Practice of intimate partner violence screening & associated factors among health care providers in Antenatal care settings , cross sectional study in 5 Teaching Hospitals in Addis Ababa, 2024/25 G.C.

Practice of intimate partner violence screening & associated factors among health care providers in Antenatal care settings , cross sectional study in 5 Teaching Hospitals in Addis Ababa, 2024/25 G.C. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Practice of intimate partner violence screening & associated factors among health care providers in Antenatal care settings , cross sectional study in 5 Teaching Hospitals in Addis Ababa, 2024/25 G.C. Eyob Dagnew Abtew, Sofanit Haile, Tesfaye Adem This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7531601/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background - According to WHO, about one in three women (30%) worldwide experience IPV in their lifetime. It can negatively affect women’s overall health. The fact is, Violence against women is preventable. The health sector has an important role as an entry point for referring women to other sectors and support services they may need. Objective – To evaluate the practice of intimate partner violence screening and associated factors in Antenatal care setting in 5 Teaching Hospitals in Addis Ababa in 2024/25 G. C. Methods – Institution-based Cross sectional study was conducted among antenatal healthcare providers at 5 Addis Ababa teaching hospitals, namely TASH, ZMH, GMH, Abebech gobena MCH hospital and St paulos millennium medical college (SPMMC) in 2024/25 G. C. Structured questionnaire was used for data collection. All Healthcare providers of these 5 teaching hospitals having more than 1 month of experience at ANC who gave informed consent were included in the study (N = 274). Healthcare providers who were not willing to give informed consent and who were on break or sick leave during the study period was excluded binary logistic regression analyses was employed to identify factors associated with the practice of IPV screening. Using 95% Confidence level and variables with a p-value < 0.05 was identified as statistically significant factors. Result : 274 participants were involved. The practice of IPV screening is alarmingly poor (17.9%). Consultants(AOR = 16.8) and female providers(AOR = 3.82) were more likely to screen than reference category. Having a confidential atmosphere (AOR = 12.3), those who took any form of GBV training (AOR = 11.1) and those who were aware of available guideline in their facility (AOR = 7.67) showed better practice. Marital status(P = 0.16), Religion(p = 0.998), Age (p = 0.630–0.887), the level of self-reported confidence did not show a statistically significant association with screening practice in the multivariable model. There is a huge gap between recommendations and actual clinical practice which underscored the need for institutional and policy-level interventions. Obstetrics & Gynecology practice of IPV screening pregnant women Addis Ababa Ethiopia Figures Figure 1 Figure 2 1. Introduction 1. 1 Background Intimate Partner Violence (IPV), also known as domestic violence or domestic abuse, is a pervasive and complex issue that affects individuals of all backgrounds, genders, and socioeconomic statuses worldwide. It encompasses a range of behaviours, including physical, sexual, emotional, and psychological abuse, perpetrated by a current or former intimate partner. IPV represents a profound violation of human rights, with devastating consequences for survivors and their communities.1 IPV is frequently introduced gradually, with overt acts of violence gradually developing from subtle indications of control and manipulation. This process may start with mild kinds of intimidation, seclusion, and compulsion before progressively progressing to physical violence and other abuses. Power differences, cultural views, societal standards, and economic inequality are some of the many variables that contribute to the complex dynamics of intimate partner violence.3 Beyond the initial physical pain survivors endure, IPV has far-reaching effects. Social isolation, mental health issues, and chronic physical problems might result from it. Survivors frequently struggle with emotions of guilt, shame, and fear, which can keep them from talking about their experiences or getting help. Adverse consequences, such as behavioral issues, developmental delays, and intergenerational cycles of violence, are also possible for children exposed to IPV.1 Despite its prevalence and harmful effects, IPV remains significantly underreported and under recognized. Many survivors face barriers to seeking help, including fear of retaliation, financial dependence, and lack of access to supportive services. Moreover, societal attitudes and misconceptions about IPV can contribute to victim blaming and stigmatization, further inhibiting survivors from seeking assistance.2 Efforts to address IPV require a multifaceted approach that involves collaboration among healthcare professionals, law enforcement agencies, policymakers, and community organizations. Prevention efforts should focus on promoting gender equality, challenging harmful gender norms, and providing comprehensive education on healthy relationships. Additionally, interventions should prioritize the safety and autonomy of survivors, offering accessible resources such as shelters, counselling services, and legal assistance.1 In conclusion, IPV is a significant public health concern. By raising awareness, challenging societal norms, and implementing evidence-based interventions, we can work towards creating safer and more supportive environments for survivors of IPV.3 IPV screening tools are essential instruments utilized by healthcare professionals to identify and address instances of abuse within intimate relationships. These tools aim to detect signs of physical, sexual, emotional, or psychological abuse experienced by individuals in their relationships. Through systematic screening, healthcare providers can effectively intervene, provide support, and potentially prevent further harm to victims. The introduction of IPV screening tools marks a significant advancement in addressing this pervasive societal issue. These tools serve as a structured approach to assess the presence and severity of IPV, allowing healthcare practitioners to offer appropriate interventions tailored to the needs of survivors. By integrating these screening tools into routine clinical practice, healthcare settings become crucial points of intervention for individuals experiencing abuse. These tools are designed to be sensitive to the nuances of abusive relationships, considering factors such as power dynamics, control, and coercion. Additionally, they prioritize confidentiality and safety, ensuring that individuals feel supported and empowered to disclose their experiences. Moreover, IPV screening tools contribute to the broader effort of raising awareness about intimate partner violence and dismantling societal norms that perpetuate abuse. By systematically screening for IPV, healthcare professionals not only identify individual cases but also contribute valuable data for research and advocacy purposes. This, in turn, informs policy initiatives and resource allocation aimed at preventing and addressing intimate partner violence on a larger scale.1 In conclusion, intimate partner violence screening play a crucial role in healthcare settings, enabling early detection, intervention, and support for survivors. By integrating these tools into routine clinical practice, healthcare professionals can contribute to the prevention and mitigation of intimate partner violence, ultimately fostering safer and healthier communities.1 1.2. Statement of the problem According to World Health Organization (WHO) survey, at least one in three women had experienced either physical or sexual violence by intimate partners. 4 Of this, 37% was reported from Africa. 5,6 up to 76.5% of Ethiopian women are exposed for IPV in their lifetime. 7–11 In low and middle income countries including Ethiopia, there are several gaps and inadequate evidence on prevalence and factors associated with intimate partner violence during pregnancy.18 Most studies were limited to intimate partner violence to non-pregnant women. However, the consequence of intimate partner violence during pregnancy is worse.19 Intimate partner violence during pregnancy has been associated with fatal and non-fatal adverse health outcomes for the pregnant woman and her unborn fetus either direct physical trauma to her body and physiological stress from current or past abuse or fetal growth and development. 20-23 30% of GBV starts in pregnancy(peak in 1st TM followed by in 3rd trimester). Many studies showed IPV is significantly associated with adverse maternal outcomes including maternal death (1.5 to 2 x higher risk) i. e. unintended pregnancies, HEG, inadequate prenatal/antenatal care, forced induced abortion, spont abortion, gestational wt gain, IUGR, pre-eclampsia, 3rd trimester bleeding, fetal IVH, depression, suicide and STIs. 24-26 In Ethiopia, even though there is some improvement in decreasing violence against women, little attention is given for violence committed by intimate partners, especially for pregnant women. 20, 25 Despite its high prevalence in Ethiopia, the screening rates by healthcare workers (HCWs) are alarmingly low, ranging from 1.5% to 12% in primary care settings. This indicates a significant gap in identifying and addressing IPV among patients. 25, 26 Despite the importance of IPV screening, many healthcare providers face challenges in implementing effective screening practices. In Ethiopia, where IPV is prevalent, there is a need to understand the practice of IPV screening among healthcare providers in ANC settings. Understanding the practice of IPV screening and identifying factors associated with IPV screening in five teaching hospitals in Addis Ababa, Ethiopia, during antenatal care will inform policy makers to design strategies to strengthen IPV screening and support victims of IPV in ANC settings, ultimately improving maternal and child health outcomes. 1.3. Significance of the study IPV is prevalent in all countries. It is more pervasive in developing countries including Ethiopia. IPV is risk for maternal health.18 The significance of the study lies in its potential to improve the detection and prevention of intimate partner violence (IPV) among pregnant women due to these key reasons: It has potential to improve detection and prevention of IPV and related complications: 1. IPV is a significant public health concern in Ethiopia, with prevalence >30%. 2. ANC: most common time for IPV is during pregnancy mostly in 1st TMPx followed by 3rd TMPx. 3. Limited Research in Ethiopia, despite its high prevalence. This study will fill this knowledge gap and provide valuable insights for policymakers and healthcare providers. 4. It provides evidence to support screening integration into routine clinical practice. 5. Five Teaching Hospitals in A. A : representative of the largest hospitals and largest city in Ethiopia and the findings can be generalized to other urban settings. 6. 2024/25 G. C: ensures that the findings are timely. 7. The results can help develop targeted training programs for healthcare providers, ensuring they are equipped to screen and address IPV in ANC settings. 8. Improved Patient Outcomes: improved maternal and child health, and enhanced overall health care quality. 9. Contribution to Global Knowledge By addressing these significant issues, this study has the potential to make a meaningful impact on the prevention and detection of intimate partner violence among pregnant women in Ethiopia. There for the finding of this study can be used for preventing the IPV, improving clinical care, advancing scientific knowledge, reducing healthcare costs, informing public policy, and ultimately enhancing the health and well-being of individuals and communities. 2. Literature review 2.1. Prevalence of intimate partner violence Intimate partner violence (IPV) is a serious public health problem that affects women of reproductive age worldwide. IPV can have negative consequences for the physical, mental, and reproductive health of women and their children. Screening for IPV in antenatal care settings can help identify women who are experiencing abuse and provide them with appropriate support and referrals.19 Population-level surveys based on reports from survivors provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence. A 2018 analysis of prevalence data from 2000–2018 across 161 countries and areas, conducted by WHO on behalf of the UN Interagency working group on violence against women, found that worldwide, nearly 1 in 3, or 30%, of women have been subjected to physical and/or sexual violence by an intimate partner or non-partner sexual violence or both . 2 Over a quarter of women aged 15–49 years who have been in a relationship have been subjected to physical and/or sexual violence by their intimate partner at least once in their lifetime (since age 15). The prevalence estimates of lifetime intimate partner violence range from 20% in the Western Pacific, 22% in high-income countries and Europe and 25% in the WHO Regions of the Americas to 33% in the WHO African region, 31% in the WHO Eastern Mediterranean Region, and 33% in the WHO South-East Asia region.2 Globally as many as 38% of all murders of women are committed by intimate partners. In addition to intimate partner violence, globally 6% of women report having been sexually assaulted by someone other than a partner, although data for non-partner sexual violence are more limited. Intimate partner and sexual violence are mostly perpetrated by men against women.2 According to the study done by Dr. Nigussie Azmeraw at 3 teaching hospitals (ZMH, GMH, TASH) in 2023 G. C, the overall prevalence of IPV was 37%. Psychological, physical and sexual violence accounts 28.4%, 20 and 21% respectively. age ≥35 compared than age 20-29 years (AOR=3.1, 95%CI=1.21, 7.75), rural area compared urban (AOR=3.6, 95%CI=1.02, 12.84), illiterate and able to write andread compared to education level of collage and above (AOR=15.7, 95%CI=3.58, 68.99 and AOR=11.1, 95%CI=3.61, 74.34) , student and merchant compared to government employer (AOR=0.61, 95%CI=0.041, 0.95 and AOR=0.74, 95%CI=0.01, 0.93), monthly income of 10000ETB (AOR=4.3, 95%CI=1.09, 8.83 and AOR=2.3, 95%CI=1.11, 11.89), paid dowery/bride compared its opposite compartment (AOR=11.9, 95%CI=5.19, 27.27), parent chowing chat and drink alcohol compared to its opposite compartment (AOR=10.1, 95%CI=2.89, 35.71 and AOR=8.9, 95%CI=4.32, 24.34) were a statistically significant factor for IPV.18 According to a Study done in south Africa on domestic and intimate partner violence among pregnant women in a low resource setting showed that, the prevalence of IPV was 15% (n =58) of the 376 sample population. Furthermore, 46% of individuals that screened positive for IPV had experienced multiple forms of abuse. 27 According to a Study done in northcentral Nigeria on the prevalence of IPV among the study population was 14.8% (50/338). In addition, among the study population, 18 (5.3%) women reported sexual abuse (forced sexual intercourse) by their intimate partners. Surprisingly, out of 50 women who suffered IPV during the pregnancy, 38 (76.0%) of them felt they were safe in their marital relationship while only 12 (24.0%) felt unsafe in their marriage. Most of the women [36 (72.0%)] who had IPV in pregnancy did not report the violence to anybody. Of the 14 (28.0%) women who reported such abuse, 12 (85.7%) disclosed it to their husbands’ parents and friends (14.3%). 28 According to the study done on Intimate partner violence in pregnancy among antenatal attendees at health facilities in West Pokot county, Kenya on prevalence of overall, IPV was in the current pregnancy was 150 (66.9%). 29 Study done in Abay Chomen district, Western Ethiopia showed that the Intimate partner violence during pregnancy was 44.5 %. More than half 157 (55.5 %) women experienced all the three forms of intimate partner violence during recent pregnancy. The simultaneous occurrence of intimate partner physical and psychological violence during pregnancy as well as joint occurrence of intimate partner physical and sexual violence was 160 (56.5 %). 24 The study done in Gondar referral hospital on Prevalence of domestic violence among pregnant showed that overall prevalence of domestic violence among pregnant woman in this study was 58.7% (95% CI: 53.8, 63.1). A high prevalence of domestic violence (53.8%) was observed among pregnant women with no income of their own, followed by housewives (52.3%).25 The proportion of women who has reported emotional, sexual, and physical IPV in the last twelve months were 10%, 29.5%, and 9.5%, respectively. The most common act of IPV reported in current relationship was partner controlling, reported by 69.0% of women. The most common controlling behavior of male partner reported by participants was insisting to know the women’s where about at all times, reported by 54.3% of women. Whereas, the least reported controlling behavior was not trusting with money (10.5%).30In this study, the overall prevalence of intimate partner violence during current pregnancy was 41.1% (95% CI: 36.0–46.0).31Study done on pregnant women in Ethiopia on Intimate Partner Violence and Associated Factors showed that, 202 (37.5%) had experienced violence by their intimate partner during the recent pregnancy.32 Despite the high prevalence of IPV, the screening rates by healthcare workers (HCWs) are alarmingly low, ranging from 1.5% to 12% in primary care settings. This indicates a significant gap in identifying and addressing IPV among patients.25 2.2. IPV screening and its barriers and facilitators 2.2.1. IPV screening According to the World Health Organization (WHO), screening for IPV should be done in a respectful, supportive, and non-judgmental manner, with the informed consent of the woman and the assurance of confidentiality and safety. The WHO recommends using validated screening tools that are culturally appropriate and context-specific. Some examples of screening tools for IPV are: • Humiliation, Afraid, Rape, Kick (HARK) • Hurt/Insult/Threaten/Scream (HITS) • Extended–Hurt/Insult/Threaten/Scream (E-HITS) • Partner Violence Screen (PVS) • Woman Abuse Screening Tool (WAST) These tools consist of a few questions that ask women about their experiences of physical, sexual, or emotional abuse by their current or former partner. The tools have different scoring systems and cut-off points to indicate a positive screen for IPV.20 A thesis on validating a screening tool for IPV in antenatal care settings should include the following components: • A clear research question and objectives • A literature review of the existing evidence on IPV screening and interventions in antenatal care settings • A description of the screening tool to be validated, including its origin, development, content, format, and administration • A description of the study design, setting, population, sample size, sampling method, inclusion and exclusion criteria, and ethical considerations • A description of the data collection methods, instruments, and procedures, including how the screening tool was compared with a reference standard or criterion • A description of the data analysis methods, including the statistical tests and measures of validity and reliability to be used • A description of the expected results, limitations, implications, and recommendations. 