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BACKGROUND: Child abuse or maltreatment is a significant global public health problem of unknown global prevalence. About 40 million children aged 0-14 years require health and social care globally. The prevalence, determinants, and trends of national or global rates of child abuse and maltreatment are largely unknown. METHODS: Data for this retrospective cross-sectional study were derived from the 2005 Egyptian Demographic and Health Survey (2005 EDHS), and included 19474 women aged 15-49 years. Multivariate logistic regression analyses by stepwise regression, backward method were used to determine the independent contribution of the possible social determinants of child abuse, with the direction and magnitude of associations expressed as odds ratios (OR) and their 95% confident interval levels (95% CI). RESULTS: Identified determinants of child abuse included exposure to intimate partner violence (IPV), justifying wife beating, exposure to generational IPV, and such factors as younger age of the women, male sex, partners' lower education, poverty, residence in urban areas, younger children, and residence in households with 3-5 children. CONCLUSIONS: Experience of IPV, mothers' justification of wife beating, and generational IPV were associated with elevated odds of child abuse. Findings indicate possible high levels of unmet child protection needs, and stress the need for professionals working with children to employ culturally-sensitive methods in investigating social determinants of child abuse.

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Background. The comparative effect of economic abuse and other forms of abuse in predicting depression and other mental health disorders has not been previously investigated despite its relevance for mental illness prevention. Objective. To determine the differential association of economic abuse on psychological distress and suicide attempts. Study Design. We used cross-sectional data from women aged 15-49 years in the 2008 Philippines Demographic and Health Surveys (PDHS) (N = 9,316). Results. Adjusting for sociodemographic confounders revealed positive associations between economic, physical, or psychological abuse and suicide attempts and psychological distress. Psychological and economic abuse were the strongest predictors of suicide attempts and psychological distress, respectively. Economic abuse was also negatively associated with psychological distress. Comorbidity with one mental health disorder greatly increased the odds of reporting the other mental health disorder. Conclusion. Overall, the results elucidate the differential effects of these forms of abuse on women's mental health.

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BACKGROUND: Improving maternal health is one of the eight Millennium Development Goals (MDGs) aimed at improving maternal healthcare and reducing maternal mortality. The utilization of maternal health services is influenced by several factors that need to be better understood. The objective of this study was to estimate the role of socio-economic position as a determinant of the utilization of maternal health care in Namibia. METHODS: Data were collected from the Namibia Demographic and Health Survey in 2006-2007, based on survey responses from 9,804 female respondents aged 15-49 years. Multivariate logistic regression analysis was performed accounting for socio-economic factors associated with the use of maternal health care services. RESULTS: The results from both bivariate and multivariate analyses confirmed the importance of education, wealth index, place of residence and marital status in explaining the utilization of maternal health care services. Wealth index was the only consistently significant predictor of all indicators of maternal health services; with other factors being significantly associated with one or more of the indicators. Women's age and occupation showed inconclusive results in relation to access to maternal health care services. CONCLUSIONS: Several socio-economic factors significantly influence the three indicators of maternal health services utilization. Effective interventions need to take these factors into consideration and to explore means that increase maternal health service utilization especially among lowly educated and poor women in rural areas.

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Economic abuse against women has for too long remained a relatively 'unseen' part of interpersonal violence, in spite of intimate partner violence (IPV) being a public health problem. Most studies on economic abuse derive especially from the USA and amongst women in shelters, and their findings are not easily generalisable to low-middle-income countries. Socio-economic inequalities render women vulnerable to control and risk of abuse. We investigated the role of socio-economic inequalities in the association between IPV and economic abuse. Logistic regression analyses were performed on cross-sectional data from a nationally representative sample of 8478 women aged 15-49 years in the 2008 Philippines Demographic and Health Surveys. Results indicated strong positive associations between both physical IPV and emotional IPV and all four forms of economic abuse. Measures of socio-economic inequalities and other covariates such as no education, primary education, unemployment and justifying wife beating were also statistically significant. Findings suggest the increased need for health care practitioners to include economic abuse during the assessment of and response to IPV, the implementation of a multidimensional approach to providing tangible support and women-centred responses in reported cases of economic abuse, as well as measures that enhance socio-economic equality and increase economic opportunities for women.

