Burden of and risk factors for sexual violence among women with and without disabilities in two sub-Saharan African countries

Figures & data

Table 1. Characteristics of study participants.

	Cameroon			Burundi			Pooled age-adjusted OR	Hetero-geneity (p-value)
	Women with disability	Women without disability	ORa	Women with disability	Women without disability	ORa
Age (year)
15–25	94 (44)	143 (34)	ref	76 (52)	94 (31.5)	ref	ref	0.3
26–35	77 (36)	141 (33)	0.8 (0.6–1.2)	37 (25)	91 (30.5)	0.5 (0.3–0.8)	0.7 (0.5–0.9)
36–45	41 (19)	139 (33)	0.5 (0.3–0.7)	34 (23)	112 (88)	0.4 (0.2–0.6)	0.4 (0.3–0.6)
Education^#
<Primary	71 (41)	29 (9)	ref	53 (45)	45 (19)	ref	ref	0.01
Primary	36 (21)	92 (28)	0.2 (0.1–0.3)	37 (32)	58 (25)	0.5 (0.3–1.0)	0.3 (0.3–0.4)
Secondary	55 (32)	145 (45)	0.2 (0.1–0.3)	23 (20)	108 (46)	0.2 (0.1–0.3)	0.2 (0.1–0.3)
Higher education	10 (6)	59 (18)	0.1 (0–0.2)	4 (3)	23 (10)	0.2 (0.1–0.5)	0.1 (0.6–1.1)
Household welfare score
Q1	123 (29)	171 (21)	ref	119 (39)	249 (41)	ref	ref	0.3
Q2 to Q4	297 (71)	636 (79)	1.5 (1.0–2.1)	183 (61)	360 (59)	1.1 (0.7–1.6)	1.3 (1.0–1.7)
Food insecurity ≤10 years
Important concern	34 (8)	32 (4)	ref	42 (14)	35 (6)	ref	ref	0.9
Not/mild concern	380 (92)	774 (96)	2.2 (1.1–4.4)	260 (86)	574 (94)	2.1 (1.1–4.0)	2.1 (1.3–3.4)
Food insecurity >15 years
Important concern	73 (54)	111 (33)	ref	26 (29)	159 (68)	ref	ref	0.05
Not/mild concern	63 (46)	225 (67)	2.4 (1.6–3.5)	65 (71)	75 (32)	1.2 (0.7–2)	1.8 (0.6–1.1)
Fosterage before age 10
yes	85 (40)	145 (34)	ref	60 (41)	92 (31)	ref	ref	0.5
no	127 (60)	277 (66)	1.3 (0.9–1.8)	87 (59)	205 (69)	1.5 (1–2.3)	1.4 (1.1–1.8)
Social support network
≤1 person	71 (34)	74 (18)	ref	62 (42)	70 (24)	ref	ref	1
>1 persons	140 (66)	348 (82)	0.4 (0.3–0.6)	85 (58)	227 (76)	0.4 (0.3–0.7)	0.4 (0.3–0.6)
Barriers to access basic services
No major difficulty	15 (7)	101 (24)	ref	13 (9)	159 (54)	ref	ref	0.01
Major difficulties in ≥1 area	197 (93)	321 (76)	4.1 (2.3–7.3)	134 (91)	138 (46)	11.9 (6.4–21.9)	7.3 (4.8–11.2)
Discussion about sexuality with parents
Yes	41 (19)	81 (19)	ref	26 (21)	56 (19)	ref	ref	0.8
No	171 (81)	342 (81)	1.0 (0.7–1.5)	100 (79)	240 (81)	1.1 (0.7–1.9)	1.1 (0.8–1.5)
Functional limitation
Moving	85 (40)	-	-	52 (35)	-	-	-	0.4
Visual	50 (24)	-	-	20 (14)	-	-	-	0.03
Hearing	39 (18)	-	-	33 (22)	-	-	-	0.4
Cognitive	42 (20)	-	-	49 (33)	-	-	-	0.006

OR Odds Ratio; OR_a age-standardized odds ratio.

Table 2. Age-standardized prevalence of violence and abuse among women with and without disability in Yaoundé (Cameroon) and Bujumbura (Burundi).

