Armed conflict, alcohol misuse, decision-making, and intimate partner violence among women in Northeastern Uganda: A population level study

Background: Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. Our objective was to determine extent of exposure to these variables and test pathways between these indicators of interest. Methods: We surveyed 605 women aged 13 to 49 who were randomly selected via multistage sampling across three districts in Northeastern Uganda in 2016. We used Mplus 7.4 to estimate a moderated structural equation model of indirect pathways between armed conflict and intimate partner violence for currently partnered women (n = 558) to evaluate the strength of the relationships between the latent factors and determine the goodness-of-fit of the proposed model with the population data. Results: Most respondents (88.8%) experienced conflict-related violence. The lifetime/ past 12 month prevalence of experiencing intimate partner violence was 65.3%/ 50.9% (psychological) and 59.9%/ 43.8% (physical). One-third (30.7%) of women's partners reportedly consumed alcohol daily. The relative fit of the structural model was superior (CFI = 0.989; TLI = 0.989). The absolute fit (RMSEA = 0.029) closely matched the population data. The partner and joint decision-making groups significantly differed on the indirect effect through partner alcohol use (a 1 b 1 = 0.209 [0.017: 0.467]). Conclusions: This study demonstrates that male partner alcohol misuse is associated with exposure to armed conflict and intimate partner violence - a relationship moderated by healthcare decision-making. These findings encourage the extension of integrated alcohol misuse and intimate partner violence policy and emergency humanitarian programming to include exposure to armed conflict and gendered decision-making practices.