Marital dissolution and associated factors in Hosanna, Southwest Ethiopia: a community-based cross-sectional study

Background Marriage dissolution, divorce, or separation from a spouse or common-law partner is a serious public health concern due to its increasing prevalence and devastating health and socio-economic consequences. Evidence suggests an increased risk of marital instability in Ethiopia. In addition, the extent of marital dissolution and other related factors have increased in the study area. Despite these, the prevalence of marital dissolution and the influence of associated factors (main reason for marriage, and parental history of marital dissolution) on marital dissolution has not been assessed in the study area. Therefore, the aim of this study was to investigate the prevalence of marital dissolution and its associated factors among residents of Hosanna town in southwestern Ethiopia in 2022. Methods We conducted a community-based cross-sectional study among 459 randomly selected Hosanna Township residents. We used structured questionnaires to collect data. Descriptive statistics and logistic regression were performed to describe the data and test-associated factors, respectively. A p-value less than 0.05 was used to define statistical significance. We used STATA 14 and IBM SPSS 25.0 computer packages to process data. Results Out of the 459 potentially eligible individuals, 450 participants properly responded to the questionnaires yielding a response rate of 98.04%. Of these, 218 (52.9%) were female. The commonly reported reason for marriage was to have children 150 (36.9%). The prevalence rate of marital dissolution was 26.0% (95% CI: (21.7%, 30.3%)). The participant's level of education and the primary reasons (motives) why they get married were statistically significantly associated with marital dissolution. The odds of marital dissolution was higher among participants who completed secondary education (AOR = 3.2, 95% CI = 1.26–8.17) compared to those having no formal education. The participants who married for companionship reasons (AOR = 0.31, 95% CI = 0.11–0.83) had significantly lower odds of marriage dissolution compared with those who married for financial security. Conclusions In this study, the prevalence of marital dissolution was high. The participant’s level of education and the primary reasons (motives) why they getting married were significantly associated with marital dissolution. Therefore, an integrated, community-based approach should be developed to prevent marital dissolution.

recognized as a lifetime commitment and ended due to the death of either of the partners [4]. However, empirical research suggests that the world is in a state of transition in the characteristics of bond formation and marriage dissolution [5]. Moreover, there is a growing acceptance of marital dissolution, weakening of marital bonds, and increased opportunity for marital instability [5]. Consequently, the magnitude of marital dissolution is rising Worldwide [6,7].
Marital dissolution is one of the major social determinants of health and attributes to the majority of chronic physical and mental health disorders [1,8]. It has been linked to worsening mental and physical health problems [1,8]. Marriage dissolution affects health in different ways. Like most stressors, marital discord can lead to the production of stress hormones, which can lead to chronic systemic diseases [9]. More commonly, anxiety, depression, and cardiovascular disorders are the commonly reported physical and mental health problems after marriage dissolution [1,8,10]. In addition to physical and mental illnesses, it is also known to be associated with injuring oneself with the intent to die. A previous study [11] speculated that marital dissolution is associated with an increased risk of suicidal ideation. It has copious consequences on children's psychological and physical wellbeing [12].
Furthermore, it exposes people to health risk behaviors such as changes in eating patterns and heavy alcohol consumption [13], and multiple sexual partners [14,15]. Correspondingly, having multiple sexual partners seems to be a common problem that divorced/separated women were more likely to report five or more lifetime sex partners than never-married women [16].
Determining the rate of marital dissolution and potential associated factors is important for developing strategies to reduce the risk of divorce. Furthermore, it is used to notify researchers, programmers, and policy-makers about the burden of marital dissolution, thereby supporting the process of mitigating the problem [17]. Previous researchers have found inconsistent findings on the proportion of marital dissolution and the effect of partners' socio-demographic characteristics on the risk of marital dissolution [1,16,18,19]. Moreover, most previous studies have used secondary data and have focused on divorce, not separation [18,20,21].
With the above issues in mind, this study assessed the factors associated with marital dissolution. The variables considered as associated factors in this study were the parental marital dissolution history, marital-related characteristics of spouses (the main reason for getting married, how many times have marriage concluded), and the information (knowledge and skill) about their marital relationship. These variables were selected based on their association with marital dissolution [22][23][24][25].
Based on prior studies [24,26], we hypothesized that parents' divorce/separation history has an association with their children's marital dissolution suggesting that couples whose parents were divorced/separated had a higher risk of marital dissolution compared to couples whose parents were not divorced or separated. Empirical studies [24,27] have shown that most children of divorced/separated parents experience emotional and communication problems, lack of commitment and selfconfidence in marriage [24,27]. These can subsequently harm future child marriage relationships. However, previous studies did not show the association between parental divorce and children's marital dissolution but rather the effects of parental divorce on children's behavior.
Furthermore, we hypothesize that the main reason for marriage is related to the dissolution of the marriage. A previous study identified that, one of the reasons related to marital dissolution was premarital reasons such as the clear purpose of marriage and the reasons for it [28]. The specific reasons (for financial reasons, to get children, for companionship, and or for falling in love) and their relationship to the marital dissolution have not been assessed.
In addition, we also hypothesize whether the number of marriages (first, second, third, etc.) contributes to the dissolution of marriage. Previous studies have assessed the association between the number of marriages and reported inconsistent results. Compared with firstmarried adults, remarried adults have positive attitudes toward divorce and are more likely to file for dissolution when experiencing marital distress [24]. However, another empirical study reported that the association between the number of marriages and marriage dissolution was questionable and suggested future research [25].
This study also hypothesizes that the marital information (knowledge and skills) possessed by partners is related to marital dissolution. Previous research has shown that factors such as lack of knowledge about marriage and relationship-building skills are significant predictors of marital breakdown [29]. It was also noted that married people who did not have basic information about their relationship experienced more problems in their marriage [30].
The effects of some of the aforementioned factors such as parental divorce/separation history, the main reason for marriage, and the number of marriages (first, second) were not assessed at the population level in the study area. Therefore, the aim of this study was to investigate the prevalence of marital dissolution and its associated factors among residents of Hosanna town in southwestern Ethiopia.

