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Mendes RCMG, da Silva GP, Perrelli JGA, Pontes CM, Pascoal LM, Lira ALBDC, Lopes MVDO, Mangueira SDO, Linhares FMP. Disrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory. Rev Bras Enferm 2024; 77:e20230464. [PMID: 39082549 PMCID: PMC11290727 DOI: 10.1590/0034-7167-2023-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/23/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES to develop and evaluate a Middle-Range Theory for the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" in high-risk pregnancies. METHODS this methodological study was conducted in two stages: theory development and evaluation. Dorothea Orem's General Nursing Model was used as the theoretical-conceptual foundation. Evaluation was conducted using the Delphi method with seven judges, and consensus was achieved when the Content Validity Index of the evaluated items was ≥ 0.80. RESULTS the theory identified 20 elements of the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" (10 risk factors, 4 at-risk populations, and 6 associated conditions), 14 propositions, and 1 pictogram. After two rounds of evaluation, the theory was considered consistent, with consensus reached for all items, each achieving a Content Validity Index ≥ 0.80. CONCLUSIONS the Middle-Range Theory included biopsychosocial factors explaining the nursing phenomenon "Disrupted Mother-Fetus Dyad Risk," which aids in nurses' diagnostic reasoning.
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Boru TM, Tefera EG, Bulto GA, Doba YS, Wakgari N, Roga EY, Ganfure G, Geda GM, Erena MM. Maternity waiting home utilization among women who gave birth in the pastoralist communities of Borana Zone, Ethiopia: A community-based mixed-method study design. Heliyon 2024; 10:e32925. [PMID: 38988556 PMCID: PMC11234036 DOI: 10.1016/j.heliyon.2024.e32925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/12/2024] Open
Abstract
Background Maternity Waiting Home (MWH) utilization is valuable for enhancing maternal and neonatal health service utilization. Although few studies have been conducted in non-pastoral areas, more evidence is needed from pastoralist communities. Hence, the study aimed to assess the utilization of MWH and its associated factors among women in pastoralist communities in Ethiopia. Methods A concurrent mixed-method design was conducted from 10 Augustto15 September 2021. The cluster sampling technique was used to select the study participants. Qualitative data was collected through focus group discussions and in-depth interviews. Multivariable logistic regression analysis is used to identify significant factors. Qualitative data were thematically analyzed and triangulated with quantitative findings. Results Only 13 % (95%CI:10.5-15.6) of women had utilized MWHs. Husbands participation in antenatal care (AOR = 5.54, 95%CI: 2.14-14.35), having caregivers at home (AOR = 2.59, 95%CI: 1.14-4.86), attending pregnant-women conferences (AOR = 5.01, 95%CI: 2.17-11.49), the husband received information about MWH (AOR = 3.6, 95%CI: 1.54-8.49), favorable attitude towards MWH (AOR = 3.15, 95%CI:1.47-6.77), birth during the rainy season (AOR = 0.35, 95%CI: 0.15-0.81) and residing within 10 km of a health center (AOR = 0.15,95%CI:0.04-0.58) were significantly associated with MWH utilization. The main themes that emerged as barriers to MWH utilization were lack of awareness, availability and accessibility of the services, norms and perceptions, lack of decision-making power, family support and women's workload. Conclusion The study found low utilization of MWHs. Husbands' involvement, having information about MWHs, a favorable attitude, the season of birth, and distance were significantly associated. Lack of transportation access, norms, and limited awareness of MWH were also found to be barriers to service utilization. Health education to raise awareness about the importance of MWHs, enabling transportation access, husbands' involvement, and encouraging women to take an active role in household decision-making are crucial to boosting MWH utilization.
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Affiliation(s)
| | - Eden Girmaye Tefera
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Yonas Sagni Doba
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hosana, Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Ephrem Yohannes Roga
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gemechu Ganfure
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gonfa Moti Geda
- Department of Medicine, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Maru Mossisa Erena
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Nguefack-Tsague G, Amani A, Dadjie VD, Koyalta D, Carole DN, Dissak-Delon FN, Cheuyem FZL, Dongmo GPL, Anastasie CM, Mviena JLM, Kibu O, Ngoufack MN, Sida MB, Juillard C, Chichom-Mefire A. Gender-based violence and its health risks on women in Yaoundé, Cameroon. Arch Public Health 2024; 82:90. [PMID: 38886777 PMCID: PMC11184865 DOI: 10.1186/s13690-024-01308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Gender-based violence (GBV) is a major public health problem that disproportionately affects women. In Cameroon, as well as other countries worldwide, GBV has immediate effects on women's health, with one in three women experiencing physical or sexual violence from an intimate partner, affecting their physical and reproductive health. The objective of this study was to determine the health risks associated with GBV among women in Yaoundé. METHODS A cross-sectional study was conducted in Yaoundé (Cameroon), from August to October 2022. Adverse health outcome included mental disorders, physical trauma, gynaecological trauma, behavioral disorders, and any other disorder. Tests of associations were used to establish relationships between qualitative variables. Associations were further quantified using crude odds ratio (OR) for univariate analysis and adjusted odds ratio (aOR) for multivariate analysis with 95% confidence interval (CI). Independent variables included: Physical violence, Sexual violence, Economic violence, Emotional violence, Age, Number of children, and Marital status. Variables with p-value˂0.05 were considered statistically significant. RESULTS A total of 404 women aged 17 to 67 years were interviewed. Emotional violence was the most commonly reported violence (78.8%), followed by economic violence (56.9%), physical violence (45.8%) and sexual violence (33.7%). The main reasons for violence were jealousy (25.7%), insolence (19.3%) and the refusal to have sexual intercourse (16.3%). The prevalences of adverse health outcomes were physical trauma (90.9%), followed by mental disorders (70,5%), gynaecological trauma (38.4%), behavioral disorders (29.7%), and other (5.5%). Most victims reported at least one of the above-mentioned conditions (80.2%). Women who were victims of any kind of violence had a higher likelihood of experiencing adverse health outcomes: physical violence [OR = 34.9, CI(10.8-112.9), p < 0.001]; sexual violence [OR = 1.5, CI(0.9-2.7), p = 0.11]; economic violence [OR = 2.4, CI(1.4-3.9), p = 0.001]; and emotional violence [OR = 2.9, CI(1.7-4.9), p < 0.001]. Using multiple binary logistic regression, only physical violence [aOR = 15.4, CI(6.7-22.5), p = 0.001] remained highly associated with an increased likelihood of having adverse health outcomes. CONCLUSION This study underscores the urgent need for comprehensive interventions to address GBV, including improved reporting and documentation of cases, increased awareness among healthcare providers, the establishment of support networks for victims, primary and secondary prevention of GBV. It is essential that the Government of Cameroon, through the Ministries in charge of Health and Women's Empowerment, minimizes the health effects of GBV through early identification, monitoring, and treatment of GBV survivors by providing them with high-quality health care services.
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Affiliation(s)
- Georges Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Adidja Amani
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Valérie Djouna Dadjie
- Higher Institute of Medical Technology, Yaoundé, Cameroon
- Challenges Initiative Solutions, Yaoundé, Cameroon
| | - Donato Koyalta
- Département de la Microbiologie, Faculté des sciences de la santé humaine, Université de Ndjamena, Ndjamena, Tchad
| | - Debora Nounkeu Carole
- Ministry of Public Health, Yaoundé, Cameroon
- Challenges Initiative Solutions, Yaoundé, Cameroon
| | - Fanny Nadia Dissak-Delon
- Department of Public Health, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Fabrice Zobel Lekeumo Cheuyem
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | | | | | - Odette Kibu
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | | | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California, Los Angeles, United States of America
| | - Alain Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Lemma T, Silesh M, Taye BT, Desta K, Moltot T, Melisew A, Sisay M, Zeneb W, Dagnaw Y. Knowledge, attitude and practice towards COVID-19 among pregnant women in Africa: A systematic review and meta-analysis. Heliyon 2024; 10:e31926. [PMID: 38882307 PMCID: PMC11177136 DOI: 10.1016/j.heliyon.2024.e31926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Background Pregnant women and recent mothers face a higher risk of severe illness from Coronavirus disease 2019 due to physiological and immunological shifts during pregnancy, rendering them more vulnerable to inflammatory lung conditions. This susceptibility poses serious threats to both maternal and newborn health. Therefore, it is imperative for pregnant women to be fully informed about Coronavirus disease 2019 and to implement preventive measures. This study aimed to evaluate the collective knowledge, attitudes, and practices related to Coronavirus disease 2019 among pregnant women across Africa. Methods The researchers collected studies from multiple databases, including Pub Med/MEDLINE, EMBASE, CINAHL, Science Direct, Scopus, Web of Science, Cochran library, and Google Scholar. A combination of search terms and Boolean operators were utilized to gather relevant literature. Each study underwent quality assessment by five authors independently, using the modified Newcastle Ottawa Scale tailored for cross-sectional research. Statistical analysis was conducted using STATA™ Version 11 software, and meta-analysis was performed using the random-effects (Der Simonian and Laird) method. Heterogeneity was evaluated using I-squared (I2) statistics, and a one-out sensitivity analysis was carried out. Results This systematic review and meta-analysis included 19 articles, involving a total of 7852 participants. It revealed that the combined estimated prevalence of good knowledge about Coronavirus disease 2019, positive attitudes, and good practices among pregnant women was found to be 61.8 % (95 % CI: 53.0%-70.65 %; I2 = 98.7 %), 51.7 % (95 % CI: 30.34%-73.6 %; I2 = 99.3 %), and 52.31 % (95 % CI: 41.48%-63.15 %; I2 = 98.8 %) respectively. Conclusion This study emphasizes a significant concern: pregnant women exhibit a notable lack of knowledge, positive attitudes, and preventive practices regarding Coronavirus disease 2019. Considering their heightened vulnerability, urgent action is required to improve their understanding, attitudes, and behaviours related to the virus. Healthcare professionals should take proactive measures to educate pregnant women, addressing this crucial gap through various strategies.
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Affiliation(s)
- Tesfanesh Lemma
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mulualem Silesh
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Kelem Desta
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tebabere Moltot
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abebayehu Melisew
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mages Sisay
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Wegayehu Zeneb
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Mchome Z, Mshana G, Malibwa D, Aloyce D, Dwarumpudi A, Peter E, Kapiga S, Stöckl H. Men's Narratives of Sexual Intimate Partner Violence in Urban Mwanza, Northwestern Tanzania. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:441-463. [PMID: 37941093 PMCID: PMC11010543 DOI: 10.1177/10790632231213831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
Engaging men has been established as central in addressing intimate partner violence. Yet few studies on intimate partner violence explored men's perspectives on what constitutes sexual violence in relationships only. To explore how men conceptualize sexual violence, we engaged a qualitative approach to unpack men's narratives of sexual IPV. The study was conducted in Mwanza, Tanzania using in-depth interviews with 30 married men. Men shared a broad spectrum of unacceptable behaviors that clearly or potentially connote sexual violence. Some of the acts were deemed to constitute sexual violence when directed to both men and women, while some were perceived as sexual violence when directed to women or men only. Threatened manhood underpinned men's conceptualization of sexual violence against them by their partners. Although a large part of men's narratives of sexual violence towards women seemed to challenge the common sexual scripts existing in patriarchal societies, some of their accounts indicated the persistence of traditional presumptions of masculine sexual entitlement. Our findings uncover additional dimensions of sexual violence that go beyond what is included in the current global frameworks, underscoring the critical need of giving people a voice in their local contexts in defining what sexual intimate partner violence entails for them. This may increase the likelihood of interventions becoming more acceptable and effective when targeting sexual violence, thereby contributing to reduced levels of sexual intimate partner violence.
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Affiliation(s)
- Zaina Mchome
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Gerry Mshana
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | - Diana Aloyce
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Annapoorna Dwarumpudi
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Esther Peter
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi Stöckl
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich
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K. C. SP, Adhikari B, Pandey AR, Pandey M, Kakchapati S, Giri S, Sharma S, Lamichhane B, Gautam G, Joshi D, Dulal BP, Regmi S, Baral SC. Unmet need for family planning and associated factors among currently married women in Nepal: A further analysis of Nepal Demographic and Health Survey-2022. PLoS One 2024; 19:e0303634. [PMID: 38820547 PMCID: PMC11142660 DOI: 10.1371/journal.pone.0303634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/30/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey. METHODS We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant's and husband's education, occupation, wealth quintile, parity, desire for child, and media exposure. RESULTS The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education. CONCLUSION Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.
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Affiliation(s)
- Saugat Pratap K. C.
