Social comorbidities? A qualitative study mapping syndemic theory onto gender-based violence and co-occurring social phenomena among Brazilian women

Intimate partner violence and its correlates in middle-aged and older adults during the COVID-19 pandemic: A multi-country secondary analysis

Intimate partner violence (IPV) may have been exacerbated during the COVID-19 pandemic. Middle-aged and older adults, ages 45 years or older, are at higher risk of COVID-19 mortality and social isolation. However, most studies on IPV during the pandemic do not focus on this important subpopulation. Informed by the social-ecological theory, this study examines individual, household, community, and country-level correlates of IPV among middle-aged and older adults in multiple countries using a cross-sectional online survey. Data from 2867 participants aged 45 or older in the International Sexual Health and Reproductive Health (I-SHARE) survey from July 2020 to February 2021 were described using univariate analysis. IPV was defined using four validated WHO measures. Individual characteristics included self-isolation and food security. At the country-level, we examined social distancing stringency. Logistic regression models with a random intercept for country were conducted to explore IPV correlates among 1730 eligible individuals from 20 countries with complete data. Most participants were heterosexual (2469/2867), cisgender (2531/2867) females (1589/2867) between the ages of 45-54 (1539/2867). 12.1% (346/2867) of participants experienced IPV during social distancing measures. After adjustment, participants who self-isolated experienced 1.4 (95% CI 1.0, 2.0, p = 0.04) times the odds of IPV compared to those who had not isolated. Those who reported an increase in food insecurity compared to pre-pandemic experienced 2.2 times the odds (95% CI 1.6, 3.0, p<0.0001) of IPV compared to those who did not report increased food insecurity. People in countries with more stringent social distancing policies were less likely to experience IPV compared to people in countries with lower levels of stringency (aOR = 0.6, 95% CI 0.4, 0.9, p = 0.04). IPV was common among middle-aged and older adults during the COVID-19 pandemic. Our data suggest the need for further crisis management and social protection measures for middle-aged and older adults who have intersecting vulnerabilities to IPV to mitigate COVID-19 impact.

Women Abused: Analysis of Assistance Provided by Urgency Mobile Service

Considering that reports of violence against women must come after a victim seeks help, the subject matter transcends health-related issues. In Brazil, mobile urgency services (SAMU/SIATE) frequently provide first aid to these women and, to the best of our knowledge, no other research has specifically examined the first reaction given to these women. The present study aimed to analyze SAMU/SIATE assistance to abused women in a cross-sectional study of the assistance to assaulted women provided by SIATE and SAMU Maringá/Norte Novo between 2011 and 2020. Women between 20 and 39 years old, non-pregnant, were the main victims, and 19.52% of them have used drugs of some kind. The (ex) partner figured as the perpetrator in 17.35%, but there was no information about this variable in 73.75% of the records. The Chi-square test shows a mortality rate superior to 70% among the severely traumatized victims. This is the first research work to examine the kind of care that SAMU/SIATE offers, and it identifies several weaknesses in its "modus operandi" that may prevent the results from being applied to larger contexts. In addition, further studies on mobile urgent care services in other provinces are required in order to suggest ways to lessen this epidemic.

Social Determinants of Child Undernutrition in Adivasi Population in Northern Kerala: A Study Using Syndemic Framework

OBJECTIVES

To understand the complex interaction of structural inequalities, co-occurring health conditions, and child undernutrition among the Adivasi population in North Kerala, India.

METHODS

A mixed-method approach was employed in this study, which combined a cross-sectional survey and a case study design. A multistage cluster sampling method was used to select 167 children aged 24 to 60 mo from the study population. The mothers of these children were interviewed using a structured questionnaire to assess individual, parental, and household-level factors associated with child undernutrition. Two Paniya settlements, one with a high prevalence of child undernutrition (HPS) and the other with a low prevalence (LPS), were chosen as the primary units of the case study.

RESULTS

The study found that the absence of a kitchen garden with fruits and vegetables [adjusted odds ratio (AOR) 2.85; 95% confidence interval (CI): 1.04-7.81] and a history of cough and fever (AOR 2.93; 95% CI: 1.24-6.93) were both associated with a higher risk of undernutrition in children. The case studies revealed that Adivasi children are undernourished due to a complex set of factors that persist throughout their lives, including unequal access to social capital, healthcare, and food security, as well as differences in hygiene practices due to the lack of access to clean water and sanitation.

CONCLUSIONS

The findings underscore the need for social interventions to complement the current focus almost entirely on food supplementation programmes. Equitable action on Adivasi child malnutrition requires urgent policy and programmatic attention to social inequalities and access to basic amenities in Adivasi areas.

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review

BACKGROUND

Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes.

METHODS

A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included.

RESULTS

Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes.

CONCLUSIONS

Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.

Time trend and spatial distribution of the cases of lethal violence against women in Brazil

OBJECTIVE

to analyze the time trend and the spatial distribution of the cases of lethal violence against women in Brazil, according to age group and to race/skin color.

METHOD

an ecological study of time series, with spatial distribution of the deaths of women victims of aggression, registered in the Mortality Information System, resident in Brazil, Brazilian geographic regions and states. Due to underreporting of deaths in some states, correction factors of the mortality rates were employed. For the trend analysis, we adopted the polynomial regression model. In addition to that, the mean rates and annual upward/downward trends were distributed considering the Brazilian federative units as analysis units.

RESULTS

the mean rate was 6.24 cases of lethal violence per 100,000 women, with a significant variation across the Brazilian regions and states. The main victims of violent death in Brazil are young, black-/brown-skinned and indigenous women, with a growing trend in these population segments. The North and Northeast regions stood out with the most significant mean annual increases (0.33; r2= 0.96 and 0.26; r2= 0.92, respectively).

CONCLUSION

there was a stable trend regarding lethal violence against women, with significant regional differences. Young, black-/brown-skinned and indigenous women are more vulnerable to violent death in Brazil.

2020 Syndemic: Convergence of COVID-19, Gender-Based Violence, and Racism Pandemics

OBJECTIVE

To conduct a rapid knowledge synthesis of literature on the social determinants of mental health of racialized women exposed to gender-based violence (GBV) during the COVID-19 pandemic.

METHODS

We adapted the Cochrane Rapid Reviews method and were guided by an equity lens in conducting rapid reviews on public health issues. Four electronic databases (Cochrane CENTRAL, Medline, ProQuest, and EBSCO), electronic news media, Google Scholar, and policy documents were searched for literature between January 2019 and October 2020 with no limitations for location. Fifty-five articles qualified for the review.

RESULTS

Health emergencies heighten gender inequalities in relation to income, employment, job security, and working conditions. Household stress and pandemic-related restrictions (social distancing, closure of services) increase women's vulnerability to violence. Systemic racism and discrimination intensify health disparities.

CONCLUSION

Racialized women are experiencing a 2020 Syndemic: a convergence of COVID-19, GBV, and racism pandemics, placing their wellbeing at a disproportionate risk. GBV is a public health issue and gender-responsive COVID-19 programming is essential. Anti-racist and equity-promoting policies to GBV service provision and disaggregated data collection are required.