A community-based intervention for improving health-seeking behavior among sexual violence survivors: a controlled before and after design study in rural Tanzania

Abstract

BackgroundDespite global recognition that sexual violence is a violation of human rights, evidence still shows it is a pervasive problem across all societies. Promising community intervention studies in the low- and middle-income countries are limited.ObjectiveThis study assessed the impact of a community-based intervention, focusing on improving the community's knowledge and reducing social acceptability of violence against women norms with the goal to prevent and respond to sexual violence.DesignThe strategies used to create awareness included radio programs, information, education communication materials, and advocacy meetings with local leaders. The intervention took place in Morogoro region in Tanzania. The evaluation used a quasi-experimental design including cross-sectional surveys at baseline (2012) and endline (2014) with men and women aged 18–49 years. Main outcome measures were number of reported rape cases at health facilities and the community's knowledge and attitudes toward sexual violence.ResultsThe number of reported rape events increased by more than 50% at health facilities during the intervention. Knowledge on sexual violence increased significantly in both areas over the study period (from 57.3 to 80.6% in the intervention area and from 55.5 to 71.9% in the comparison area; p<0.001), and the net effect of the intervention between the two areas was statistically significant (6.9, 95% CI 0.2–13.5, p=0.03). There was significant improvement in most of the attitude indicators in the intervention area, but not in the comparison area. However, the intervention had no significant effect on the overall scores of acceptance attitudes in the final assessment when comparing the two areas (−2.4, 95% CI: −8.4 to 3.6, p=0.42).ConclusionsThe intervention had an effect on some indicators on knowledge and attitudes toward sexual violence even after a short period of intervention. This finding informs the public health practitioners of the importance of combined strategies in achieving changes.

Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men’s health in sub-Saharan Africa

“…Of the 47 countries in the SSA region, 14 countries (30%) hosted all of the 56 studies retrieved. Three-quarters of all studies took place in East Africa (5 countries hosting 22 studies [ 30 – 51 ]) and in Southern Africa (4 countries hosting 21 studies [ 52 – 72 ]). The remaining quarter of studies took place in 3 West African countries [ 73 – 82 ] and 2 Central African countries [ 83 – 85 ].…”

“… It appeared that exposure to health campaigns resulted in improved health seeking behaviour, condom use and uptake of HIV tests [ 32 , 33 ] especially when promoted health services were free of charges [ 53 , 58 ]. Additionally, most media campaigns improved knowledge of and attitudes towards GBV, family planning, maternal health issues and HIV [ 30 , 49 , 61 ]. Particularly, men were reported to be interested in practical programmes such as those demonstrating proper use of condoms [ 32 ].…”

“…Among the later, two were urology related [ 59 , 77 ], one involved MSM [ 48 ] and one intervention specifically introduced a form of monetary incentives for men [ 33 ]. Only one intervention was gender transformative [ 30 ] [ 30 , 32 , 33 , 48 , 49 , 53 , 55 , 58 , 59 , 61 , 77 ] Community-based health services ( n = 8) Health services provided included community-based TB diagnosis, HIV testing, care, and treatment and comprehensive SRH. Few other interventions were church based [ 73 , 84 ] Gender norms of traditional masculinity (bodily resilience, self-reliance, and control) and the perceived stigma relating to specific health conditions such as HIV or TB were described as main intersecting barriers for men to seek help for their health.…”

Community based intervention to prevent domestic violence against women in the reproductive age in Northwestern Ethiopia: a protocol for quasi-experimental study

“…Likewise, a quasi-experimental study employed in Tanzania (2012) confirmed that community based intervention using local mass media and advocacy meeting improve knowledge on sexual VAW significantly from 57.3 to 80.6%. The combined intervention had a substantial effect on awareness raising and improve attitude towards VAW norms ( p < 0.001) [ 80 ]. Therefore, evidence from randomized controlled trail, quasi-experimental and longitudinal studies concluded that community based comprehensive intervention such as integrated IPV prevention services (economic empowerment, gender norm transformation to promote gender equality and equitable relationship power, involving men, mass media and advocacy meeting) are some of proven evidences based interventions to prevent IPV.…”

Sexual exploitation of adolescent students in Tanzania: Implication for social services

“…Therefore, more resources should be directed to rural areas for community education. For instance, a community-based intervention, 'SASA', implemented in rural Tanzania aimed at improving health-seeking behaviour among sexual violence survivors is an example of good practice (Abeid et al, 2015). Findings generated from a quasiexperimental design demonstrated that interventions through strategies such as radio programmes, educational materials and advocacy meetings with local leaders, affected rural citizens' awareness of sexual violence, as with reports of rape, improving knowledge of and attitudes towards sexual violence.…”