Spatial distribution and determinants of intimate partner violence among reproductive-age women in Ethiopia: Spatial and Multilevel analysis
Authors: Angaw Dessie Abebaw , Melesse Alemakef Wagnew , Geremew Bisrat Misganaw , Tesema Getayeneh Antehunegn 
Published: February 2021

Abstract
Background
Intimate partner violence is a serious global public health problem particularly in low-and middle-income countries such as Ethiopia where women's empowerment is limited. Despite the high prevalence of intimate partner violence in Ethiopia, there is limited evidence on the spatial distribution and determinants of intimate partner violence among reproductive-age women. Exploring the spatial distribution of intimate partner violence is crucial to identify hotspot areas of intimate partner violence to design targeted health care interventions. Therefore, this study aimed to investigate the spatial distribution and determinants of intimate partner violence among reproductive-age women in Ethiopia.

Methods
A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 6090 reproductive-age women were included in the study. The spatial scan statistical analysis was done to identify the significant hotspot areas of intimate partner violence. A multilevel binary logistic regression analysis was fitted to identify significant determinants of intimate partner violence. Deviance, Intra-cluster Correlation Coefficient (ICC), Median Odds Ratio, and Proportional Change in Variance (PCV) were used for model comparison as well as for checking model fitness. Variables with a p-value less than 0.2 were considered in the multivariable analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare statistical significance and strength of association between intimate partner violence and independent variables.

Results
The spatial analysis revealed that the spatial distribution of intimate partner violence was significantly varied across the country (Moran’s I = 0.1007, p-value < 0.0001). The SaTScan analysis identified a total of 192 significant clusters, of these 181 were primary clusters located in the Benishangul-Gumuz, Gambella, northwest Amhara, and west Oromia regions. In the multivariable multilevel analysis; women aged 45–49 years (AOR = 2.79, 95% CI 1.52–5.10), women attained secondary education (AOR = 0.61, 95% CI 0.38–0.98), women in the richest household (AOR = 0.58, 95% CI 0.35–0.97), > 10 family size (AOR = 3.85, 95% CI 1.41–10.54), and high community women empowerment (AOR = 0.66, 95% CI 0.49–0.8)) were significantly associated with intimate partner violence.

Conclusions
Intimate partner violence among reproductive-age women had significant spatial variation across the country. Women's age, education status, family size, community women empowerment, and wealth status were found significant determinants of intimate partner violence. Therefore, public health programs should design targeted interventions in identified hot spot areas to reduce the incidence of intimate partner violence. Besides, health programmers should scale up public health programs designed to enhance women's autonomy to reduce the incidence of intimate partner violence and its consequences.