sciences
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                Drug Research and Development
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                Mathematical and Statistical Techniques
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                Custom metadata
                Data are available on request to the Research Administration of icddr,b following icddr,b’s data policy. The request should be made to Armana Ahmed ( aahmed@ 123456icddrb.org ), Head, Research Administration, icddr,b.

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