Sexual Violence and Associated Factors Against Housemaid’s Living in Debre-Tabor Town, Northwest Ethiopia.

Objectives: Sexual violence is a serious public health and human rights problem with both short and long term consequence on women’s physical, mental, sexual and reproductive health. But no sucient study about housemaid sexual violence conducted in Ethiopia. Therefore, the aim of this study is to assess the magnitude of sexual violence and its associated factors among housemaids living in Debre Tabor town, North West Ethiopia 2018. Results: From 636 participants included in the study 27.8% (95% CI: 24.2%-31.4%) housemaids had experienced sexual violence in their life time. Housemaid who had no formal education(AOR=2.1,95%CI=1.13, 3.76), housemaid coming from rural (AOR=2.73, 95%CI=1.31, 5.69), housemaids whose both parents dead (AOR=2.6, 95%CI=1.47, 4.61), employer who had extended family in the house (AOR=2.9,95%CI=1.77, 4.75), male employer alcohol consumption(AOR=2.56, 95%CI=1.61, 4.1) and age of female employer ≥ 50 years (AOR=4.29, 95%CI=1.95, 9.48) were increase the probability of housemaids’ sexual violence. In conclusion this study, high prevalence of housemaid violence has been reported. To resolve the problem, it is important to create awareness and bring behavioral change to empower housemaid.


Introduction
Sexual violence can be de ned as "any sexual act, attempt to obtain a sexual act, or other act directed against a person's sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work". Sexual violence can include the following threat of rape attempted rape, rape, Sexual harassment and sexual contact with force [1].
Violence against women is a public health problem as well as a basic violation of women's human rights [2]. The impact of violence is beyond physical injuries it also accounts disability, depression, physical and reproductive problem, and risky sexual behavior [3].
In the world 10 up to 50% of women suffered with sexual violence by their intimate partners [4]. in sub-Saharan Africa the experience of women with physical and/or sexual violence by their intimate partner ranges from 27-59% [5]. In Ethiopia 59% of women were exposed to sexual violence [4].
Generally, in the countries where the statuses of women are low, younger women are more likely to suffer from domestic violence. Ethiopia has one of the highest prevalence of both physical and sexual violence by their intimate partner [6]. Most study conducted on violence against women agreed that lower educational status, abuse of (alcohol, kchat, and smoke) and younger women are more likely increase experience of violence against women [7][8][9].
Gender based violence affected the signi cant segment of populations on girls and women across all group and classes [10]. At worldwide with in its informal nature of domestic worker still challenge to regulation and policy implementation lead to limited opportunities of access to social and legal protection [11].
Universally, all type of violence overlap in relationship and a signi cant public health problem worldwide but the level and pattern of violence greatly varies between setting, culture and segment of the population [12].
Even though there are many studies conducted on violence in the globe and also in our country Ethiopia in all segment of girls and/or women, there is lack of information about magnitude and associated factors of sexual violence against housemaids.
Therefore, this study amide to assess the magnitude of sexual violence and also tried to identify factors associated with sexual violence among housemaid. So, this research nding hope to alleviate scarce of information on housemaids sexual violence in Debre-Tabor town northwest Ethiopia.

Study design and period
Community based cross-sectional study was conducted in Debre-Tabor town northwest Ethiopia from April, 1-30/ 2018. Debre Tabor is the capital town of South Gondar zone which is located 666 km far

Results
Socio-demographic characteristics of housemaids from Addis Ababa the capital city of Ethiopia; to northwest Ethiopia. As the data obtained from South Gondar zone city administration the town had 92,530 populations (2010 EPY).
Sample size and sampling procedure A sample of 541 study participants was determined using single population proportion formula taking 28.6% prevalence of sexual violence against housemaids [13], considering 95% CI, 5% margin of error, 1.5 design effect and 15% non-respondent rate. Finally 636 participants were included in the study. Cluster sampling was used to select study participants. In the study area there are four Kebeles; from those kebeles 50% of ketenas was selected by using simple random sampling, and the sample size was proportionally allocated for each kebele and study participants in the households were selected from all selected Ketenas until achieving the required number of respondents.