Study design
A community-based cross-sectional study was conducted to assess the prevalence (point-prevalence) of marital dissolution among Hosanna residents.

Study setting
This study was conducted in Hosanna town. Hosanna is the administrative and commercial center of the Hadiya Administrative Zone in the Southern regional state of Ethiopia. It is located 232 km South West of Addis Ababa. As for demographic characteristics, the population of Hosanna has been rapidly growing since its inception. According to the housing and population census of Ethiopia, the population of the Town was 13,467 in 1984, and (31,701) ten years later in 19,944 [31]. In 2007, Hosanna had a population of 69,995 people [31]. According to Hosanna Municipality and the Ethiopian Demographic and Health Survey [31], the town of Hosanna is divided into six Kebele (smaller administrative units in Ethiopia). We used this pre-arranged structure of the town for the current study.
In Ethiopia, only Twenty-seven percent of women aged 15-49 have never married and 11 percent are divorced. Correspondingly, less than one percent of women aged 45-49 have never been married indicating that both marriage and marital dissolution are universal in Ethiopia [32]. Recruitment of participants and data collection were carried out from February 1 to March 30, 2022.

Participants
Individuals who lived in Hosanna town and were able to answer specific marital questions were included in this study. We used marital-specific questions such as the "current marital status, " "the prime reasons for getting married", "age at marriage", and "parental marital dissolution history", to consider people as eligible for this study. These variables were considered because they were associated with marital dissolution, which was the outcome variable of this study. The prospective study participants were recruited from the framed source population. Those who met the eligibility criteria were included in the study population. We obtained the data of details of the existing government structure, the number of Households, and the total number of people living in each administrative unit of the Town from Hosanna Town Municipality, Kebele Administrations, and Urban Health Extension workers. The research team included field supervisors and data collectors.
The first eligibility criterion was living in Hosanna Town. Since this study was carried out in Hosanna, people who have been living in Hosanna Town for at least six months were included in the current study. We assessed this criterion by asking participants. The ever-married individuals with a marriage history: currently married (in marital union during the data collection period), divorced, or widowed were included in the study without age and sex restriction. In contrast, a few individuals who refused to participate in the study and were unable to provide adequate information due to health problems at the time of data collection were excluded from the study.

