Asmamaw Atnafu Ayalneh ¹ Endalamaw Salelew ² Samrawit Mihret Fetene ¹ Wubshet Debebe Negash ¹ Adane Kebede ¹ Tsegaye Gebremedhin Haile ¹ Melaku Birhanu Alemu ¹ Jinha Park ³ Selamawit Tefera ³ Bruhtesfa Mouhabew Alene ⁴ Endalkachew Dellie ^5*

• ¹ Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ² Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ³ KOFIH Ethiopia offices, Addis Ababa, Ethiopia
• ⁴ Institute of technology, Department of biomedical engineering, University of Gondar, Gondar, Ethiopia
• ⁵ Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, University of Gondar, Gondar, Ethiopia

Background: Gender-based violence (GBV) was one of the major problems that women and girls encountered during the conflict between the Ethiopian federal government and the Tigray People's Liberation Front (TPLF). However, there was an evidence gap about the problem of gender-based violence victims caused by the ongoing conflict in these areas. Therefore, this study aimed to assess the prevalence of GBV and its contributing factors in the conflict-affected northeastern Amhara region of Ethiopia.Methods: A community-based cross-sectional study was conducted from July 7 th to September 30 th , 2023, among 597 women and girls who lived in the three most conflict-affected districts (Wadla, Lay-Gaynt, and Meket) in northeastern Amhara regional state of Ethiopia. GBV was assessed using the WHO multi-country study on women's health and domestic violence against women questionnaire, which has 13 items and measures three violence domains (emotional, physical, and sexual). The analysis was conducted using SPSS version 20 software. Factors that showed significant association with GBV at p-values less than 0.2 in the bi-variable binary logistic regression analysis were included in the multivariable model. The significantly associated factors with GBV were determined using the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a p-value of <0.05 in the multivariable model.The study found that the overall prevalence of gender-based violence was 39.0% (95%CI: 35.2-43.6). Among the participants who experienced GBV, 36.7% experienced emotional violence, 15.4% experienced physical violence, and 8.9% experienced sexual violence. Factors such as being divorced, low social support, witnessing family violence, substance use, and participation in war were positively associated with GBV. 4 Conclusions: Two-fifths of women and girls in the conflict-affected areas of the northeastern Amhara region were experiencing violence. This indicates the urgent need for collaboration between healthcare managers and policymakers to address victims of gender-based violence in conflict-affected areas. Efforts should focus on enhancing social support systems and addressing substance use to mitigate this pressing problem.