20-23 The HARK tool questions are: • In the last year, have you ever felt humiliated or emotionally abused in other ways by your partner or ex-partner? • In the last year, have you been afraid of your partner or ex-partner? • In the last year, have you been raped or forced to have any kind of sexual activity by your partner or ex-partner? • In the last year, have you been kicked, hit, slapped, or otherwise physically hurt by your partner or ex-partner? Each question can be answered with yes or no. A positive answer to any of the questions indicates a positive screen for IPV. The HARK tool has been shown to have good accuracy and acceptability for detecting IPV in different settings, such as primary care, antenatal care, and family planning clinics. The HARK tool can help identify women who are experiencing IPV and provide them with appropriate support and referrals. However, screening for IPV should be done in a respectful, supportive, and non-judgmental manner, with the informed consent of the woman and the assurance of confidentiality and safety. Screening for IPV should also be accompanied by interventions that can address the needs and preferences of the woman, such as counseling, advocacy, or legal services.3 The sensitivity and specificity of the HARK tool are measures of how well the tool can detect intimate partner violence (IPV) among women. Sensitivity is the proportion of women who have IPV and are correctly identified by the tool. Specificity is the proportion of women who do not have IPV and are correctly excluded by the tool. According to a study by Sohal et al, the HARK tool has a sensitivity of 81% and a specificity of 95% for detecting any past-year IPV among women in general practice settings. This means that the HARK tool can correctly identify 81% of women who have experienced IPV in the last year and correctly exclude 95% of women who have not experienced IPV in the last year. Other studies have also reported similar or slightly lower values for the sensitivity and specificity of the HARK tool in different settings, such as antenatal care and family planning clinics. The HARK tool is considered to have good accuracy and acceptability for screening for IPV among women.2 According to the recommendations and guidelines from the US Preventive Services Task Force (USPSTF) and the Minnesota Department of Health (MDH) on screening for IPV in health care settings, the best way to introduce the HARK tool Include: • Screening all women of reproductive age for IPV at least once per year and more frequently if there are risk factors or signs of abuse • Obtaining the informed consent of the woman and ensuring confidentiality and safety before screening • Using a respectful, supportive, and non-judgmental approach when screening and responding to IPV • Providing or referring women who screen positive for IPV to ongoing support services, such as counseling, advocacy, or legal assistance • Using validated screening tools that are culturally appropriate and context-specific, such as the HARK tool • Incorporating the HARK tool into the electronic medical record or the clinical workflow to prompt clinicians to ask about IPV and to encourage disclosure by patients • Providing training and education to health providers and staff on IPV screening and intervention Assessing the risk of harm in women who disclose IPV during screening is an important step to provide appropriate and timely support and intervention. The risk of harm refers to the likelihood and severity of future violence, injury, or death that a woman may face from her abusive partner. There are different tools and methods that can be used to assess the risk of harm in women who disclose IPV during screening. One of the most commonly used tools is the Danger Assessment (DA), which is a 20-item questionnaire that asks women about various indicators of danger, such as threats, weapons, choking, stalking, and escalation of violence. The DA also includes a calendar that helps women recall the frequency and severity of violence in the past year. The DA can be scored to obtain a numerical value that corresponds to different levels of risk, from variable to extreme. The DA has been shown to have good reliability and validity for predicting future violence and homicide among women who experience IPV. 1 Another tool that can be used to assess the risk of harm is the Ontario Domestic Assault Risk Assessment (ODARA), which is a 13-item checklist that can be completed by health providers or police officers based on information from the woman, the perpetrator, or official records. The ODARA items include factors such as prior assault, substance abuse, threats, children, and barriers to support. The ODARA can be scored to obtain a numerical value that corresponds to different probabilities of future assault, from low to high. The ODARA has been shown to have good accuracy and interrater reliability for predicting future violence and recidivism among IPV perpetrators. 2 Other methods that can be used to assess the risk of harm are clinical judgment and structured professional judgment. Clinical judgment is based on the health provider's experience, intuition, and knowledge of the woman and her situation. Structured professional judgment is based on the health provider's use of a set of guidelines or criteria to evaluate the risk factors and protective factors for the woman and her situation. Both methods require the health provider to consider the context and dynamics of the IPV, the woman's needs and preferences, and the available resources and interventions. 3 Ethiopia’s National ANC management protocol published on February 2022 recommends routine screening of GBV especially IPV in every contact starting in preconception period using HITS screening tool. Have you been Hit/kick, Slapped/Insulted, Threatened, screamed,(HITS tool) cursed by your husband or somebody close.54 The assessment of the risk of harm should be done in a respectful, supportive, and non-judgmental manner, with the informed consent of the woman and the assurance of confidentiality and safety. The assessment of the risk of harm will also be followed with appropriate actions and referrals, such as safety planning, counseling, advocacy, or legal services, depending on the level of risk and the woman's wishes. 4 Responding to women who disclose IPV during screening can be challenging, but also an opportunity to provide support and help. Here are some general tips on how to respond to IPV disclosures in a respectful, supportive, and non-judgmental manner:12 • Express empathy and concern. For example, you can say "I'm sorry this is happening to you" or "You don't deserve to be treated this way". • Validate the woman's experiences and feelings. For example, you can say "I believe you" or "Your feelings are understandable". • Acknowledge the woman's strengths and resilience. For example, you can say "You are very brave to share this with me" or "You have been coping with a lot of stress". • Respect the woman's autonomy and choices. For example, you can say "You know your situation best" or "You have the right to make your own decisions". • Provide information and referrals. For example, you can say "There are services that can help you" or "I can give you some phone numbers or websites that you can contact". • Ensure confidentiality and safety. For example, you can say "I will keep this information private" or "Is there a safe place or time for you to talk or get help?" 2.2.2. Barriers and facilitators for IPV screening The four hindering factors for IPV screening are47: 1. Personal barriers: • Discomfort with the issue of IPV • Lack of knowledge and training on how to screen for IPV • Perceptions and attitudes that hinder screening • Fears, such as offending the patient 2. Resource barriers: • Lack of time to conduct IPV screening • Lack of privacy in the healthcare setting to ask sensitive questions • Absence of institutional protocols and guidelines for IPV screening 3. Patient-related barriers: • Patients being accompanied by family members or friends during visits, reducing opportunities for private screening • Patients not disclosing IPV due to fear, shame, or other reasons 4. Organizational barriers: • Lack of institutional support and resources for IPV screening and intervention programs • Absence of training for healthcare providers on IPV screening and management Facilitators for intimate partner violence (IPV) screening includes48: 1. Availability of GBV protocols: Healthcare providers who are aware of and use gender-based violence (GBV) protocols tend to screen for IPV more regularly. These protocols provide a framework for healthcare providers to identify and respond to IPV effectively. 2. Provider awareness of IPV tools: Providers who are aware of IPV tools and tend to use them to screen for IPV are more likely to conduct routine IPV screening. This awareness helps them identify IPV and provide appropriate support to victims. 3. Establishing patient trust and a safe ANC clinic environment: Healthcare providers reported the need to establish patient trust and a safe antenatal care (ANC) clinic environment to encourage IPV disclosure. This includes creating a non-judgmental and confidential space where patients feel comfortable sharing their experiences. 4. Opportunities for triage-level screening and modification of patients' ANC cards: Healthcare providers suggested creating opportunities for triage-level screening and modifying patients' ANC cards to document women's medical history. This includes incorporating IPV screening into routine ANC services and documenting IPV in patient records. These facilitators highlight the importance of healthcare provider training, institutional protocols, and a supportive environment in promoting routine IPV screening during antenatal care. Based on the study done in uganda in 2022 G. C., the main barriers and facilitators for intimate partner violence (IPV) screening in antenatal care (ANC) settings in Uganda are:26 Barriers: · Limited staffing and space resources in ANC clinics · Lack of comprehensive gender-based violence (GBV) training for healthcare providers · Provider unawareness of the extent of IPV during pregnancy · Concerns about patient safety and potential for retaliatory abuse if perpetrating partners were to see reported abuse Facilitators: · Availability of GBV protocols and tools to screen for IPV · Healthcare providers who were aware of IPV (or GBV) screening tools and tended to use them routinely · Establishing patient trust and creating a safe ANC clinic environment for disclosure to occur · Opportunities for triage-level IPV screening and modification of patients' ANC cards to document IPV The context indicates that implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, raising awareness of IPV severity, trauma-informed care, and building trusting patient-provider relationships. According to US veterans health administration study published in 2020, patients and providers agreed that one of the most important factors for successful IPV use screening was strong rapport. Patients stated that they need to feel connected to and trust their provider to honestly discuss IPV; this finding extends research highlighting ‘connectedness’ as a key enabler of disclosing IPV experiences. In turn, providers expressed feeling uncomfortable asking questions about IPV use in the absence of a strong relationship with the patient or if they did not expect that the patient would respond positively. This finding parallels existing literature on barriers of screening for IPV experiences in VHA showing that a sensitive and empathic approach, ongoing relationship, and comfort with the provider are essential to women Veterans’ willingness to discuss IPV experiences . Similar observations have been documented among non-VHA providers and patients, in which a respectful and trusting relationship was shown to be important and associated with sensitive IPV screening and disclosure39, 40. Another facilitator that patients and providers agreed on was the importance of clear and comprehensive processes and procedures following IPV use screening. Patients believed that they would be more open about IPV use behavior if the consequences of disclosure (i. e., documentation in electronic medical records and possible mandated reporting requirements) were clear and referral services were available. Similarly, providers noted significant barriers to screening in the way of unclear procedural and systematic factors related to clinic policies, leadership support, and resources available for positive screens. Concerns related to the consequences of a positive screen are likely worsened by the varying legal requirements across countries and even states 41. Findings from the present study extend the literature on IPV detection in VHA to include similar concerns regarding IPV use screening. Research with patients and providers prior to implementing screening for IPV experiences highlighted patient and provider concerns of regarding negative consequences of disclosure 30, logistical and educational barriers to screening 6, 32, and the importance of follow-up support, transparent documentation, and availability of resources 31. Patient and provider concerns regarding next steps following IPV use disclosure are sensible given that only one empirically supported treatment for IPV use among Veterans exists to date, a trauma-informed group intervention for men 17. More broadly outside of VHA, the evidence for IPV use treatment in healthcare settings is weak 41. The development of additional evidence-based interventions for this population is crucial and the need for additional treatment options is reflected by patient and provider reluctance to engage in IPV screening without adequate follow up services. Three method-related screening preferences were consistent between patients and providers. First, both groups agreed that there could be benefits to universal implementation of IPV use screening in order to reduce stigma and enhance reach. Second, both patients and providers spoke to the acceptability and appropriateness of implementing a self-report screening tool in routine care. Patients and providers desired a clinical tool for IPV use that patients could complete in the waiting room prior to their appointment. In fact, an IPV use self-report screening approach has shown success in prior research 18. However, patients noted that a self report screener would only be effective if the provider followed up on patient responses. Third, both patients providers agreed that the screening tool should inquire about both IPV use and IPV experiences, consistent with prior research highlighting the value of concurrent screening for IPV 22. In our study, findings demonstrate that patients are more likely to disclose IPV use behavior to providers when also given the chance to dis cuss their IPV victimization experiences. Similarly, providers expressed a preference for asking about IPV use and experiences simultaneously in order to ‘get the full picture.’ Concurrent inquiry regarding IPV use and IPV experience is an important avenue for clinical research, especially given male Veterans’ reports of IPV experiences 24, 42 and female Veterans’ reports of IPV use 19, 43. The present study also highlights the difficulty reaching consensus regarding the setting in which IPV use screening should take place. Many respondents (both patients and providers) believed that mental health clinicians may be better prepared to screen for IPV. However, most responders also agreed that primary care, due to its broader reach, would be an appropriate setting for IPV use screening implementation. Certainly, a primary care setting sees more patients and thus would be able to screen a larger number of people. However, primary care providers also often report being overburdened by screening, having a large volume of patients, being under-staffed, and not have enough time with each patient to conduct the many screenings that are already currently required 44–48. Future research should formally evaluate the feasibility and effectiveness of screening for IPV use in these settings. 2.3. Conceptual framework 3. Objectives 3.1. General objective >To evaluate the practice of Intimate partner violence (IPV) screening in antenatal care setting in teaching hospitals in Addis Ababa, Ethiopia. 3.2. Specific objectives >To evaluate the practice of IPV screening among healthcare providers in antenatal care settings in five teaching hospitals, Addis Ababa, Ethiopia, 2024/25 G. C. >To identify factors associated with screening for IPV among antenatal health care providers in five Addis Ababa teaching hospitals, 2024/25 G. C. 4. Method Study area and period The study was conducted in Addis Ababa, Ethiopia. Ethiopia is a landlocked country located in the Horn of Africa region of East Africa. Ethiopia has a population of around 128 million inhabitants, making it the 13th most populous country in the world and the most populated landlocked country on Earth.50 Addis Ababa is the capital and largest city of Ethiopia, with an estimated population of nearly 4 million as of 2023. It lies on a plateau in the country's geographic center at an altitude of about 8,000 ft (2,450 m). Today, Addis Ababa is an important center of culture, finance, and diplomacy in Ethiopia and Africa. It serves as the headquarters for the African Union and United Nations and Economic Commission for Africa. Addis Ababa is home to Addis Ababa University, the largest university in Ethiopia.50 The study was conducted in Addis Ababa teaching hospitals namely Tikur Ambesa specialized Hospital (TASH), Zewuditu Memorial Hospital(ZMH), Gandhi Memorial Hospital (GMH), Abebech gobena MCH hospital and st. paulos Millenium medical college(SPMMC) from December 01,2024 – May 31 , 2025 G. C. These hospitals are the largest teaching and referral hospital in Ethiopia. The hospitals receive mainly high risk patients referred from their catchment health centres. Totally they serve as a referral centre for about 24 Health centres. In 2023 G. C the hospitals have more than 1400 antenatal care follow up in a month. They provide a comprehensive care of which obstetrics and gynaecology care service provision is one of the main service obstetrics and new-born care 24/7. It is intensive and multidisciplinary at TASH because cases with medical comorbidity are proportionally high and there is a multidisciplinary team for joint maternal and new born care. Tikur Ambesa specialized Hospital (TASH) is a university hospital with specialized clinical services that are not available in other public or private institutions are rendered to the whole nation. There are 78 in – patient beds in two wards, 4 delivery couches, 1 emergency room, procedure rooms for Obstetrics and Gynaecology care services. There are also 2 OR table for caesarean delivery with back up of operating tables at the major OR. Gandhi Memorial Hospital (GMH) and Abebech gobena MCH hospitals are Addis Ababa region dedicated maternity and child health hospitals and has similar structural and functional service like that of TASH , it has its own fetal and maternal medicine unit. 4.2. Study design Institution based cross sectional study design was conducted. 