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BACKGROUND: There is limited research about IPV against women and associated factors in Sub-Saharan Africa, not least Mozambique. The objective of this study was to examine the occurrence, severity, chronicity and "predictors" of IPV against women in Maputo City (Mozambique). METHODS: Data were collected during a 12 month-period (consecutive cases, with each woman seen only once) from 1,442 women aged 15-49 years old seeking help for abuse by an intimate partner at the Forensic Services at the Maputo Central Hospital, Maputo City, Mozambique. Interviews were conducted by trained female interviewers, and data collected included demographics and lifestyle variables, violence (using the previously validated Revised Conflict Tactics Scale (CTS2), and control (using the Controlling Behaviour Scale Revised (CBS-R). The data were analysed using bivariate and multivariate methods. RESULTS: The overall experienced IPV during the past 12 months across severity (one or more types, minor and severe) was 70.2% (chronicity, 85.8 ± 120.9).a Severe IPV varied between 26.3-45.9% and chronicity between 3.1 ± 9.1-12.8 ± 26.9, depending on IPV type. Severity and chronicity figures were higher in psychological aggression than in the other IPV types. Further, 26.8% (chronicity, 55.3 ± 117.6) of women experienced all IPV types across severity. The experience of other composite IPV types across severity (4 combinations of 3 types of IPV) varied between 27.1-42.6% and chronicity between 35.7 ± 80.3-64.9 ± 110.9, depending on the type of combination. The combination psychological aggression, physical assault and sexual coercion had the highest figures compared with the other combinations. The multiple regressions showed that controlling behaviours, own perpetration and co-occurring victimization were more important in "explaining" the experience of IPV than other variables (e.g. abuse as a child). CONCLUSIONS: In our study, controlling behaviours over/by partner, own perpetration, co-occurring victimization and childhood abuse were more important factors in "explaining" sustained IPV. More investigation into women's IPV exposure and its "predictors" is warranted in Sub-Saharan Africa, particularly Mozambique.

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BACKGROUND: Intimate partner violence (IPV) is a major public health problem with serious consequences for women's physical, mental, sexual and reproductive health. Reproductive health outcomes such as unwanted and terminated pregnancies, fetal loss or child loss during infancy, non-use of family planning methods, and high fertility are increasingly recognized. However, little is known about the role of community influences on women's experience of IPV and its effect on terminated pregnancy, given the increased awareness of IPV being a product of social context. This study sought to examine the role of community-level norms and characteristics in the association between IPV and terminated pregnancy in Nigeria. METHODS: Multilevel logistic regression analyses were performed on nationally-representative cross-sectional data including 19,226 women aged 15-49 years in Nigeria. Data were collected by a stratified two-stage sampling technique, with 888 primary sampling units (PSUs) selected in the first sampling stage, and 7,864 households selected through probability sampling in the second sampling stage. RESULTS: Women who had experienced physical IPV, sexual IPV, and any IPV were more likely to have terminated a pregnancy compared to women who had not experienced these IPV types.IPV types were significantly associated with factors reflecting relationship control, relationship inequalities, and socio-demographic characteristics. Characteristics of the women aggregated at the community level (mean education, justifying wife beating, mean age at first marriage, and contraceptive use) were significantly associated with IPV types and terminated pregnancy. CONCLUSION: Findings indicate the role of community influence in the association between IPV-exposure and terminated pregnancy, and stress the need for screening women seeking abortions for a history of abuse.

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BACKGROUND: Little knowledge exists in Mozambique and sub-Saharan Africa about the mental health (symptoms of depression, anxiety, and somatization) of women victims and perpetrators of intimate partner violence (IPV) by type of abuse (psychological aggression, physical assault without/with injury, and sexual coercion). This study scrutinizes factors associated with mental health among women victims and perpetrators of IPV over the 12 months prior to the study. METHODS AND MATERIALS: Mental health data were analyzed with bivariate and multiple regression methods for 1442 women aged 15-49 years who contacted Forensic Services at Maputo Central Hospital (Maputo City, Mozambique) for IPV victimization between April 1, 2007 and March 31, 2008. RESULTS: In bivariate analyses, victims and perpetrators of IPVs scored higher on symptoms of mental health than their unaffected counterparts. Multiple regressions revealed that controlling behaviors, mental health comorbidity, social support, smoking, childhood abuse, sleep difficulties, age, and lack of education were more important in explaining symptoms of mental health than demographics/socioeconomics or life-style factors. Victimization and perpetration across all types of IPV were not associated with symptoms of mental health. CONCLUSION: In our sample, victimization and perpetration were not important factors in explaining mental ill health, contrary to previous findings. More research into the relationship between women's IPV victimization and perpetration and mental health is warranted as well as the influence of controlling behaviors on mental health.