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bikram Adhikari
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Achyut Raj Pandey
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Merina Pandey
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Sampurna Kakchapati
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Santosh Giri
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Shreeman Sharma
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bipul Lamichhane
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Ghanshyam Gautam
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Deepak Joshi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bishnu Prasad Dulal
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Shophika Regmi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Sushil Chandra Baral
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
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Khan A, Zeb I, Zhang Y, Fazal S, Ding J. Relationship between psychological capital and mental health at higher education: Role of perceived social support as a mediator. Heliyon 2024; 10:e29472. [PMID: 38644826 PMCID: PMC11033138 DOI: 10.1016/j.heliyon.2024.e29472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
Research in Positive Psychology has indicated a correlation between Psychological Capital (PsyCap) and Mental health (MH). However, the specific contribution of Perceived Social Support (PSS) in the connection between PsyCap and MH, particularly within higher education, remains uninvestigated. This study investigated how PSS could mediate the effect of PsyCap on students' MH using a cross-sectional research design. The sample encompassed 443 undergraduate graduate students at Huazhong University of Science and Technology in Wuhan, China. Results from Partial Least Squares Structural Equation Modeling (PLS-SEM) showed that both PsyCap (β = 0.815, t = 31.074, p < 0.000) and PSS (β = 0.405, t = 28.051, p < 0.000) have a positive impact on students' MH. Additionally, PSS was identified as a significant mediator in relation to students' MH (b = 0.080, t = 2.319, p < 0.020). This study emphasizes the importance of developing these factors in educational and support programs to enhance students' well-being. Moreover, the results offer significant conceptual and practical insights for higher education faculty, psychologists, and curriculum designers.
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Affiliation(s)
- Aashiq Khan
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Irum Zeb
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Shawana Fazal
- Department of Education, Hazara University, Mansehra, Pakistan
| | - Jie Ding
- School of Journalism and Information Communication, Huazhong University of Science and Technology, Wuhan, China
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Birhane BM, Assefa Y, Belay DM, Nibret G, Munye Aytenew T, Liyeh TM, Gelaw KA, Tiruneh YM. Interventions to improve the quality of maternal care in Ethiopia: a scoping review. Front Glob Womens Health 2024; 5:1289835. [PMID: 38694232 PMCID: PMC11061455 DOI: 10.3389/fgwh.2024.1289835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Quality improvement interventions have been part of the national agenda aimed at reducing maternal and neonatal morbidities and mortality. Despite different interventions, neonatal mortality and morbidity rates remain steady. This review aimed to map and synthesize the evidence of maternal and newborn quality improvement interventions in Ethiopia. Methods A scoping review was reported based on the reporting items for systematic reviews and meta-analysis extensions for the scoping review checklist. Data extraction, collation, and organization were based on the Joanna Briggs Institute manual of the evidence synthesis framework for a scoping review. The maternal and neonatal care standards from the World Health Organization and the Donabedian quality of health framework were used to summarize the findings. Results Nineteen articles were included in this scoping review. The review found that the studies were conducted across various regions of Ethiopia, with the majority published after 2013. The reviewed studies mainly focused on three maternal care quality interventions: mobile and electronic health (eHealth), quality improvement standards, and human resource mobilization. Moreover, the reviewed studies explored various approaches to quality improvement, such as providing training to healthcare workers, health extension workers, traditional birth attendants, the community health development army, and mothers and supplying resources needed for maternal and newborn care. Conclusion In conclusion, quality improvement strategies encompass community involvement, health education, mHealth, data-driven approaches, and health system strengthening. Future research should focus on the impact of physical environment, culture, sustainability, cost-effectiveness, and long-term effects of interventions. Healthcare providers' knowledge, skills, attitudes, satisfaction, and adherence to guidelines should also be considered.
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Affiliation(s)
- Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gedefaye Nibret
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Tewachew Muche Liyeh
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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Abiyo J, Nabirye RC, Nambozo B, Mukunya D, Nantale R, Oguttu F, Wani S, Musaba MW, Tumuhamye J, Epuitai J. "I have come to remove it because of heavy bleeding": a mixed-methods study on early contraceptive implant removal and the underlying factors in eastern Uganda. Contracept Reprod Med 2024; 9:17. [PMID: 38627845 PMCID: PMC11020533 DOI: 10.1186/s40834-024-00279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Early contraceptive implant removal without intentions to conceive predisposes women to unintended pregnancies.. Some of the unintended pregnancies end in unsafe abortions which further increases the risk of maternal mortality and morbidity. Therefore, we assessed the proportion of women who had early contraceptive implant removal. We also explored the reasons for early contraceptive implant removalamong women at Mbale Regional Referral Hospital in eastern Uganda. METHODS We conducted a sequential explanatory mixed methods study at Mbale Regional Referral Hospital between November 2022 to December 2022. For quantitative data, we performed a secondary analysis on data extracted from the integrated family planning registers. We used systematic random sampling to select 600 clients' serial numbers from the registers. The outcome variable was early contraceptive implant removal defined as removal of the implant by the woman before 18 months from the time of insertion. For qualitative data, we conducted 11 in-depth interviews among women who had come for contraceptive implant removal at the family planning clinic. We also conducted two key informant interviews with midwives working at the family planning unit. Quantitative data were analysed using Stata version 14.0 (Stata Corp LLC, College Station, Texas, USA) while qualitative data were analysed by thematic content analysis. RESULTS In this study, 15% (91/600) of the women discontinued contraceptive implants within 12 months, 29% (175/600) within 18 months, 38% (230/600) within 24 months and 40% (240/600) within 36 months of insertion. Among the women who discontinued contraceptive implant use, only 6.7% (40/600) switched to another family planning method. Out of the 175 women who removed contraceptive implants early, side effects 61.1% (107/175) desire to conceive 53.1% ( 93/175),, and gender-based violence 8.6% (15/175) were the major reasons for removal. From the qualitative interviews, the major reasons for early contraceptive implant removal were side effects such as heavy menstrualbleeding. CONCLUSION A third of women discontinued contraceptive implant use within 18 months. Addressing concerns regarding side effects and male partner disapproval of modern contraceptives may improve continued use of implants.
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Affiliation(s)
- Janet Abiyo
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
| | - Rose Chalo Nabirye
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
| | - Brendah Nambozo
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda.
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
| | - Faith Oguttu
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
| | - Solomon Wani
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
- Busitema University Centre of Excellency for Maternal Reproductive and Child Health, Mbale, Uganda
| | - Josephine Tumuhamye
- Makerere University Hospital, Makerere University Kampala, Kampala, P.O.BOX 7062, Uganda
| | - Joshua Epuitai
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, P.0 Box 1460, Uganda
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Pichon M, Buller AM, Gimunta V, Rutenge O, Thiaw Y, Sono R, Howard-Merrill L. Qualitative evaluation of an edutainment intervention to prevent age-disparate transactional sex in Tanzania: Changes in educational aspirations and gender equitable attitudes towards work. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002527. [PMID: 38568918 PMCID: PMC10990206 DOI: 10.1371/journal.pgph.0002527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
Age-disparate transactional sex is a major contributor to the disproportionate rates of HIV experienced by adolescent girls in sub-Saharan Africa, and a key driver of unintended adolescent pregnancy. This paper comprises one element of the impact evaluation of the Learning Initiative on Norms, Exploitation and Abuse (LINEA) radio drama intervention to prevent age-disparate transactional sex. It provides new insights into the radio drama's influence on distal drivers of age-disparate transactional sex identified in formative research: girls' own educational aspirations, and gendered attitudes towards work. The intervention, which targeted adolescent girls and their caregivers in the Shinyanga Region of Tanzania, uses an edutainment approach to prevent transactional sex between girls aged 12-16 years and men at least 5-10 years older. We distributed the 39-episode radio drama on USB flash drives to 331 households and conducted longitudinal in-depth interviews with 59 participants. We conducted a thematic analysis of endline (December 2021) transcripts from 23 girls, 18 women caregivers, and 18 men caregivers of girls (n = 59), and midline (November 2021) transcripts from a sub-sample of these participants: 16 girls, 16 women and 13 men (n = 45). Findings suggest the radio drama created an enabling environment for preventing age-disparate transactional sex by increasing girls' motivation to focus on their studies and remain in school. There was also strong evidence of increased gender-equitable attitudes about work among girls and women and men caregivers. These supported women joining the workforce in positions traditionally reserved for men and challenging the male provider role. Our findings suggest that the LINEA radio drama can supplement interventions that address structural drivers of age-disparate transactional sex. The radio drama may also have impacts beyond preventing age-disparate transactional sex, such as reducing girls' HIV morbidity and mortality, and challenging attitudes that promote sexual and gender-based violence to foster more gender-equitable communities across Tanzania.
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Affiliation(s)
- Marjorie Pichon
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ana Maria Buller
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Oscar Rutenge
- Tanganyika Christian Refugee Service, Dar es Salaam, United Republic of Tanzania
| | - Yandé Thiaw
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Revocatus Sono
- Amani Girls Organization, Mwanza, United Republic of Tanzania
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
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Mekonnen BD, Tsega SS. Child sexual abuse and its determinants among children in Addis Ababa Ethiopia: Systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001979. [PMID: 38569122 PMCID: PMC10990560 DOI: 10.1371/journal.pgph.0001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Child sexual abuse is a significant public health concern and a breach of basic human rights affecting millions of children each year globally. It is typically not reported by victims, hence it remains usually concealed. Except for single studies with varying reports, there is no national studies conducted on child sexual abuse in Ethiopia. Therefore, this review determined the pooled magnitude and determinants of sexual abuse among children in Ethiopia. Potential articles were searched from PubMed, Science Direct, Scopus, and Web of science using relevant searching key terms. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the quality of all selected articles. Data were analyzed using STATA Version 14 software. Publication bias was checked using Egger's test and funnel plot. Cochran's chi-squared test and I2 values were used to assess heterogeneity. A random-effects model was applied during meta-analysis. The pooled prevalence of sexual abuse among 5,979 children in Ethiopia was 41.15% (95% CI: 24.44, 57.86). Sex of children (OR: 2.14, 95%CI: 1.12, 4.06), smoking (OR: 4.48, 95%CI: 1.26, 76.79), khat chewing (OR: 3.68, 95%CI: 1.62, 21.93), and alcohol use (OR: 4.77, 95%CI: 2.22, 10.25) were the determinants of child sexual abuse. The main perpetrators of sexual abuse against children were neighbors, boy/girlfriends, family members, school teachers, and stranger person. Child sexual abuse commonly took place in the victim's or perpetrator's home, school, and neighbor's home. This review revealed that the magnitude of child sexual abuse in Ethiopia was relatively high and multiple factors determined the likelihood of sexual violence against children. Thus, policy-makers and concerned stakeholders should strengthen comprehensive sexual and reproductive health education to reduce the magnitude and consequences of child sexual abuse. Moreover, support with special attention should be given to children with mental illness and physical disabilities.
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Affiliation(s)
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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12
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Sibande GC, Malapela RG. Factors influencing the utilisation of Youth Friendly Health Services in Blantyre, Malawi. Health SA 2024; 29:2411. [PMID: 38628229 PMCID: PMC11019059 DOI: 10.4102/hsag.v29i0.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/06/2023] [Indexed: 04/19/2024] Open
Abstract
Background Usage of Youth Friendly Health Services (YFHSs) remains unsatisfactory in sub-Saharan Africa despite global agreements on the utilisation of these services among the youths. Aim The aim of the study was to identify factors that influence the utilisation of YFHSs in Blantyre, Malawi. Setting Four health centres in Blantyre, Malawi. Methods A descriptive quantitative research design using multistage sampling was used to randomly sample (N = 293) unmarried youths and collect data using a structured questionnaire. Data were analysed using a computerised statistical package for social sciences (SPSS) version 26. Chi-square (χ²) was used to test the significance of the association between variables, and the p-value (p < 0.05) was considered significant. Regression analysis was used to examine the influence of independent variables on the utilisation of the services. Results Less than half of the respondents have ever accessed YFHSs (43%). The Chi-square test showed that the following variables had a significant association with utilisation of the services (p < 0.05): gender, age, knowledge, signage, printed health education materials, provider attitudes and being shy or fear of being seen at the services. Conclusion Age, knowledge, signpost, printed health education materials, provider attitudes and being shy or fear of being seen at the YFHSs are factors that influenced the utilisation of the services. Working on these factors would help to increase utilisation. Contribution The study findings will help to fill the gap in the provision of YFHSs and thus increase utilisation of the services.
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Affiliation(s)
- Grace C Sibande
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Rakgadi G Malapela
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
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Aboagye RG, Donkoh IE, Okyere J, Seidu AA, Ahinkorah BO, Yaya S. Association between sexual violence and multiple high-risk fertility behaviours among women of reproductive age in sub-Saharan Africa. BMC Public Health 2024; 24:432. [PMID: 38347447 PMCID: PMC10860313 DOI: 10.1186/s12889-023-17444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/08/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Intimate partner violence has adverse outcomes on the sexual and reproductive health of women. In this study, we examined the association between sexual violence and multiple high-risk fertility behaviours (MHRFB) among women in sub-Saharan Africa (SSA). METHODS We conducted a cross-sectional analysis of data pooled from the most recent Demographic and Health Surveys of 20 countries in SSA. We included countries with most recent datasets conducted from 2015 to 2021 and had data on all variables included in the study. A weighted sample of 88,011 was included in the study. We used a multilevel binary logistic regression to examine the association between sexual violence and MHRFB, controlling for other covariates. The regression results were presented using adjusted odds ratio (aOR) with 95% confidence interval (CI). Statistical significance was set at p < 0.05. RESULTS The overall prevalence of MHRFB was 22.53% (95% CI: 22.26-22.81), which ranged from 9.94% in South Africa to 30.38% in Chad. For sexual violence, the pooled prevalence was 7.02% (95% CI: 6.86-7.19). Burundi (20.58%) and the Gambia (2.88%) reported the highest and lowest proportions, respectively. Women who experienced sexual violence were more likely to engage in MHRFB compared to those who did not experience sexual violence [aOR = 1.11, 95% CI: 1.02, 1.21]. CONCLUSION There is a positive association between sexual violence and the risk of MHRFB. Our findings underscore a need for sub-Saharan African countries to strengthen their efforts to reduce the occurrence of sexual violence in intimate partner relationships. To augment efforts and accelerate social change, sub-Saharan African countries can introduce pro-poor policies and interventions to improve the wealth status of women. Also, empowering women through the encouragement of attaining higher education would be a useful step in lowering the risk of MHRFB in SSA.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Irene Esi Donkoh
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada.
