Evaluating changes in the prevalence of female genital mutilation/cutting among 0-14 years old girls in Nigeria using data from multiple surveys: A novel Bayesian hierarchical spatio-temporal model

Female genital mutilation and its associated factors among adolescent girls and young women in Tanzania: analysis of the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS)

INTRODUCTION

The morbidity and mortality associated with Female Genital Mutilation (FGM) have been clearly documented. Controlling and eventually eradication this practice is very important. Despite a loud call from the WHO and other international organisations, there are extensive nationalities and societies from both developed and developing countries still practising FGM. Understanding the current magnitude and associated factors in Tanzania may bring more light for possible interventions intended to control FGM. This study is timely for this aim.

OBJECTIVE

To determine the prevalence of female genital mutilation and its associated factors among adolescent girls and young women in Tanzania.

METHODS

Secondary data analysis was conducted on data from the 2022 Tanzanian Demographic and Health Survey. The weighted sample included in this study was 2965 adolescent girls and young women aged 15-24 years. Data analysis was performed using Stata 18.0 software. The strength of the association was assessed using the adjusted odds ratio (aOR) along with its corresponding 95% confidence interval (CI).

RESULTS

The overall prevalence of FGM among adolescent girls and young women in Tanzania was 4.9% (95% CI = 3.37, 6.97). The prevalence varied significantly across the zones, ranging from < 1% in both Zanzibar and Southern zones to 19.7% in the Northern zone. Moreover, the results revealed that factors associated with FGM were rural areas (aOR = 2.09, 95% CI = 1.80, 5.44); no education (aOR = 11.59, 95% CI = 4.97, 27.03); poor (aOR = 2.41, 95% CI = 1.20, 4.83); unskilled manuals (aOR = 3.76, 95% CI = 1.97, 7.15); continued FGM (aOR = 3.86, 95% CI = 1.62, 9.18); FGM required by religion (aOR = 8.5, 95% CI = 3.15, 22.96) and watching television at least once a week (aOR = 0.20, 95% CI = 0.70, 1.56) among adolescents and young women in Tanzania.

CONCLUSION

Female genital mutilation among adolescent girls and young women aged 15-24 years in Tanzania has decreased slightly between 2015/16 and 2022 from 5.9% to 4.9% respectively. This was mostly associated with education level, place of residence, occupation, wealth index, mass media exposure, attitudes towards FGM. More tailored programs focusing on high prevalence zones targeting adolescent girls and young women are needed to end female genital mutilation by 2030.

Comparison of FGM prevalence among Nigerian women aged 15-49 years using two household surveys conducted before and after the COVID-19 pandemic

BACKGROUND

Due to its economic burden and change of focus, there is no gainsaying of the potential impacts of the COVID-19 pandemic on the progress of several female genital mutilation (FGM) interventions across the various countries. However, the magnitude of the potential changes in likelihood and prevalence should be more accurately explored and quantified using a statistically robust comparative study. In this study, we examined the differences in the likelihood and prevalence of FGM among 15-49 years old women before and after the pandemic in Nigeria.

METHODS

We used advanced Bayesian hierarchical models to analyse post-COVID-19 datasets provided by the Multiple Indicator Cluster Surveys (MICS 2021) and pre-COVID-19 data from the Demographic and Health Surveys (DHS 2018).

RESULTS

Results indicated that although there was an overall decline in FGM prevalence nationally, heterogeneities exist at state level and at individual-/community-level characteristics. There was a 6.9% increase in prevalence among women who would like FGM to continue within the community. FGM prevalence increased by 18.9% in Nasarawa, while in Kaduna there was nearly 40% decrease.

CONCLUSIONS

Results show that FGM is still a social norm issue in Nigeria and that it may have been exacerbated by the COVID-19 pandemic. The methods, data and outputs from this study would serve to provide accurate statistical evidence required by policymakers for complete eradication of FGM.

Somalian women with female genital mutilation had increased risk of female sexual dysfunction: a cross-sectional observational study

Studies regarding the impact of female genital mutilation/cutting (FGM/C) on sexual function are scarce. This study is the first to explore the rate of female sexual dysfunction (FSD) among Somalian women who underwent FGM and its association with different FGM types. This study was carried out among women with a history of FGM who visited our clinic for a medical check-up. It relied on data including socio-demographic features, type of FGM determined by an examination, and the Female Sexual Function Index (FSFI) scores. Overall, 255 women were included. While 43.9% (n = 112) of the respondents had a history of Type 3 FGM, 32.2% had Type 2 (n = 82), and 23.9% had Type 1 (n = 61) FGM. Among all patients, 223 had FSD (87.6%). There was a significant association between the FGM type and FSD (p < 0.001). The mean total FSFI score for the patients with Type 1, 2, and 3 FGM was 22.5, 19.7, and 17.3, respectively, all indicating FSD. The FSD is prevalent among mutilated Somalian women. Patients with Type 3 FGM had the lowest mean total FSFI scores indicating that the impact on sexual function was correlated with the extent of tissue damage during FGM.