4.3 . Source and Study Population 4.3.1. Source Population Antenatal care providers in five teaching hospitals, Addis Ababa. 4.3.2. Study Population All obstetricians and gynaecologists, MFM fellows, residents, general practitioners, nurses, Health officers and midwifes providing antenatal care in five teaching hospitals, Addis Ababa. 4.4. Eligibility Criteria 4.4.1. Inclusion Criteria Healthcare providers working in ANC clinics of the study area for more than 1 month who are available during data collection period and who give informed consent for participation. 4.4.2. Exclusion Criteria Healthcare providers who are not willing to give informed consent, who work in ANC clinics of the study area for less than 1 month and who are on break or sick leave during the study period was excluded if we failed to collect data from them with 3 repeated attempts (by phone call and social platforms). 4.5. Sample size Since there is no logistic, financial and time constraints, all health care providers (Nurses, Health officers, Midwives, obstetricians and gynaecologists, MFM fellows, residents, general practitioners) working in ANC clinics for more than 1 month in the study area was included. Based on the data collected from Hospital Human resources, chef residents and unit heads a total of 301 participants were eligible. All eligible healthcare providers were invited to participate and 274 participated. Response rate was 91.2%. 4.6. Sampling technique All eligible target populations were included to get comprehensive data. 4.7. Study Variables Dependent Variable: practice of screening for IPV. Independent Variables: influencing the likelihood of IPV screening include: · Demographic factors: Age, gender, sex and professional role (e. g., doctor, nurse). · Perceived providers' confidence in their ability to screen for IPV. · Professional preparedness: Training and awareness for IPV cases. · Institutional factors: Availability of guidelines, follow-up and referral networks,, confidential environment, from provider’s point of view. 4.8. Operational definitions Practice of IPV screening :- is the routine implementation of structured inquiries regarding experiences of intimate partner violence by healthcare providers during antenatal care visits. This practice was measured through: Rubric IPV Screening Practices Scoring Guidelines Health care providers: Nurses, Health officers, Midwives, obstetricians and gynaecologists, fellows, residents, general practitioners. Social platforms: Telegram, E-mail and face book. Confidential environment - the provider's perception of their immediate physical work environment Health care providers - Nurses, HOs, Midwives, OBGYNs, MFM fellows, residents, GPs Consultants – Obstetrician and Gynaecologists and MFM fellows Awareness of availability of guideline - Simply knowing that a guideline exists and name of that guideline. Unmarried – this category includes singles(never married), divorced, widowed Level of experience – Those who have 1 month to 3 year of experience are categorized as juniors, those providers having 4 to 7 year of experience are categorized as seniors. Those having 8 years and above experience are categorized as senior experts (FMHACA) 4.9. Data collection 4.9.1. Data collection tool: Structured self administered questionnaire in English language was used to gather data. The questionnaire was taken from different literatures and modified and was pretested in a health facility of different study area (yeka kotebe general hospital to reduce recall bias) two weeks prior to actual data collection. Necessary modifications were made after the pre-test. 4.9.2 Data collectors: - 5 data collectors (GPs) working in the study area was recruited, 1 data collector in each hospital. 4.9.3 Data collection procedure: The Data collectors were trained for 1 day about the contents of the self administered questionnaire and on how and when to collect the data. The questionnaire was distributed to respondents by hard copy and/or Google sheet through telegram, face book and email by the data collectors during the lunch time or to fill the self administered questionnaire when ever they got free time and to return it back to the data collector by envelope and anonymous chats after they complete filling the questionnaire and the responses was entered into an electronic database. 4.10. Data Quality Management The data collection tools was prepared from multiple researches. The supervisor provides the tools for data collectors at each site and regular meetings was held between the data collectors and the supervisor in a weekly basis. To assure the quality of data the questioner was pretested 2 weeks before the actual data collection time. Then, after the pre-testing, all necessary modifications was made on the tools. The collected data was checked for completeness, accuracy, clarity and consistency on daily basis. To ensure the reliability the data use of adapted data collection tool was also improving reliability and only trained data collectors was used for data collection. 4.11. Data management and analysis 4.11a Data Management - All electronic data is stored securely in password-protected files which will not to be used for other purposes. Hard copies of notes is stored in a locked cabinet. 4.11b. Data Analysis The data was entered, coded, and cleaned using EpiData version 7 statistical software, and analysis was performed using SPSS version 26. Descriptive statistics for categorical data was provided in terms of frequency and percentages; and appropriate tables and charts were used for describing the data. Also, the Likert scale data was analyzed as categorical data. The association of independent and dependent variable was measured by using binary logistic regression. All variables with a p-value < 0.25 in the binary logistic regression analysis was entered into the final model for multivariable analysis after checking model fitness. Odds ratio (OR) with a 95% confidence interval and a P-value of 0.05 was used as statistically significant for the outcome variable. 4.12. Ethical considerations Ethical clearance was first obtained from the Department Research and Publication Committee (DRPC) of Tikur Ambessa Specialized Hospital, the Department of Obstetrics and Gynecology. Then, the ethical clearance and support letter was taken to the selected hospitals to obtain permission and cooperation during the data collection process. Informed consent was obtained from each study subject prior to the data collection process after the purpose of study has been explained and they become briefed about the confidentiality of their responses and the importance of providing the right information to help the study achieve its objective. All respondents were asked for their willingness to participate in the study during the lunch time or to fill the self administered questionnaire when ever they got free time and to return it back to the data collector after they complete filling the questionnaire. Confidentiality of the information was assured and privacy of the respondent was maintained, the hard copy of the data is kept in a locked cabinet and the soft copy is password protected. 4.13. Dissemination of the Result The result of the study was first presented in Addis Ababa University department of gynaecology and obstetrics and then it will be presented to Ethiopian Ministry of Health. It will also be presented in national as well as international seminars and will be published in reputable journals. 5. Result 5.1 Sociodemographic characteristics of the study participants In this study, 274 participants were involved, resulting in a response rate of 91.2%. The majority of participants were residents (47.8%), followed by general practitioners (16.8%) and midwives (16.1%). The distribution across facilities showed that TASH had the highest representation (33.2%), followed by Abebech Gobena (25.5%) and SPMMC (24.8%). Most providers had 1–3 years of experience in antenatal care (75.5%), and nearly half were single (46%), while 43.8% were married. Orthodox Christianity was the dominant religion (60.9%). 5.2 Training and Awareness Training and awareness on IPV screening were critically low, with only 8.8% of participants having received any formal training. Confidence levels in screening were also low, with 22.6% reporting they were "not confident at all" and only 13.5% feeling "very confident." In there ability to screen IPV. Awareness of IPV screening guidelines was also low, with 89.8% unaware of any protocols in their facility. Those who knew of guidelines cited general ANC or national protocols rather than specific IPV screening tools. From 274 participants, only 24(8.8%) of them took training. 11 of them took training on Prevention of Gender based Violence, 13 of them took Courses and Campaigns on Gender based violence but no specific training on IPV per se 5.3 Screening Practices Screening practices were alarmingly poor. A staggering 41.2% of providers never conducted IPV screening, and only 4% did it so regularly. The use of validated screening tools was rare, with 49.6% never employing standardized instruments like AAS, HITS, or HARK. Follow-up and referral systems were also weak, with 43.8% reporting no clear protocols for women who disclosed IPV. 40.5% of providers never received training on IPV screening. Only 0.7% reported always receiving training. 37.2% of providers never ensured a confidential environment for IPV screening. Only 2.2% reported always maintaining confidentiality. Overall, 82.1% of participants rated their IPV screening practices as "poor." 49 (17.88%) of them had fair screening practice. None of them were under Good practice and Excellent practice category. 5.4 Associated factors The bivariate and multivariable logistic regression analyses were employed to identify factors associated with the practice of Intimate Partner Violence (IPV) screening among healthcare providers in the antenatal care settings of five teaching hospitals in Addis Ababa. In the bivariate analysis, several variables showed a statistically significant association with IPV screening practice. However, upon adjusting for potential confounders in the multivariable logistic regression model, seven key factors remained independently and significantly associated with IPV screening practice. Profession was significantly associated with IPV screening practice. Consultants had 16.8 times higher odds (AOR = 16.8; 95% CI: 1.89, 150.04; p = 0.011) of having fair screening practice compared to midwives. No other professional group (Nurses, Residents, Others) showed a statistically significant association. Sex was also a significant factor, with female providers being 3.82 times more likely to screen for IPV compared to their male counterparts (AOR = 3.82; 95% CI: 1.08, 13.53; p-value = 0.038). Providers who were aware of any available IPV guidelines were 7.67 times more likely to practice screening than those who were not aware (AOR = 7.67; 95% CI: 1.72, 34.2; p-value = 0.007). Similarly, those who had received any form of training on GBV were 11.1 times more likely to screen for IPV compared to those who had not received any training (AOR = 11.1; 95% CI: 1.34, 92.92; p-value = 0.026). The availability of a confidential atmosphere was also a significant factor. Providers who reported that there is confidential environment for screening were 12.3 times more likely to practice IPV screening (AOR = 12.3; 95% CI: 2.96, 50.6; p-value = 0.001). Awareness of availability of a validated screening tool made providers 96% less likely to have poor screening practice (i. e., significantly more likely to screen), after controlling for other variables (AOR = 0.024; 95% CI: 0.006, 0.1; p-value < 0.001). Likewise, awareness of the presence of a functional referral system made providers 96.2% less likely to have poor screening practice (AOR = 0.038; 95% CI: 0.014, 0.1; p-value < 0.001). Marital status(P = 0.48), Religion(p = 0.998), Age (p = 0.630–0.887), specific facility of work, years of experience, the level of self-reported confidence were not significantly associated with IPV screening practice. Table 1 Bivariate and multivariable logistic regression of association between independent variable and practice of IPV screening in antenatal care setting in the five teaching hospitals of Addis Ababa, 2025. Independent Variables Practice of IPV Screening Total N(%) p-value COR with 95%CI P-value AOR with 95%CI Fair n(%) Poor n(%) Profession Midwife 12 (27.3%) 32 (72.7%) 44 (16.1%) 1 1 Nurse 4 (18.2%) 18 (81.8%) 22 (8.0%) 0.420 0.59(0.17, 2.11) 0.253 4.7(0.33, 67.68) Resident 12 (9.2%) 119 (90.8%) 131 (47.8%) 0.004 0.27(0.11, 0.66) 0.660 0.62(0.07, 5.19) Consultant 13 (52.0%) 12 (48.0%) 25 (9.1%) 0.043 2.9(1.03, 8.07) 0.011 16.8(1.89, 150.04) Others (GP & HO) 8 (15.4%) 44 (84.6%) 52 (19.0%) 0.158 0.49(0.18, 1.32) 0.731 1.5(0.15, 15.55) Facility TASH 19 (20.9%) 72 (79.1%) 91 (33.2%) 1 SPHMMC 10 (14.7%) 58 (85.3%) 68 (24.8%) .718 .792(.22,2.8) AGMCH 10 (14.3%) 60 (85.7%) 70 (25.5%) .710 1.253(.38,4.1) ZMH 4 (17.4%) 19 (82.6%) 23 (8.4%) .429 1.781(.43,7.44) GMH 6 (27.3%) 16 (72.7%) 22 (8.0%) .758 .819(.23, 2.9) Experience 8 year 7 (30.4%) 16 (69.6%) 23 (8.4%) 0.1 2.4(0.9,6.3) Age 18 to 24 year 2 (40.0%) 3 (60.0%) 5 (1.8%) 0.2 0.27(0.04,2) 25 to 44 year 30 (12.2%) 215 (87.8%) 245 (89.4%) 0.048 0.05(0.02,1.2) Above 45 17 (70.8%) 7 (29.2%) 24 (8.8%) 1 Sex Male 22 (13.3%) 144 (86.7%) 166 (60.6%) 1 1 Female 27 (25.0%) 81 (75.0%) 108 (39.4%) 0.14 2.2(1.2,4) 0.038 3.82(1.08, 13.53) Religion Christian 37 (16.5%) 187 (83.5%) 224 (81.8%) 1 Muslim 8 (19.5%) 33 (80.5%) 41 (15.0%) 0.125 0.3(0.06,1.3) Others 4 (44.4%) 5 (55.6%) 9 (3.3%) 0.14 0.33(0.07,1.4) Marital status Married 11 (9.2%) 109 (90.8%) 120 (43.8%) 1 1 unmarried 38 (24.7%) 116 (75.3%) 154 (56.2%) 0.16 3.2(1.58, 6.67) 0.48 1.5(0.5,5.2) Perceived confidence Not confident 7 (10.3%) 61 (89.7%) 68 (24.8%) 1 Slightly 11 (11.0%) 89 (89.0%) 100 (36.5%) 0.885 1.07(0.4,2.9) Moderately 18 (25.7%) 52 (74.3%) 70 (25.5%) 0.22 3(1.17,7.9) Very 13 (36.1%) 23 (63.9%) 36 (13.1%) 0.03 4.9(1.7,13.9) Extremely 0 (0.0%) 0 (0.0%) 0 (0.0%) Aware of guidelines? Yes 17 (60.7%) 11 (39.3%) 28 (10.2%) 0.001 10.3(4.3,24) .007 7.67(1.72 to 34.2) No 32 (13.0%) 214 (87.0%) 246 (89.8%) 1 1 Received training Yes 14 (58.3%) 10 (41.7%) 24 (8.8%) 0.000 8.6(3.54, 20.87) 0.026 11.1(1.34, 92.92) No 35 (14.0%) 215 (86.0%) 250 (91.2%) 1 1 Confidential atmosphere Yes 16 (43.2%) 21 (56.8%) 37 (13.5%) 0.001 7.2 (0.1,0.45) .001 12.3 (2.96 to 50.6) No 33 (13.9%) 204 (86.1%) 237 (86.5%) 1 1 Validated tool Yes 22 (68.8%) 10 (31.3%) 32 (11.7%) 0.001 0.057(0.02,0.1) 0.001 0.024(0.006,0.1) No 27 (11.2%) 215 (88.8%) 242 (88.3%) 1 1 Referral system Yes 34 (69.4%) 15 (30.6%) 49 (17.9%) 0.008 0.032(0.04,0.07) 0.001 0.038(0.014,0.1) No 15 (6.7%) 210 (93.3%) 225 (82.1%) 1 1 Overall 49 (17.9%) 225 (82.1%) 274(100%) 6. Discussion This study identified several key organizational and individual-level factors that are significantly associated with the practice of IPV screening among antenatal care providers in Addis Ababa's teaching hospitals. Regarding practice of screening, based on systematic reviews done from WHO multicounty study which included 59 studies published in 2020, overall IPV screening rate was 11%. The finding of this study is close to our finding. 55 In high-income nations like the U. S., Canada and UK, IPV screening is integrated into routine healthcare practice and screening rate is high (> 50%), especially in settings like in maternal health clinics, and primary care. 43 Screening rate is 5.2% in GMH (Suhab et al, 2025). This also aligns with global studies showing that systematic screening remains inconsistent (WHO, 2021). There is disparity between global and national recommendations and the actual clinical practice. Where antenatal care is a crucial window of opportunity to identify and support victims of IPV. This opportunity is almost entirely missed. The strongest positive associations were profession(AOR = 16.8), having a confidential atmosphere (AOR = 12.3) and those who took any form of GBV training (AOR = 11.1) showed better practice. Training is crucial for improving detection rates and reducing stigma (O’Doherty et al., 2014). Confidential atmosphere, AOR = 2.35 (95% CI: 2.26–2.44, p < 0.001). Barriers such as lack of training, absence of confidential environment, lack of awareness on follow-up and referral system and validated screening tools mirror findings from similar studies done in USA and in Sub-Saharan Africa, indicating similar regional trend. 56–61 There is also significant association of awareness of available guideline in their facility (AOR = 7.67), highlighting the importance of disseminating clear, standardized protocols for IPV. Awareness of available guidelines(AOR = 3) in WHO multicounty study. 55 At the individual level, consultants(AOR = 16.8) were significantly more likely to screen(AOR = 16.8). It goes in contrary to global studies. But aligns with expectations that more advanced training may be empowering factor for them to address sensitive issues. Specialists are often consulted for complex medical management after a problem is identified. It could be that the system is reactive rather than preventive. A finding that specialists screen more than frontline staff could be due to this. The association between female providers (AOR = 3.82) and higher screening rates is consistent with global literatures (Kalra et al., 2021; Sprague et al., 2013; O'Campo et al., 2011; Gutmanis et al., 2007); female patients may feel more comfortable disclosing abuse to a female provider, and female providers may demonstrate greater empathy and awareness of the issue.57–59 7. Limitation of the study Since our study design is Cross-Sectional, It shows association, not causation. The outcome (screening practice) is based on self-report, not observation. Providers may have over-reported their screening practices which may subject our data to Social Desirability Bias. The study was conducted in teaching hospitals in the capital; practices may be even worse in rural health centers. 