	Women with disability		Women without disability
	Cameroon	Burundi	Cameroon	Burundi
Physical Violence
In childhood	31.7 (24.4–38.9)	58.2 (50.4–66)	29.6 (24.4–34.8)	68.7 (60.4–77)
After 15 years	9.7 (5.2–14.3)	23.8 (15.1–32.5)	6.2 (3.7–8.7)	22.6 (16.2–28.9)
Recent (last 12 months)	NA	13 (6.8–19.2)	NA	3.7 (1.6–5.8)
Unwanted touching	NA	35.3 (25.7–44.9)	NA	36.8 (28.7–45)
Intimate partner violence^a	NA	17.1 (7.7–26.5)	NA	9.1 (5.2–12.9)
Sexual violence	22 (16–28)	16.6 (10.2–23)	14.9 (11.4–18.3)	7.1 (4.1–10)

NA: not available in this survey; a: proportion estimated among the women engaged in an intimate relationship for at least 12 months.

Figure 1. Age-adjusted lifetime sexual violence of women with disabilities compared to those without disabilities by types of limitation (mobility, visual, hearing and cognitive).

Figure 2. Estimated hazard of sexual violence among women with and without disabilities at the Burundi and Cameroon study sites.

Table 3. Pooled age-adjusted OR for sexual violence associated with disability by living environment between age 10 and 25.

	Disability		Interaction
	Yes	No	Additive RERI (p-value)	Multiplicative OR (95%CI)
Immediate social environment
Living with parents	ref	2.1 (1.3–3.5)		p = 0.05
Extended family	1.6 (0.9–2.8)	2 (1.1–3.7)	−0.7 (p = 0.2)	0.6 (0.3–1.3)
Living with a partner	1.8 (0.8–4.1)	8.9 (3.7–21.4)	8.2 (p = 0.08)	2.6 (0.9–7.9)
Main activity
Student	ref	1.6 (1.0–2.7)		p = 0.9
Paid work	0.4 (0.1–3.3)	2.2 (0.5–9.2)	1.1 (p = 0.3)	3.0 (0.3–36)
Informal work	1.1 (0.4–2.8)	2.2 (0.9–5.6)	0.6 (p = 0.4)	1.3 (0.4–4.5)
No activity	0.8 (0.2–3.4)	2.2 (1.3–3.9)	0.9 (p = 0.09)	2.0 (0.4–9.5)
Homework	2.3 (0.7–7.8)	3.8 (0.9–15.9)	0.9 (p = 0.5)	1.1 (0.2–6.2)

Table 4. Results of the mediation analysis. Pooled OR of sexual violence for women with disability adjusted for the different aspects of participants’ education or food insecurity trajectories and age (95%CI), and estimated proportion of the association mediated by the factor (p-value).

	All participants with disability		Cognitive limitation excluded		Only participants with cognitive limitation
	ORap adjusted for factor	% mediated (p)	ORap adjusted for factor	% mediated (p)	ORap adjusted for factor	% mediated (p)
None (reference)	1.82 (1.30–2.54)	_	1.50 (1.03–2.2)	_	2.87 (1.77–4.64)	_
Education
Highest level achieved	1.47 (1.03–2.09)	34% (<0.001)	1.35 (0.91–1.99)	27% (0.06)	1.71 (0.96–3.07)	49% (<0.001)
Early school drop-out	1.71 (1.21–2.42)	10% (0.2)	1.50 (1.02–2.20)	<1% (0.9)	2.66 (1.49–4.76)	7% (0.7)
Cumulative time spent studying	1.68 (1.18–2.38)	13% (0.08)	1.48 (1.01–2.18)	<1% (0.8)	2.54 (1.42–4.54)	11% (0.5)
Current student status	1.78 (1.27–2.51)	3% (0.3)	1.50 (1.02–2.20)	<1% (0.96)	2.92 (1.73–4.93)	<1% (0.8)
Food insecurity
Current	1.79 (1.26–2.55)	<1 (0.8)	1.56 (1.03–2.32)	11% (0.2)	2.42 (1.42–4.15)	<1% (0.9)
Persistent	1.79 (1.26–2.54)	<1 (0.4)	1.55 (1.04–2.29)	8% (0.3)	2.47 (1.44–4.25)	5% (0.1)

OR_ap: pooled age-adjusted odds ratio.