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Habito M, Hennegan J, Rasphone K, Phanthachith S, Sihanath T, Akiyama M, Azzopardi PS, Kennedy E, Kosaikanont R. From 'Pen Sao' to 'Tue Pa': Understanding diverse pathways to adolescent pregnancy in Lao People's Democratic Republic through qualitative investigation with girls in Vientiane Capital, Vientiane Province, and Luang Namtha. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002825. [PMID: 38306586 PMCID: PMC10836915 DOI: 10.1371/journal.pgph.0002825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
Adolescent birth rates in Lao People's Democratic Republic (PDR) remain the highest in Southeast Asia. There is growing recognition that adolescent pregnancy in Lao PDR is occurring within and outside marriage, but there is a lack of robust qualitative evidence to understand girls' pathways to adolescent pregnancy and contributing factors, especially outside of union (cohabitation or marriage). This study aimed to improve understanding of pathways to adolescent pregnancy in Lao PDR among girls who experienced pregnancy at age 18 or below. We conducted participatory timeline interviews with 57 girls from urban, peri-urban, and rural communities in Vientiane Capital, Vientiane Province, and Luang Namtha, and follow-up interviews with a subset of 20 girls. We identified six pathways to pregnancy, including pathways outside (n = 23) and within union (n = 34). Outside-union pathways diverged according to the nature of sex preceding pregnancy (consensual/pressured, or forced), and pregnancy intention (unplanned, partner-led, or planned). Within-union pathways diverged according to the nature of the relationship before union (romantic or no romantic relationship/arranged union), who initiated the union (couple/girl, parent/partner, or pressured), and pregnancy intention. Factors contributing to girls' pregnancy included barriers to sexual and reproductive health (SRH) information and services; partner's control over reproductive decision-making; male sexual entitlement and alcohol use driving pressured/forced sex; cultural acceptance of child marriage and early union; and attitudes and norms regarding sex and pregnancy outside of union. Our findings support strengthening comprehensive sexuality education, including a focus on addressing myths about contraception, building girls' and boys' communication skills, engaging in respectful relationships, and addressing harmful gender norms. Our findings also highlight the need to improve girls' access to adolescent-responsive SRH services, address harmful substance use, challenge sociocultural barriers to young people accessing SRH information and services, and respond to sociocultural and financial drivers of child marriage/early union that contribute to adolescent pregnancy.
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Affiliation(s)
- Marie Habito
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julie Hennegan
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | | | | | | | - Maki Akiyama
- UNFPA Asia Pacific Regional Office, Bangkok, Thailand
| | - Peter S Azzopardi
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Telethon Kids Institute, Adelaide, South Australia, Australia
| | - Elissa Kennedy
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Kaombe TM. A bivariate Poisson regression to analyse impact of outlier women on correlation between female schooling and fertility in Malawi. BMC Womens Health 2024; 24:55. [PMID: 38245736 PMCID: PMC10799448 DOI: 10.1186/s12905-024-02891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Women's levels of education and fertility are commonly associated. In Sub-Saharan Africa, the pace of decreasing fertility rates varies greatly, and this is linked to women's levels of education. However, this association may be influenced by unusual females who have uncommon measurements on both variables. Despite this, most studies that researched this association have only analysed the data descriptively, without taking into account the effect of potential outliers. This study aimed to examine the presence and impact of outlier women on the relationship between female education and fertility in Malawi, using regression methods. METHODS To analyse the correlation between women's schooling and fertility and evaluate the effect of outliers on this relationship, a bivariate Poisson model was applied to three recent demographic and health surveys in Malawi. The R software version 4.3.0 was used for model fitting, outlier computations, and correlation analysis. The STATA version 12.0 was used for data cleaning. RESULTS The findings revealed a correlation of -0.68 to -0.61 between schooling and fertility over 15 years in Malawi. A few outlier women were identified, most of whom had either attended 0 or at least 9 years of schooling and had born either 0 or at least 5 children. The majority of the outliers were non-users of modern contraceptive methods and worked as domestic workers or were unemployed. Removing the outliers from the analysis led to marked changes in the fixed effects sizes and slight shifts in correlation, but not in the direction and significance of the estimates. The woman's marital status, occupation, household wealth, age at first sex, and usage of modern contraceptives exhibited significant effects on education and fertility outcomes. CONCLUSION There is a high negative correlation between female schooling and fertility in Malawi. Some outlier women were identified, they had either attended zero or at least nine years of schooling and had either born zero or at least five children. Most of them were non-users of modern contraceptives and domestic workers. Their impact on regression estimates was substantial, but minimal on correlation. Their identification highlights the need for policymakers to reconsider implementation strategies for modern contraceptive methods to make them more effective.
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Affiliation(s)
- Tsirizani Mwalimu Kaombe
- Department of Mathematical Sciences, School of Natural and Applied Sciences, University of Malawi, Zomba, Malawi.
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Bohren MA, Iyer A, Barros AJ, Williams CR, Hazfiarini A, Arroyave L, Filippi V, Chamberlain C, Kabakian-Khasholian T, Mayra K, Gill R, Vogel JP, Chou D, George AS, Oladapo OT. Towards a better tomorrow: addressing intersectional gender power relations to eradicate inequities in maternal health. EClinicalMedicine 2024; 67:102180. [PMID: 38314054 PMCID: PMC10837533 DOI: 10.1016/j.eclinm.2023.102180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 02/06/2024] Open
Abstract
An equity lens to maternal health has typically focused on assessing the differences in coverage and use of healthcare services and critical interventions. While this approach is important, we argue that healthcare experiences, dignity, rights, justice, and well-being are fundamental components of high quality and person-centred maternal healthcare that must also be considered. Looking at differences across one dimension alone does not reflect how fundamental drivers of maternal health inequities-including racism, ethnic or caste-based discrimination, and gendered power relations-operate. In this paper, we describe how using an intersectionality approach to maternal health can illuminate how power and privilege (and conversely oppression and exclusion) intersect and drive inequities. We present an intersectionality-informed analysis on antenatal care quality to illustrate the advantages of this approach, and what is lost in its absence. We reviewed and mapped equity-informed interventions in maternal health to existing literature to identify opportunities for improvement and areas for innovation. The gaps and opportunities identified were then synthesised to propose recommendations on how to apply an intersectionality lens to maternal health research, programmes, and policies.
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Affiliation(s)
- Meghan A. Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Aluisio J.D. Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Caitlin R. Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS-Argentina), Buenos Aires, Argentina
| | - Alya Hazfiarini
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Luisa Arroyave
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Roopan Gill
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
- Vitala Global Foundation, Vancouver, British Columbia, Canada
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Asha S. George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Western Cape, South Africa
- South African Medical Research Council, South Africa
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Wondimagegene YA, Debelew GT, Koricha ZB. Effectiveness of peer-led education interventions on contraceptive use, unmet need, and demand among adolescent girls in Gedeo Zone, South Ethiopia. A cluster randomized controlled trial. Glob Health Action 2023; 16:2160543. [PMID: 36695098 PMCID: PMC9879192 DOI: 10.1080/16549716.2022.2160543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings. OBJECTIVE The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia. METHODS A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention. RESULT After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. CONCLUSIONS School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.
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Affiliation(s)
- Yohannes Addisu Wondimagegene
- College of Health Sciences and Medicine, Department of Health, Behavior, and Society, Dilla University, Dilla, Ethiopia,CONTACT Yohannes Addisu Wondimagegene College of Health Sciences and Medicine, Department of Health, Behavior, and Society, Dilla University, Ethiopia
| | - Gurmesa Tura Debelew
- Institute of Health, Faculty of Public Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu Koricha
- Institute of Health, Faculty of Public Health, Department of Health, Behavior, and Society, Jimma University, Jimma, Ethiopia
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Govathson C, Long L, Moolla A, Mngadi-Ncube S, Ngcobo N, Mongwenyana C, Lince-Deroche N, Pascoe S. Understanding school-going adolescent's preferences for accessing HIV and contraceptive care: findings from a discrete choice experiment among learners in Gauteng, South Africa. BMC Health Serv Res 2023; 23:1378. [PMID: 38066547 PMCID: PMC10704722 DOI: 10.1186/s12913-023-10414-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Many Adolescents in Sub-Saharan Africa do not access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the Learners' preferences for how services are delivered so that implementation strategies can reflect this. METHODS A discrete choice experiment (DCE) was used to elicit preferences. The DCE was completed between 07/2018 and 09/2019 and conducted in 10 high schools situated in neighbourhoods of varying socio-economic status (SES) in Gauteng (South Africa). Learners aged ≥ 15 years (Grades 9-12) were consented and enrolled in the DCE. Parental consent and assent were required if < 18 years old. Conditional logistic regression was used to determine preferred attributes for HIV and contraceptive service delivery. Results were stratified by gender and neighbourhood SES quintile (1 = Lowest SES; 5 = Highest SES). RESULTS 805 Learners were enrolled (67% female; 66% 15-17 years; 51% in grades 9-10). 54% of Learners in quintile 1 schools had no monthly income (family support, grants, part-time jobs etc.); 38% in quintile 5 schools had access to R100 ($7.55) per month. Preferences for accessing HIV and contraceptive services were similar for male and female Learners. Learners strongly preferred services provided by friendly, non-judgmental staff (Odds ratio 1.63; 95% Confidence Interval: 1.55-1.72) where confidentiality was ensured (1.33; 1.26-1.40). They preferred services offered after school (1.14; 1.04-1.25) with value-added services like free Wi-Fi (1.19; 1.07-1.32), food (1.23; 1.11-1.37) and youth-only waiting areas (1.18; 1.07-1.32). Learners did not have a specific location preference, but preferred not to receive services within the community (0.82; 0.74-0.91) or school (0.88; 0.80-0.96). Costs to access services were a deterrent for most Learners irrespective of school neighbourhood; female Learners were deterred by costs ≥$3.85 (0.79; 0.70-0.91); males by costs ≥ R100 ($7.55) (0.86; 0.74-1.00). CONCLUSIONS Preferences that encourage utilisation of services do not significantly differ by gender or school neighbourhood SES. Staff attitude and confidentiality are key issues affecting Learners' decisions to access HIV and contraceptive services. Addressing how healthcare providers respond to young people seeking sexual and reproductive health services is critical for improving adolescents' uptake of these services.
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Affiliation(s)
- Caroline Govathson
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Lawrence Long
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Aneesa Moolla
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Sithabile Mngadi-Ncube
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Nkosinathi Ngcobo
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Constance Mongwenyana
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | | | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa.
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Byansi W, Howell TH, Filiatreau LM, Nabunya P, Kaiser N, Kasson E, Ssewamala FM, Cavazos-Rehg P. Sexual Health Behaviors and Knowledge Among Ugandan Adolescent Girls: Implications for Advancing Comprehensive Sexual Health Education Technology. CHILD & YOUTH CARE FORUM 2023; 52:1227-1247. [PMID: 38031566 PMCID: PMC10683936 DOI: 10.1007/s10566-023-09730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 02/04/2023]
Abstract
Background Adolescent girls in Uganda have four-fold HIV infections than adolescent boys. Several barriers to accessing comprehensive sexual health education exist for adolescent girls in Uganda, including unequal, social, and economic statuses, limited access to education and health care services, discrimination, and violence. Objective This study qualitatively examines sexual health behaviors and literacy among Ugandan adolescent girls and explores how technology may be leveraged to improve sexual and reproductive health outcomes in this population. Methods Four focus group discussions (FGDs) were conducted among 32 adolescent girls aged 14-17 years enrolled in Suubi mHealth. Participants were randomly selected from four secondary schools participating in a randomized clinical trial known as Suubi4Her (N = 1260). FGDs were conducted in the local language, audio-recorded, transcribed verbatim, and translated. Translated transcripts were imported into Dedoose for data management and coding. Emerging themes included Influences for Sex/Relationships, HIV Knowledge, and Sources of Sexual Health Information. Results Participants reported common influences for sexual engagement included seeking resource security, limited parental communication, and peer influences. Participants also demonstrated knowledge gaps, requesting information such as how to prevent unplanned pregnancies and HIV, endorsing sexual health myths, and describing limitations to accessing sexual health information. Conclusions Noticeable inconsistencies and limited access to information and resources regarding basic sexual health knowledge were reported, which inevitably increases adolescent girls' risks for adverse sexual and reproductive health outcomes. Developing culturally appropriate interventions may help advance the sexual and reproductive health needs of Ugandan adolescent girls.