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BACKGROUND: The role of gender inequities in explaining women's access to reproductive health care was examined in four countries (two sub-Saharan African and two South Asian countries). The extent of gender inequities varies across and within countries, and is rooted in the different cultural practices and gender norms within these different countries, and differences in the status and autonomy of women. METHODS: Demographic and Health Survey data from women aged 15-49 years within these countries were analyzed with multivariate logistic regression analysis to examine the role of multidimensional characteristics of gender inequities, operationalized as access to skilled antenatal care, tetanus toxoid injection during pregnancy, and access to skilled antenatal care. RESULTS: Significant associations were found between several dimensions of gender inequities (with the exception of decision-making autonomy) and reported use of maternal reproductive health care services. Several pathways of influence between the outcome and exposure variables were also identified. CONCLUSION: Dimensions of gender inequities (with the exception of decision-making autonomy) differentially influenced woman's use of reproductive health care services, thus highlighting the urgent need for concerted and sustained efforts to change these harmful traditional values if several of these countries are to meet Millennium Development Goal-5.

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BACKGROUND: This study aimed to simultaneously examine the association between multiple dimensions of gender inequities and full childhood immunization. METHODS: A multilevel logistic regression analysis was performed on nationally representative sample data from the 2008 Nigeria Demographic and Health Survey, which included 33,385 women aged 15-49 years who had a total of 28,647 live-born children; 24,910 of these children were included in this study. RESULTS: A total of 4283 (17%) children had received full immunization. Children of women whose spouse did not contribute to household earnings had a higher likelihood of receiving full childhood immunization (odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.02-3.77), and children of women who lacked decision-making autonomy had a lower likelihood of receiving full childhood immunization (OR 0.74, 95% CI 0.60-0.91). The likelihood of receiving full childhood immunization was higher among female children (OR 1.28, 95% CI 1.06-1.54), Yoruba children (OR 2.45, 95% CI 1.19-4.26), and children resident in communities with low illiteracy (OR 1.82, 95% CI 1.06-3.12), but lower for children of birth order 5 or above (OR 0.64, 95% CI 0.45-0.96), children of women aged ≤ 24 years (OR 0.66, 95% CI 0.50-0.87) and 25-34 years (OR 0.79, 95% CI 0.63-0.99), children of women with no education (OR 0.33, 95% CI 0.21-0.54) and primary education (OR 0.66, 95% CI 0.45-0.97), as well as children of women resident in communities with high unemployment (OR 0.34, 95% CI 0.20-0.57). CONCLUSIONS: The woman being the sole provider for her family (i.e., having a spouse who did not contribute to household earnings) was associated with a higher likelihood of fully immunizing the child, and the woman lacking decision-making autonomy was associated with a lower likelihood of fully immunizing the child. These findings draw attention to the need for interventions aimed at promoting women's employment and earning possibilities, whilst changing gender-discriminatory attitudes within relationships, communities, and society in general.

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BACKGROUND: Intimate partner violence (IPV) against women is a serious public health issue with recognizable direct health consequences. This study assessed the association between IPV and traumatic physical health consequences on women in Nigeria, given that communities exert significant influence on the individuals that are embedded within them, with the nature of influence varying between communities. METHODS: Cross-sectional nationally-representative data of women aged 15 - 49 years in the 2008 Nigeria Demographic and Health Survey was used in this study. Multilevel logistic regression analysis was used to assess the association between IPV and several forms of physical health consequences. RESULTS: Bruises were the most common form of traumatic physical health consequences. In the adjusted models, the likelihood of sustaining bruises (OR = 1.91, 95% CI = 1.05 - 3.46), wounds (OR = 2.54, 95% CI = 1.31 - 4.95), and severe burns (OR = 3.20, 95% CI = 1.63 - 6.28) was significantly higher for women exposed to IPV compared to those not exposed to IPV. However, after adjusting for individual- and community-level factors, women with husbands/partners with controlling behavior, those with primary or no education, and those resident in communities with high tolerance for wife beating had a higher likelihood of experiencing IPV, whilst mean community-level education and women 24 years or younger were at lower likelihood of experiencing IPV. CONCLUSIONS: Evidence from this study shows that exposure to IPV is associated with increased likelihood of traumatic physical consequences for women in Nigeria. Education and justification of wife beating were significant community-level factors associated with traumatic physical consequences, suggesting the importance of increasing women's levels of education and changing community norms that justify controlling behavior and IPV.