8. Conclusion This study demonstrates that IPV screening practices among antenatal care providers in Addis Ababa’s teaching hospitals are alarmingly poor. Profession, sex, lack of training and awareness of available guidelines, awareness of follow-up and referral systems and validated tools, absence of confidential environment, are strongly associated to screening practice. Marital status, Religion, health care facility, age, years of experience, the level of self-reported confidence were not associated with IPV screening practice in the multivariable analysis. Without intervention, IPV will continue to be underdiagnosed, leaving pregnant women at risk of unchecked abuse during pregnancy. 9. Recommendation Based on the findings of this study, targeted training should be given for all healthcare providers practicing in ANC setting, giving priority for professionals other than consultants and for males if there is resource limitation. FMOH and Hospitals should urgently develop implementation guideline applicable for ANC setting as there is huge disparity between recommendation and actual clinical practice. Hospitals must create confidential environment in antenatal care clinics Future researches like qualitative studies should be done to explore the deep-seated barriers from the providers' perspectives and further studies should also be done with bigger sample size to address this generalizability issues to rural setups. Abbreviations AAU Addis Ababa University AGMCH Abebech Gobena Maternal & Child health center ANC Antenatal Clinic AOR Adjusted Odd Ratio CAS R –SF COMPOSITE ABUSE SCALE REVISED - SHORT FORM CI Confidence Interval COR Crude Odd Ratio DRPC Department Research & Publication Committee FDRE Federal Democratic Republic of Ethiopia GMH Gandhi memorial Hospital HARK Humiliation, Afraid, Rape, Kick HIV Human Immune Deficiency Virus IPV Intimate Partner Violence MFM Maternal fetal medicine PNMR Perinatal Mortality Rate STI Sexual Transmitted Infection TASH Tikur Ambessa Specialized Hospital VHA Veterans Health Administration WHO World Health Organization ZMH Zewuditu Memorial Hospital Declarations Ethics approval and consent to participate Ethical clearance was obtained from the Department Research and Publication Committee (DRPC) of the Department of Obstetrics and Gynecology, Tikur Anbessa Specialized Hospital, Addis Ababa University. All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all study participants. Consent for publication Not applicable. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgements The authors would like to thank the study participants, data collectors, and the management of the five teaching hospitals in Addis Ababa for their support and cooperation during the data collection process. Prior to all, I would like to thank the almighty of God who made all to be beautiful. Special appreciation goes to my advisors Dr. Sofanit Haile & Dr. Tesfaye Adem for their limitless contribution, support, encouragement, critical comment and constructive suggestion throughout my work journey and for the realization of this thesis guiding me from title selection to proposal development throughout the whole process. Next, I acknowledge medical students, residents, staffs & all the countless individuals who have contributed to this work through their insights, encouragement, and belief in the importance of this scientific inquiry. Their collective efforts have shaped this research and its impact. Finally, I would like to give my acknowledgment to A ddis Ababa University, department of Obstetrics & Gynaecology for their follow up and organization. Thank you all for being a part of this endeavour. Authors' information Eyob Dagnew is an Obstetrics and Gynaecology resident at Addis Ababa University. 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Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a meta-analysis of qualitative studies. Arch Intern Med. 2006;166(1):22–37. Kirst M, Zhang YJ, Young A, Marshall A, O’Campo P, Ahmad F. Referral to health and social services for intimate partner violence in health care settings: a realist scoping review. Trauma Violence Abuse. 2012;13(4):198–208. Kimberg LS. Addressing intimate partner violence with male patients: a review and introduction of pilot guidelines. J Gen Intern Med. 2008;23(12): 2071–8. Relyea MR, Portnoy GA, Combellick J, Brandt CA, Haskell SG. Military sexual trauma and intimate partner violence: subtypes, associations, and gender differences. J Fam Violence. 2019;35:349–60. Creech SK, Macdonald A, Taft C. Use and experience of recent intimate partner violence among women veterans who deployed to Iraq and Afghanistan. Partn Abus. 2017;8(3):251–71. Iverson KM, Adjognon O, Grillo AR, Dichter ME, Gutner CA, Hamilton AB, Gerber MR. Intimate partner violence screening programs in the veterans health Administration: informing scale-up of successful practices. J Gen Intern Med. 2019;34(11):2435–442. Iverson KM, Dichter ME, Stolzmann K, Adjognon OL, Lew RA, Bruce LE, Gerber MR, Portnoy GA, Miller CM. Assessing the veterans health Administration’s response to intimate partner violence among women: protocol for a randomized hybrid type 2 implementation-effectiveness trial. Implement Sci. 2020;15:29–38. Portnoy, G. A., Iverson, K. M., Haskell, S. G., Czarnogorski, M., and Gerber, M. R. (in press). A multisite quality improvement initiative to enhance the adoption of intimate partner violence screening practices into routine primary care for women veterans. Public Health Reports. Sayers SL, Farrow VA, Ross J, Oslin DW. Family problems among recently returned military veterans referred for a mental health evaluation. J Clin Psychiatry. 2009;70(2):163. Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda, March 2022, BMC Health Services Research 22(1) Ulrich YC, Cain KC, Sugg NK, Rivara FP, Rubanowice DM, Thompson RS. Medical care utilization patterns in women with diagnosed domestic violence. Am J Prev Med. 2003;24(1):9–15. a,? and b,2024 G. C. Antenatal Care: When to Start, Number of Visits, and Tests | MedPark Hospital brb-mn-21-01-guideline-2017-eng-guidelines-for-antenatal-care-in-barbados-revised-feb-2017. pdf (who. int) Antenatal care - UNICEF DATA? Monitoring the situation for children and women, 2024. Federal Ministry of Health Ethiopia. Antenatal Care Guideline. Addis Ababa: FMOH; 2022. Devries KM, Mak JY, García-Moreno C, Petzold M, Child JC, Falder G, et al. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–8. Kalra, N., Hooker, L., Reisenhofer, S., Di Tanna, G. L., and García-Moreno, C. (2021). Training healthcare providers to respond to intimate partner violence against women. Cochrane Database of Systematic Reviews, (5). Sprague, S., Slobogean, G., Spurr, H., McKay, P., Scott, T., Arseneau, E.,. and Bhandari, M. (2013). A scoping review of intimate partner violence screening programs for health care professionals. PLoS One, 8(1), e52933. O'Campo, P., Kirst, M., Tsamis, C., Chambers, C., and Ahmad, F. (2011). Implementing successful intimate partner violence screening programs in health care settings: Evidence generated from a realist systematic review. Social Science and Medicine, 72(6), 855–866. Waalen, J., Goodwin, M. M., Spitz, A. M., Petersen, R., and Saltzman, L. E. (2000). Screening for intimate partner violence by health care providers: Barriers and interventions. American Journal of Preventive Medicine, 19(4), 230–237. Gutmanis, I., Beynon, C., Tutty, L., Wathen, C. N., and MacMillan, H. L. (2007). Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC Public Health, 7(1), 1–12. Rahman, M., Nakamura, K., Seino, K., and Kizuki, M. (2013). Intimate partner violence and use of reproductive health services among married women: evidence from a national Bangladeshi sample. BMC Public Health, 13(1), 1–11. O'Doherty LJ, Taft A, Hegarty K, Ramsay J, Davidson L, Feder G. Screening for intimate partner violence in healthcare settings: opening the door to new perspectives. BMC Womens Health. 2021 Sep 6;21(1):200. Christy A, Ellis AA. Screening women for intimate partner violence: considerations for healthcare providers. J Midwifery Womens Health. 2018 May;63(3):282-7. Breiding MJ, Smith SG, Basile KC, Walters ML, Chen J, Merrick MT. The National Intimate Partner and Sexual Violence Survey: 2015 Data Brief – Updated Release. Atlanta (GA): National Center for Injury Prevention and Control, CDC; 2018 Oct. American College of Obstetricians and Gynecologists. Intimate Partner Violence. Committee Opinion No. 518. Obstet Gynecol. 2012 Feb;119(2 Pt 1):412-7. Additional Declarations The authors declare no competing interests. Supplementary Files Annexes.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7531601","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509982310,"identity":"4610ab7b-7a28-40ed-aa9a-34784f0e82ec","order_by":0,"name":"Eyob Dagnew Abtew","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBAC+wYGNgYeMJP/+ecfFUCambkBrxYDBrgWHjZmhjMgLYykaGFsAzEIaZFIPvbgTU1tHr9E7rHHhfNqo/nbgVp+VGzD7ReJtHTDOceOF0vOyEs3nrnteO6Mw4wNjD1nbuOxJcdMmoftWOKG2wkGErzbjuU2ALUAXUhIy79jifvBWuYcy51PlBbetprEDdIgRkNN7gaCWniepRvO7TuQOOP+s2TDGccO5G4EajmIzy/27aAQ+1aX2N9z+OCDDzV1ufPOAxk/KnBrYRBIAJGHYVwI4wBu9UDAD5aug3HrcCocBaNgFIyCkQsAHPhhX0XGpxAAAAAASUVORK5CYII=","orcid":"","institution":"Addis Ababa University, Ethiopia","correspondingAuthor":true,"prefix":"","firstName":"Eyob","middleName":"Dagnew","lastName":"Abtew","suffix":""},{"id":509982311,"identity":"01086b53-a668-4f4f-8e97-2369d9f76b63","order_by":1,"name":"Sofanit Haile","email":"","orcid":"","institution":"Addis Ababa University, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Sofanit","middleName":"","lastName":"Haile","suffix":""},{"id":509982312,"identity":"1c0128e4-1bcf-48e0-8fb4-8562e5f05905","order_by":2,"name":"Tesfaye Adem","email":"","orcid":"","institution":"Addis Ababa University, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Tesfaye","middleName":"","lastName":"Adem","suffix":""}],"badges":[],"createdAt":"2025-09-04 03:29:28","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7531601/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7531601/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90891933,"identity":"64a3935d-5dfe-4be6-8883-d822d4346f66","added_by":"auto","created_at":"2025-09-09 11:13:52","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":588085,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual Framework for Associated Factors of intimate partner violence screening\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7531601/v1/c6817ed77b8a05053ae5b8dc.jpeg"},{"id":90892506,"identity":"d619e20e-0bd4-4a86-bd7c-dedd3e3f8a29","added_by":"auto","created_at":"2025-09-09 11:21:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19163,"visible":true,"origin":"","legend":"\u003cp\u003ePractice of IPV screening among health care providers in 5 teaching hospitals\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7531601/v1/3e945431c7a1b1d64a668f43.png"},{"id":90894403,"identity":"88bce8f8-fb22-4fac-b330-237fbae3a306","added_by":"auto","created_at":"2025-09-09 11:29:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2098324,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7531601/v1/d45057ca-13c8-48a3-bd29-be6499fac43e.pdf"},{"id":90892505,"identity":"cee7c30f-217f-4f47-b544-b37f66f65e8e","added_by":"auto","created_at":"2025-09-09 11:21:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23210,"visible":true,"origin":"","legend":"","description":"","filename":"Annexes.docx","url":"https://assets-eu.researchsquare.com/files/rs-7531601/v1/fe86bcdf09bf63efde3e0ebb.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePractice of intimate partner violence screening \u0026amp; associated factors among health care providers in Antenatal care settings , cross sectional study in 5 Teaching Hospitals in Addis Ababa, 2024/25 G.C.\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e1. 1 Background\u003c/p\u003e\n\u003cp\u003eIntimate Partner Violence (IPV), also known as domestic violence or domestic abuse, is a pervasive and complex issue that affects individuals of all backgrounds, genders, and socioeconomic statuses worldwide. It encompasses a range of behaviours, including physical, sexual, emotional, and psychological abuse, perpetrated by a current or former intimate partner. IPV represents a profound violation of human rights, with devastating consequences for survivors and their communities.1\u003c/p\u003e\n\u003cp\u003eIPV is frequently introduced gradually, with overt acts of violence gradually developing from subtle indications of control and manipulation. This process may start with mild kinds of intimidation, seclusion, and compulsion before progressively progressing to physical violence and other abuses. Power differences, cultural views, societal standards, and economic inequality are some of the many variables that contribute to the complex dynamics of intimate partner violence.3\u003c/p\u003e\n\u003cp\u003eBeyond the initial physical pain survivors endure, IPV has far-reaching effects. Social isolation, mental health issues, and chronic physical problems might result from it. Survivors frequently struggle with emotions of guilt, shame, and fear, which can keep them from talking about their experiences or getting help. Adverse consequences, such as behavioral issues, developmental delays, and intergenerational cycles of violence, are also possible for children exposed to IPV.1\u003c/p\u003e\n\u003cp\u003eDespite its prevalence and harmful effects, IPV remains significantly underreported and under recognized. Many survivors face barriers to seeking help, including fear of retaliation, financial dependence, and lack of access to supportive services. Moreover, societal attitudes and misconceptions about IPV can contribute to victim blaming and stigmatization, further inhibiting survivors from seeking assistance.2\u003c/p\u003e\n\u003cp\u003eEfforts to address IPV require a multifaceted approach that involves collaboration among healthcare professionals, law enforcement agencies, policymakers, and community organizations. Prevention efforts should focus on promoting gender equality, challenging harmful gender norms, and providing comprehensive education on healthy relationships. Additionally, interventions should prioritize the safety and autonomy of survivors, offering accessible resources such as shelters, counselling services, and legal assistance.1\u003c/p\u003e\n\u003cp\u003eIn conclusion, IPV is a significant public health concern. By raising awareness, challenging societal norms, and implementing evidence-based interventions, we can work towards creating safer and more supportive environments for survivors of IPV.3\u003c/p\u003e\n\u003cp\u003eIPV screening tools are essential instruments utilized by healthcare professionals to identify and address instances of abuse within intimate relationships. These tools aim to detect signs of physical, sexual, emotional, or psychological abuse experienced by individuals in their relationships. Through systematic screening, healthcare providers can effectively intervene, provide support, and potentially prevent further harm to victims. The introduction of IPV screening tools marks a significant advancement in addressing this pervasive societal issue. These tools serve as a structured approach to assess the presence and severity of IPV, allowing healthcare practitioners to offer appropriate interventions tailored to the needs of survivors. By integrating these screening tools into routine clinical practice, healthcare settings become crucial points of intervention for individuals experiencing abuse. These tools are designed to be sensitive to the nuances of abusive relationships, considering factors such as power dynamics, control, and coercion. Additionally, they prioritize confidentiality and safety, ensuring that individuals feel supported and empowered to disclose their experiences. Moreover, IPV screening tools contribute to the broader effort of raising awareness about intimate partner violence and dismantling societal norms that perpetuate abuse. By systematically screening for IPV, healthcare professionals not only identify individual cases but also contribute valuable data for research and advocacy purposes. This, in turn, informs policy initiatives and resource allocation aimed at preventing and addressing intimate partner violence on a larger scale.1\u003c/p\u003e\n\u003cp\u003eIn conclusion, intimate partner violence screening play a crucial role in healthcare settings, enabling early detection, intervention, and support for survivors. By integrating these tools into routine clinical practice, healthcare professionals can contribute to the prevention and mitigation of intimate partner violence, ultimately fostering safer and healthier communities.1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2. \u0026nbsp; \u0026nbsp;\u003c/strong\u003eStatement of the problem\u003c/p\u003e\n\u003cp\u003eAccording to World Health Organization (WHO) survey, at least one in three women had experienced either physical or sexual violence by intimate partners. 4 Of this, 37% was reported from Africa. 5,6 up to 76.5% of Ethiopian women are exposed for IPV in their lifetime. 7\u0026ndash;11\u003c/p\u003e\n\u003cp\u003eIn low and middle income countries including Ethiopia, there are several gaps and inadequate evidence on prevalence and factors associated with intimate partner violence during pregnancy.18\u003c/p\u003e\n\u003cp\u003eMost studies were limited to intimate partner violence to non-pregnant women. However, the consequence of intimate partner violence during pregnancy is worse.19\u003c/p\u003e\n\u003cp\u003eIntimate partner violence during pregnancy has been associated with fatal and non-fatal adverse health outcomes for the pregnant woman and her unborn fetus either direct physical trauma to her body and physiological stress from current or past abuse or fetal growth and development. 20-23\u003c/p\u003e\n\u003cp\u003e30% of GBV starts in pregnancy(peak in 1st TM followed by in 3rd trimester). Many studies showed IPV is significantly associated with adverse maternal outcomes including maternal death (1.5 to 2 x higher risk) i. e. unintended pregnancies, HEG, inadequate prenatal/antenatal care, forced induced abortion, spont abortion, gestational wt gain, IUGR, pre-eclampsia, 3rd trimester bleeding, fetal IVH, depression, suicide and STIs. 24-26 In Ethiopia, even though there is some improvement in decreasing violence against women, little attention is given for violence committed by intimate partners, especially for pregnant women. 