Variables and definitions
The prevalence of marital dissolution is the outcome of this study. The prevalence of marital dissolution was determined from the study sample. In other words, we estimated the point prevalence of marital breakdown (divorce or sedation) from the study sample that was identified during the data collection period. The marital specific characteristics prime reasons to get married, age at marriage, type of marriage, forms of marriage, parental marital dissolution history, General health status (presence of known chronic illness), behavioral correlates(substance use, Communication problem, conflicting behavior, marital commitment), and socio-demographic factors(sex, religion, level of education, house ownership) were the independent variables.
In this study, marriage was defined as the legal or formal union of two people (of the opposite sex), a man and a woman, as partners in a personal relationship. Moreover, divorce was defined as the legal termination of a marriage, the separation of husband and wife which confers on the parties the right to remarriage according to the laws of each country [33,34]. Whereas, separation refers to the termination of a marriage on the basis of civil, religious, and/or other traditional provisions without conferring on the parties the right to remarry [33,34]. Correspondingly, marital dissolution is defined as the termination of a marital relationship as a result of divorce or separation [33,34].

Data sources and measurement
In this study, we collected raw data directly from the study participants. Thus, the study participants were the data sources. Data were collected using a series of forms completed using face-to-face interview techniques. The form includes demographics, general health, and marriage-specific characteristics.
Data were collected using a structured questionnaire. A questionnaire was developed by reviewing relevant literature [22,23,[33][34][35][36][37][38][39]. It was prepared in English and translated into Amharic. The questionnaire had three parts, the first part contained four questions and was about the socio-demographic characteristics of the individual participants, the second part contained three questions designed to collect data on general health and health risk behavior, and the third part contained eleven items designed to assess the marital specific characteristics and marital dissolution.
The questionnaire was pre-tested on 10% of the sample in an adjacent Town (Durame, capital town of Kembata Zone) where the study didn't take place. Therefore, a modification was made based on the results of the pre-test, and the modified version was used for actual data collection. The internal consistency of the items in the questionnaire was acceptable with the value of Cronbach's alpha (0.71), exceeding the index of 0.7 [40,41].
Prior to data collection, the data collectors and supervisory teams contacted officials of each administrative unit with official letters. The households and individual participants were selected with the help of a guide from the respective administrative units. After contacting these individuals, the details of the concern of the team were explained to each participant by the assigned team leader, and the process of informed consent was secured.
Prior to the participant recruitment and data collection process, the research team received two days of training (basic principles of research ethics, data collection tools, and the roles and responsibilities of each team member). Six first-year health science students collected data. Two public health professionals were assigned to supervise the data collection process. The investigators of the research project coordinated the entire fieldwork.

Bias
Depending on the study design different techniques were undertaken to ascertain both the selection and information bias in this study. In the selection stage, the study participants were randomly selected based on the predetermined criteria and included in the study. During the data collection process, revisits were scheduled to complete the missed data and reduced the information bias [42]. Furthermore, several individuals participated in the data collection to enhance the depth of the findings. The training was given to data collectors to familiarize them with the local culture, research instruments, and principles of research ethics. Statistical procedures were also performed to treat information bias due to missing data [42].

Study size and sampling techniques
We used a single population proportion formula to determine the number of individuals to be included in the study [43] that is appropriate for the estimation of a single proportion [44]. The proportion of marital dissolution was obtained from a previous study (45%) [20], estimated with 95% confidence and 5% precision, and took into account a 20% non-response rate to determine the sample size. Consequently, the sample size was 459.
This sample size was proportionally allocated to each Kebele based on the number of households in each Kebele (Fig. 1). The town of Hosanna is divided into six kebels. We used this pre-arranged structure of the town to frame the current study. We used the STAT CALC program of the EPI INFO statistical package to calculate the sample size.
A simple random sampling technique was employed to select the study participants. The list of Households in each sub-cities that were documented in the respective administrative units was used to select the study participants. We first randomly assign a numeric code from one to six to each of the six sub-cities. Arada 1 is the first English alphabet letter, Bobicho 2, Heto 3, Sech Duna 6, and so on. Depending on the number of Households in each Sub-cities, we assigned four-digit alpha-numeric codes for each household. For example in Sech Duna Kebele there are three thousand six hundred and twentynine registered Households, so, the code for the first Household was 6 and the code for the last Household was 30,629. Correspondingly, there were forty-thousand two hundred and fifty Households in Bobicho Kebele, the code for the first Household was 2 and the code for the last Household was 40,250. A similar procedure was followed to code and select study participants in all Kebele. Finally, among all households, randomly selected households using computer-generated numbers were included in the study. In situations where there was more than one person who satisfy the inclusion criteria in a given household, an individual was selected using a simple random technique (lottery method) and included in this study These codes, which we posted on the existing family archives, were removed as soon as the data collection process was completed.