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Affiliation(s)
- William Byansi
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Tyriesa Howard Howell
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
| | - Lindsey M. Filiatreau
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
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Shukla S, Castro Torres AF, Satish RV, Shenderovich Y, Abejirinde IOO, Steinert JI. Factors associated with adolescent pregnancy in Maharashtra, India: a mixed-methods study. Sex Reprod Health Matters 2023; 31:2249284. [PMID: 37712990 PMCID: PMC10506432 DOI: 10.1080/26410397.2023.2249284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Reducing the adolescent birth rate is paramount in achieving the health-related Sustainable Development Goals, given that pregnancy and childbirth are the leading cause of mortality among young women aged 15-19. This study aimed to explore predictors of adolescent pregnancy among girls aged 13-18 years in Maharashtra, India, during the COVID-19 pandemic. Using a mixed-methods approach, primary data were gathered from two regions in Maharashtra between February and April 2022. Quantitative data from face-to-face interviews with 3049 adolescent girls assessed various household, social, and behavioural factors, as well as the socioeconomic and health impacts of COVID-19. Qualitative data from seven in-depth interviews were analysed thematically. The findings reveal that girls from low socioeconomic backgrounds face a higher likelihood of adolescent pregnancy. Multivariable analysis identified several factors associated with increased risk, including older age, being married, having more sexual partners, and experiencing COVID-19-related economic vulnerability. On the other hand, rural residence, secondary and higher secondary education of the participants, and higher maternal education were associated with a decreased likelihood of adolescent pregnancy. In the sub-sample of 565 partnered girls, partner's emotional abuse also correlated with higher rates of adolescent pregnancy. Thematic analysis of qualitative data identified four potential pathways leading to adolescent pregnancy: economic hardships and early marriage; personal safety, social norms, and early marriage; social expectations; and lack of knowledge on contraceptives. The findings underscore the significance of social position and behavioural factors and the impact of external shocks like the COVID-19 pandemic in predicting adolescent pregnancy in Maharashtra, India.Plain Language Summary: Adolescent pregnancy is an important health issue for young girls. In South Asia, one out of every five adolescent girls becomes a mother before turning 18, and in India, around 9% of girls aged 15-19 get pregnant yearly. This study focused on understanding the factors associated with adolescent pregnancy in Maharashtra, India, especially after the COVID-19 pandemic. We collected information from both urban and rural areas in Maharashtra. A total of 3049 adolescent girls participated in a survey, and seven girls participated in detailed interviews. Our analysis showed that factors like older age, being married, having multiple sexual partners, and experiencing economic difficulties due to COVID-19 increased the chances of adolescent pregnancy. On the other hand, living in rural areas, higher education for both the girls and their mothers reduced the likelihood of adolescent pregnancy. Qualitative analysis revealed that economic challenges, concerns about safety and societal norms, early marriage, societal expectations, and lack of knowledge about contraceptives could contribute to adolescent pregnancy in Maharashtra.
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Affiliation(s)
- Shruti Shukla
- PhD Candidate and Research Associate, TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | | | - Rucha Vasumati Satish
- Field Coordinator and Freelance Researcher based in Pune, Maharashtra, TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - Yulia Shenderovich
- Senior Lecturer, Wolfson Centre for Young People’s Mental Health, Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Assistant Professor, Division of Social & Behavioural Health Sciences, University of Toronto, Dalla Lana School of Public Health and Women’s College Hospital Research Institute, Toronto, Canada
| | - Janina Isabel Steinert
- Principal Investigator, TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
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21
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Mutea L, Maluni J, Kabue M, Were V, Ontiri S, Michielsen K, Gichangi P. The effectiveness of combined approaches towards improving utilisation of adolescent sexual and reproductive health services in Kenya: a quasi-experimental evaluation. Sex Reprod Health Matters 2023; 31:2257073. [PMID: 37791876 PMCID: PMC10552573 DOI: 10.1080/26410397.2023.2257073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15-19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents' discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42-0.79, P = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08-0.82, P = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.
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Affiliation(s)
- Lilian Mutea
- PhD Candidate, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Deputy Office Director, Health Population and Nutrition Office, USAID Kenya & East Africa, Nairobi, Kenya
| | | | - Mark Kabue
- Senior Monitoring, Evaluation, Research and Learning Adviser, Jhpiego USA, Baltimore MD, USA
| | - Vincent Were
- Data Analyst, KEMRI-Wellcome Trust, Nairobi, Kenya
| | - Susan Ontiri
- Monitoring and Evaluation Adviser, Jhpiego, Nairobi, Kenya
| | - Kristien Michielsen
- Associate Professor, International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Peter Gichangi
- Full Professor, Technical University of Mombasa, Kenya; Visiting Professor, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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22
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Benjamin KA, Lamberti N, Cooke M. Predictors of non-adherence to cervical cancer screening among immigrant women in Ontario, Canada. Prev Med Rep 2023; 36:102524. [PMID: 38116269 PMCID: PMC10728462 DOI: 10.1016/j.pmedr.2023.102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Cervical cancer is one of the most common types of cancer among women and is largely preventable with regular screening using Papanicolau (Pap) tests. In Canada, all provinces have regular screening programs, although with slightly differing recommendations. Previous research has found that immigrant women, who are a large proportion of the Canadian population, are at higher risk of being under-screened, or non-adherent to the recommended screening frequency. Using data from the 2017 Canadian Community Health Survey, this study examined: (1) the extent to which immigration status and time since immigration are associated with Pap test adherence in Ontario, and (2) predictors of Pap test adherence for immigrants and Canadian born populations in Ontario, Canada's most populous province, with a focus on the role of racial or ethnic identity among immigrants. Estimates of 3-year test adherence were 71.3 % (95 %CI: 66.9-75.7) among immigrant women and 75.4 % (95 %CI: 73.1-77.1) among non-immigrant women. Recent immigrants (6-10 years in Canada) had lower adherence (63.5 %, 95 %CI: 48.0-80.0). Logistic regression models found that immigrant women had lower adherence than Canadian-born women, controlling for age, household income, education, and having a primary care physician. Subgroup analysis found that South Asian immigrant women were least likely to be adherent. These results support targeted programming to increase screening adherence among recent immigrants and raise concerns regarding potential barriers to screening. Data that allow better disaggregation of racial and ethnic identities are important for better understanding the potential implications of these patterns for racial inequities in health.
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Affiliation(s)
- Kayla A. Benjamin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nina Lamberti
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON M5T 3M6, Canada
| | - Martin Cooke
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
- Department of Sociology and Legal Studies, Faculty of Arts, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
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23
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Metzler J, Hutchinson A, Kiss K. Setting research priorities for prevention and response to child marriage in communities in the Arab region: findings from a multi-stage Delphi study involving practitioners across the region. Sex Reprod Health Matters 2023; 31:2275840. [PMID: 38010883 PMCID: PMC11003645 DOI: 10.1080/26410397.2023.2275840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Globally, more than 12 million girls under the age of 18 are forced to marry every year. Progress on ending child marriage in the Arab region is slowing, and risks being reversed, due to an increase in conflict-affected populations and widespread economic crisis. The aim of this paper is to consider the research priorities across the region to inform effective and accelerated child marriage prevention and response programming within the Arab region. Seventy-three specialists supporting child marriage prevention and response programming in the Arab region engaged with up to three phases of an online Delphi consultation process on research gaps and the research environment between July 2019 and December 2021. Proposals of research gaps were elicited, reviewed, and rated by participants to confirm a shared learning agenda. Participants identified 50 different research gaps across 7 main areas, reaching a high level of consensus support for 23 of 50 statements. Clear consensus was reached in relation to an increased need to produce and use evidence to support programme development, and further research on specific drivers and consequences of child marriage. The least consensus was found in relation to how research can inform prevention and response efforts within the law and legal system. The results provide the foundation of a child marriage research agenda for the Arab region which takes into account regional distinctiveness and builds on the global momentum for child marriage research. Mechanisms are in place to do this through the Regional Action Forum, and other networks across the region.
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Affiliation(s)
- Janna Metzler
- Associate Director, Research, Women’s Refugee Commission, New York, NY, USA
| | - Aisha Hutchinson
- Senior Lecturer in Social Sciences, School of Education, Communication and Society, King’s College London, London, UK
| | - Katrina Kiss
- Postgraduate Researcher, School of Education, Communication and Society, King’s College London, London, UK
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24
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Raina N, Khanna R, Gupta S, Jayathilaka CA, Mehta R, Behera S. Progress in achieving SDG targets for mortality reduction among mothers, newborns, and children in the WHO South-East Asia Region. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 18:100307. [PMID: 38028159 PMCID: PMC10667297 DOI: 10.1016/j.lansea.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
As we reach midway towards the 2030 Sustainable Developmental Goals (SDG), this paper reviews the progress made by the WHO South-East Asia Region (SEAR) and member countries towards achieving the SDG targets for maternal, newborn and child mortality under the regional flagship initiative. Indicators for mortality and service coverage were obtained for all countries and progress assessed in comparison to other regions and between countries. Equity analysis was conducted to focus on the impact on marginalized populations. The article also informs about the priority actions taken by the WHO SEAR office and countries in accelerating reductions in maternal, newborn and child mortality. Moving forward, the region and countries must strategize to sustain the gains made so far and also address challenges of inequities, sub-optimal quality of care, newer priorities like stillbirths, birth defects, early childhood development, and public health emergencies and adverse effects of climate change on human health.
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Affiliation(s)
- Neena Raina
- WHO Regional Office for South-East Asia, Delhi, India
| | - Rajesh Khanna
- WHO Regional Office for South-East Asia, Delhi, India
| | | | | | - Rajesh Mehta
- Formerly with WHO Regional Office for South-East Asia, Delhi, India
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25
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Black CJ, McEwen FS, Smeeth D, Popham CM, Karam E, Pluess M. Effects of war exposure on pubertal development in refugee children. Dev Psychol 2023; 59:1559-1572. [PMID: 37410441 PMCID: PMC10527927 DOI: 10.1037/dev0001569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Increasing research shows pubertal development accelerates following threats while it decelerates following deprivation. Yet, these environmental stressors are unlikely to occur in isolation. We investigated how war exposure and energetic stress impact pubertal development using data from the longitudinal Biological Pathways of Risk and Resilience in Syrian Refugee Children study. Our sample included 1,600 male and female Syrian refugee children and their caregivers who lived in temporary settlements in Lebanon. We hypothesized that (a) energetic stress suppresses pubertal development; (b) war exposure accelerates pubertal timing in boys and increases risk of menarche in girls, but only when energetic stress is low; and (c) when energetic stress is elevated, effects of war exposure on pubertal development will be attenuated. Among boys, we did not find support for Hypothesis 1, but Hypotheses 2 and 3 were supported. Exposure to morbidity/mortality threats accelerated pubertal timing; this effect was attenuated under conditions of elevated energetic stress. Among girls, we found support for Hypothesis 1, but not for Hypotheses 2 and 3. Elevated energetic stress decreased the risk of menarche in girls. Neither war exposure, nor any interactions with energetic stress, predicted risk of menarche. Sensitivity analyses revealed a significant interaction between bombing exposure and the amount of time since leaving Syria. Bombing decreased the risk of menarche, but only for girls who had left Syria four or more years prior to data collection. We discuss implications for translational efforts advocating for puberty screening in medical and mental health settings to identify trauma-exposed youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Candace J. Black
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Fiona S. McEwen
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Demelza Smeeth
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Cassandra M. Popham
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Elie Karam
- Department of Psychiatry and Clinical Psychology, Balamand University, St Georges Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Lebanon
| | - Michael Pluess
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
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Ngusie HS, Ahmed MH, Mengiste SA, Kebede MM, Shemsu S, Kanfie SG, Kassie SY, Kalayou MH, Gullslett MK. The effect of capacity building evidence-based medicine training on its implementation among healthcare professionals in Southwest Ethiopia: a controlled quasi-experimental outcome evaluation. BMC Med Inform Decis Mak 2023; 23:172. [PMID: 37653419 PMCID: PMC10472735 DOI: 10.1186/s12911-023-02272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Evidence-based medicine (EBM) bridges research and clinical practice to enhance medical knowledge and improve patient care. However, clinical decisions in many African countries don't base on the best available scientific evidence. Hence, this study aimed to determine the effect of training interventions on background knowledge and awareness of EBM sources, attitude, competence, and practice of EBM among healthcare professionals. METHOD We designed a controlled group quasi-experimental pre-post test study to evaluate the effect of capacity-building EBM training. A total of 192 healthcare professionals were recruited in the study (96 from the intervention and 96 from the control group). We used a difference-in-differences (DID) analysis to determine the effect of the training. Along the way, we used a fixed effect panel-data regression model to assess variables that could affect healthcare professionals' practice of EBM. The cut point to determine the significant effect of EBM training on healthcare professionals' background knowledge and awareness of EBM sources, attitude, and competence was at a P-value < 0.05. RESULT The DID estimator showed a significant net change of 8.0%, 17.1%, and 11.4% at P < 0.01 on attitude, competence, and practice of EBM, respectively, whereas no significant increment in the background knowledge and awareness of EBM sources. The fixed effect regression model showed that the attitude [OR = 2.288, 95% CI: (1.049, 4.989)], competence [OR = 4.174, 95% CI: 1.984, 8.780)], technical support [OR = 2.222, 95% CI: (1.043, 3.401)], and internet access [OR = 1.984, 95% CI: (1.073, 4.048)] were significantly affected EBM practice. CONCLUSION The capacity-building training improved attitude, competence, and EBM practice. Policymakers, government, and other concerned bodies recommended focusing on a well-designed training strategy to enhance the attitude, competence, and practice towards EBM among healthcare professionals. It was also recommended to enhance internet access and set mechanisms to provide technical support at health facilities.
