title: Risk factors for homicide victimization in post-genocide Rwanda: a population -based case- control study.
abstract: BACKGROUND
  Homicide is one of the leading causes of mortality in the World. Homicide risk factors vary significantly between countries and regions. In Rwanda, data on homicide victimization is unreliable because no standardized surveillance system exists. This study was undertaken to identify the risk factors for homicide victimization in Rwanda with particular attention on the latent effects of the 1994 genocide.
  
  
  METHODS
  A population-based matched case-control study was conducted, with subjects enrolled prospectively from May 2011 to May 2013. Cases of homicide victimization were identified via police reports, and crime details were provided by law enforcement agencies. Three controls were matched to each case by sex, 5-year age group and village of residence. Socioeconomic and personal background data, including genocide exposure, were provided via interview of a family member or through village administrators. Conditional logistic regression, stratified by gender status, was used to identify risk factors for homicide victimization.
  
  
  RESULTS
  During the study period, 156 homicide victims were enrolled, of which 57 % were male and 43 % were female. The most common mechanisms of death were wounds inflicted by sharp instruments (knives or machetes; 41 %) followed by blunt force injuries (36.5 %). Final models indicated that risk of homicide victimhood increased with victim alcohol drinking patterns. There was a dose response noted for alcohol use: for minimal drinking versus none, adjusted odds ratio (aOR) = 3.1, 95%CI: 1,3-7.9; for moderate drinking versus none, aOR = 10.1, 95%CI: 3.7-24.9; and for heavy drinking versus none, aOR = 11.5, 95%CI: 3.6-36.8. Additionally, having no surviving parent (aOR = 2.7, 95%CI: 1.1-6.1), previous physical and/or sexual abuse (aOR = 28.1, 95%CI: 5.1-28.3) and drinking illicit brew and/or drug use (aOR = 7.7, 95%CI: 2.4-18.6) were associated with a higher risk of being killed. The test of interaction revealed that the variables that were significantly associated with a higher risk of homicide victimhood, did not exhibit any difference according to sex of the victim. However, the effect of belonging to a religion differed between women and men, but was significantly protective for both (aOR = 0.002, 95%CI: 0.001-0.054 and aOR = 0.20, 95%CI: 0.052-0.509, respectively).
  
  
  CONCLUSIONS
  Homicide victims in Rwanda are relatively young and the proportion of female victims is one of the highest globally. Contrary to the initial study considerations, genocide exposure (either as a survivor or perpetrator) was not a significant predictor of homicide victimization. Rather, risk factors were similar to those described in other countries, regardless of gender status. Sensitizing communities against alcohol heavy drinking, and illicit brew drinking and/or drug abuse and physical or sexual violence could reduce the homicide rate in Rwanda.
authors: Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda. wrubanzana@nursph.org.|Rwanda National Police Directorate of Medical Service, Kigali, Rwanda. wrubanzana@nursph.org.
authors: Wilson
authors: W
authors: Rubanzana
authors: Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda. jntagani@nursph.org.
authors: Joseph
authors: J
authors: Ntaganira
authors: Oregon Health & Science University, School of Medicine, Portland, Oregon, USA. forensictrauma@gmail.com.|Umeå University, Faculty of Medicine, Section of Forensic Medicine, Umeå, Sweden. forensictrauma@gmail.com.|Department of Forensic Medicine, Aarhus University, Faculty of Health Sciences, Aarhus, Denmark. forensictrauma@gmail.com.
authors: Michael D
authors: MD
authors: Freeman
authors: Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda. bethhedt@gmail.com.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA. bethhedt@gmail.com.
authors: Bethany L
authors: BL
authors: Hedt-Gauthier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D019548:Crime Victims / Q000706:statistics & numerical data*; D005260:Female; D063365:Genocide / Q000523:psychology*; D006708:Homicide / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D012959:Socioeconomic Factors; D055815:Young Adult