The WHO World Report on Violence and Health 2002(Krug et al., 2002) proposed a classification of violence into three broad categories: self-directed violence, interpersonal violence and collective violence. Self-directed violence, the type of violence that a person inflicts on him or herself, includes suicide, self-abuse and self-mutilation. Interpersonal violence, on the other hand, is inflicted by one person or a small group of persons on another. It is subdivided into family and intimate partner violence, in which the perpetrator is a family member and community violence, which is violence between individuals who are unrelated, who may be friends, acquaintances or strangers. The third of the broad category, collective violence is defined as violence inflicted by organized groups, terrorist organizations and sovereign states in pursuit of social, religious, economic and political agenda (Krug et al., 2002). War between nations is included in this category of violence.
The pattern, consequences and manifestations of violence have been found to be different among populations, gender and age groups (WHO, 2014). The current research shows that males constitute majority of victims (53.7%; 126/220) and perpetrators (79.3%; 169/213) of interpersonal violence in Enugu, most notably adult males in second, third decade of life. This is similar to findings from many previous studies (Brennan et al. 2006; Eni et al.2009; Fothergill and Hashemi, 2008; Nkombua, 2007). However, the 57.3% proportion of male victims found in the present study falls short of the high figures of between 72 and 94% reported in these previous studies, which clearly show that males bear the brunt of interpersonal violence. The work by Okulate (2005) is unique in its finding of more female victims.
Risk factors for interpersonal violence have been organized into four ecological levels: individual factors, relationship factors, community factors and societal factors (Krug et al., 2002). The consensus presently is that no single factor explains why an individual becomes a victim or a perpetrator of violence. Rather, violence manifests as a result of complex interaction among factors in the four ecological levels (Krug et al., 2002). Explanation of sex differences in behavior and aggression and enquiry into why the male gender is a foremost risk factor for interpersonal violence, has been a subject of interest to social scientists (Wood et al. 2002; Archer, 2004). Authorities in Psychology have advanced theories and elaborated research evidence that highlight Sexual behavior, reproductive competition, neuro-hormonal factors, gender constructs and cultural expectations as underlying factors of sex difference in aggression and violence (Archer, 2004). In our society as in many others, the cultural expectation of the male role borders on machismo. The male is expected to “stand up and fight.”
In Enugu, interpersonal violence cases reported to the police authorities usually happened between two individuals. Sixty six percent (145/220) of the victims in this study were found to have been assailed by one person. This agrees with a report from UK, which noted that 62% of 24,660 cases of interpersonal violence were perpetrated by a single person attacker (Brennan et al., 2006). However, as a pointer to variable manifestations of violence in different populations, Okulate(2005) reported that community violence in Port-Harcourt involved a group of young persons, often strangers and mostly operating in gangs (Okulate, 2005).
The distribution of cases and the settings in which interpersonal violence occurred as found in this study are quite instructive. Conflict in residential quarters accounted for the highest number(36.8%) of cases of interpersonal violence followed by disagreement during work- or business-related transactions (31.8%).This pattern highlights a yet to be reported promoter of interpersonal violence in Nigerian cities—inadequate housing. Even though housing had been identified as a risk factor for interpersonal violence (Krug et al., 2002; Rosenberg et al. 2006), it seems the precise way in which it contributes to violence varies with respect to categories of violence and populations of people. For instance, Michael Yonas et al. (2007) identified vacant housing together with lack of employment opportunities, paucity of local businesses, inadequate trash management and poor street lighting as neighborhood level factors which promote youth violence in some areas of Baltimore city. In their study, vacant and dilapidated housing in the neighborhood was identified as clandestine rendezvous for illicit drug use and free space for stashing and selling of guns, thus fueling youth and street violence in the communities in question (Yonas et al., 2007). Street violence constituted a minor proportion of cases seen in the present study and housing as a contributing factor to violence does so in the context of inadequacy and concomitant overcrowding. Housing deficits in Nigerian cities as a result of rapid urbanization has long been documented (Abiodun, 1976). More recently, the World Bank estimates Nigeria has a housing shortfall of 17million units (Parby et al.2015).The large mass of people who throng the urban cities in search of employment live mostly in rented apartments in which multiple households are accommodated in one dwelling or compound. In this housing arrangement, unrelated families and individuals are compelled to share housing facilities and appurtenances. Our study shows that interpersonal conflict often arose in this setting sometimes over matters as trivial as use of clothesline. It seems the prevailing tenement system in our urban city creates the milieu for a good number of reported cases of interpersonal violence and so eradication of this form of interpersonal violence would require provision of adequate housing.