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Affiliation(s)
- Habtamu Setegn Ngusie
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Mohammadjud Hasen Ahmed
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | | | | | - Shuayib Shemsu
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Shuma Gosha Kanfie
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Sisay Yitayih Kassie
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Mulugeta Hayelom Kalayou
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Budu E, Dadzie LK, Salihu T, Ahinkorah BO, Ameyaw EK, Aboagye RG, Seidu AA, Yaya S. Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis. BMC Womens Health 2023; 23:444. [PMID: 37612594 PMCID: PMC10463475 DOI: 10.1186/s12905-023-02601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Contraceptive use is crucial to achieving Sustainable Development Goal 3. Evidence of socioeconomic inequality in the use of modern contraceptives is essential to address the developing inequality in its utilisation given the low prevalence of contraceptive use among women in Benin. This study examined the socioeconomic inequalities in modern contraceptive use among women in Benin. METHODS We performed a cross-sectional analysis of the 2017-18 Benin Demographic and Health Survey data. A weighted sample of 7,360 sexually active women of reproductive age was included in the study. We used a concentration curve to plot the cumulative proportion of women using modern contraception. Decomposition analysis was conducted to determine factors accounting for the socioeconomic disparities in modern contraceptive use. RESULTS We noted that the richest women had higher odds of modern contraceptive use (adjusted odds ratio [aOR] = 1.67, CI = 1.22-2.30) compared to the poorest women. Other factors that showed significant associations with modern contraception use were age, marital status, religious affiliation, employment status, parity, women's educational level, and ethnicity. We found that modern contraceptive use is highly concentrated among the rich, with rich women having a higher propensity of using modern contraception relative to the poor. Also, the disadvantaged to modern contraceptive use included the poor, those aged 45-49, married women, those working, those with four or more live births, rural residents, and women of Bariba and related ethnicity. Conversely, favourable concentration in modern contraceptive use was found among the rich, women aged 20-24, the divorced, women with two live births, the highly educated, those with media exposure, and women of Yoruba and related ethnicity. CONCLUSION The study has shown that wealthy women are more likely to utilize contraceptives than the poor. This is because wealthy women could afford both the service itself and the travel costs to the health facility, hence overcoming any economic barriers to using modern contraception. Other factors such as age, marital status, religion, employment status, parity, mother's educational level, and ethnicity were associated with contraceptive use in Benin. The Benin government and other stakeholders should develop family planning intercession techniques that address both the supply and demand sides of the equation, with a focus on reaching the illiterate and under-resourced population without admittance to modern contraception.
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Affiliation(s)
- Eugene Budu
- Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Tarif Salihu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- REMS Consult Limited, Sekondi-Takoradi, Western Region Ghana
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Wa, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Abdul-Aziz Seidu
- REMS Consult Limited, Sekondi-Takoradi, Western Region Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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28
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Hareru HE, Wtsadik DS, Ashenafi E, Debela BG, Lerango TL, Ewunie TM, Abebe M. Variability and awareness of obstetric fistula among women of reproductive age in sub-Saharan African countries: A systematic review and meta-analysis. Heliyon 2023; 9:e18126. [PMID: 37560629 PMCID: PMC10407677 DOI: 10.1016/j.heliyon.2023.e18126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Obstetric fistula among women of reproductive age is a significant public health issue in developing countries, including Sub-Saharan Africa. However, the pooled awareness of obstetric fistula among women of reproductive age in Sub-Saharan Africa and its variation between countries have not yet been studied. Hence, the review aims to assess variability and awareness of obstetric fistula among women of reproductive age in Sub-Saharan African Countries. METHOD Articles were searched using different electronic databases, such as PubMed, Web of science, science direct (Scopus), Google scholar, and HINARI and manual search without regard to publication date. A random-effects model was used to ascertain the pooled prevalence of obstetric fistula awareness among women of reproductive age in Sub-Saharan Africa. Publication bias was checked by using funnel plot and Egger's test at a 5% level of significance. I2 test statistics was performed to evaluate heterogeneity among included studies. In addition, to identify the possible reason for the potential heterogeneity between the studies, sub-group and meta-regression analyses were conducted. A sensitivity analysis was performed to determine the impact of individual research on the overall results. The data were extracted by using Microsoft excel and analyzed using statistical software STATA/SE version 17. RESULT A total of 22 studies with 79,693 women of reproductive age were included in this systematic review and meta-analyses. In Sub-Saharan Africa, the pooled prevalence of awareness towards obstetric fistula among women of reproductive age was 40.85% (95% CI: 33.48, 48.22%). Analysis of the subgroups by specific countries revealed significant variation. The highest awareness of obstetric fistula was found among Tanzanian women of reproductive age (61.10%, 95% CI: 55.87-66.33%), whereas the lowest awareness was found in research from the Gambia (12.80%, 95% CI: 12.20-13.40%).The likelihood of obstetric fistula awareness were lower by a factor of 0.424 among studies with sample sizes greater than 3542 (β = -0.424 (95% CI: -0.767 to 0.081), p -value <0.05). CONCLUSION According to the current review, there is a low level of awareness about obstetric fistula among women of reproductive age in sub-Saharan Africa, and the results of the sub-group analysis by country showed wide variations. Therefore, we emphasize the need for country-specific public health initiatives to raise awareness about obstetric fistula among women of reproductive age, which could reduce the risk of delayed treatment.
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Affiliation(s)
- Habtamu Endashaw Hareru
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay Wtsadik
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Eden Ashenafi
- Department of Reproductive Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Berhanu Gidisa Debela
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Temesgen Leka Lerango
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Temesgen Muche Ewunie
- Department of Human Nutrition, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Sahoo J, Mohanty S, Gupta S, Panigrahi SK, Mohanty S, Prasad D, Epari V. Prevalence and Risk Factors of Iron Deficiency Anemia among the Tribal Residential Adolescent School Students of Odisha: A Cross-Sectional Study. Indian J Community Med 2023; 48:562-566. [PMID: 37662116 PMCID: PMC10470574 DOI: 10.4103/ijcm.ijcm_453_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 04/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Globally, anemia is one of the biggest public health challenges. The highest prevalence of anemia is seen among adolescents. Tribal communities are especially at a disadvantage, with several studies documenting a high prevalence of anemia among tribal adolescents. We investigated the prevalence of anemia and its associated risk factors among the tribal residential adolescent school students in Odisha. Material and Methods In a cross-sectional survey, the prevalence of anemia was estimated by spectrophotometry among adolescents of residential schools in three predominantly tribal districts of Odisha. The severity of anemia was defined as per the World Health Organization classification for adolescents. Results The mean age of 953 subjects was 13.07 ± 1.48 years. The prevalence of anemia was found to be 37.3%. As per the World Health Organization classification, 19.9% had mild anemia, 16.3% had moderate, and 1% had severe anemia. Consumption of Iron Folic Acid (IFA) was associated with the level of hemoglobin at a statistically significant level. Conclusion We found that the prevalence of anemia was lower than in similar studies conducted in other parts of the country. Despite poor coverage of beneficiaries with iron and folic acid at the national level, our study showed better compliance and was associated with a significantly higher level of hemoglobin among those who consumed IFA.
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Affiliation(s)
- Jyotiranjan Sahoo
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Smaraki Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sandhya Gupta
- Department of Physiology, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sandeep K. Panigrahi
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sambedana Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | | | - Venkatarao Epari
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
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Mäkelä T, Saisto T, Salmela-Aro K, Miettinen J, Sintonen H, Rouhe H. Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study. BMC Pregnancy Childbirth 2023; 23:468. [PMID: 37349712 DOI: 10.1186/s12884-023-05790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Prenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples. METHODS In a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument. RESULTS PTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women's mean 15D score was lower than partners' and that of age- and gender-standardized general population, while partners' mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively). CONCLUSIONS PTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.
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Affiliation(s)
- Tia Mäkelä
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland.
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland.
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
| | - Katariina Salmela-Aro
- Department of Educational Sciences, University of Helsinki, PO BOX 9, Helsinki, 00014, Finland
| | - Jenny Miettinen
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
- Espoo Health Care Center, City of Espoo, PO BOX 1, Espoo, 02070, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, PO BOX 20, Helsinki, 00014, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
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Mugumba E, Kagwa M, Muhumuza D, Namukwaya R, Amunyongire R, Maling S. Prevalence and correlates of intimate partner violence following partner notification among index HIV clients attending primary healthcare facilities in Uganda. AIDS Care 2023; 35:859-866. [PMID: 36120933 PMCID: PMC10020122 DOI: 10.1080/09540121.2022.2122390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Assisted partner notification (APN) program was adopted by Uganda to increase individuals testing for HIV through their partners who test HIV positive. Thus, early enrollment in treatment and ensuring prevention services for the affected couple. However, APN is associated with high levels of Intimate partner violence (IPV). We aimed at determining the prevalence of IPV following APN in a cross-sectional study of newly diagnosed HIV clients in southwestern Uganda. We used the modified version of the Conflict Tactics Scale to assess IPV. We also collected information on sociodemographics of the index clients and their sexual partners, and outcome of linkage to care of partner. Logistic regression was used to determine the factors associated with IPV. We enrolled 327 index clients, mean age was 39.1, 63.6% were female and 35.5 experienced IPV following APN. The likelihood of experiencing IPV was more than twice if a health worker/provider disclosed the status to the partner. However, if the partners turned out to be HIV positive, it was protective against experiencing IPV, adjusted odds ratio 0.39, 95% confidence interval 0.23-0.69, p = 0.001. We conclude that IPV is common following partner notification in rural Uganda and should be screened and addressed.
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Affiliation(s)
- Eria Mugumba
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Kagwa
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickson Muhumuza
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Racheal Namukwaya
- Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara Uganda
| | - Ronaldo Amunyongire
- Department of Nursing, Mbarara University of Science and Technology, Mbarara Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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Singh A, Kumar V, Singh H, Chowdhury S, Sharma S. Assessing the coverage of full antenatal care among adolescent mothers from scheduled tribe and scheduled caste communities in India. BMC Public Health 2023; 23:798. [PMID: 37127687 PMCID: PMC10150462 DOI: 10.1186/s12889-023-15656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The persistently high rates of maternal mortality and morbidity among historically marginalised social groups, such as adolescent Scheduled Castes (SCs) and Scheduled Tribes (STs) in India, can be attributed, in part, to the low utilisation of full antenatal healthcare services. Despite efforts by the Indian government, full antenatal care (ANC) usage remains low among this population. To address this issue, it is crucial to determine the factors that influence the utilisation of ANC services among adolescent SC/ST mothers. However, to date, no national-level comprehensive study in India has specifically examined this issue for this population. Our study aims to address this research gap and contribute to the understanding of how to improve the utilisation of ANC services among adolescent SC/ST mothers in India. DATA AND METHODS Data from the fourth round of the National Family Health Survey 2015-16 (NFHS-4) was used. The outcome variable was full antenatal care (ANC). A pregnant mother was considered to have 'full ANC' only when she had at least four ANC visits, at least two tetanus toxoid (TT) injections, and consumed 100 or more iron-folic acid (IFA) tablets/syrup during her pregnancy. Bivariate analysis was used to examine the disparity in the coverage of full ANC. In addition, binary logistic regression was used to understand the net effect of predictor variables on the coverage of full ANC. RESULTS The utilisation of full antenatal care (ANC) among adolescent SC/ST mothers was inadequate, with only 18% receiving full ANC. Although 83% of Indian adolescent SC/ST mothers received two or more TT injections, the utilisation of the other two vital components of full ANC was low, with only 46% making four or more ANC visits and 28% consuming the recommended number of IFA tablets or equivalent amount of IFA syrup. There were statistically significant differences in the utilisation of full ANC based on the background characteristics of the participants. The statistical analysis showed that there was a significant association between the receipt of full ANC and factors such as religion (OR = 0.143, CI = 0.044-0.459), household wealth (OR = 5.505, CI = 1.804-16.800), interaction with frontline health workers (OR = 1.821, CI = 1.241-2.670), and region of residence in the Southern region (OR = 3.575, CI = 1.917-6.664). CONCLUSION In conclusion, the study highlights the low utilisation of full antenatal care services among Indian adolescent SC/ST mothers, with only a minority receiving the recommended number of ANC visits and consuming the required amount of IFA tablets/syrup. Addressing social determinants of health and recognising the role of frontline workers can be crucial in improving full ANC coverage among this vulnerable population. Furthermore, targeted interventions tailored to the unique needs of different subgroups of adolescent SC/ST mothers are necessary to achieve optimal maternal and child health outcomes.
