Psychological Violence and Associated Factors Among Housemaid’s in Northwest Ethiopia.

Background: psychological violence often called emotional violence is a form of violence that may result in psychological trauma. Psychological violence can destroy intimate relationships, friendships and even our relationship with us. The majority of human beings may have been a victim of some form of psychological violence at some point of their life. Therefore this study expected to assess the magnitude of Psychological violence and its associated factors among housemaids. Methods: A community based cross-sectional study was conducted from April 1-30/ 2018. About 688 study participants were selected using cluster sampling. Data were entered into Epi info version 7.2.2.6 and analyzed with SPSS version 20 then, mainly analyzed using descriptive statistic and Binary logistic regression. Result: A community based cross-sectional study was conducted from April 1-30/ 2018 among 688 randomly selected housemaids. From 688 participated in the study, about 387(56.3%) (95%CI: 52.6 -60.2) housemaids had experienced at least one form of psychological violence in their life time. From those who had experienced violence, 175(25.4%) (95%CI: 22.1%-28.6%) had experienced in the last 12 months. No formal education (AOR=3.13, 95%CI: 1.76, 5.57), primary education (AOR=2.09, 95%CI: 1.12, 3.90), being rural (AOR=2.04, 95%CI: 1.13, 3.71), and family live situation and alcohol consumption of employers had signicant association with housemaid psychological violence. Conclusion: n this study,high prevalence of housemaid psychological violence has been reported. To resolve the problem, it is important to expand information education communication and behavioral change to empower housemaid.


Introduction
Psychological violence which includes behavior that is anticipated to intimidate and Persecute, and takes the form of threats of abandonment or abuse, con nement to the home, surveillance, threats to take away custody of the children, destruction of objects, isolation, verbal aggression and constant humiliation [1] Violence against women has reached epidemic proportions in many societies and suggests that no racial, ethnic, or socio-economic group is protected [2]. Violence against women is a public health problem as well as a basic violation of women's human rights [3]. The impact of violence is beyond physical injuries it also accounts disability, depression, physical and reproductive problem, and risky sexual behavior [4].
Gender based violence is insidious human right issues of public consequence [5].
In the world (24 -38%) of children experienced with psychological violence [6]. in sub-Saharan Africa the experience of women with psychological sexual violence by their intimate partner ranges from 12.1% Rwanda-48.6% Uganda [5]. In Ethiopia 24% of women were exposed to psychological violence [7].
Generally: in the countries where the status of women were low younger women more likely to suffer from domestic violence. Ethiopia has one of the highest prevalence of both physical and sexual violence by their intimate partner [8]. 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 [9][10][11].
Gender based violence affected the signi cant segment of populations on girls and women across all group and classes [12]. 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 [13] 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 [14] However there are many study conducted on violence in the globe and also in our country Ethiopia there is lack of information about magnitude and associated factors of violence against housemaids.
Therefore this study will assess the magnitude of violence against housemaids and also try to identify factors associated with housemaid violence. So this research nding hope to alleviate scarce of information on housemaids violence in South Gondar zone.

Study design and period
Community based cross-sectional study design was conducted from April, 1-30/ 2018.The study was conducted in Debre Tabor town Northwest Ethiopia. Debre Tabor is the capital town of South Gondar zone which is located 666 km far 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
The sample size was determined using single population proportion formula, taking 62.3% prevalence of psychological violence against married women in a study conducted in Debre-tabor town north west Ethiopia [15],by considering 95% CI, 5% margin of error, 1.5 design effect and 20% non-respondent rate.
Finally 688 study participants were included in the study.
Cluster sampling was employed to select study participants. In this 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 Kebeles. Then, study participants in the households were selected from each selected Ketena until achieving the required number of respondents.

Data collection procedures
A structured, pre-tested Interviewer administered questionnaire was used, that was adopted from WHO multi country study and then was translated in to the local language Amharic. Four MPH for supervisors and 8 health extension workers for data collectors were recruited and training was provided for 3 days.
The questionnaire was pretested on 5% of the total sample size from wereta town. Data was collected through face to face interviewing from each respondent. Psychological violence was taken as the dependent variable while employers' characteristics and housemaids' characteristics were considered as independent variables. Housemaid psychological violence was measured as if a housemaid experience any acts of insulted her or made her feel bad about herself, belittled or humiliated her in front of other people, done things to scare or intimidate her on purpose ,he looked at her, by yelling and smashing things, threatened when asking her friends/family, threatened to hurt her or someone she care about was considered as ''yes'' otherwise ''no'' [16].

Data quality control
Data was 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.   more likely to experienced violence as compared to those who had secondary education and above.

Socio-demographic characteristics of respondents
Pertaining to resident of housemaids, who previously resided at rural areas were 2 times (AOR=2.04, 95% CI: 1.13, 3.71) more likely to experience psychological violence than those who resided at urban.
Housemaid whose family resided rural areas were 2 times (AOR=1.84, 95% CI: 1.12, 3.01) more likely to experienced psychological violence than those whose families resided in urban.
Women who had better employment status could have access of information about violence and they can easily protect themselves.
Educational status of respondents was signi cantly associated with housemaid psychological violence.
Where, housemaids who have no formal education were 3 times more likely to experience violence. Comparable nding was obtained from a study conducted in western Ethiopia ,northwest Ethiopia, Eastern Sudan, rural Vietnam and WHO multicounty study showed that women who had low educational status were more likely experience domestic violence [9,10,17,18,20,23,24]. This is due to the fact that low educational status of women had no power to protect the violence.
Rural residence of respondents and their families were signi cantly associated with experience of housemaid violence. Housemaid who resided in rural areas and whose family resided in rural area were 2 times more likely to experienced violence as compared to who resided urban area. This nding was consistent with a study conducted in western Ethiopia, eastern India, around Gondar, and Gondar town northwest Ethiopia, showed that rural residency were more likely experience domestic violence [9,18,23,25]. Housemaids who previously resided at country side 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 [19] this could be due to socio-demographic and socio-cultural difference of the study participants.
Housemaid who had only father alive were 2 times more likely experience lifetime psychological violence, respondents who had only mother alive were 2 times more likely experience housemaid psychological violence when compared to those who had both father and mother alive respondents. This nding in line with other study [11]. Family support could increase the con dence of housemaid this help to protect them from any violence.
Alcohol consumption of employers was signi cantly associated with housemaid violence. Participants whose female employers drank alcohol were 8 times and male employer drank alcohol were 3 times more likely experience life time housemaid psychological violence when compared to participants whose employer not take alcohol. This nding consistent with a study conducted in Mekele town, northern Ethiopia and Debre Tabor town northwest Ethiopia showed that employers and husbands drink alcohol were more likely increase experience of violence than those whose employers and husbands not drink alcohol respectively [11,15,26]. 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 psychological violence has been reported. Being rural resident, no formal education, only father alive, only mother alive and alcohol consumption of employers were important predictors of housemaid violence. Women and children affair 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.
Finally, further research need to address the economical violence of housemaid is very important.

Limitation Of The Study
The limitation of this study was that 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 had 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.

Declaration
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, who aged 18 years and above written informed consent was obtained. Participants who less than 18 years age written assent was obtained from their employers after clear describing purpose, bene t, and risk of the study and their right on decision of participation in the study.

Consent to publish
Not applicable

Availability of Data and Materials
The datasets analyzed during this study are available from the authors on reasonable request. Figure 1