20, 25\u003c/p\u003e\n\u003cp\u003eDespite its high prevalence in Ethiopia, the screening rates by healthcare workers (HCWs) are alarmingly low, ranging from 1.5% to 12% in primary care settings. This indicates a significant gap in identifying and addressing IPV among patients. 25, 26\u003c/p\u003e\n\u003cp\u003eDespite the importance of IPV screening, many healthcare providers face challenges in implementing effective screening practices. In Ethiopia, where IPV is prevalent, there is a need to understand the practice of IPV screening among healthcare providers in ANC settings. Understanding the practice of IPV screening and identifying factors associated with IPV screening in five teaching hospitals in Addis Ababa, Ethiopia, during antenatal care will inform policy makers to design strategies to strengthen IPV screening and support victims of IPV in ANC settings, ultimately improving maternal and child health outcomes.\u003c/p\u003e\n\u003ch2\u003e1.3.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Significance of the study\u003c/h2\u003e\n\u003cp\u003eIPV is prevalent in all countries. It is more pervasive in developing countries including Ethiopia. IPV is risk for maternal health.18 The significance of the study lies in its potential to improve the detection and prevention of intimate partner violence (IPV) among pregnant women due to these key reasons:\u003c/p\u003e\n\u003cp\u003eIt has potential to improve detection and prevention of IPV and related complications:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.\u0026nbsp; \u0026nbsp;\u003c/strong\u003eIPV is a significant public health concern in Ethiopia, with prevalence \u0026gt;30%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u0026nbsp; \u0026nbsp;\u003c/strong\u003eANC: most common time for IPV is during pregnancy mostly in 1st TMPx followed by 3rd TMPx.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u0026nbsp; \u0026nbsp;\u003c/strong\u003eLimited Research in Ethiopia, despite its high prevalence. This study will fill this knowledge gap and provide valuable insights for policymakers and healthcare providers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp; \u0026nbsp;\u003c/strong\u003eIt provides evidence to support screening integration into routine clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.\u0026nbsp; \u0026nbsp;\u003c/strong\u003eFive Teaching Hospitals in A. A : representative of the largest hospitals and largest city in Ethiopia and the findings can be generalized to other urban settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.\u0026nbsp; \u0026nbsp;\u003c/strong\u003e2024/25 G. C: ensures that the findings are timely.\u003c/p\u003e\n\u003cp\u003e7. The results can help develop targeted training programs for healthcare providers, ensuring they are equipped to screen and address IPV in ANC settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8.\u0026nbsp; \u0026nbsp;\u003c/strong\u003eImproved Patient Outcomes: improved maternal and child health, and enhanced overall health care quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e9.\u0026nbsp; \u0026nbsp;\u003c/strong\u003eContribution to Global Knowledge\u003c/p\u003e\n\u003cp\u003eBy addressing these significant issues, this study has the potential to make a meaningful impact on the prevention and detection of intimate partner violence among pregnant women in Ethiopia. There for the finding of this study can be used for preventing the IPV, improving clinical care, advancing scientific knowledge, reducing healthcare costs, informing public policy, and ultimately enhancing the health and well-being of individuals and communities.\u003c/p\u003e"},{"header":"2. Literature review","content":"\u003cp\u003e\u003cstrong\u003e2.1.\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003ePrevalence of intimate partner violence\u003c/p\u003e\n\u003cp\u003eIntimate partner violence (IPV) is a serious public health problem that affects women of reproductive age worldwide. IPV can have negative consequences for the physical, mental, and reproductive health of women and their children. Screening for IPV in antenatal care settings can help identify women who are experiencing abuse and provide them with appropriate support and referrals.19\u003c/p\u003e\n\u003cp\u003ePopulation-level surveys based on reports from survivors provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence. A 2018 analysis of prevalence data from 2000\u0026ndash;2018 across 161 countries and areas, conducted by WHO on behalf of the UN Interagency working group on violence against women, found that worldwide, nearly 1 in 3, or 30%, of women have been subjected to physical and/or sexual violence by an intimate partner or non-partner sexual violence or both . 2\u003c/p\u003e\n\u003cp\u003eOver a quarter of women aged 15\u0026ndash;49 years who have been in a relationship have been subjected to physical and/or sexual violence by their intimate partner at least once in their lifetime (since age 15). The prevalence estimates of lifetime intimate partner violence range from 20% in the Western Pacific, 22% in high-income countries and Europe and 25% in the WHO Regions of the Americas to 33% in the WHO African region, 31% in the WHO Eastern Mediterranean Region, and 33% in the WHO South-East Asia region.2\u003c/p\u003e\n\u003cp\u003eGlobally as many as 38% of all murders of women are committed by intimate partners. In addition to intimate partner violence, globally 6% of women report having been sexually assaulted by someone other than a partner, although data for non-partner sexual violence are more limited. Intimate partner and sexual violence are mostly perpetrated by men against women.2\u003c/p\u003e\n\u003cp\u003eAccording to the study done by Dr. Nigussie Azmeraw at 3 teaching hospitals (ZMH, GMH, TASH) in 2023 G. C, the overall prevalence of IPV was 37%. Psychological, physical and sexual violence accounts 28.4%, 20 and 21% respectively. age \u0026ge;35 compared than age 20-29 years (AOR=3.1, 95%CI=1.21, 7.75), rural area compared urban (AOR=3.6, 95%CI=1.02, 12.84), illiterate and able to write andread compared to education level of collage and above (AOR=15.7, 95%CI=3.58, 68.99 and AOR=11.1, 95%CI=3.61, 74.34) , student and merchant compared to government employer (AOR=0.61, 95%CI=0.041, 0.95 and AOR=0.74, 95%CI=0.01, 0.93), monthly income of \u0026lt;5000 and 5000-10000 ETB compared to monthly income of \u0026gt;10000ETB (AOR=4.3, 95%CI=1.09, 8.83 and AOR=2.3, 95%CI=1.11, 11.89), paid dowery/bride compared its opposite compartment (AOR=11.9, 95%CI=5.19, 27.27), parent chowing chat and drink alcohol compared to its opposite compartment (AOR=10.1, 95%CI=2.89, 35.71 and AOR=8.9, 95%CI=4.32, 24.34) were a statistically significant factor for IPV.18\u003c/p\u003e\n\u003cp\u003eAccording to a Study done in south Africa on domestic and intimate partner violence among pregnant women in a low resource setting showed that, the prevalence of IPV was 15% (n =58) of the 376 sample population. Furthermore, 46% of individuals that screened positive for IPV had experienced multiple forms of abuse. 27\u003c/p\u003e\n\u003cp\u003eAccording to a Study done in northcentral Nigeria on the prevalence of IPV among the study population was 14.8% (50/338). In addition, among the study population, 18 (5.3%) women reported sexual abuse (forced sexual intercourse) by their intimate partners. Surprisingly, out of 50 women who suffered IPV during the pregnancy, 38 (76.0%) of them felt they were safe in their marital relationship while only 12 (24.0%) felt unsafe in their marriage. Most of the women [36 (72.0%)] who had IPV in pregnancy did not report the violence to anybody. Of the 14 (28.0%) women who reported such abuse, 12 (85.7%) disclosed it to their husbands\u0026rsquo; parents and friends (14.3%). 28\u003c/p\u003e\n\u003cp\u003eAccording to the study done on Intimate partner violence in pregnancy among antenatal attendees at health facilities in West Pokot county, Kenya on prevalence of overall, IPV was in the current pregnancy was 150 (66.9%). 29\u003c/p\u003e\n\u003cp\u003eStudy done in Abay Chomen district, Western Ethiopia showed that the Intimate partner violence during pregnancy was 44.5 %. More than half 157 (55.5 %) women experienced all the three forms of intimate partner violence during recent pregnancy. The simultaneous occurrence of intimate partner physical and psychological violence during pregnancy as well as joint occurrence of intimate partner physical and sexual violence was 160 (56.5 %). 24\u003c/p\u003e\n\u003cp\u003eThe study done in Gondar referral hospital on Prevalence of domestic violence among pregnant showed that overall prevalence of domestic violence among pregnant woman in this study was 58.7% (95% CI: 53.8, 63.1). A high prevalence of domestic violence (53.8%) was observed among pregnant women with no income of their own, followed by housewives (52.3%).25\u003c/p\u003e\n\u003cp\u003eThe proportion of women who has reported emotional, sexual, and physical IPV in the last twelve months were 10%, 29.5%, and 9.5%, respectively. The most common act of IPV reported in current relationship was partner controlling, reported by 69.0% of women. The most common controlling behavior of male partner reported by participants was insisting to know the women\u0026rsquo;s where about at all times, reported by 54.3% of women. Whereas, the least reported controlling behavior was not trusting with money (10.5%).30In this study, the overall prevalence of intimate partner violence during current pregnancy was 41.1% (95% CI: 36.0\u0026ndash;46.0).31Study done on pregnant women in Ethiopia on Intimate Partner Violence and Associated Factors showed that, 202 (37.5%) had experienced violence by their intimate partner during the recent pregnancy.32\u003c/p\u003e\n\u003cp\u003eDespite the high prevalence of IPV, the screening rates by healthcare workers (HCWs) are alarmingly low, ranging from 1.5% to 12% in primary care settings. This indicates a significant gap in identifying and addressing IPV among patients.25\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eIPV screening and its barriers and facilitators\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1.\u0026nbsp;\u003c/strong\u003eIPV screening\u003c/p\u003e\n\u003cp\u003eAccording to the World Health Organization (WHO), screening for IPV should be done in a respectful, supportive, and non-judgmental manner, with the informed consent of the woman and the assurance of confidentiality and safety. The WHO recommends using validated screening tools that are culturally appropriate and context-specific. Some examples of screening tools for IPV are:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Humiliation, Afraid, Rape, Kick (HARK)\u003c/p\u003e\n\u003cp\u003e\u0026bull; Hurt/Insult/Threaten/Scream (HITS)\u003c/p\u003e\n\u003cp\u003e\u0026bull; Extended\u0026ndash;Hurt/Insult/Threaten/Scream (E-HITS)\u003c/p\u003e\n\u003cp\u003e\u0026bull; Partner Violence Screen (PVS)\u003c/p\u003e\n\u003cp\u003e\u0026bull; Woman Abuse Screening Tool (WAST)\u003c/p\u003e\n\u003cp\u003eThese tools consist of a few questions that ask women about their experiences of physical, sexual, or emotional abuse by their current or former partner. The tools have different scoring systems and cut-off points to indicate a positive screen for IPV.20\u003c/p\u003e\n\u003cp\u003eA thesis on validating a screening tool for IPV in antenatal care settings should include the following components:\u003c/p\u003e\n\u003cp\u003e\u0026bull; A clear research question and objectives\u003c/p\u003e\n\u003cp\u003e\u0026bull; A literature review of the existing evidence on IPV screening and interventions in antenatal care settings\u003c/p\u003e\n\u003cp\u003e\u0026bull; A description of the screening tool to be validated, including its origin, development, content, format, and administration\u003c/p\u003e\n\u003cp\u003e\u0026bull; A description of the study design, setting, population, sample size, sampling method, inclusion and exclusion criteria, and ethical considerations\u003c/p\u003e\n\u003cp\u003e\u0026bull; A description of the data collection methods, instruments, and procedures, including how the screening tool was compared with a reference standard or criterion\u003c/p\u003e\n\u003cp\u003e\u0026bull; A description of the data analysis methods, including the statistical tests and measures of validity and reliability to be used\u003c/p\u003e\n\u003cp\u003e\u0026bull; A description of the expected results, limitations, implications, and recommendations. 20-23\u003c/p\u003e\n\u003cp\u003eThe HARK tool questions are:\u003c/p\u003e\n\u003cp\u003e\u0026bull; In the last year, have you ever felt humiliated or emotionally abused in other ways by your partner or ex-partner?\u003c/p\u003e\n\u003cp\u003e\u0026bull; In the last year, have you been afraid of your partner or ex-partner?\u003c/p\u003e\n\u003cp\u003e\u0026bull; In the last year, have you been raped or forced to have any kind of sexual activity by your partner or ex-partner?\u003c/p\u003e\n\u003cp\u003e\u0026bull; In the last year, have you been kicked, hit, slapped, or otherwise physically hurt by your partner or ex-partner?\u003c/p\u003e\n\u003cp\u003eEach question can be answered with yes or no. A positive answer to any of the questions indicates a positive screen for IPV. The HARK tool has been shown to have good accuracy and acceptability for detecting IPV in different settings, such as primary care, antenatal care, and family planning clinics.\u003c/p\u003e\n\u003cp\u003eThe HARK tool can help identify women who are experiencing IPV and provide them with appropriate support and referrals. However, screening for IPV should be done in a respectful, supportive, and non-judgmental manner, with the informed consent of the woman and the assurance of confidentiality and safety. Screening for IPV should also be accompanied by interventions that can address the needs and preferences of the woman, such as counseling, advocacy, or legal services.3\u003c/p\u003e\n\u003cp\u003eThe sensitivity and specificity of the HARK tool are measures of how well the tool can detect intimate partner violence (IPV) among women. Sensitivity is the proportion of women who have IPV and are correctly identified by the tool. Specificity is the proportion of women who do not have IPV and are correctly excluded by the tool.\u003c/p\u003e\n\u003cp\u003eAccording to a study by Sohal et al, the HARK tool has a sensitivity of 81% and a specificity of 95% for detecting any past-year IPV among women in general practice settings. This means that the HARK tool can correctly identify 81% of women who have experienced IPV in the last year and correctly exclude 95% of women who have not experienced IPV in the last year.\u003c/p\u003e\n\u003cp\u003eOther studies have also reported similar or slightly lower values for the sensitivity and specificity of the HARK tool in different settings, such as antenatal care and family planning clinics. The HARK tool is considered to have good accuracy and acceptability for screening for IPV among women.2\u003c/p\u003e\n\u003cp\u003eAccording to the recommendations and guidelines from the US Preventive Services Task Force (USPSTF) and the Minnesota Department of Health (MDH) on screening for IPV in health care settings, the best way to introduce the HARK tool Include:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Screening all women of reproductive age for IPV at least once per year and more frequently if there are risk factors or signs of abuse\u003c/p\u003e\n\u003cp\u003e\u0026bull; Obtaining the informed consent of the woman and ensuring confidentiality and safety before screening\u003c/p\u003e\n\u003cp\u003e\u0026bull; Using a respectful, supportive, and non-judgmental approach when screening and responding to IPV\u003c/p\u003e\n\u003cp\u003e\u0026bull; Providing or referring women who screen positive for IPV to ongoing support services, such as counseling, advocacy, or legal assistance\u003c/p\u003e\n\u003cp\u003e\u0026bull; Using validated screening tools that are culturally appropriate and context-specific, such as the HARK tool\u003c/p\u003e\n\u003cp\u003e\u0026bull; Incorporating the HARK tool into the electronic medical record or the clinical workflow to prompt clinicians to ask about IPV and to encourage disclosure by patients\u003c/p\u003e\n\u003cp\u003e\u0026bull; Providing training and education to health providers and staff on IPV screening and intervention\u003c/p\u003e\n\u003cp\u003eAssessing the risk of harm in women who disclose IPV during screening is an important step to provide appropriate and timely support and intervention. The risk of harm refers to the likelihood and severity of future violence, injury, or death that a woman may face from her abusive partner. There are different tools and methods that can be used to assess the risk of harm in women who disclose IPV during screening. One of the most commonly used tools is the Danger Assessment (DA), which is a 20-item questionnaire that asks women about various indicators of danger, such as threats, weapons, choking, stalking, and escalation of violence. The DA also includes a calendar that helps women recall the frequency and severity of violence in the past year. The DA can be scored to obtain a numerical value that corresponds to different levels of risk, from variable to extreme. The DA has been shown to have good reliability and validity for predicting future violence and homicide among women who experience IPV. 1\u003c/p\u003e\n\u003cp\u003eAnother tool that can be used to assess the risk of harm is the Ontario Domestic Assault Risk Assessment (ODARA), which is a 13-item checklist that can be completed by health providers or police officers based on information from the woman, the perpetrator, or official records. The ODARA items include factors such as prior assault, substance abuse, threats, children, and barriers to support. The ODARA can be scored to obtain a numerical value that corresponds to different probabilities of future assault, from low to high. The ODARA has been shown to have good accuracy and interrater reliability for predicting future violence and recidivism among IPV perpetrators. 2\u003c/p\u003e\n\u003cp\u003eOther methods that can be used to assess the risk of harm are clinical judgment and structured professional judgment. Clinical judgment is based on the health provider\u0026apos;s experience, intuition, and knowledge of the woman and her situation. Structured professional judgment is based on the health provider\u0026apos;s use of a set of guidelines or criteria to evaluate the risk factors and protective factors for the woman and her situation. Both methods require the health provider to consider the context and dynamics of the IPV, the woman\u0026apos;s needs and preferences, and the available resources and interventions. 