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BACKGROUND: Controlling behavior is more common and can be equally or more threatening than physical or sexual violence. This study sought to determine the role of husband/partner controlling behavior and power relations within intimate relationships in the lifetime risk of physical and sexual violence in Nigeria. METHODS: This study used secondary data from a cross-sectional nationally-representative survey collected by face-to-face interviews from women aged 15 - 49 years in the 2008 Nigeria Demographic and Health Survey. Utilizing a stratified two-stage cluster sample design, data was collected frrm 19 216 eligible with the DHS domestic violence module, which is based on the Conflict Tactics Scale (CTS). Multivariate logistic regression analysis was used to determine the role of husband/partner controlling behavior in the risk of ever experiencing physical and sexual violence among 2877 women aged 15 - 49 years who were currently or formerly married or cohabiting with a male partner. RESULTS: Women who reported controlling behavior by husband/partner had a higher likelihood of experiencing physical violence (RR = 3.04; 95% CI: 2.50 - 3.69), and women resident in rural areas and working in low status occupations had increased likelihood of experiencing physical IPV. Controlling behavior by husband/partner was associated with higher likelihood of experiencing physical violence (RR = 4.01; 95% CI: 2.54 - 6.34). In addition, women who justified wife beating and earned more than their husband/partner were at higher likelihood of experiencing physical and sexual violence. In contrast, women who had decision-making autonomy had lower likelihood of experiencing physical and sexual violence. CONCLUSION: Controlling behavior by husband/partner significantly increases the likelihood of physical and sexual IPV, thus acting as a precursor to violence. Findings emphasize the need to adopt a proactive integrated approach to controlling behavior and intimate partner violence within the society.

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BACKGROUND: Regions with geographically diverse ecology and socioeconomic circumstances may have different disease exposures and child health outcomes. This study assessed variations in the risks of death in children under age 5 across regions of Nigeria and determined characteristics at the individual and community levels that explain possible variations among regions. METHODS: Multilevel Cox proportional hazards analysis was performed using a nationally representative sample of 6,029 children from 2,735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios (HR) with 95% confidence intervals (CI) were used to express measures of association among the characteristics. Variance partition coefficients and Wald statistic were used to express measures of variation. RESULTS: Patterns of under-5 mortality cluster within families and communities. The risks of under-5 deaths were significantly higher for children of mothers residing in the South South (Niger Delta) region (HR: 1.30; 95% CI: 1.76-2.20) and children of mothers residing in communities with a low proportion of mothers attending prenatal care by a doctor (HR: 1.36; 95% CI: 1.15-1.86). In addition, the cross-level interaction between mothers' education and community prenatal care by a doctor was associated with a more than 40% higher risk of dying (HR: 1.41; 95% CI: 1.21-1.78). CONCLUSION: The findings suggest the need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions such as the South South (Niger Delta) region. Further studies on community-levels determinants of under-5 mortality are needed.

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BACKGROUND: Each ethnic group has its own cultural values and practices that widen inequalities in child health and survival among ethnic groups. This study seeks to examine the mediatory effects of ethnicity and socioeconomic position on under-5 mortality in Nigeria. METHODS: Using multilevel logistic regression analysis of a nationally representative sample drawn from 7620 females age 15 to 49 years in the 2003 Nigeria Demographic and Health Survey, the risk of death in children younger than 5 years (under-5 deaths) was estimated using odds ratios with 95% confidence intervals for 6029 children nested within 2735 mothers who were in turn nested within 365 communities. RESULTS: The prevalence of under-5 death was highest among children of Hausa/Fulani/Kanuri mothers and lowest among children of Yoruba mothers. The risk of under-5 death was significantly lower among children of mothers from the Igbo and other ethnic groups, as compared with children of Hausa/Fulani/Kanuri mothers, after adjustment for individual- and community-level factors. Much of the disparity in under-5 mortality with respect to maternal ethnicity was explained by differences in physician-provided community prenatal care. CONCLUSIONS: Ethnic differences in the risk of under-5 death were attributed to differences among ethnic groups in socioeconomic characteristics (maternal education and to differences in the maternal childbearing age and short birth-spacing practices. These findings emphasize the need for community-based initiatives aimed at increasing maternal education and maternal health care services within communities.

