The burden and determinants of intimate partner violence against reproductive-age women in four East African countries: evidence from 2021/2023 DHS dataset.

BACKGROUND: Intimate Partner Violence (IPV) remains a critical public health and human rights issue, disproportionately affecting women in low-resource settings. Despite various interventions, IPV persists in East Africa due to entrenched gender norms, economic dependence, and weak law enforcement. This study aimed to determine the prevalence and associated factors of IPV among reproductive-age women in East Africa using recent Demographic and Health Survey (DHS) data. METHODS: A multilevel analysis was conducted using DHS datasets from Kenya, Madagascar, Mozambique, and Tanzania (2021-2023). A weighted sample of 27,265 reproductive-age women who had ever been in a union was included. IPV was assessed through self-reported experiences of physical, sexual, or emotional violence. Multilevel logistic regression models identified individual- and community-level factors associated with IPV, using adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS: The pooled IPV prevalence was 40.18% (95% CI: 34.83%-45.53%), with emotional violence (29.82%) being the most common, followed by physical (27.56%) and sexual violence (9.94%). The highest pooled prevalence of IPV was found in Kenya (46.34%), followed by Madagascar (41.06%) and Tanzania (39.21%), whereas the lowest prevalence was reported in Mozambique (34.03%). Significant factors associated with IPV included age (25-29, 30-34, 35-39, 40-44, 45-49), primary (AOR = 1.42, 95% CI: 1.25-1.62) and secondary education (AOR = 1.42, 95% CI: 1.25-1.81), being widowed, divorced, or separated (AOR = 1.84, 95% CI: 1.66-2.04), male-headed household (AOR = 1.11, 95% CI: 1.02, 1.21), age-at first cohabitation before 18 years old (AOR = 1.11, 95% CI: 1.03, 1.19), partner alcohol consumption (AOR = 2.38, 95% CI: 2.22-2.55), witnessing maternal abuse (AOR = 1.96, 95% CI: 1.82-2.11), justifying wife-beating (AOR = 1.26, 95% CI: 1.27-1.46), jealousy (AOR = 3.44, 95% CI: 3.23-3.67), fear of a partner (AOR = 3.56, 95% CI: 3.33-3.81), tobacco use (AOR = 1.16, 95% CI: 1.06, 1.26), rural residence (AOR = 1.12, 95% CI: 1.03-1.23), and media exposure (AOR = 1.17, 95% CI: 1.08-1.28). CONCLUSION: IPV remains alarmingly high in East Africa, driven by gender norms, economic vulnerabilities, and weak institutional support. Addressing IPV requires strengthening legal enforcement, expanding economic empowerment initiatives, and promoting gender-sensitive education. Tailored interventions should prioritize rural areas, address alcohol-related IPV, and challenge societal attitudes that normalize violence.