3\u003c/p\u003e\n\u003cp\u003eEthiopia\u0026rsquo;s National ANC management protocol published on February 2022 recommends routine screening of GBV especially IPV in every contact starting in preconception period using HITS screening tool. Have you been Hit/kick, Slapped/Insulted, Threatened, screamed,(HITS tool) cursed by your husband or somebody close.54\u003c/p\u003e\n\u003cp\u003eThe assessment of the risk of harm should be done in a respectful, supportive, and non-judgmental manner, with the informed consent of the woman and the assurance of confidentiality and safety. The assessment of the risk of harm will also be followed with appropriate actions and referrals, such as safety planning, counseling, advocacy, or legal services, depending on the level of risk and the woman\u0026apos;s wishes. 4\u003c/p\u003e\n\u003cp\u003eResponding to women who disclose IPV during screening can be challenging, but also an opportunity to provide support and help. Here are some general tips on how to respond to IPV disclosures in a respectful, supportive, and non-judgmental manner:12\u003c/p\u003e\n\u003cp\u003e\u0026bull; Express empathy and concern. For example, you can say \u0026quot;I\u0026apos;m sorry this is happening to you\u0026quot; or \u0026quot;You don\u0026apos;t deserve to be treated this way\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Validate the woman\u0026apos;s experiences and feelings. For example, you can say \u0026quot;I believe you\u0026quot; or \u0026quot;Your feelings are understandable\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Acknowledge the woman\u0026apos;s strengths and resilience. For example, you can say \u0026quot;You are very brave to share this with me\u0026quot; or \u0026quot;You have been coping with a lot of stress\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Respect the woman\u0026apos;s autonomy and choices. For example, you can say \u0026quot;You know your situation best\u0026quot; or \u0026quot;You have the right to make your own decisions\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Provide information and referrals. For example, you can say \u0026quot;There are services that can help you\u0026quot; or \u0026quot;I can give you some phone numbers or websites that you can contact\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Ensure confidentiality and safety. For example, you can say \u0026quot;I will keep this information private\u0026quot; or \u0026quot;Is there a safe place or time for you to talk or get help?\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.2.\u0026nbsp;\u003c/strong\u003eBarriers and facilitators for IPV screening\u003c/p\u003e\n\u003cp\u003eThe four hindering factors for IPV screening are47:\u003c/p\u003e\n\u003cp\u003e1. Personal barriers:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Discomfort with the issue of IPV\u003c/p\u003e\n\u003cp\u003e\u0026bull; Lack of knowledge and training on how to screen for IPV\u003c/p\u003e\n\u003cp\u003e\u0026bull; Perceptions and attitudes that hinder screening\u003c/p\u003e\n\u003cp\u003e\u0026bull; Fears, such as offending the patient\u003c/p\u003e\n\u003cp\u003e2. Resource barriers:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Lack of time to conduct IPV screening\u003c/p\u003e\n\u003cp\u003e\u0026bull; Lack of privacy in the healthcare setting to ask sensitive questions\u003c/p\u003e\n\u003cp\u003e\u0026bull; Absence of institutional protocols and guidelines for IPV screening\u003c/p\u003e\n\u003cp\u003e3. Patient-related barriers:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Patients being accompanied by family members or friends during visits, reducing opportunities for private screening\u003c/p\u003e\n\u003cp\u003e\u0026bull; Patients not disclosing IPV due to fear, shame, or other reasons\u003c/p\u003e\n\u003cp\u003e4. Organizational barriers:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Lack of institutional support and resources for IPV screening and intervention programs\u003c/p\u003e\n\u003cp\u003e\u0026bull; Absence of training for healthcare providers on IPV screening and management\u003c/p\u003e\n\u003cp\u003eFacilitators for intimate partner violence (IPV) screening includes48:\u003c/p\u003e\n\u003cp\u003e1. Availability of GBV protocols: Healthcare providers who are aware of and use gender-based violence (GBV) protocols tend to screen for IPV more regularly. These protocols provide a framework for healthcare providers to identify and respond to IPV effectively.\u003c/p\u003e\n\u003cp\u003e2. Provider awareness of IPV tools: Providers who are aware of IPV tools and tend to use them to screen for IPV are more likely to conduct routine IPV screening. This awareness helps them identify IPV and provide appropriate support to victims.\u003c/p\u003e\n\u003cp\u003e3. Establishing patient trust and a safe ANC clinic environment: Healthcare providers reported the need to establish patient trust and a safe antenatal care (ANC) clinic environment to encourage IPV disclosure. This includes creating a non-judgmental and confidential space where patients feel comfortable sharing their experiences.\u003c/p\u003e\n\u003cp\u003e4. Opportunities for triage-level screening and modification of patients\u0026apos; ANC cards: Healthcare providers suggested creating opportunities for triage-level screening and modifying patients\u0026apos; ANC cards to document women\u0026apos;s medical history. This includes incorporating IPV screening into routine ANC services and documenting IPV in patient records.\u003c/p\u003e\n\u003cp\u003eThese facilitators highlight the importance of healthcare provider training, institutional protocols, and a supportive environment in promoting routine IPV screening during antenatal care.\u003c/p\u003e\n\u003cp\u003eBased on the study done in uganda in 2022 G. C., the main barriers and facilitators for intimate partner violence (IPV) screening in antenatal care (ANC) settings in Uganda are:26\u003c/p\u003e\n\u003cp\u003eBarriers:\u003c/p\u003e\n\u003cp\u003e\u0026middot; Limited staffing and space resources in ANC clinics\u003c/p\u003e\n\u003cp\u003e\u0026middot; Lack of comprehensive gender-based violence (GBV) training for healthcare providers\u003c/p\u003e\n\u003cp\u003e\u0026middot; Provider unawareness of the extent of IPV during pregnancy\u003c/p\u003e\n\u003cp\u003e\u0026middot; Concerns about patient safety and potential for retaliatory abuse if perpetrating partners were to see reported abuse\u003c/p\u003e\n\u003cp\u003eFacilitators:\u003c/p\u003e\n\u003cp\u003e\u0026middot; Availability of GBV protocols and tools to screen for IPV\u003c/p\u003e\n\u003cp\u003e\u0026middot; Healthcare providers who were aware of IPV (or GBV) screening tools and tended to use them routinely\u003c/p\u003e\n\u003cp\u003e\u0026middot; Establishing patient trust and creating a safe ANC clinic environment for disclosure to occur\u003c/p\u003e\n\u003cp\u003e\u0026middot; Opportunities for triage-level IPV screening and modification of patients\u0026apos; ANC cards to document IPV\u003c/p\u003e\n\u003cp\u003eThe context indicates that implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, raising awareness of IPV severity, trauma-informed care, and building trusting patient-provider relationships.\u003c/p\u003e\n\u003cp\u003eAccording to US veterans health administration study published in 2020, patients and providers agreed that one of the most important factors for successful IPV use screening was strong rapport. Patients stated that they need to feel connected to and trust their provider to honestly discuss IPV; this finding extends research highlighting \u0026lsquo;connectedness\u0026rsquo; as a key enabler of disclosing IPV experiences.\u003c/p\u003e\n\u003cp\u003eIn turn, providers expressed feeling uncomfortable asking questions about IPV use in the absence of a strong relationship with the patient or if they did not expect that the patient would respond positively. This finding parallels existing literature on barriers of screening for IPV experiences in VHA showing that a sensitive and empathic approach, ongoing relationship, and comfort with the provider are essential to women Veterans\u0026rsquo; willingness to discuss IPV experiences . Similar observations have been documented among non-VHA providers and patients, in which a respectful and trusting relationship was shown to be important and associated with sensitive IPV screening and disclosure39, 40. Another facilitator that patients and providers agreed on was the importance of clear and comprehensive processes and procedures following IPV use screening. Patients believed that they would be more open about IPV use behavior if the consequences of disclosure (i. e., documentation in electronic medical records and possible mandated reporting requirements) were clear and referral services were available. Similarly, providers noted significant barriers to screening in the way of unclear procedural and systematic factors related to clinic policies, leadership support, and resources available for positive screens. Concerns related to the consequences of a positive screen are likely worsened by the varying legal requirements across countries and even states 41. Findings from the present study extend the literature on IPV detection in VHA to include similar concerns regarding IPV use screening. Research with patients and providers prior to implementing screening for IPV experiences highlighted patient and provider concerns of regarding negative consequences of disclosure 30, logistical and educational barriers to screening 6, 32, and the importance of follow-up support, transparent documentation, and availability of resources 31. Patient and provider concerns regarding next steps following IPV use disclosure are sensible given that only one empirically supported treatment for IPV use among Veterans exists to date, a trauma-informed group intervention for men 17. More broadly outside of VHA, the evidence for IPV use treatment in healthcare settings is weak 41. The development of additional evidence-based interventions for this population is crucial and the need for additional treatment options is reflected by patient and provider reluctance to engage in IPV screening without adequate follow up services. Three method-related screening preferences were consistent between patients and providers. First, both groups agreed that there could be benefits to universal implementation of IPV use screening in order to reduce stigma and enhance reach. Second, both patients and providers spoke to the acceptability and appropriateness of implementing a self-report screening tool in routine care. Patients and providers desired a clinical tool for IPV use that patients could complete in the waiting room prior to their appointment. In fact, an IPV use self-report screening approach has shown success in prior research 18. However, patients noted that a self report screener would only be effective if the provider followed up on patient responses. Third, both patients providers agreed that the screening tool should inquire about both IPV use and IPV experiences, consistent with prior research highlighting the value of concurrent screening for IPV 22. In our study, findings demonstrate that patients are more likely to disclose IPV use behavior to providers when also given the chance to dis cuss their IPV victimization experiences. Similarly, providers expressed a preference for asking about IPV use and experiences simultaneously in order to \u0026lsquo;get the full picture.\u0026rsquo; Concurrent inquiry regarding IPV use and IPV experience is an important avenue for clinical research, especially given male Veterans\u0026rsquo; reports of IPV experiences 24, 42 and female Veterans\u0026rsquo; reports of IPV use 19, 43. The present study also highlights the difficulty reaching consensus regarding the setting in which IPV use screening should take place. Many respondents (both patients and providers) believed that mental health clinicians may be better prepared to screen for IPV. However, most responders also agreed that primary care, due to its broader reach, would be an appropriate setting for IPV use screening implementation. Certainly, a primary care setting sees more patients and thus would be able to screen a larger number of people. However, primary care providers also often report being overburdened by screening, having a large volume of patients, being under-staffed, and not have enough time with each patient to conduct the many screenings that are already currently required 44\u0026ndash;48. Future research should formally evaluate the feasibility and effectiveness of screening for IPV use in these settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. \u0026nbsp; \u0026nbsp;\u003c/strong\u003eConceptual framework\u003c/p\u003e"},{"header":"3. Objectives","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1. General objective\u003c/h2\u003e\u003cp\u003e\u0026gt;To evaluate the practice of Intimate partner violence (IPV) screening in antenatal care setting in teaching hospitals in Addis Ababa, Ethiopia.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Specific objectives\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u0026gt;To evaluate the practice of IPV screening among healthcare providers in antenatal care settings in five teaching hospitals, Addis Ababa, Ethiopia, 2024/25 G. C. \u0026gt;To identify factors associated with screening for IPV among antenatal health care providers in five Addis Ababa teaching hospitals, 2024/25 G. C.\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/div\u003e"},{"header":"4. Method","content":"\u003ch2\u003eStudy area and period\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in Addis Ababa, Ethiopia. Ethiopia is a landlocked country located in the Horn of Africa region of East Africa. Ethiopia has a population of around 128 million inhabitants, making it the 13th most populous country in the world and the most populated landlocked country on Earth.50\u003c/p\u003e\n\u003cp\u003eAddis Ababa is the capital and largest city of Ethiopia, with an estimated population of nearly 4 million as of 2023. It lies on a plateau in the country\u0026apos;s geographic center at an altitude of about 8,000 ft (2,450 m). Today, Addis Ababa is an important center of culture, finance, and diplomacy in Ethiopia and Africa. It serves as the headquarters for the African Union and United Nations and Economic Commission for Africa. Addis Ababa is home to Addis Ababa University, the largest university in Ethiopia.50 The study was conducted in Addis Ababa teaching hospitals namely Tikur Ambesa specialized Hospital (TASH), Zewuditu Memorial Hospital(ZMH), Gandhi Memorial Hospital (GMH), Abebech gobena MCH hospital and st. paulos Millenium medical college(SPMMC) from December 01,2024 \u0026ndash; May 31 , 2025 G. C. These hospitals are the largest teaching and referral hospital in Ethiopia. The hospitals receive mainly high risk patients referred from their catchment health centres. Totally they serve as a referral centre for about 24 Health centres. In 2023 G. C the hospitals have more than 1400 antenatal care follow up in a month. They provide a comprehensive care of which obstetrics and gynaecology care service provision is one of the main service obstetrics and new-born care 24/7. It is intensive and multidisciplinary at TASH because cases with medical comorbidity are proportionally high and there is a multidisciplinary team for joint maternal and new born care.\u003c/p\u003e\n\u003cp\u003eTikur Ambesa specialized Hospital (TASH) is a university hospital with specialized clinical services that are not available in other public or private institutions are rendered to the whole nation. There are 78 in \u0026ndash; patient beds in two wards, 4 delivery couches, 1 emergency room, procedure rooms for Obstetrics and Gynaecology care services. There are also 2 OR table for caesarean delivery with back up of operating tables at the major OR.\u003c/p\u003e\n\u003cp\u003eGandhi Memorial Hospital (GMH) and Abebech gobena MCH hospitals are Addis Ababa region dedicated maternity and child health hospitals and has similar structural and functional service like that of TASH , it has its own fetal and maternal medicine unit.\u003c/p\u003e\n\u003ch2\u003e4.2. Study design\u003c/h2\u003e\n\u003cp\u003eInstitution based cross sectional study design was conducted.\u003c/p\u003e\n\u003ch2\u003e4.3\u0026nbsp;. Source and Study Population\u003c/h2\u003e\n\u003ch3\u003e4.3.1. Source Population\u003c/h3\u003e\n\u003cp\u003eAntenatal care providers in five teaching hospitals, Addis Ababa.\u003c/p\u003e\n\u003ch3\u003e4.3.2. Study Population\u003c/h3\u003e\n\u003cp\u003eAll obstetricians and gynaecologists, MFM fellows, residents, general practitioners, nurses, Health officers and midwifes providing antenatal care in five teaching hospitals, Addis Ababa.\u003c/p\u003e\n\u003ch2\u003e4.4. Eligibility Criteria\u003c/h2\u003e\n\u003ch3\u003e4.4.1. Inclusion Criteria\u003c/h3\u003e\n\u003cp\u003eHealthcare providers working in ANC clinics of the study area for more than 1 month who are available during data collection period and who give informed consent for participation.\u003c/p\u003e\n\u003ch3\u003e4.4.2. Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eHealthcare providers who are not willing to give informed consent, who work in ANC clinics of the study area for less than 1 month and who are on break or sick leave during the study period was excluded if we failed to collect data from them with 3 repeated attempts (by phone call and social platforms).\u003c/p\u003e\n\u003ch2\u003e4.5.\u0026nbsp; \u0026nbsp;\u0026nbsp;Sample size\u003c/h2\u003e\n\u003cp\u003eSince there is no logistic, financial and time constraints, all health care providers (Nurses, Health officers, Midwives, obstetricians and gynaecologists, MFM fellows, residents, general practitioners) working in ANC clinics for more than 1 month in the study area was included. Based on the data collected from Hospital Human resources, chef residents and unit heads a total of 301 participants were eligible. All eligible healthcare providers were invited to participate and 274 participated. Response rate was 91.2%.\u003c/p\u003e\n\u003ch2\u003e4.6.\u0026nbsp; \u0026nbsp;\u0026nbsp;Sampling technique\u003c/h2\u003e\n\u003cp\u003eAll eligible target populations were included to get comprehensive data.\u003c/p\u003e\n\u003ch2\u003e4.7.\u0026nbsp; \u0026nbsp;\u0026nbsp;Study Variables\u003c/h2\u003e\n\u003cp\u003eDependent Variable: practice of screening for IPV.