The Impact of an Intervention to Prevent Intimate Partner Violence Against Women in Tanzania: Findings from the Maisha Cluster Randomised Controlled Trial

Abstract

Background: Globally, about 30% of women have experienced physical and/or sexual violence from an intimate partner during their lifetime. We assessed the impact of a violence prevention intervention delivered to women participating in a group-based microfinance scheme. Methods: We conducted an unblinded, cluster randomized controlled trial among women in 66 microfinance groups, in Tanzania, to evaluate a 10-session participatory intervention that aims to empower women, prevent IPV and promote healthy relationships. If at least 70% of members consented, microfinance groups were randomly assigned to receive the intervention or be wait-listed for the intervention post-trial (control). Main outcomes, assessed 24 months post-intervention, were: a composite of reported past-year physical and/or sexual IPV (primary); past-year physical, sexual and emotional IPV; and acceptability and tolerance of IPV. An intention-to-treat analysis was conducted adjusting for age, education and baseline measure of the respective outcome. The trial is registered at ClinicalTrials.gov, NCT02592252. Findings: Between September 2014 and June 2015, 33 groups (n=544 women) were allocated to intervention and 33 (n=505 women) to control. Overall, 485 (89%) intervention and 434 (86%) control women completed outcomes assessment. Among intervention women, 112 (23%) reported past-year physical and/or sexual IPV compared with 119 (27%) among control women (adjusted odds ratio [aOR] 0·69, 95%CI 0·47-1·01, p=0·056). Intervention women reported significantly less physical IPV (aOR 0·64, 95%CI 0·41-0·99, p=0·043). They were also less likely to be accepting of IPV (aOR 0·45, 95%CI 0·34-0·61, p<0·001), believe IPV to be a private matter (aOR 0·51, 95%CI 0·32-0·81, p=0·005), or be tolerant of IPV (aOR 0·68, 95%CI 0·45-1·01, p=0·055). There were no significant differences in reported sexual or emotional IPV. Trial Registration Number: The trial is registered at ClinicalTrials.gov, NCT02592252. Interpretation: Over a two-year period, physical IPV was reduced by nearly a third, indicating that IPV is preventable in high-risk settings such as Tanzania. Funding: Anonymous donor and STRIVE Consortium funded by UK Aid. Declaration of Interest: Following initiation of the trial, CW has been seconded to the UK Government Department for International Development as their chief scientific advisor. Her ongoing role in this trial is in her academic capacity at LSHTM. No other interests declared. Ethical Approval: The trial was conducted following WHO recommendations on researching violence against women, and was approved by the Tanzanian National Health Research Ethics Committee of the National Institute for Medical Research (Ref: NIMR/HQ/R.8a/Vol. IX/1512), and the research ethics committee of the London School of Hygiene & Tropical Medicine (LSHTM, Ref: 11642).