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Affiliation(s)
- Aditya Singh
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- External Research Collaborator, Girl Innovation, Research and Learning (GIRL) Centre, Population Council, New York, USA
| | - Vineet Kumar
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
| | - Harpreet Singh
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sourav Chowdhury
- Department of Geography, Raiganj University, Raiganj, West Bengal, India
| | - Sanjana Sharma
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Nelson LE, Ogunbajo A, Abu-Ba'are GR, Conserve DF, Wilton L, Ndenkeh JJ, Braitstein P, Dow D, Arrington-Sanders R, Appiah P, Tucker J, Nam S, Garofalo R. Using the Implementation Research Logic Model as a Lens to View Experiences of Implementing HIV Prevention and Care Interventions with Adolescent Sexual Minority Men-A Global Perspective. AIDS Behav 2023; 27:128-143. [PMID: 35947235 PMCID: PMC10191897 DOI: 10.1007/s10461-022-03776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Adolescents and sexual minority men (SMM) are high priority groups in the United Nations' 2021 - 2016 goals for HIV prevention and viral load suppression. Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of SMM. Consequently, there is not a robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, we integrated the Implementation Research Logic Model with components of the Consolidated Framework for Implementation Research and applied it as a framework for a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania and United States). Using self-reported qualitative survey data of project principal investigators, we identified 17 of the most influential implementation determinants as well as a range of 17 strategies that were used in 90 instances to support intervention implementation. We highlight lessons learned in the implementation research process and provide recommendations for researchers considering future HIV implementation science studies with adolescent SMM.
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Affiliation(s)
- LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA.
- Yale Institute of Global Health, Yale University, New Haven, CT, USA.
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA.
| | - Adedotun Ogunbajo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gamji Rabiu Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA
- School of Nursing, University of Rochester, NY, Rochester, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
| | - Jackson Junior Ndenkeh
- Center for International Health, Ludwig Maximilian University of Munich, Munich, Germany
| | - Paula Braitstein
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dorothy Dow
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Renata Arrington-Sanders
- Division of Adolescent/Young Adult Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick Appiah
- Youth Alliance for Health & Human Rights, Ashanti, Kumasi, Ghana
| | - Joe Tucker
- Division of Infectious Diseases, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Soohyun Nam
- School of Nursing, Yale University, New Haven, CT, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kang Y, Colson-Fearon D, Kim M, Park S, Stephens M, Kim Y, Wetzler E. Socio-economic and psychosocial determinants of violent discipline among parents in Asia Pacific countries during COVID-19: Focus on disadvantaged populations. CHILD ABUSE & NEGLECT 2023; 139:106059. [PMID: 36805614 PMCID: PMC9933874 DOI: 10.1016/j.chiabu.2023.106059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/11/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mobility restrictions and economic downfall as a result of the COVID-19 pandemic may increase the risk of child maltreatment, including increased risk for violent discipline use by parents. OBJECTIVE We examined the socio-economic and psychosocial determinants of violent discipline among parents against children in Asia Pacific countries. PARTICIPANTS & SETTINGS This secondary data analysis included 7765 parents with children 6-18 years old in eight Asia Pacific countries. METHODS 24 potential determinants were identified, including household demographic factors, parents' psychosocial status, and livelihood changes. The dependent variable was parental use of violent discipline (physical, severe physical, psycho-social aggression, and any violent discipline). Univariate and multivariable logistic regression analysis was conducted. RESULTS A total of 41 % of households reported violent discipline. Parental demographic characteristics that were positively related to use of violent discipline were living in rural areas, not being a household head, female sex, age younger than 35 years, and large family size. Poor parental mental health status, loss of job or reduced income due to COVID-19, lack of food at household level, parent engagement in petty trade, and owning a business also predicted violent discipline. Mandatory curfew and receiving pandemic-related education materials were also positive predictors. CONCLUSION Some socio-demographic factors, economic hardship due to COVID-19, and poor mental health status of parents are associated with the use of violent discipline against children in the Asia Pacific region. These results highlight several potential target areas for child protection interventions by governmental and non-profit organizations, including economic, social, and mental health interventions.
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Affiliation(s)
- Yunhee Kang
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Darien Colson-Fearon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Myungsun Kim
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Soim Park
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Yunseop Kim
- College of Medicine, Korea University, Seoul, South Korea
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Ferede TA, Muluneh AG, Wagnew A, Walle AD. Prevalence and associated factors of early sexual initiation among youth female in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys. BMC Womens Health 2023; 23:147. [PMID: 36997947 PMCID: PMC10061848 DOI: 10.1186/s12905-023-02298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
Background Early sexual initiation is a major public health concern globally, specifically in Sub-Saharan African (SSA) countries where reproductive health care services are limited. It is strongly related to increased risk of HIV/AIDS, sexually transmitted diseases, unwanted pregnancy, adverse birth outcomes, and psychosocial problems. However, there is limited evidence on the prevalence and associated factors of early sexual initiation among youth females in SSA. Methods A secondary data analysis was employed based on the recent DHSs of sub-Saharan African countries. A total weighted sample of 184,942 youth females was considered for analysis. Given the hierarchical nature of DHS data, a multilevel binary logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) test were used to assess the presence of clustering. Four nested models were fitted and the model with the lowest deviance (-2LLR0 was selected as the best-fitted model. Variables with p-value < 0.2 in the bivariable multilevel binary logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the strength and statistical significance of the association. Results The prevalence of early sexual initiation among youth females in sub-Saharan Africa was 46.39% [95%CI: 41.23%, 51.5%] ranging from 16.66% in Rwanda to 71.70% in Liberia. In the final model, having primary level education [AOR = 0.82, 95% CI; 0.79, 0.85], and [AOR = 0.50, 95%CI; 0.48, 0.52], being rural [AOR = 1.05, 95%CI: 1.03, 1.07], having media exposure [AOR = 0.91, 95%CI: 0.89, 0.94], and belonged to a community with high media exposure [AOR = 0.92, 95%CI: 0.89,0.96] were found significantly associated with early sexual initiation. Conclusion The prevalence of early sexual initiation among youth females in SSA was high. Educational status, wealth index, residence, media exposure, and community media exposure have a significant association with early sexual initiation. These findings highlight those policymakers and other stakeholders had better give prior attention to empowering women, enhancing household wealth status, and media exposure to increase early sexual in the region.
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Affiliation(s)
- Tigist Andargie Ferede
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Atalay Goshu Muluneh
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemakef Wagnew
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agmasie Damtew Walle
- grid.513714.50000 0004 8496 1254Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
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Malunga G, Sangong S, Saah FI, Bain LE. Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000-2022. Arch Public Health 2023; 81:27. [PMID: 36805786 PMCID: PMC9940412 DOI: 10.1186/s13690-023-01045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia. METHODS This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies. RESULTS Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment. CONCLUSION From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.
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Affiliation(s)
- Gift Malunga
- United Nations Population Fund, UNFPA, UN House, Lusaka, Zambia
| | - Sidney Sangong
- ICAP Global Health, Columbia Mailman School of Public Health, Yaoundé, Cameroon
| | - Farrukh Ishaque Saah
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana. .,Global South Health Research and Services, Amsterdam, Netherlands.
| | - Luchuo Engelbert Bain
- Global South Health Research and Services, Amsterdam, Netherlands ,grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincolnshire, UK
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Ahinkorah BO, Aboagye RG, Okyere J, Seidu AA, Budu E, Yaya S. Correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa. BMC Pregnancy Childbirth 2023; 23:93. [PMID: 36737736 PMCID: PMC9896730 DOI: 10.1186/s12884-023-05361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adolescent girls and young women are vulnerable populations who are at risk of several adverse sexual and reproductive health outcomes, including unintended pregnancies, sexually transmitted infections, unsafe abortions, and death from pregnancy-related complications. In this study, we examined the correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa (SSA). METHODS We extracted data from the most recent Demographic and Health Surveys (DHS) of 31 countries in SSA. Countries whose surveys were conducted from 2010 to 2020 were included in the study. A total of 108,572 adolescent girls and young women (15-24 years) were included in the study. We used a multilevel mixed-effect binary logistic regression analysis to examine the correlates of repeat pregnancies among adolescent girls and young women in SSA. RESULTS We found that adolescent girls and young women aged 20-24 [aOR = 2.36; 95%CI = 2.22, 2.51], those married [aOR = 7.52; 95%CI = 6.81, 8.30], living with a partner [aOR = 7.51; 95%CI = 6.87, 8.21], and those who had sexual intercourse before age 20 [aOR = 1.41; 95%CI = 1.33, 1.51] had higher odds of experiencing repeat pregnancies compared to those aged 15-19, those never in a union, those whose first sexual intercourse occurred at age 20 and above, respectively. Respondents exposed to listening to radio [aOR = 1.12; 95%CI = 1.06, 1.18] and those who justified intimate partner violence [aOR=1.13; 95%CI = 1.07, 1.19] had higher odds of experiencing repeat pregnancies compared to those who never listened to radio and those who did not justify intimate partner violence, respectively. Young women who had attained secondary or higher educational level [aOR = 0.83; 95%CI = 0.78, 0.90], those exposed to reading newspaper or magazine [aOR = 0.90; 95%CI = 0.82, 0.98], those residing in rural areas [aOR = 0.92; 95%CI = 0.86, 0.98], and those belonging to the richer [aOR = 0.87; 95%CI = 0.80, 0.95] and richest [aOR = 0.68; 95%CI = 0.61, 0.76] wealth quintile were less likely to experience repeat pregnancies. CONCLUSION The correlates of repeat pregnancies include age, age at first sexual intercourse, marital status, exposure to media, justification of intimate partner violence, wealth index, educational attainment, and place of residence. The findings underscore the need for governments and policymakers in SSA to implement policies that target the most at-risk groups: those with no formal education, the poor, and adolescent girls. Our findings also highlight the need to strengthen advocacy against the justification of intimate partner violence and intensify girl-child education.
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Affiliation(s)
- Bright Opoku Ahinkorah
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Richard Gyan Aboagye
- grid.449729.50000 0004 7707 5975Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Joshua Okyere
- grid.9829.a0000000109466120Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana ,grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- grid.511546.20000 0004 0424 5478Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Eugene Budu
- grid.415489.50000 0004 0546 3805Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Sanni Yaya
- grid.28046.380000 0001 2182 2255School of International Development and Global Studies, University of Ottawa, Ottawa, Canada ,grid.7445.20000 0001 2113 8111The George Institute for Global Health, Imperial College London, London, UK
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Siafaka V, Tsonis O, Christogiannis C, Kontouli KM, Margariti K, Barbalia Z, Flindris S, Manifava E, Paschopoulou KI, Tzioras S, Baltogianni M, Mavridis D, Paschopoulos M. Psychometric properties of the Greek versions of the Pandemic-Related Pregnancy Stress Scale and the Pandemic-Related Postpartum Stress Scale and associated risk factors during the second year of the COVID-19 pandemic. BJPsych Open 2023; 9:e25. [PMID: 36721918 PMCID: PMC9970181 DOI: 10.1192/bjo.2022.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected perinatal mental health. Reliable tools are needed to assess perinatal stress during pandemic situations. AIMS To assess the psychometric properties of the Greek versions of the Pandemic-Related Pregnancy Stress Scale (PREPS) and the Pandemic-Related Postpartum Stress Scale (PREPS-PP) and to explore the associations between women's characteristics and perinatal stress during the second pandemic wave. METHODS The PREPS and PREPS-PP were completed by 264 pregnant and 188 postpartum women, respectively, who also completed the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). RESULTS The internal consistency was similar for PREPS and PREPS-PP. It was good for preparedness stress (a = 0.77 and α = 0.71, respectively) and infection stress (α = 0.83 for both scales) but low for positive appraisal (α = 0.46 and α = 0.41, respectively). Of the pregnant women, 55.33% and 55.27%, respectively, reported scores of ≥40 on STAI-S and STAI-T, and the respective percentages for the postpartum women were 47.34% and 46.80%. In addition, 14.39% of the pregnant women and 20.74% of the postpartum women scored ≥13 on the EPDS. Higher preparedness stress on PREPS and PREPS-PP was associated with primiparity (P = 0.022 and P = 0.021, respectively) and disrupted perinatal care (P = 0.069 and P = 0.007, respectively). In postpartum women, higher infection stress was associated with chronic disease (P = 0.037), primiparity (P = 0.02) and perceived risk of infection (P = 0.065). Higher score on infection stress was associated with disrupted perinatal care in both groups (P = 0.107 and P = 0.010, respectively). CONCLUSIONS The Greek versions of PREPS and PREPS-PP are valid tools for the assessment of women at risk of perinatal stress during a health crisis.