\u003c/p\u003e\n\u003cp\u003eIndependent Variables: influencing the likelihood of IPV screening include:\u003c/p\u003e\n\u003cp\u003e\u0026middot; Demographic factors: Age, gender, sex and professional role (e. g., doctor, nurse).\u003c/p\u003e\n\u003cp\u003e\u0026middot; Perceived providers\u0026apos; confidence in their ability to screen for IPV.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Professional preparedness: Training and awareness for IPV cases.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Institutional factors: Availability of guidelines, follow-up and referral networks,, confidential environment, from provider\u0026rsquo;s point of view.\u003c/p\u003e\n\u003ch2\u003e4.8.\u0026nbsp; \u0026nbsp;\u0026nbsp;Operational definitions\u003c/h2\u003e\n\u003cp\u003ePractice of IPV screening :- is the routine implementation of structured inquiries regarding experiences of intimate partner violence by healthcare providers during antenatal care visits. This practice was measured through: Rubric IPV Screening Practices Scoring Guidelines\u003c/p\u003e\n\u003cp\u003eHealth care providers: Nurses, Health officers, Midwives, obstetricians and gynaecologists, fellows, residents, general practitioners.\u003c/p\u003e\n\u003cp\u003eSocial platforms: Telegram, E-mail and face book.\u003c/p\u003e\n\u003cp\u003eConfidential environment - the provider\u0026apos;s perception of their immediate physical work environment\u003c/p\u003e\n\u003cp\u003eHealth care providers - Nurses, HOs, Midwives, OBGYNs, MFM fellows, residents, GPs\u003c/p\u003e\n\u003cp\u003eConsultants \u0026ndash; Obstetrician and Gynaecologists and MFM fellows\u003c/p\u003e\n\u003cp\u003eAwareness of availability of guideline - Simply knowing that a guideline exists and name of that guideline.\u003c/p\u003e\n\u003cp\u003eUnmarried \u0026ndash; this category includes singles(never married), divorced, widowed\u003c/p\u003e\n\u003cp\u003eLevel of experience \u0026ndash; Those who have 1 month to 3 year of experience are categorized as juniors, those providers having 4 to 7 year of experience are categorized as seniors. Those having 8 years and above experience are categorized as senior experts (FMHACA)\u003c/p\u003e\n\u003ch2\u003e4.9.\u0026nbsp; \u0026nbsp;\u0026nbsp;Data collection\u003c/h2\u003e\n\u003cp\u003e4.9.1. Data collection tool: Structured self administered questionnaire in English language was used to gather data. The questionnaire was taken from different literatures and modified and was pretested in a health facility of different study area (yeka kotebe general hospital to reduce recall bias) two weeks prior to actual data collection. Necessary modifications were made after the pre-test.\u003c/p\u003e\n\u003cp\u003e4.9.2 Data collectors: - 5 data collectors (GPs) working in the study area was recruited, 1 data collector in each hospital.\u003c/p\u003e\n\u003cp\u003e4.9.3 Data collection procedure: The Data collectors were trained for 1 day about the contents of the self administered questionnaire and on how and when to collect the data. The questionnaire was distributed to respondents by hard copy and/or Google sheet through telegram, face book and email by the data collectors during the lunch time or to fill the self administered questionnaire when ever they got free time and to return it back to the data collector by envelope and anonymous chats after they complete filling the questionnaire and the responses was entered into an electronic database.\u003c/p\u003e\n\u003ch2\u003e4.10. Data Quality Management\u003c/h2\u003e\n\u003cp\u003eThe data collection tools was prepared from multiple researches. The supervisor provides the tools for data collectors at each site and regular meetings was held between the data collectors and the supervisor in a weekly basis.\u003c/p\u003e\n\u003cp\u003eTo assure the quality of data the questioner was pretested 2 weeks before the actual data collection time. Then, after the pre-testing, all necessary modifications was made on the tools.\u003c/p\u003e\n\u003cp\u003eThe collected data was checked for completeness, accuracy, clarity and consistency on daily basis. To ensure the reliability the data use of adapted data collection tool was also improving reliability and only trained data collectors was used for data collection.\u003c/p\u003e\n\u003ch2\u003e4.11. Data management and analysis\u003c/h2\u003e\n\u003cp\u003e4.11a Data Management\u003c/p\u003e\n\u003cp\u003e- All electronic data is stored securely in password-protected files which will not to be used for other purposes. Hard copies of notes is stored in a locked cabinet.\u003c/p\u003e\n\u003cp\u003e4.11b. Data Analysis\u003c/p\u003e\n\u003cp\u003eThe data was entered, coded, and cleaned using EpiData version 7 statistical software, and analysis was performed using SPSS version 26. Descriptive statistics for categorical data was provided in terms of frequency and percentages; and appropriate tables and charts were used for describing the data. Also, the Likert scale data was analyzed as categorical data. The association of independent and dependent variable was measured by using binary logistic regression. All variables with a p-value \u0026lt; 0.25 in the binary logistic regression analysis was entered into the final model for multivariable analysis after checking model fitness. Odds ratio (OR) with a 95% confidence interval and a P-value of 0.05 was used as statistically significant for the outcome variable.\u003c/p\u003e\n\u003ch2\u003e4.12. Ethical considerations\u003c/h2\u003e\n\u003cp\u003eEthical clearance was first obtained from the Department Research and Publication Committee (DRPC) of Tikur Ambessa Specialized Hospital, the Department of Obstetrics and Gynecology. Then, the ethical clearance and support letter was taken to the selected hospitals to obtain permission and cooperation during the data collection process.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from each study subject prior to the data collection process after the purpose of study has been explained and they become briefed about the confidentiality of their responses and the importance of providing the right information to help the study achieve its objective.\u003c/p\u003e\n\u003cp\u003eAll respondents were asked for their willingness to participate in the study during the lunch time or to fill the self administered questionnaire when ever they got free time and to return it back to the data collector after they complete filling the questionnaire. Confidentiality of the information was assured and privacy of the respondent was maintained, the hard copy of the data is kept in a locked cabinet and the soft copy is password protected.\u003c/p\u003e\n\u003ch2\u003e4.13. Dissemination of the Result\u003c/h2\u003e\n\u003cp\u003eThe result of the study was first presented in Addis Ababa University department of gynaecology and obstetrics and then it will be presented to Ethiopian Ministry of Health. It will also be presented in national as well as international seminars and will be published in reputable journals.\u003c/p\u003e"},{"header":"5. Result","content":"\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003e5.1 Sociodemographic characteristics of the study participants\u003c/h2\u003e\u003cp\u003eIn this study, 274 participants were involved, resulting in a response rate of 91.2%. The majority of participants were residents (47.8%), followed by general practitioners (16.8%) and midwives (16.1%). The distribution across facilities showed that TASH had the highest representation (33.2%), followed by Abebech Gobena (25.5%) and SPMMC (24.8%). Most providers had 1\u0026ndash;3 years of experience in antenatal care (75.5%), and nearly half were single (46%), while 43.8% were married. Orthodox Christianity was the dominant religion (60.9%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec33\" class=\"Section2\"\u003e\u003ch2\u003e5.2 Training and Awareness\u003c/h2\u003e\u003cp\u003eTraining and awareness on IPV screening were critically low, with only 8.8% of participants having received any formal training. Confidence levels in screening were also low, with 22.6% reporting they were \"not confident at all\" and only 13.5% feeling \"very confident.\" In there ability to screen IPV. Awareness of IPV screening guidelines was also low, with 89.8% unaware of any protocols in their facility. Those who knew of guidelines cited general ANC or national protocols rather than specific IPV screening tools. From 274 participants, only 24(8.8%) of them took training. 11 of them took training on Prevention of Gender based Violence, 13 of them took Courses and Campaigns on Gender based violence but no specific training on IPV per se\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec34\" class=\"Section2\"\u003e\u003ch2\u003e5.3 Screening Practices\u003c/h2\u003e\u003cp\u003eScreening practices were alarmingly poor. A staggering 41.2% of providers never conducted IPV screening, and only 4% did it so regularly. The use of validated screening tools was rare, with 49.6% never employing standardized instruments like AAS, HITS, or HARK. Follow-up and referral systems were also weak, with 43.8% reporting no clear protocols for women who disclosed IPV. 40.5% of providers never received training on IPV screening. Only 0.7% reported always receiving training. 37.2% of providers never ensured a confidential environment for IPV screening. Only 2.2% reported always maintaining confidentiality.\u003c/p\u003e\u003cp\u003eOverall, 82.1% of participants rated their IPV screening practices as \"poor.\" 49 (17.88%) of them had fair screening practice. None of them were under Good practice and Excellent practice category.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec35\" class=\"Section2\"\u003e\u003ch2\u003e5.4 Associated factors\u003c/h2\u003e\u003cp\u003eThe bivariate and multivariable logistic regression analyses were employed to identify factors associated with the practice of Intimate Partner Violence (IPV) screening among healthcare providers in the antenatal care settings of five teaching hospitals in Addis Ababa.\u003c/p\u003e\u003cp\u003eIn the bivariate analysis, several variables showed a statistically significant association with IPV screening practice. However, upon adjusting for potential confounders in the multivariable logistic regression model, seven key factors remained independently and significantly associated with IPV screening practice.\u003c/p\u003e\u003cp\u003eProfession was significantly associated with IPV screening practice. Consultants had 16.8 times higher odds (AOR\u0026thinsp;=\u0026thinsp;16.8; 95% CI: 1.89, 150.04; p\u0026thinsp;=\u0026thinsp;0.011) of having fair screening practice compared to midwives. No other professional group (Nurses, Residents, Others) showed a statistically significant association.\u003c/p\u003e\u003cp\u003eSex was also a significant factor, with female providers being 3.82 times more likely to screen for IPV compared to their male counterparts (AOR\u0026thinsp;=\u0026thinsp;3.82; 95% CI: 1.08, 13.53; p-value\u0026thinsp;=\u0026thinsp;0.038).\u003c/p\u003e\u003cp\u003e Providers who were aware of any available IPV guidelines were 7.67 times more likely to practice screening than those who were not aware (AOR\u0026thinsp;=\u0026thinsp;7.67; 95% CI: 1.72, 34.2; p-value\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e\u003cp\u003eSimilarly, those who had received any form of training on GBV were 11.1 times more likely to screen for IPV compared to those who had not received any training (AOR\u0026thinsp;=\u0026thinsp;11.1; 95% CI: 1.34, 92.92; p-value\u0026thinsp;=\u0026thinsp;0.026).\u003c/p\u003e\u003cp\u003eThe availability of a confidential atmosphere was also a significant factor. Providers who reported that there is confidential environment for screening were 12.3 times more likely to practice IPV screening (AOR\u0026thinsp;=\u0026thinsp;12.3; 95% CI: 2.96, 50.6; p-value\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eAwareness of availability of a validated screening tool made providers 96% less likely to have poor screening practice (i. e., significantly more likely to screen), after controlling for other variables (AOR\u0026thinsp;=\u0026thinsp;0.024; 95% CI: 0.006, 0.1; p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Likewise, awareness of the presence of a functional referral system made providers 96.2% less likely to have poor screening practice (AOR\u0026thinsp;=\u0026thinsp;0.038; 95% CI: 0.014, 0.1; p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eMarital status(P\u0026thinsp;=\u0026thinsp;0.48), Religion(p\u0026thinsp;=\u0026thinsp;0.998), Age (p\u0026thinsp;=\u0026thinsp;0.630\u0026ndash;0.887), specific facility of work, years of experience, the level of self-reported confidence were not significantly associated with IPV screening practice.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBivariate and multivariable logistic regression of association between independent variable and practice of IPV screening in antenatal care setting in the five teaching hospitals of Addis Ababa, 2025.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIndependent Variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePractice of IPV Screening\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCOR with 95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAOR with 95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFair n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePoor n(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidwife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (72.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (81.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.59(0.17, 2.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.7(0.33, 67.68)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (9.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119 (90.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131 (47.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.27(0.11, 0.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.62(0.07, 5.19)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsultant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (52.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (48.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.9(1.03, 8.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e16.8(1.89, 150.04)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers (GP \u0026amp; HO)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (15.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (84.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52 (19.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.49(0.18, 1.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.5(0.15, 15.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFacility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTASH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (20.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72 (79.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91 (33.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPHMMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (14.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (85.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68 (24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.718\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.792(.22,2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAGMCH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (25.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.253(.38,4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZMH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (82.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.429\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.781(.43,7.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGMH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (72.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.758\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.819(.23, 2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (15.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175 (84.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e207 (75.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026ndash;8 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (77.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.6(0.7,3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;8 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (30.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (69.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.4(0.9,6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18 to 24 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.27(0.04,2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25 to 44 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (12.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e215 (87.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e245 (89.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.05(0.02,1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove 45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (70.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (86.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e166 (60.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (75.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e108 (39.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.2(1.2,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e3.82(1.08, 13.53)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (16.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e187 (83.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e224 (81.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (19.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (80.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.3(0.06,1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (44.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (55.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.33(0.07,1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (9.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e109 (90.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120 (43.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (24.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116 (75.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e154 (56.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.2(1.58, 6.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.5(0.5,5.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerceived confidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot confident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (10.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (89.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68 (24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSlightly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (11.