One other insight from our data is the idea of interpersonal violence as a corollary to individual’s socio-cultural roles, daily circumstances and life endeavors. This is seen in our finding of strong statistical association between victim’s gender and circumstance or categories of violence. In our society, males and females have different roles and preoccupations. Traditionally, females are home keepers while men are expected to work and fend for their families. Thus, violence in residential quarters was mostly a female problem while business and work-related violence was found more common in males. In addition, women do not traditionally own land in our society so land-related violence was, in our study, found to be predominantly a male issue.
The low figure (2.3%) of intimate partner violence recorded in this study stands in sharp contrast to findings in recent community surveys, and is most likely due to underreporting of this category of violence to the police. Ezeudu et al. (2019) reported 43.7% prevalence of intimate partner violence one year before pregnancy, in 702 women attending antenatal clinics in Enugu State. Similarly a survey of 300 women in south western Nigeria reported ever-experienced spousal violence prevalence rate of 47.3% and spousal violence prevalence rate of 32% in the 12 months preceding the survey (Akinsanya and Odusina, 2012). In another study, Anolue and Uzoma ( 2017) found a prevalence of 56% among 682 women surveyed in a community setting. There are cultural and societal norms which dissuade partners in abusive relationship from reporting to police and legal authorities. For this type of violence to be curtailed, a program designed to encourage victims of domestic violence to report is needed. Such program should include divesting the framework for receiving complaints of domestic violence from the Police authorities whose operational procedure in Nigeria can be quite harrowing for both victim and assailant. In addition, introduction of a standardized protocol could streamline and improve evidence gathering as well as health management of victims of sexual violence (Zerbo 2018).
This study also shows that cranio-facial region received the most injuries in interpersonal violence. This may be due to the fact of its exposure and accessibility. We also found frequent injuries to the upper limbs. This is not surprising given that the upper limb is, by reflex, deployed in defense during assaults.
Objects deployed as weapons of assault included bottles, wood, workman tools, knife and gun. A motley of other objects such as razor blade, metal keys, hot pressing iron, elephant tusk, pestle and leather belt were also used. Body parts were readily used. The array of weapons suggest that most times, whatever object was handy in the heat of conflict became a weapon of assault. Guns were only involved in seven of the incidents and on these occasions, they were rather used as bludgeons (gun whipping) instead of firearms. This suggests some restraints and reluctance to kill in some of these incidents. Few private individuals own guns in Nigeria, as gun ownership requires strict licensing process.
Regarding the type of injury sustained, 32% frequency of laceration seen in our study is less than 41% reported by Nkombua ( 2007) but more than 16% frequency in the study by Brink et al. (1998) who also observed that “pattern of assault injuries may differ between countries and communities due to cultural and social factors and tradition.” In addition, more than 70% of the weapon or mechanism of assault in our study had capacity for inflicting only blunt injuries and this may explain the level of laceration seen in our study.
All subjects in this study were referred to us by the police and this could have introduced some form of bias and limited the number and spectrum of interpersonal violence seen in this study. Many people in Nigeria are overly cautious of dealing with the police authorities because of the difficulties of making a case. This fact was very much demonstrated by Olasoji and colleagues in a study comparing the rate of reporting of assault cases to the police authorities and to the Accident and Emergency unit of a university teaching hospital in Maiduguri, Nigeria. In their study, 58% of the cases presenting at the accident and emergency reported to the police while 42% preferred not to involve the police. In addition, only 41% of cases reported to the police were captured in police records (Olasoji et al. 2005).
Violence is a legal and criminal justice issue as well as a public health concern. Confronting violence with the public health approach requires epidemiological studies to determine the major risk factors and priorities for action.