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OBJECTIVE: To assess the role of rural-urban migration in the risks of under-five death; to identify possible mechanisms through which migration may influence mortality; and to determine individual- and community-level relationships between migration status and under-five death. METHOD: Multilevel Cox regression analysis was used on a nationally representative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios with 95% confidence intervals were used to express the measures of association between the characteristics, and intra-class coefficients were used to express the measures of variation. RESULTS: Children of rural non-migrant mothers had significantly lower risks of under-five death than children of rural-urban migrant mothers. The disruption of family and community ties, low socio-economic position and vulnerability, and the difficulties migrants face in adapting into the new urban environment, may predispose the children of rural-urban migrants to higher mortality. CONCLUSION: Our results stress the need for community-level and socio-economic interventions targeted at migrant groups within urban areas to improve their access to health care services, maternal education, as well as the general socio-economic situation of women.

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BACKGROUND: Vaccine-preventable diseases are responsible for severe rates of morbidity and mortality in Africa. Despite the availability of appropriate vaccines for routine use on infants, vaccine-preventable diseases are highly endemic throughout sub-Saharan Africa. Widespread disparities in the coverage of immunization programmes persist between and within rural and urban areas, regions and communities in Nigeria. This study assessed the individual- and community-level explanatory factors associated with child immunization differentials between migrant and non-migrant groups. METHODS: The proportion of children that received each of the eight vaccines in the routine immunization schedule in Nigeria was estimated. Multilevel multivariable regression analysis was performed using a nationally representative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities. Odds ratios with 95% confidence intervals were used to express measures of association between the characteristics. Variance partition coefficients and Wald statistic i.e. the ratio of the estimate to its standard error were used to express measures of variation. RESULTS: Individual- and community contexts are strongly associated with the likelihood of receiving full immunization among migrant groups. The likelihood of full immunization was higher for children of rural non-migrant mothers compared to children of rural-urban migrant mothers. Findings provide support for the traditional migration perspectives, and show that individual-level characteristics, such as, migrant disruption (migration itself), selectivity (demographic and socio-economic characteristics), and adaptation (health care utilization), as well as community-level characteristics (region of residence, and proportion of mothers who had hospital delivery) are important in explaining the differentials in full immunization among the children. CONCLUSION: Migration is an important determinant of child immunization uptake. This study stresses the need for community-level efforts at increasing female education, measures aimed at alleviating poverty for residents in urban and remote rural areas, and improving the equitable distribution of maternal and child health services.

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BACKGROUND: Living in socioeconomically disadvantaged areas is associated with increased -childhood mortality risks. As city living becomes the predominant social context in low- and middle-income countries, the resulting rapid urbanization together with the poor economic circumstances of these countries greatly increases the risks of mortality for children < 5 years of age (under-5 mortality). OBJECTIVE: In this study we examined the trends in urban population growth and urban under-5 mortality between 1983 and 2003 in Nigeria. We assessed whether urban area socioeconomic dis-advantage has an impact on under-5 mortality. METHODS: Urban under-5 mortality rates were directly estimated from the 1990, 1999, and 2003 Nigeria Demographic and Health Surveys. Multilevel logistic regression analysis was performed on data for 2,118 children nested within data for 1,350 mothers, who were in turn nested within data for 165 communities. RESULTS: Urban under-5 mortality increased as urban population steadily increased between 1983 and 2003. Urban area disadvantage was significantly associated with under-5 mortality after adjusting for individual child- and mother-level demographic and socioeconomic characteristics. CONCLUSIONS: Significant relative risks of under-5 deaths at both individual and community levels underscore the need for interventions tailored toward community- and individual-level interventions. We stress the need for further studies on community-level determinants of under-5 mortality in disadvantaged urban areas.