Statistical methods
The collected data were coded, cleaned, and entered into IBM SPSS 25 (International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) for Windows version 25 for analysis. We described the sample using frequencies, percentages, and diagrams. The distribution of the data set was tested using statistical tests (Shapiro-Wilk test, and Kolmogorov-Smirnov test) and graphical (histogram) methods [45].
We used logistic regression (bivariate and multivariate) analysis to assess whether there was a significant association between the associated factors and dependent variables. Before fitting the final model and reporting the results, we performed the necessary evaluations, including Multicollinearity and goodness-of-fit tests. Therefore, the Variance Inflation Factors (VIFs) test was used to assess the Multicollinearity among the independent variables, and those that showed no Multicollinearity were fitted to the multivariable logistic regression model through a backward stepwise method to reduce the effects of cofounders. The variables with a p-value of < 0.2 in the Bivariable analysis were considered for multivariable logistic regression analysis.
The Hosmer-Lemeshow goodness-of-fit statistic was used to check the model fit. We used the adjusted odds ratio with a 95% confidence interval to examine the strength and direction of the association between the independent variable and the outcome variable. A P-value of less than 0.05 [46] was used to define statistical significance. Finally, the findings were presented in the form of tables, graphs, and text. STATA 14 software package (Stata Corporation, College Station, Texas, 77,845, USA) and IBM SPSS 25.0 was used for data analysis.

Participants
Out of the 459 potentially eligible individuals, 450 participants responded to each item listed in the questionnaires yielding a response rate of 98.04%.Overall, the data of 450 participants were included in the analysis. Of these, 218 (52.9%) were women. The age of the study participants was measured in years with a mean age of 36.91 years and a standard deviation (SD) of 6.67 years.
Details of the background characteristics of participants are depicted in Table 1 below,

Marital-related characteristics of study participants
Of a total of 450 participants, 407 (90.4%) had a marriage history, from which the majority of them 241(59.2%) did not get marital information regarding the reasons for getting married; 150(36.9%) of study participants chose to get married to have children. Two hundred and fourteen (52.6%) of ever-married participants reported marital conflicts and conflicts often occur during illness72 (33.6%) and holidays.72 (33.6%) ( Table 2).

The prevalence of marital dissolution
The analyses of the prevalence of marital dissolution in the total sample suggest that 106 (26.0%) [95% CI: (21.7, 30.3)] of study participants reported that they had experienced marital dissolution. The proportion was 41 (38.7%) for males and 65(61.3%) for female participants. Correspondingly, the prevalence of marital dissolution is higher in those who reported no marital education (65 (61.3%)) compared to participants who ever had marital education (41 (38.7%)). The 57 (53.8%). participants reported the individual partners' behavioral factors as a major reason for marital dissolution (Fig. 2). Of those who experienced marital dissolution, 68.9% of them reported no parental history of marital dissolution and 28.3% had a parental history of marital dissolution.

Logistic regression findings
The p-value of the final model is greater than the conventional threshold (0.05), indicating that the model fits well (chi-square = 4.323, P-value = 0. 827) [39],47. A VIF closer to 1 for a given range of independent variables (1.01-1.05) indicates the absence of Multicollinearity among the predictors in the model [48]. The binary logistic regression analysis showed that the participant's level of education and the primary reasons (motives) why they got married were statistically significantly associated with marital dissolution In multivariate analysis (Table 3), participants who had completed secondary education had higher odds of marital breakdown than those with no formal education (AOR: 3.2, 95% CI 1. 26-8.17). On the other hand, although more women reported marital dissolution, the association was not statistically significant (P-value = 0.24). Nonetheless, participants who married for companionship reasons (AOR = 0.31, 95% CI = 0.11-0.83) had significantly lower odds of marital dissolution compared with those who married for financial security.

