title: A community-based intervention for improving health-seeking behavior among sexual violence survivors: a controlled before and after design study in rural Tanzania.
abstract: BACKGROUND
  Despite global recognition that sexual violence is a violation of human rights, evidence still shows it is a pervasive problem across all societies. Promising community intervention studies in the low- and middle-income countries are limited.
  
  
  OBJECTIVE
  This study assessed the impact of a community-based intervention, focusing on improving the community's knowledge and reducing social acceptability of violence against women norms with the goal to prevent and respond to sexual violence.
  
  
  METHODS
  The strategies used to create awareness included radio programs, information, education communication materials, and advocacy meetings with local leaders. The intervention took place in Morogoro region in Tanzania. The evaluation used a quasi-experimental design including cross-sectional surveys at baseline (2012) and endline (2014) with men and women aged 18-49 years. Main outcome measures were number of reported rape cases at health facilities and the community's knowledge and attitudes toward sexual violence.
  
  
  RESULTS
  The number of reported rape events increased by more than 50% at health facilities during the intervention. Knowledge on sexual violence increased significantly in both areas over the study period (from 57.3 to 80.6% in the intervention area and from 55.5 to 71.9% in the comparison area; p<0.001), and the net effect of the intervention between the two areas was statistically significant (6.9, 95% CI 0.2-13.5, p=0.03). There was significant improvement in most of the attitude indicators in the intervention area, but not in the comparison area. However, the intervention had no significant effect on the overall scores of acceptance attitudes in the final assessment when comparing the two areas (-2.4, 95% CI: -8.4 to 3.6, p=0.42).
  
  
  CONCLUSIONS
  The intervention had an effect on some indicators on knowledge and attitudes toward sexual violence even after a short period of intervention. This finding informs the public health practitioners of the importance of combined strategies in achieving changes.
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.|Department of Obstetrics/Gynecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania; muzsalim@yahoo.com.
authors.forename: Muzdalifat
authors.initials: M
authors.lastname: Abeid
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.|Department of Obstetrics/Gynecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors.forename: Projestine
authors.initials: P
authors.lastname: Muganyizi
authors.affiliation: Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors.forename: Rose
authors.initials: R
authors.lastname: Mpembeni
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.|Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Darj
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Axemo
mesh_terms: D000293:Adolescent; D000328:Adult; D019058:Community Networks; D003430:Cross-Sectional Studies; D005260:Female; D014943:Global Health; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011902:Rape / Q000706:statistics & numerical data; D012107:Research Design; D012424:Rural Population; D012742:Sex Offenses / Q000517:prevention & control*; D017741:Survivors / Q000523:psychology*; D013636:Tanzania; D055815:Young Adult
keywords: Tanzania; community intervention; evaluation; sexual violence