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Affiliation(s)
| | - Orestis Tsonis
- Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christos Christogiannis
- Evidence Synthesis Methods Team, Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Katerina-Maria Kontouli
- Evidence Synthesis Methods Team, Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Kalypso Margariti
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | - Zoe Barbalia
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | - Stefanos Flindris
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | - Eleni Manifava
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Maria Baltogianni
- Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitris Mavridis
- Evidence Synthesis Methods Team, Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Investigation of the female infertility risk associated with anti-cancer therapy. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023:10.1007/s12094-023-03087-8. [PMID: 36689055 DOI: 10.1007/s12094-023-03087-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/24/2023]
Abstract
Female infertility is a significant health issue worldwide with a rising incidence. Anti-cancer therapy is one of the most important reasons for increasing infertility. Although anti-cancer treatment increases the rate of survival, it decreases the quality of life through its side effects. The most substantial side effects are sexual dysfunction and infertility. Breast cancer is the most common cancer. The first-line treatment of breast cancer is chemotherapy by alkylating agents like cyclophosphamide, which leads to infertility. For instance, persistent chemotherapy-induced amenorrhea among breast cancer patients could affect almost half of the patients that undergo such therapy. However, some agents or therapeutic methods can ameliorate these intoxicating effects. Chemotherapy plus gonadotropin-releasing hormone agonist, in breast cancer patients, can not only improve overall survival but also reduce ovarian toxicity. Age plays an essential role in chemotherapy-induced amenorrhea. Chemotherapy at a younger age can reduce the risk of infertility. Gynecological cancers including uterine and ovarian cancer, which have high mortality rates, are the most related cancers to infertility. Surgery is the primary treatment of gynecological cancers. Studies demonstrated that fertility-sparing surgery is a better option than radical surgery. In addition, neoadjuvant chemotherapy is mostly a better option than primary cytoreductive surgery in terms of survival and fertility. Immune checkpoint inhibitors (ICIs) have recently played a major role in treating various cancer types. However, ICIs are associated with hypophysitis, which affects ovaries and can lead to infertility. There are some options for ovarian preservation such as embryo cryopreservation, oocyte cryopreservation, ovarian transposition, ovarian tissue cryopreservation, and ovarian suppression by GnRH agonists. Anti-müllerian hormone level can be utilized to monitor the ovarian reserve. Moreover, to avoid fertility loss, approaches such as using transplantation of human placenta mesenchymal stem cells, administrating anti-inflammatory agents and hormone therapy are under investigation.
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Das U, Rout S. Are delay ages at marriage increasing? Pre-marital sexual relation among youth people in the place of residence in India. BMC Womens Health 2023; 23:16. [PMID: 36631806 PMCID: PMC9835306 DOI: 10.1186/s12905-022-02149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Adolescent sexual and reproductive health is a major public health issue throughout the world. At the same time shifting of marriage are undergoing discernible changes in country like India. This paper attempts to examine the effect of delay age at marriage on the risks of pre-marital sexual intercourse for the youth people in the place of residence. METHODS Data used in the present study is from various annual publications of Sample Registration System (SRS) and four round of National Family Health Survey, which was conducted in 2015-2016. The Kaplan-Meier life table technique and multivariate regression models are used to examine the premarital sex by the place of residence and marriage cohort. RESULTS Findings of the study indicate that the reasons underlying delayed marriage differs between blow 21 years age group and 22-30 years age group. Multinomial analysis clearly shows education, wealth quintile and mass media are major controlling factors of delayed age at marriage. Residing in urban adolescent women who belonged to better economic family background and exposed to mass media had a higher probability to experience premarital sexual intercourse than the rural adolescent in delay age group. CONCLUSION The study concludes that the restorative the empowerment of youth especially for women and health care provider should consider a multidimensional approach for higher education among youth people and safe sexual behaviour in pre-marital sexual intercourse.
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Affiliation(s)
- Ujjwal Das
- grid.444315.30000 0000 9013 5080P.G. Department of Geography, Fakir Mohan University, Balasore, Odisha India
| | - Sasmita Rout
- grid.444315.30000 0000 9013 5080P.G. Department of Geography, Fakir Mohan University, Balasore, Odisha India
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Tesfay N, Hailu G, Woldeyohannes F. Effect of optimal antenatal care on maternal and perinatal health in Ethiopia. Front Pediatr 2023; 11:1120979. [PMID: 36824654 PMCID: PMC9941639 DOI: 10.3389/fped.2023.1120979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Receiving at least four antenatal care (ANC) visits have paramount importance on the health of mothers and perinates. In Ethiopia, several studies were conducted on ANC service utilization; however, limited studies quantified the effect of care on maternal and perinate health. In response to this gap, this study is conducted to quantify the effect of optimal ANC care (≥4 visits) on maternal and perinatal health among women who received optimal care in comparison to women who did not receive optimal care. METHODS The study utilized the Ethiopian perinatal death surveillance and response (PDSR) system dataset. A total of 3,814 reviewed perinatal deaths were included in the study. Considering the nature of the data, preferential within propensity score matching (PWPSM) was performed to determine the effect of optimal ANC care on maternal and perinatal health. The effect of optimal care was reported using average treatment effects of the treated [ATT]. RESULT The result revealed that optimal ANC care had a positive effect on reducing perinatal death, due to respiratory and cardiovascular disorders, [ATT = -0.015, 95%CI (-0.029 to -0.001)] and extending intrauterine life by one week [ATT = 1.277, 95%CI: (0.563-1.991)]. While it's effect on maternal health includes, avoiding the risk of having uterine rupture [ATT = -0.012, 95%CI: (-0.018 to -0.005)], improving the utilization of operative vaginal delivery (OVD) [ATT = 0.032, 95%CI: (0.001-0.062)] and avoiding delay to decide to seek care [ATT = -0.187, 95%CI: (-0.354 to -0.021)]. CONCLUSION Obtaining optimal ANC care has a positive effect on both maternal and perinatal health. Therefore, policies and interventions geared towards improving the coverage and quality of ANC services should be the top priority to maximize the benefit of the care.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Department, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Kenny L, Lokot M, Bhatia A, Hassan R, Pyror S, Dagadu NA, Aden A, Shariff A, Bacchus LJ, Hossain M, Cislaghi B. Gender norms and family planning amongst pastoralists in Kenya: a qualitative study in Wajir and Mandera. Sex Reprod Health Matters 2022; 30:2135736. [DOI: 10.1080/26410397.2022.2135736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Leah Kenny
- Research Officer, London School of Hygiene and Tropical Medicine, London, UK
- London School of Economics and Political Science, London, UK
| | - Michelle Lokot
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Amiya Bhatia
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahma Hassan
- PhD Fellow, University of Nairobi, Nairobi, Kenya
| | - Shannon Pyror
- Family Planning Technical Lead, Save the Children, Washington DC, USA
| | | | - Abdullahi Aden
- Programme Manager, Wajir Field Office, Save the Children, Nairobi, Kenya
| | - Abdalla Shariff
- Programme Manager, Mandera Field Office Save the Children, Nairobi, Kenya
| | - Loraine J. Bacchus
- Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Mazeda Hossain
- Associate Professorial Research Fellow, London School of Hygiene and Tropical Medicine, London, UK
- Honorary Associate Professor, London School of Economics and Political Science, London, UK
| | - Beniamino Cislaghi
- Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
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Bossard C, Chihana M, Nicholas S, Mauambeta D, Weinstein D, Conan N, Nicco E, Suzi J, OConnell L, Poulet E, Ellman T. HIV, sexual violence, and termination of pregnancy among adolescent and adult female sex workers in Malawi: A respondent-driven sampling study. PLoS One 2022; 17:e0279692. [PMID: 36584132 PMCID: PMC9803093 DOI: 10.1371/journal.pone.0279692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
Female Sex Workers (FSWs) are a hard-to-reach and understudied population, especially those who begin selling sex at a young age. In one of the most economically disadvantaged regions in Malawi, a large population of women is engaged in sex work surrounding predominantly male work sites and transport routes. A cross-sectional study in February and April 2019 in Nsanje district used respondent driven sampling (RDS) to recruit women ≥13 years who had sexual intercourse (with someone other than their main partner) in exchange for money or goods in the last 30 days. A standardized questionnaire was filled in; HIV, syphilis, gonorrhea, and chlamydia tests were performed. CD4 count and viral load (VL) testing occurred for persons living with HIV (PLHIV). Among 363 study participants, one-quarter were adolescents 13-19 years (25.9%; n = 85). HIV prevalence was 52.6% [47.3-57.6] and increased with age: from 14.7% (13-19 years) to 87.9% (≥35 years). HIV status awareness was 95.2% [91.3-97.4], ART coverage was 98.8% [95.3-99.7], and VL suppression 83.2% [77.1-88.0], though adolescent FSWs were less likely to be virally suppressed than adults (62.8% vs. 84.4%). Overall syphilis prevalence was 29.7% [25.3-43.5], gonorrhea 9.5% [6.9-12.9], and chlamydia 12.5% [9.3-16.6]. 72.4% had at least one unwanted pregnancy, 17.9% had at least one abortion (40.1% of which were unsafe). Half of participants reported experiencing sexual violence (SV) (47.6% [42.5-52.7]) and more than one-tenth (14.2%) of all respondents experienced SV perpetrated by a police officer. Our findings show high levels of PLHIV-FSWs engaged in all stages of the HIV cascade of care. The prevalence of HIV, other STIs, unwanted pregnancy, unsafe abortion, and sexual violence remains extremely high. Peer-led approaches contributed to levels of ART coverage and HIV status awareness similar to those found in the general district population, despite the challenges and risks faced by FSWs.
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Affiliation(s)
- Claire Bossard
- Epicentre, Médecins Sans Frontières, Paris, France
- * E-mail:
| | | | | | | | | | | | - Elena Nicco
- OCB, Médecins Sans Frontières, Blantyre, Malawi
| | - Joel Suzi
- The Malawi National Aids Commission, Lilongwe, Malawi
| | - Lucy OConnell
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | | | - Tom Ellman
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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Tsega NT, Belay DG, Aragaw FM, Asratie MH, Gashaw M, Endalew M. Magnitude and associated factors of intimate partner violence among youth women in Ethiopia: multilevel analysis based on 2016 Ethiopian Demographic and Health Survey. BMC Womens Health 2022; 22:549. [PMID: 36572908 PMCID: PMC9793678 DOI: 10.1186/s12905-022-02143-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The period of youth is important for the foundation of healthy and stable relationships, women's health and well-being. Youth women face a higher risk of experiencing violence than older women. Intimate partner violence (IPV) against youth women is a significant public health concern. Despite paramount negative health consequences of IPV for the survivor, as per our knowledge, research study on IPV and associated factors among youth women in Ethiopia is scarce. Therefore, this study aimed to assess the magnitude and associated factors of IPV among youth women in Ethiopia. METHODS The data was accessed from 2016 Ethiopia demographic and health survey (EDHS) which was a cross sectional population based household survey. It was also conducted using a multi-stage stratified random cluster sampling approach. The data were cleaned, weighted, and analyzed using STATA Version 14 software. The total weighted sample of 1077 youth women were used in this study. Multilevel logistic regression modeling was used to determine factors associated with IPV among youth women. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to declare the significant variables. RESULTS Among the total participants, 30.27% (95% CI 27.59, 33.09) of youth women experienced IPV. Individual level variables such as: Being widowed/divorced/separated (AOR = 2.28; 95% CI 1.33, 3.91), having a partner who drinks alcohol (AOR = 5.76; 95% CI 3.42, 9.69), witnessing inter-parental violence during childhood (AOR = 3.45; 95% CI 2.21, 5.37), being afraid of partners (AOR = 7.09; 95% CI 4.30, 11.68), and from community level variables, youth women residing in communities with a low proportion of educated youth women (AOR = 0.31; 95% CI 0.13, 0.78) were significantly associated with having experience of IPV. CONCLUSION The magnitude of intimate partner violence among youth women in Ethiopia was relatively high as compared to the global estimate of IPV. Individual and community level variables such as currently widowed/divorced/separated women, having a partner who drinks alcohol, witnessing inter-parental violence, being afraid of partner, and women from a low proportion of community level youth women's education were significantly associated with intimate partner violence. To decrease this public health problem, it is better to strengthen legislation on the purchase and sale of alcohol, provide legal protection for separated/divorced women, establish effective legal response services for IPV, promote gender equality, and provide psychological support for those who witnessed inter-parental violence during childhood to reduce IPV.
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Affiliation(s)
- Nuhamin Tesfa Tsega
- grid.59547.3a0000 0000 8539 4635Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- grid.59547.3a0000 0000 8539 4635Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- grid.59547.3a0000 0000 8539 4635Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- grid.59547.3a0000 0000 8539 4635Department of Physiotherapy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mastewal Endalew
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Adibi Larijani H, Moslehi S, Dowlati M. Identifying the Preparedness Components for Sexual Violence in Natural Disasters: A Systematic Review. Med J Islam Repub Iran 2022; 36:158. [PMID: 36721492 PMCID: PMC9884150 DOI: 10.47176/mjiri.36.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Indexed: 02/02/2023] Open
Abstract
Background: The probability of sexual violence in areas affected by natural disasters may increase. An increase in the rate of unwanted pregnancies and subsequent intentional abortions, physical and mental injuries, and death can be the consequences of sexual violence. One of the characteristics of natural disasters is their unpredictability and ambiguity. Since decisions must be made quickly during the response, there must be adequate planning in advance, and preparedness in the community will reduce surprises in the responding organizations. This study aimed to identify the factors affecting the preparedness against sexual violence in natural disasters. Methods: In this study, an electronic search was performed in the MEDLINE (PubMed), Scopus, Web of Science, and ProQuest databases. Other search resources, such as Science.gov, Scienceopen.cond Meta-search engines, organizational websites, including UNICEF, UNFPA, and IFRC, as well as key journals and the International Disaster and Risk Conference were hand-searched from 1/1/1990 to 8/29/2021. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was used to select the studies, and the findings were finally analyzed by thematic analysis method using MAXQDA10 software. Results: A total of 40 papers out of a total of 2978 studies were considered in this analysis. Macropolicies, empowerment, contextualization, management and organization, command community-based, and responsive planning were the five primary categories that were found. Conclusion: Preparedness measures are highly important to respond promptly and effectively to sexual violence and should be integrated into disaster preparedness programs. The findings of this study can be used by disaster response managers and policymakers in developing and improving preparedness programs.
