Risk for Severe Intimate Partner Violence in Nairobi’s Informal Settlements: Tailoring the Danger Assessment to Kenya

Shannon N. Wood; Nancy Perrin; Irene Akumu; Ben Asira; Amber Clough; Nancy Glass; Jacquelyn Campbell; Michele R. Decker

doi:10.9745/GHSP-D-23-00116

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FIGURE
ROC Curves Comparing Diagnostic Statistics on Responses to Original DA, Kenya-DA, and Kenya-DA Weighted Among Intimate Partner Violence Survivors, Nairobi, Kenya
Abbreviation: DA, Danger Assessment; ROC, receiver operating characteristic.

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TABLE 1.

Sample Characteristics of myPlan Kenya Intervention Participants at Baseline by Violence Severity at Follow-Up, Nairobi, Kenya

	Overall, No. (%) (n=103)	Follow-Up Violence Severity (n=103)
	Overall, No. (%) (n=103)	Less Severe IPV, % (n=61)	Severe IPV, % (n=42)	P Value^a
Study site
Korogocho	48 (46.6)	55.7	33.3	.08^b
Dandora	32 (31.1)	24.6	40.5
Huruma	23 (22.3)	19.7	26.2
Age, mean (SD), years^c	27.1 (4.7)	27.3 (5.0)	26.8 (4.3)	.61
Ethnicity
Kikuyu	41 (39.8)	39.3	40.5	.63
Luo	30 (29.1)	31.2	26.2
Luhya	13 (12.6)	14.8	9.5
Other	19 (18.5)	14.8	23.8
Religion
Christian	94 (91.3)	95.1	85.7	.15
Other	9 (8.7)	4.9	14.3
Recently migrated to Nairobi	25 (24.3)	23.0	26.2	.71
Current relationship status
Married	89 (86.4)	82.0	92.9	.15
Unmarried	14 (13.6)	18.0	7.1
Lives with current partner	93 (90.3)	85.3	97.6	.05^b
Number of children, mean (SD)^c	2.2 (1.2)	2.3 (1.2)	2.0 (1.1)	.27
Highest level of education completed
Primary or less	62 (60.2)	60.7	59.5	.40
Some secondary	19 (18.5)	14.8	23.8
Secondary or higher	22 (21.4)	24.6	16.7
Currently unemployed	95 (92.2)	91.8	92.9	1.00
Concurrent partner (participant)	11 (10.7)	6.6	16.7	.12
Concurrent partner (partner)	59 (57.3)	57.4	57.1	.95

Abbreviation: IPV, intimate partner violence; SD, standard deviation.
↵^a T-tests used to test differences between violence severity for continuous variables. Chi-squared tests used to test differences between violence severity for binary/categorical variables; Fisher’s exact test for cells <5.
↵^b P<.1 for confounding assessment.
↵^c Continuous variable.

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TABLE 2.

Prevalence of Danger Assessment Items at Baseline and Correlation With Violence Severity at Follow-Up Among myPlan Kenya Intervention Participants, Nairobi, Kenya

Item	Overall Item Prevalence at Baseline, %	Item Prevalence at Baseline by Follow-Up^a Violence Severity (n=103)			Phi	RRR (95% CI)	Item Weight^b
Item	Overall Item Prevalence at Baseline, %	Less Severe IPV, % (n=61)	Severe IPV, % (n=42)	P Value	Phi	RRR (95% CI)	Item Weight^b
1. Has the physical violence increased in severity or frequency over the past year?	75.7	68.9	85.7	.05	0.19	2.71 (0.98, 7.52)	1
2. Does he own a dangerous weapon he would use during a fight (machete, gun, sword, club, knife, whip, etc.)?	62.1	49.2	81.0	.001	0.32	4.39^c (1.75, 11.01)	3
3. During the past year, have you left him after living together or being a couple (even if you got back together)?	82.5	80.3	85.7	.48	0.07	1.47 (0.50, 4.28)	not retained
4. Is he unemployed?	37.9	31.2	47.6	.09	0.17	2.01 (0.89, 4.52)	1
5. Has he ever used a weapon against you or threatened you with a lethal weapon (machete, gun, sword, club, knife, whip, etc.)?	66.0	55.7	81.0	.008	0.26	3.38^c (1.34, 8.48)	2
6. Does he threaten to kill you?	64.1	55.7	76.2	.03	0.21	2.54^d (1.06, 6.07)	1
7. Has he previously been in trouble with the police or chief for violence against his partner or children?	52.4	44.3	64.3	.05	0.20	2.27^d (1.01, 5.09)	1
8. Do you have a child that is not his?	32.0	36.1	26.2	.29	0.10	0.63 (0.27, 1.49)	not retained
9. Has he ever forced you to have sex when you did not wish to do so?	82.5	73.8	95.2	.007	0.28	7.11^c (1.53, 32.35)	4
10. Does he ever try to choke you?	58.3	39.3	85.7	<.001	0.46	9.25^c (3.38, 25.28)	4
11. Does he use drugs, such as bhang, khat, heroine, or cocaine?	49.5	44.3	57.1	.20	0.13	1.67 (0.76, 3.71)	not retained
12. Does he have a drinking problem?	55.3	52.5	59.5	.48	0.07	1.33 (0.60, 2.95)	not retained
13. Does he control most or all of your daily activities? For instance: does he tell you who you can be friends with, when you can see your family, how much money you can spend, whether or not you can use birth control?	73.8	68.9	81.0	.17	0.14	1.92 (0.75, 4.93)	1
14. Is he violently and constantly jealous of you? (For instance, does he say “If I can't have you, no one can”?)	89.3	83.6	97.6	.03	0.22	8.04^d (0.99, 65.40)	4
15. Have you ever been beaten by him while you were pregnant?	61.2	49.2	78.6	.003	0.30	3.79^c (1.55, 9.24)	2
16. Has he ever threatened or tried to commit suicide?	32.0	23.0	45.2	.02	0.23	2.77^d (1.18, 6.50)	1
17. Does he threaten to harm your children?	19.4	9.8	33.3	.003	0.29	4.58^c (1.58, 13.2)	3
18. Do you believe he is capable of killing you?	58.3	49.2	71.4	.02	0.22	2.58^d (1.11, 5.96)	1
19. Does he follow or spy on you, leave threatening notes or messages, destroy your belongings, or call you when you don't want him to?	75.7	68.9	85.7	.05	0.19	2.71 (0.98, 7.53)	1
20. Have YOU ever threatened or tried to commit suicide?	33.0	26.2	42.9	.08	0.17	2.11 (0.91, 4.86)	1

Abbreviations: CI, confidence interval; IPV, intimate partner violence; RRR, relative risk ratio.
↵^a Chi-squared tests used to test difference in baseline danger assessment item between violence severity at follow-up; Fisher’s exact test for cells <5.
↵^b Due to small n’s, weighting for Kenya-Danger Assessment weighted was based on effect size rather than statistical significance. RRR of 2 to <3=weight of 1; RRR of 3 to <4=weight of 2; RRR of 4 to <5=weight of 3; RRR of 5+=weight of 4.
^c P<.01.
^d P<.05.

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TABLE 3.

Diagnostic Statistics and Logistic Regressions on Responses to the Nairobi Danger Assessment Scale for Risk of Severe IPV Among IPV Survivors in Nairobi, Kenya

C-

Statistic

Sensitivity, % (n=103)

Specificity, % (n=103)

OR (95% CI)

Original Danger Assessment

0.73

57.14

75.41

1.26 (1.12, 1.41)^a

Kenya-Danger Assessment

0.75