Abstract
IntroductionInterpersonal violence in South Africa is the second highest contributor to the burden of disease after HIV/AIDS and 62% is estimated to be from intimate partner violence (IPV). This study aimed to evaluate how women experiencing IPV present in primary care, how often IPV is recognized by health care practitioners and what other diagnoses are made.MethodsAt two urban and three rural community health centres, health practitioners were trained to screen all women for IPV over a period of up to 8 weeks. Medical records of 114 thus identified women were then examined and their reasons for encounter (RFE) and diagnoses over the previous 2-years were coded using the International Classification of Primary Care. Three focus group interviews were held with the practitioners and interviews with the facility managers to explore their experience of screening.ResultsIPV was previously recognized in 11 women (9.6%). Women presented with a variety of RFE that should raise the index of suspicion for IPV– headache, request for psychiatric medication, sleep disturbance, tiredness, assault, feeling anxious and depressed. Depression was the commonest diagnosis. Interviews identified key issues that prevented health practitioners from screening.ConclusionThis study demonstrated that recognition of women with IPV is very low in South African primary care and adds useful new information on how women present to ambulatory health services. These findings offer key cues that can be used to improve selective case finding for IPV in resource-poor settings. Universal screening was not supported by this study.
Highlights
Interpersonal violence in South Africa is the second highest contributor to the burden of disease after HIV/ AIDS and 62% is estimated to be from intimate partner violence (IPV)
This study investigated how women with IPV present in primary care, how often IPV is recognized by health care practitioners and what other diagnoses are made
The top 15 reasons for encounter (RFE) and diagnoses are presented in Tables 1 and 2; and represent 53.1% and 59.4% of the total RFE and diagnoses
Summary
Interpersonal violence in South Africa is the second highest contributor to the burden of disease after HIV/ AIDS and 62% is estimated to be from intimate partner violence (IPV). In South Africa interpersonal violence is the second highest contributor to the burden of disease, after HIV/AIDS [1]. Intimate partner violence (IPV) accounts for 62.4% of the total interpersonal violence burden in females. More women are killed in South Africa by their current or ex-intimate male partner than in any other country with a rate of 8.8 per 100000 women [2]. The Domestic Violence Act of 1998 defined IPV as ‘‘actual or threatened physical, emotional, verbal, sexual and/or financial abuse’’ [3]. The intent, and sense of entitlement, to control and dominate are defining features of IPV, as is the repetitive nature of the behavior and its tendency to escalate in severity [4]
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