Data collection procedures
A structured, pre-tested Interviewer administered questionnaire adopted from WHO multi country study was used. The questionnaire was translated in to the local language Amharic and pretested was administered on 5% of the sample at Woreta town. Four MPH for supervisors and 8 health extension workers for data collectors were recruited and training was provided for 3 days. Sexual violence was taken as the dependent variable while employers' characteristics and housemaids' characteristics were considered as independent variables. Housemaid violence was measured as if a housemaid experience any acts physically forced to have sexual intercourse when she did not want to and/or because she was afraid of what partner might do and/or had unwanted sex position and/or had unwanted warm up for sex was considered as ''yes'' otherwise ''no'' [4].

Data quality control
Data were collected by well-trained data collectors using pretested questionnaires. Training was given to supervisors and data collectors. Data were reviewed and checked for its completeness before entering for analysis.

Data processing and analysis:
Data were entered into Epi-info version 7.2.2.6 and exported into SPSS version 20.0. The data were also cleaned, coded, and analyzed with SPSS. Descriptive analysis was done to describe the different characteristics of the employers and housemaids. Binary logistic regression analysis was done to identify association between independent and dependent variables. To identify factors signi cantly associated with the outcome variable adjusted odds ratio (AOR) with 95% con dence interval (CI) was used. Variable having p-value less than 0.05 were considered as signi cant predictors.
About 636 of were participated in the study, among the participants 386(60.7%) were in the age group of 15-19 years, with the mean age of 19.76 (± 4.63 SD) years. About 319(50.2%) of participants had no formal education. Majority 525(82.5%) of were previously resided in rural area. About 593(93.2%) of were orthodox Christian. Around 570(89.6%) of housemaid were single. About 255(40.1%) of them had both father and mother. Participants, 302(47.5%) were paid from 301-500 ETB. Concerning work experience 448(70.4%) of housemaid had 1-4 years of work experience. About 414(65.1%) were start work at the age of 15 years and above. (Table1)