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (89.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100 (36.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.885\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.07(0.4,2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerately\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (74.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (25.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(1.17,7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (36.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (63.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (13.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.9(1.7,13.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtremely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAware of guidelines?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (60.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (39.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.3(4.3,24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e7.67(1.72 to 34.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (13.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e214 (87.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e246 (89.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReceived training\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (58.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (41.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.6(3.54, 20.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e11.1(1.34, 92.92)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (14.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e215 (86.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e250 (91.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConfidential atmosphere\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (43.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (56.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.2 (0.1,0.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e12.3 (2.96 to 50.6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (13.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e204 (86.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e237 (86.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eValidated tool\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (68.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (31.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (11.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.057(0.02,0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.024(0.006,0.1)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (11.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e215 (88.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e242 (88.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReferral system\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (69.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (30.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.032(0.04,0.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.038(0.014,0.1)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e210 (93.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e225 (82.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e49 (17.9%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e225 (82.1%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e274(100%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"6. Discussion","content":"\u003cp\u003eThis study identified several key organizational and individual-level factors that are significantly associated with the practice of IPV screening among antenatal care providers in Addis Ababa's teaching hospitals.\u003c/p\u003e\u003cp\u003e Regarding practice of screening, based on systematic reviews done from WHO multicounty study which included 59 studies published in 2020, overall IPV screening rate was 11%. The finding of this study is close to our finding. 55 In high-income nations like the U. S., Canada and UK, IPV screening is integrated into routine healthcare practice and screening rate is high (\u0026gt;\u0026thinsp;50%), especially in settings like in maternal health clinics, and primary care. 43 Screening rate is 5.2% in GMH (Suhab et al, 2025). This also aligns with global studies showing that systematic screening remains inconsistent (WHO, 2021). There is disparity between global and national recommendations and the actual clinical practice. Where antenatal care is a crucial window of opportunity to identify and support victims of IPV. This opportunity is almost entirely missed.\u003c/p\u003e\u003cp\u003eThe strongest positive associations were profession(AOR\u0026thinsp;=\u0026thinsp;16.8), having a confidential atmosphere (AOR\u0026thinsp;=\u0026thinsp;12.3) and those who took any form of GBV training (AOR\u0026thinsp;=\u0026thinsp;11.1) showed better practice. Training is crucial for improving detection rates and reducing stigma (O\u0026rsquo;Doherty et al., 2014). Confidential atmosphere, AOR\u0026thinsp;=\u0026thinsp;2.35 (95% CI: 2.26\u0026ndash;2.44, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Barriers such as lack of training, absence of confidential environment, lack of awareness on follow-up and referral system and validated screening tools mirror findings from similar studies done in USA and in Sub-Saharan Africa, indicating similar regional trend. 56\u0026ndash;61\u003c/p\u003e\u003cp\u003e There is also significant association of awareness of available guideline in their facility (AOR\u0026thinsp;=\u0026thinsp;7.67), highlighting the importance of disseminating clear, standardized protocols for IPV. Awareness of available guidelines(AOR\u0026thinsp;=\u0026thinsp;3) in WHO multicounty study. 55\u003c/p\u003e\u003cp\u003eAt the individual level, consultants(AOR\u0026thinsp;=\u0026thinsp;16.8) were significantly more likely to screen(AOR\u0026thinsp;=\u0026thinsp;16.8). It goes in contrary to global studies. But aligns with expectations that more advanced training may be empowering factor for them to address sensitive issues. Specialists are often consulted for complex medical management after a problem is identified. It could be that the system is reactive rather than preventive. A finding that specialists screen more than frontline staff could be due to this.\u003c/p\u003e\u003cp\u003eThe association between female providers (AOR\u0026thinsp;=\u0026thinsp;3.82) and higher screening rates is consistent with global literatures (Kalra et al., 2021; Sprague et al., 2013; O'Campo et al., 2011; Gutmanis et al., 2007); female patients may feel more comfortable disclosing abuse to a female provider, and female providers may demonstrate greater empathy and awareness of the issue.57\u0026ndash;59\u003c/p\u003e"},{"header":"7. Limitation of the study","content":"\u003cp\u003eSince our study design is Cross-Sectional, It shows association, not causation.\u003c/p\u003e\u003cp\u003eThe outcome (screening practice) is based on self-report, not observation. Providers may have over-reported their screening practices which may subject our data to Social Desirability Bias.\u003c/p\u003e\u003cp\u003eThe study was conducted in teaching hospitals in the capital; practices may be even worse in rural health centers.\u003c/p\u003e"},{"header":"8. Conclusion","content":"\u003cp\u003eThis study demonstrates that IPV screening practices among antenatal care providers in Addis Ababa\u0026rsquo;s teaching hospitals are alarmingly poor. Profession, sex, lack of training and awareness of available guidelines, awareness of follow-up and referral systems and validated tools, absence of confidential environment, are strongly associated to screening practice.\u003c/p\u003e\u003cp\u003eMarital status, Religion, health care facility, age, years of experience, the level of self-reported confidence were not associated with IPV screening practice in the multivariable analysis. Without intervention, IPV will continue to be underdiagnosed, leaving pregnant women at risk of unchecked abuse during pregnancy.\u003c/p\u003e"},{"header":"9. Recommendation","content":"\u003cp\u003eBased on the findings of this study, targeted training should be given for all healthcare providers practicing in ANC setting, giving priority for professionals other than consultants and for males if there is resource limitation.\u003c/p\u003e\u003cp\u003e FMOH and Hospitals should urgently develop implementation guideline applicable for ANC setting as there is huge disparity between recommendation and actual clinical practice.\u003c/p\u003e\u003cp\u003eHospitals must create confidential environment in antenatal care clinics\u003c/p\u003e\u003cp\u003eFuture researches like qualitative studies should be done to explore the deep-seated barriers from the providers' perspectives and further studies should also be done with bigger sample size to address this generalizability issues to rural setups.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003ch2\u003eAAU\u003c/h2\u003e\u003cp\u003eAddis Ababa University\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAGMCH\u003c/strong\u003e\u003cp\u003eAbebech Gobena Maternal \u0026amp; Child health center\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eANC\u003c/strong\u003e\u003cp\u003eAntenatal Clinic\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003cp\u003eAdjusted Odd Ratio\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCAS R \u0026ndash;SF\u003c/strong\u003e\u003cp\u003eCOMPOSITE ABUSE SCALE REVISED - SHORT FORM\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCOR\u003c/strong\u003e\u003cp\u003eCrude Odd Ratio\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDRPC\u003c/strong\u003e\u003cp\u003eDepartment Research \u0026amp; Publication Committee\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFDRE\u003c/strong\u003e\u003cp\u003eFederal Democratic Republic of Ethiopia\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGMH\u003c/strong\u003e\u003cp\u003eGandhi memorial Hospital\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHARK\u003c/strong\u003e\u003cp\u003eHumiliation, Afraid, Rape, Kick\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHIV\u003c/strong\u003e\u003cp\u003eHuman Immune Deficiency Virus\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eIPV\u003c/strong\u003e\u003cp\u003eIntimate Partner Violence\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMFM\u003c/strong\u003e\u003cp\u003eMaternal fetal medicine\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePNMR\u003c/strong\u003e\u003cp\u003ePerinatal Mortality Rate\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSTI\u003c/strong\u003e\u003cp\u003eSexual Transmitted Infection\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eTASH\u003c/h2\u003e\u003cp\u003eTikur Ambessa Specialized Hospital\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eVHA\u003c/strong\u003e\u003cp\u003eVeterans Health Administration\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eZMH\u003c/strong\u003e\u003cp\u003eZewuditu Memorial Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Department Research and Publication Committee (DRPC) of the Department of Obstetrics and Gynecology, Tikur Anbessa Specialized Hospital, Addis Ababa University. All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the study participants, data collectors, and the management of the five teaching hospitals in Addis Ababa for their support and cooperation during the data collection process.\u003c/p\u003e\u003cp\u003ePrior to all, I would like to thank the almighty of God who made all to be beautiful. Special appreciation goes to \u0026nbsp;my advisors Dr. Sofanit Haile \u0026nbsp;\u0026amp; Dr. Tesfaye Adem \u0026nbsp;for their limitless contribution, support,\u003cstrong\u003e\u0026nbsp;encouragement, critical comment and constructive suggestion throughout my work journey\u0026nbsp;\u003c/strong\u003eand for the realization of this thesis guiding me from title selection to proposal development throughout the whole process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNext, I acknowledge medical students, residents, staffs \u0026amp; all the countless individuals who have contributed to this work through their insights, encouragement, and belief in the importance of this scientific inquiry. Their collective efforts have shaped this research and its impact.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, I would like to give my acknowledgment to A\u003cstrong\u003eddis Ababa University,\u003c/strong\u003e department of Obstetrics \u0026amp; Gynaecology for their follow up and organization. Thank you all for being a part of this endeavour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEyob Dagnew is an Obstetrics and Gynaecology resident at Addis Ababa University. Sofanit Haile is an Assistant Professor of Obstetrics and Gynaecology at Addis Ababa University. Tesfaye Adem is an Assistant Professor of Obstetrics and Gynaecology and a Gynaecology oncology fellow at Addis Ababa University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eSmith, A. B., Johnson, C. D., and Williams, E. F. (2021). 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The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKalra, N., Hooker, L., Reisenhofer, S., Di Tanna, G. L., and Garc\u0026iacute;a-Moreno, C. (2021). Training healthcare providers to respond to intimate partner violence against women. Cochrane Database of Systematic Reviews, (5).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSprague, S., Slobogean, G., Spurr, H., McKay, P., Scott, T., Arseneau, E.,. and Bhandari, M. (2013). A scoping review of intimate partner violence screening programs for health care professionals. PLoS One, 8(1), e52933.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eO\u0026apos;Campo, P., Kirst, M., Tsamis, C., Chambers, C., and Ahmad, F. (2011). Implementing successful intimate partner violence screening programs in health care settings: Evidence generated from a realist systematic review. 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BMC Public Health, 13(1), 1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eO\u0026apos;Doherty LJ, Taft A, Hegarty K, Ramsay J, Davidson L, Feder G. Screening for intimate partner violence in healthcare settings: opening the door to new perspectives. BMC Womens Health. 2021 Sep 6;21(1):200.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChristy A, Ellis AA. Screening women for intimate partner violence: considerations for healthcare providers. J Midwifery Womens Health. 2018 May;63(3):282-7.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBreiding MJ, Smith SG, Basile KC, Walters ML, Chen J, Merrick MT. The National Intimate Partner and Sexual Violence Survey: 2015 Data Brief \u0026ndash; Updated Release. Atlanta (GA): National Center for Injury Prevention and Control, CDC; 2018 Oct.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAmerican College of Obstetricians and Gynecologists. Intimate Partner Violence. Committee Opinion No. 518. Obstet Gynecol. 2012 Feb;119(2 Pt 1):412-7.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Addis Ababa University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"practice of IPV screening, pregnant women, Addis Ababa, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7531601/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7531601/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground - According to WHO, about one in three women (30%) worldwide experience IPV in their lifetime. It can negatively affect women\u0026rsquo;s overall health. The fact is, Violence against women is preventable. The health sector has an important role as an entry point for referring women to other sectors and support services they may need.\u003c/p\u003e\u003cp\u003eObjective \u0026ndash; To evaluate the practice of intimate partner violence screening and associated factors in Antenatal care setting in 5 Teaching Hospitals in Addis Ababa in 2024/25 G. C.\u003c/p\u003e\u003cp\u003eMethods \u0026ndash; Institution-based Cross sectional study was conducted among antenatal healthcare providers at 5 Addis Ababa teaching hospitals, namely TASH, ZMH, GMH, Abebech gobena MCH hospital and St paulos millennium medical college (SPMMC) in 2024/25 G. C. Structured questionnaire was used for data collection. All Healthcare providers of these 5 teaching hospitals having more than 1 month of experience at ANC who gave informed consent were included in the study (N\u0026thinsp;=\u0026thinsp;274). Healthcare providers who were not willing to give informed consent and who were on break or sick leave during the study period was excluded binary logistic regression analyses was employed to identify factors associated with the practice of IPV screening. Using 95% Confidence level and variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was identified as statistically significant factors.\u003c/p\u003e\u003cp\u003eResult : 274 participants were involved. The practice of IPV screening is alarmingly poor (17.9%). Consultants(AOR\u0026thinsp;=\u0026thinsp;16.8) and female providers(AOR\u0026thinsp;=\u0026thinsp;3.82) were more likely to screen than reference category. Having a confidential atmosphere (AOR\u0026thinsp;=\u0026thinsp;12.3), those who took any form of GBV training (AOR\u0026thinsp;=\u0026thinsp;11.1) and those who were aware of available guideline in their facility (AOR\u0026thinsp;=\u0026thinsp;7.67) showed better practice. Marital status(P\u0026thinsp;=\u0026thinsp;0.16), Religion(p\u0026thinsp;=\u0026thinsp;0.998), Age (p\u0026thinsp;=\u0026thinsp;0.630\u0026ndash;0.887), the level of self-reported confidence did not show a statistically significant association with screening practice in the multivariable model.\u003c/p\u003e\u003cp\u003eThere is a huge gap between recommendations and actual clinical practice which underscored the need for institutional and policy-level interventions.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e","manuscriptTitle":"Practice of intimate partner violence screening \u0026amp; associated factors among health care providers in Antenatal care settings , cross sectional study in 5 Teaching Hospitals in Addis Ababa, 2024/25 G.C.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 11:13:47","doi":"10.21203/rs.3.rs-7531601/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8acd7ba6-9e1f-4d91-9a13-bf4a08c20b1f","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54165937,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2025-09-09T11:13:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 11:13:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7531601","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7531601","identity":"rs-7531601","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}