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OBJECTIVES: We assessed the levels and trends of childhood mortality between 1990 and 2006, and assessed the determinants of under-five mortality. Results of this study are intended to aid formulate health policy interventions in the achievement of the Millennium Development Goals. METHODS: Three Uganda Demographic Health Survey (DHS) data sets collected in 1995, 2000/2001 and 2006 were used to estimate the levels and trends of childhood mortality between 1990 and 2006. The 2006 Uganda DHS was used to assess the determinants of under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 9,006 women aged 15-49 years who contributed 8369 children to the study. Proportions of the children were estimated, and Pearson's chi-square test was used to determine differences. Multivariate logistic regression analyses was used to assess the determinants of under-five mortality RESULTS: Under-five mortality remained unchanged between the periods 1991-1995 and 1996-2000, and then declined in the period 2001-2005. Results of the Cox regression modelling show that sex of the child (female) was associated with a lower risk of under-five mortality, while birth interval (less than 24 months after the preceding birth), type of birth (multiple), region of residence (northern region), and mother's education (primary, and no education) were associated with an increased risk of children dying before their fifth birthday. CONCLUSIONS: Uganda is not on track to meet the MDG Goal 4 (cutting under-five mortality by two-thirds by 2015-using the 1990 level as the baseline). However, with prompt multi-sectoral child health promotion strategies, coupled with diminished impacts of HIV/AIDS, and armed conflicts, improved maternal education, public enlightenment to lengthen birth intervals, improved living conditions in the north, the potential for Uganda to close the MDG 4 target gap remains high. Further studies are needed to assess the effects of contextual determinants of child survival in Uganda.

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BACKGROUND: Immunization coverage in many parts of Nigeria is far from optimal, and far from equitable.Nigeria accounts for half of the deaths from Measles in Africa, the highest prevalence of circulating wild poliovirus in the world, and the country is among the ten countries in the world with vaccine coverage below 50 percent. Studies focusing on community-level determinants therefore have serious policy implications METHODS: Multilevel multivariable regression analysis was used on a nationally-representative sample of women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey. Multilevel regression analysis was performed with children (level 1) nested within mothers (level 2), who were in turn nested within communities (level 3). RESULTS: Results show that the pattern of full immunization clusters within families and communities, and that socio-economic characteristics are important in explaining the differentials in full immunization among the children in the study. At the individual level, ethnicity, mothers' occupation, and mothers' household wealth were characteristics of the mothers associated with full immunization of the children. At the community level, the proportion of mothers that had hospital delivery was a determinant of full immunization status. CONCLUSION: Significant community-level variation remaining after having controlled for child- and mother-level characteristics is indicative of a need for further research on community-levels factors, which would enable extensive tailoring of community-level interventions aimed at improving full immunization and other child health outcomes.

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Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.

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BACKGROUND: The Niger Delta region of Nigeria has been undergoing collective violence for over 25 years, which has constituted a major public health problem. The objectives of this study were to investigate the predictors of women's attitudes toward intimate partner violence in the Niger Delta in comparison to that of women in other parts of Nigeria. METHODS: The 2003 Nigeria Demographic and Health Survey was used for this study. Respondents were selected using a stratified two-stage cluster sampling procedure through which 3725 women were selected and interviewed. These women contributed 6029 live born children born to the survey. Internal consistency of the measure of the women's attitudes towards intimate partner violence against a woman was assessed using Cronbach's alpha (alpha). Percentage distributions of the relevant characteristics of the respondents were carried out, and multivariable logistic regression analysis was used to measure the magnitude and direction of the relationship between the outcome and predictor variables were expressed as odds ratios (OR) and statistical significance was determined at the 95 percent confident interval level (CI). RESULTS: Tolerance for intimate partner violence among the women in the Niger delta (47 percent) was higher than that of women from the rest of the country (42 percent). Rural residence, lower household wealth, lower status occupations, and media access (newspaper and radio) were associated with lower risk of justifying IPV among the women in the Niger Delta. In contrast full or partial autonomy in household decisions regarding food to be cooked, and access to television were associated with a lower risk of justifying violence. CONCLUSION: The increased justification of intimate partner violence among the women in the Niger Delta could be explained by a combination of factors, among which are cognitive dissonance theory (attitudes that do not fit with other opinions they hold as a means of coping with their situation), ecological theory (behaviour or attitudes being shaped by current factors in their neighbourhood, community or family), and gender-role attitudes. Further in-depth studies are required to fully understand women's attitudes toward violence in areas of conflict.