Factors associated with housemaid sexual violence
In bi-variable logistic regression analysis educational status, previous resident, family live situation, employer alcohol consumption, marital status of housemaid, marital status of employers, age of female employer and extended family living with employers were signi cantly associated with housemaid sexual violence. In the nal model, educational status, previous resident, family live situation, age of female employer, extended family living with employers and male employer alcohol consumption were remaining signi cantly associated with lifetime housemaid sexual violence at 5% level of signi cance.
The result of the study revealed that housemaids who had no formal education were 2 times (AOR = 2.06 95%CI: 1.13, 3.76) more likely to experienced sexual violence as compared to those who had secondary education and above.
Pertaining to resident of housemaids, housemaids who previously lived at rural areas were 3 times (AOR = 2.73, 95% CI: 1.31, 5.69) more likely to experience sexual violence than those who resided at urban.
Housemaid whose both parents dead were 3 times (AOR = 2.6, 95% CI: 1.47, 4.61), more likely to experienced sexual violence as compared to those who had both father and mother alive.
With regard to alcohol consumption, housemaid whose male employer drank alcohol were 3 times (AOR = 2.56, 95% CI: 1.61, 4.1) more likely to experience sexual violence as compared to those who not drank alcohol (Table 3). which is in line with the nding from Addis Ababa, Ethiopia(28.6%), Bair Dar, northwest Ethiopia(24.3%) and Nekemte town, western Ethiopia(26.1%) [13][14][15]. The nding was higher as compared to a study conducted in eastern Sudan(17%) [16]. This discrepancy could partly be due to socio-demographic difference, the other study conducted on government employees. Women who had better employment status could have access of information about violence and they can easily protect themselves.
Housemaids who have no formal education were 2 times more likely to experience sexual violence.
Comparable nding was obtained from a study conducted in shimelba refugee camp, northern Ethiopia, Eastern Sudan, and Eastern India showed that women less than secondary education were more likely experience violence [8,16,17]. This is due to the fact that low educational status of women had no power to protect the violence.
Housemaid who resided in rural areas was 3 times more likely to experienced sexual violence as compared to who resided urban area. This nding was consistent with a study conducted in Eastern India, Gondar town northwest Ethiopia and around Gondar northwest Ethiopia showed that rural residency were more likely experience violence where compared to urban residence [17][18][19]. Housemaids who came from rural had no information about violence and they couldn't complain to legal bodies. But this nding contradicted with a study from Ghana, showed that women who resided urban areas were 35% more likely increase risk of domestic violence [20] this could be due to socio-demographic and sociocultural difference of the study participants.
Housemaid who had no both parents were 3 times more likely experience lifetime sexual violence when compared to those who had both father and mother alive respondents. Family support could increase the con dence of housemaid this help to protect them from any violence.
Participants whose employer had extended family living with them were 3 times more likely experienced with sexual violence. Extended family could be increase the exposure of sexual violence due to crowded family size and poor follow-up.
Housemaids whose female employer aged ≥ 50 years old were 4 times more likely exposed to sexual violence when compared to female employer aged ≤ 29 years old. This is due to the fact that increase age of the wife could be decrease sexual interest of the husband with hers and shifting sexual relation to housemaid.
Participants whose male employer drank alcohol were 3 times more likely experience life time housemaid sexual violence when compared to participants whose employer not take alcohol. This nding consistent with a study conducted in Mekele town, northern Ethiopia, Addis Ababa and Debre Tabor town northwest Ethiopia showed that housemaid whose employer drink alcohol were more likely experience violence than those whose employer not drink alcohol [9,13,21]. This is due to the fact that alcohol has depressive mental impairment and which encourages human beings to undertake violence against their house maids.

Conclusion
In this study, high prevalence of housemaid sexual violence has been reported. Being rural resident, no formal education, both parent dead, extended family living with employers, age of female employer and alcohol consumption of male employers were important predictors of housemaid sexual violence. Local government o cials like, labor and social affair o ce and women and children o ce need to expand of information education communication and behavioral change on housemaid to empower and report violence as a crime and also need to improve community awareness about housemaid violence.

Limitation Of The Study
The limitation of this study was the data collectors interviewed only housemaid as a proxy respondents for their employer that depend on housemaid report only, this lead to bias when they come to reporting employer characteristics. And have been encountered with social desirability bias due to sensitivity of the information and also exposed with recall bias due to the nature of cross-sectional design.
Abbreviations AOR Adjusted Odds Ratio, CI:Con dence Interval, COR:Crude Odds Ratio, ETB Ethiopian Birr, OR:Odds Ratio, SD:Standard Deviation, SPSS:Statistical Package for Social Sciences, WHO:World Health Organization.

Declarations
Ethical approval and consent to participate: Ethical approval was obtained from university of Gondar, institute of public health ethical review committee. O cial letter was obtained from Debre Tabor town administration, mayor o ce. From each participant, whose age 18 years and above written informed consent was obtained. Participants who less than 18 years age written assent was obtained from their employers after clearly describing the purpose, bene t, and risk of the study and their right on decision of participation in the study. Their name was omitted for assurance of con dentiality and privacy. Interview was performed at suitable and secure place to respondents. Finally questionnaire was cleaned, stored and analyzed at secured place.

Consent to publish
Not applicable

Availability of Data and Materials
The datasets analyzed during this study are available from the authors on reasonable request.

Competing interest
The authors declare that they have no competing interest.

Funding
There was no external funding source for this study.
Authors' contributions KAA designed the study, developed the proposal, participated in the data collection, performed analysis and interpretation of data and drafted the paper. AAG and AML assisted in the design of the study, proposal writing, data analysis, and interpretation of the study. KAA carried out the manuscript preparation. All authors reviewed and approved the nal manuscript.