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Affiliation(s)
- Haleh Adibi Larijani
- Department of Health in Disasters and Emergencies, School of Health
Management and Information Sciences, Iran University of Medical Sciences, Tehran,
Iran
| | - Shandiz Moslehi
- Department of Health in Disasters and Emergencies, School of Health
Management and Information Sciences, Iran University of Medical Sciences, Tehran,
Iran ,Health Management and Economics Research Center, Health Management
Research Institute, Iran University of Medical Sciences, Tehran, Iran , Corresponding author:Shandiz Moslehi,
| | - Mohsen Dowlati
- Department of Health in Disasters and Emergencies, School of Health
Management and Information Sciences, Iran University of Medical Sciences, Tehran,
Iran
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Kundu S, Kundu S, Rahman MA, Kabir H, Al Banna MH, Basu S, Reza HM, Hossain A. Prevalence and determinants of contraceptive method use among Bangladeshi women of reproductive age: a multilevel multinomial analysis. BMC Public Health 2022; 22:2357. [PMID: 36526989 PMCID: PMC9756620 DOI: 10.1186/s12889-022-14857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Much scholarly debate has centered on Bangladesh's family planning program (FPP) in lowering the country's fertility rate. This study aimed to investigate the prevalence of using modern and traditional contraceptive methods and to determine the factors that explain the contraceptive methods use. METHODS The study used data from the 2017-18 Bangladesh Demographic and Health Survey (BDHS), which included 11,452 (weighted) women aged 15-49 years in the analysis. Multilevel multinomial logistic regression was used to identify the factors associated with the contraceptive method use. RESULTS The prevalence of using modern contraceptive methods was 72.16%, while 14.58% of women used traditional methods in Bangladesh. In comparison to women in the 15-24 years age group, older women (35-49 years) were more unwilling to use modern contraceptive methods (RRR: 0.28, 95% CI: 0.21-0.37). Women who had at least a living child were more likely to use both traditional and modern contraceptive methods (RRR: 4.37, 95% CI: 3.12-6.11). Similarly, given birth in the previous 5 years influenced women 2.41 times more to use modern method compared to those who had not given birth (RRR: 2.41, 95% CI: 1.65-3.52). Husbands'/partners' decision for using/not using contraception were positively associated with the use of both traditional (RRR: 4.49, 95% CI: 3.04-6.63) and modern methods (RRR: 3.01, 95% CI: 2.15-4.17) rather than using no method. This study suggests rural participants were 21% less likely to utilize modern methods than urban participants (RRR: 0.79, 95% CI: 0.67-0.94). CONCLUSION Bangladesh remains a focus for contraceptive use, as it is one of the most populous countries in South Asia. To lower the fertility rate, policymakers may design interventions to improve awareness especially targeting uneducated, and rural reproductive women in Bangladesh. The study also highlights the importance of male partners' decision-making regarding women's contraceptive use.
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Affiliation(s)
- Satyajit Kundu
- grid.443020.10000 0001 2295 3329Global Health Institute, North South University, Dhaka, 1229 Bangladesh ,grid.263826.b0000 0004 1761 0489School of Public Health, Southeast University, Nanjing, 210096 China ,grid.443081.a0000 0004 0489 3643Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602 Bangladesh
| | - Subarna Kundu
- grid.412118.f0000 0001 0441 1219Statistics Discipline, Khulna University, Khulna, 9208 Bangladesh
| | - Md. Ashfikur Rahman
- grid.412118.f0000 0001 0441 1219Development Studies Discipline, Khulna University, Khulna, 9208 Bangladesh
| | - Humayun Kabir
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
| | - Md. Hasan Al Banna
- grid.443081.a0000 0004 0489 3643Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602 Bangladesh
| | - Saurav Basu
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, New Delhi, 122002 India
| | - Hasan Mahmud Reza
- grid.443020.10000 0001 2295 3329Department of Pharmaceutical Sciences, North South University, Dhaka, 1229 Bangladesh
| | - Ahmed Hossain
- grid.412789.10000 0004 4686 5317College of Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates
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Swarray-Deen A, Attah DA, Sefogah PE, Oduro NE, Nuamah HG, Nuamah MA, Adzadi C, Oppong SA. Perinatal autopsy in Ghana: Healthcare workers knowledge and attitude. Front Glob Womens Health 2022; 3:1021474. [PMID: 36589149 PMCID: PMC9794746 DOI: 10.3389/fgwh.2022.1021474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background Perinatal mortality refers to stillbirths and early neonatal deaths. Stillbirth, the death of a foetus from 28 weeks or with a birth weight below 1,000 g, and early neonatal deaths, the death of a new-born within 24 h of delivery, are among the most distressing global health problems, with approximately 2 million stillbirths occurring annually. Although a post-mortem examination of the stillborn baby is essential for understanding and learning the cause of stillbirth, many couples decline the procedure. Sub-Saharan Africa has one of the highest stillbirth rates in the world, yet there is a dearth of studies on post-mortem uptake from the region. Aim To explore healthcare professionals' views and perceptions of perinatal autopsy in Ghana. Methods Mixed-method approach consisted of semi-structured interviews and an electronic cross-sectional survey to evaluate the views and perceptions of healthcare professionals at Korle-Bu Teaching Hospital on autopsy for stillbirths and early neonatal deaths. Descriptive quantitative data were summarised in frequencies and percentages, and statistical results and descriptions were tabulated and coded in terms of types of barriers. For the qualitative aspect, the audio-taped interviews were transcribed, themes generated, and direct quotes and descriptions were coded for all knowledge, beliefs, attitudes and practices concerning the barriers and facilitators for post-mortem. Results Ninety-nine healthcare professionals participated. No participant had formal training regarding counselling for perinatal autopsy and 40% had " no idea " who is responsible for counselling and obtaining consent for a perinatal autopsy. Forty-four percent (44%) of the participants knew of only the "Conventional/ Full" autopsy and <4% were aware of less invasive methods of performing an autopsy. Qualitative data showed healthcare worker influence, religious and financial considerations impede the implementation of perinatal autopsies. Despite the low uptake of perinatal autopsies, interviews from healthcare workers suggest acceptance rates would improve if parents knew about different options, especially less invasive procedures. Conclusion At Ghana's largest referral centre, perinatal autopsy counselling and uptake are at extremely low levels. Most healthcare professionals have little knowledge, skills, and capacity to advise parents regarding perinatal autopsies. Training is needed to update the workforce on recommended perinatal autopsy practices.
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Affiliation(s)
- Alim Swarray-Deen
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Dzifa A. Attah
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Promise E. Sefogah
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana,Correspondence: Promise E. Sefogah
| | - Nana E. Oduro
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Hanson G. Nuamah
- Department of Epidemiology & Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Mercy A. Nuamah
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Catherine Adzadi
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
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Pichon M, Carter DJ, Howard-Merrill L, Sono R, Gimunta V, Rutenge O, Thiaw Y, Stoebenau K, Perrin N, Buller AM. A mixed-methods, exploratory, quasi-experimental evaluation of a radio drama intervention to prevent age-disparate transactional sex in Tanzania. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1000853. [PMID: 36531443 PMCID: PMC9755860 DOI: 10.3389/frph.2022.1000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Age-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania. METHODS In a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12-16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores. RESULTS Longitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (β = -6.26; 95% CI: -12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (β = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men. CONCLUSIONS Given the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation.
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Affiliation(s)
- Marjorie Pichon
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel J Carter
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
| | - Revocatus Sono
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Veronicah Gimunta
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Oscar Rutenge
- Tanganyika Christian Refugee Service, Shinyanga Unit, United Republic of Tanzania
| | - Yandé Thiaw
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Nancy Perrin
- Department of Behavioral and Community Health, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Ana Maria Buller
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Lokubal P, Corcuera I, Balil JM, Frischer SR, Kayemba CN, Kurinczuk JJ, Opondo C, Nair M. Abortion decision-making process trajectories and determinants in low- and middle-income countries: A mixed-methods systematic review and meta-analysis. EClinicalMedicine 2022; 54:101694. [PMID: 36277313 PMCID: PMC9579809 DOI: 10.1016/j.eclinm.2022.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND About 45.1% of all induced abortions are unsafe and 97% of these occur in low- and middle-income countries (LMICs). Women's abortion decisions may be complex and are influenced by various factors. We aimed to delineate women's abortion decision-making trajectories and their determinants in LMICs. METHODS We searched Medline, EMBASE, PsychInfo, Global Health, Web of Science, Scopus, IBSS, CINAHL, WHO Global Index Medicus, the Cochrane Library, WHO website, ProQuest, and Google Scholar for primary studies and reports published between January 1, 2000, and February 16, 2021 (updated on June 06, 2022), on induced abortion decision-making trajectories and/or their determinants in LMICs. We excluded studies on spontaneous abortion. Two independent reviewers extracted and assessed quality of each paper. We used "best fit" framework synthesis to synthesise abortion decision-making trajectories and thematic synthesis to synthesise their determinants. We analysed quantitative findings using random effects model. The study protocol is registered with PROSPERO number CRD42021224719. FINDINGS Of the 6960 articles identified, we included 79 in the systematic review and 14 in the meta-analysis. We identified nine abortion decision-making trajectories: pregnancy awareness, self-reflection, initial abortion decision, disclosure and seeking support, negotiations, final decision, access and information, abortion procedure, and post-abortion experience and care. Determinants of trajectories included three major themes of autonomy in decision-making, access and choice. A meta-analysis of data from 7737 women showed that the proportion of the overall women's involvement in abortion decision-making was 0.86 (95% CI:0.73-0.95, I2 = 99.5%) and overall partner involvement was 0.48 (95% CI:0.29-0.68, I2 = 99.6%). INTERPRETATION Policies and strategies should address women's perceptions of safe abortion socially, legally, and economically, and where appropriate, involvement of male partners in abortion decision-making processes to facilitate safe abortion. Clinical heterogeneity, in which various studies defined "the final decision-maker" differentially, was a limitation of our study. FUNDING Nuffield Department of Population Health DPhil Scholarship for PL, University of Oxford, and the Medical Research Council Career Development Award for MN (Grant Ref: MR/P022030/1).
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Affiliation(s)
- Paul Lokubal
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Corresponding author at: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington OX3 7LF Oxford, UK.
| | - Ines Corcuera
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | | | - Sandrena Ruth Frischer
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christine Nalwadda Kayemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Uzunov AV, Secara DC, Mehedințu C, Cîrstoiu MM. Preeclampsia and neonatal outcomes in adolescent and adult patients. J Med Life 2022; 15:1488-1492. [PMID: 36762320 PMCID: PMC9884345 DOI: 10.25122/jml-2022-0264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/20/2022] [Indexed: 02/11/2023] Open
Abstract
Preeclampsia is an important health problem with a higher prevalence in the adolescent population. Furthermore, preeclampsia causes adverse maternal and neonatal outcomes. Newborns can be affected by preeclampsia, resulting in lower birth weight or Apgar score, the need for neonatal intensive care, or prematurity. All these complications are also associated with adolescent pregnancies, and together with preeclampsia, it can determine poorer neonatal outcomes. The aim of the study was to compare the neonatal outcomes of adolescents and adults with preeclampsia. We analyzed data on all the newborns of adolescents with preeclampsia (n=12) who delivered at the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest between January 1st, 2019, and December 31st, 2019 and compared it with data from 12 aleatory newborns of adults diagnosed with preeclampsia. The prevalence of preeclampsia was higher in the adolescent population compared with the adult one. The weight of newborns was lower among adolescents with preeclampsia. There were no significant differences in Apgar scores between the two groups. Preterm delivery was more frequent in adolescent patients with preeclampsia. Preeclampsia is an additional risk factor for adolescent pregnancy, but it is also a severe materno-fetal complication for this population.
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Affiliation(s)
- Ana Veronica Uzunov
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Corresponding Author: Ana Veronica Uzunov, Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. E-mail:
| | - Diana Cristina Secara
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Department of Obstetrics and Gynaecology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Department of Obstetrics and Gynaecology, Clinical Hospital of Obstetrics and Gynaecology Filantropia, Bucharest, Romania
| | - Monica Mihaela Cîrstoiu
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Department of Obstetrics and Gynaecology, University Emergency Hospital Bucharest, Bucharest, Romania
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