Discussion
This study aimed to investigate the prevalence of marriage dissolution among married people in Hosanna Township. The prevalence of marital dissolution in this study area was 26.0%, which was comparable to that of study in Ethiopia, where approximately 25% of married women were reported to be divorced from their first relationship [18]. However, the results of this study was lower than the reported rate of marital dissolution in Ethiopia. 45% of first marriages in Ethiopia end in divorce [20]. Furthermore, this finding is much higher than the Ethiopian Demographic and Health Survey report (2019), which showed that 6% of women (15-49 years) in Ethiopia were divorced or separated in Ethiopia [32].
Differences in the methods used, as well as the composition of the study populations, could explain the observed discrepancies between previous and current findings. For example, previous studies used National Family and Fertility Survey data and restricted  group [20]. This finding builds on existing evidence showing the prevalence of marriage dissolution remained high in Ethiopia.
This finding raises concerns over the social tie in the community. Marriage is a huge social institution [49] and a foundation for society [22]. It is concluded through religious doctrines, traditional ceremonies (customs of the society in which it is found) [50], or a public act [51]. It is governed by the codes of ethics and family law [35]. On the other hand, divorce, or marital dissolution is a judicially administered process that legally terminates a marriage that permits remarrying [35]. So, a disturbance in  this institution indirectly reflects the weakening of the social tie and the erosion of the entire system surrounding marital relations in Ethiopia. Further, the cross-tabulation analysis revealed that more women (61.3%) than men (38.7%) reported marital dissolution. The logistic regression findings revealed a negative relationship between the highest level of education and marital dissolution, meaning that people who have completed secondary education were more likely to have marital dissolution compared to those who had no formal education. This finding is consistent with previous reports showing how education level affects the presence of marriage dissolution [36,37]. Again, this study was consistent with previous reports in Ethiopia [39].
In contrast to this, a previous study reported that individuals who did not attend formal education had higher odds of experiencing marital dissolution [18]. Recent research has also concluded that marriages with at least one highly educated partner are less likely to divorce than uneducated couples [52]. Furthermore, another study in rural South Africa indirectly revealed the effect of education on marriage dissolution and reported that those with higher education were more likely to remain in one marriage than those who had never attended school [19]. Being limited to women and methodological differences between the previous and the current study could more likely explain the observed differences [18].
The negative aspects of education, for instance, giving more credit to scientific issues over social and religious values, the tendency to look at more options, the need not want to live deprived of one's rights, and coping with post-divorce/separation social and economic problems, etc., could more likely explain the negative effects of education on marital dissolution. Most distressed couples prefer to stay together rather than file for marital dissolution due to fear of the negative consequences of marital dissolution on their life and children [53].
In Ethiopia, couples who wish to divorce or separate are notified "You considered the consequences before you rush to divorce/separate?" by their family, court judges, and friends. Educated people will be better able to cope with the social and economic consequences of marital dissolution. Second; it is well-known that people with higher education tend to understand their roles and responsibilities [54]. Whereas, if either or both spouses fail to fulfill their obligations and put undue pressure on each other, the marriage may end in divorce or separation.
In addition to the effect of level of education, the present study also assessed the association between the circumstances of entry into marriage (prime reason to get married) and marital dissolution and identified that the proportion of marital dissolution was significantly lower among participants who get married to get children and for companionship reasons compared to those who get married with motives (such as for financial security (arranged marriage)).
We were unable to find similar studies that directly described the effects of arranged marriages (marriages entered into for financial security) on marriage dissolution. However, previous studies consistently reported the negative effect of "arranged marriages" (marriages proposed by other people for various reasons than by mates for love and companionship [23] on marital dissolution The risk of divorce was more common among residents whose marriages were arranged.
On the other hand, romantic marriages were stable because they were based on affection between the two individuals [38]. It is generally observed that the risk of marital dissolution was low among partners who get marry for love and companionship compared to those for financial security. Marriage is one of the ancient and socially acceptable companionships between a man and a woman, which is regulated by beliefs, customs, laws, and attitudes that prescribe the rights and duties of the partners [33,55]. It must then be based on love and the free will of the couple. In contrast, pre-arranged and moneyoriented marriages should be discouraged. The strength of this study is that it was based on a simple random sampling technique and therefore, the findings can be generalized to the studied population [56]. The limitation of the present study is that the temporal link between the outcome and the exposure cannot be established because data were collected at one point in time.

Conclusions
In conclusion, Ethiopia has a high marital dissolution rate. A partner's level of education and the primary reasons surrounding entry into marriage are the predictors of marital dissolution. Preventing arranged marriages, such as those for economic security, and developing strategies to balance marital relationships and education will reduce the rate of marriage dissolution in Ethiopia.
Notably, this research highlights the fact that unless corrective measures are taken, marital dissolution is likely to escalate further. This event infers the need for urgent and integrated actions to assure strong, happy, and enduring marriages. Society is also recommended to discourage marital dissolution and arranged marriages (marriages for social, economic, or other purposes than for love and companionship between the partners) to increase the likelihood that people have an enduring and presumably happier family life.