Circumcising daughters in Nigeria: To what extent does education influence mothers' FGM/C continuation attitudes?

Education has been adjudged as an important behavioural change intervention and a key player in combating Female Genital Mutilation/Cutting (FGM/C). An assumed pathway is that it influences FGM/C attitudes. However, empirical evidence that explores this assumption is scarce. Hence, our study examines whether the associative effect of FGM/C continuation attitudes on circumcision of daughters is influenced by the level of a mother's education in Nigeria. We extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The study focused on youngest daughters that were born in the last five years preceding the survey. A sample of 5,039 children with complete data on variables of interest to the study were analysed. The main outcome variable for this study is "circumcision among youngest daughters". The key explanatory variables were maternal "FGM/C continuation attitudes" and "education". At 95% confidence interval, we conducted a two-level logistic regression modelling and introduced interaction between the key independent variables. In the study's sample, the prevalence of FGM/C was 34%. It was lower for daughters whose mothers had higher education (12%) and believe FGM/C should discontinue (11.1%). Results from the multivariate analysis show statistically significant odds of circumcision for a daughter whose mother has had higher education and believes FGM/C should discontinue (OR-0.28, 95%CI: 0.08-0.98). For women who believe FGM/C should discontinue, the probability of daughter's circumcision reduced by 40% if the mother has attained higher education. Among those who believe FGM/C should continue, the probability of daughter's circumcision worsened if the mother had attained higher education (64%), however, this result was influenced by mothers' experience of circumcision. Education influences FGM/C attitudes, nonetheless, women's cutting experience can be a conduit for which the practice persists. Promoting female education should be accompanied by strong political commitment towards enforcing laws on FGM/C practice.

Variations in the Prevalence of Female Genital Mutilation Among Reproductive-aged Women in Nigeria Across Three Generations

BACKGROUND AND OBJECTIVE

Female genital mutilation (FGM) is widespread mainly in low and middle-income countries. Nigeria is one of the countries with the highest prevalence of FGM, accounting for about one of every four cases globally. The purpose of this study was to determine the prevalence of FGM among three generations in Abuja, the federal capital city of Nigeria.

METHODS

This is a cross-sectional study among women of reproductive age (15-49 years) within two area councils of Abuja (Bwari and Abuja Municipal) and Nyanya suburban district adjoining the federal capital territory in Nigeria. The respondents are pregnant women attending antenatal care at four selected health facilities. Data were collected using Google Forms and were analyzed with SPSS for Windows version 25.

RESULTS

This study comprised data from 634 females (who had an average age of 33±6.0 years) from four major healthcare facilities in Abuja. The most common age group was 30 - 34 years (29.2%). The prevalence of FGM in the first generation (37.7%) was significantly higher than in the second (28.5%) and the third generations (8.7%) (p<0.01). The prevalence of FGM in the second generation was also significantly higher than in the third (p<0.01). The predictors of women circumcising their daughters include primary/no-education AOR 1.48 (95% CI: 0.41-5.31; p<0.05), being a traditionalist 4.94 (95% CI: 0.29-84.56; p<0.05), or Muslim 2.27 (95% CI: 0.94-5.49; p<0.05), respondent's mother being circumcised 1.69 (95% CI: 0.26-10.85, p<0.05) or mother's circumcision unknown 5.41 (95% CI: 0.78-37.34; p<0.05), respondents being circumcised 54.71 (95% CI: 0.78-37.34; p<0.001), culture 2.48 (95% CI: 1.00-6.19; p<0.05), and ignorance of adverse psycho-social/emotional effects of FGM 4.39 (95% CI: 1.46-13.17; p<0.05).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Although there is a decline in FGM prevalence from the first generation to the third generation in Nigeria, the current prevalence of 8.7% remains a public health concern. Nigerian women's ongoing experience of FGM requires both individual and stakeholders' involvement to eradicate health-related problems such as tissue damage, infection, scarring, infertility, and pains during sexual intercourse, urination, and menstruation.

Mapping the Burden of Hypertension in South Africa: A Comparative Analysis of the National 2012 SANHANES and the 2016 Demographic and Health Survey

This study investigates the provincial variation in hypertension prevalence in South Africa in 2012 and 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors. Data were analysed from participants aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) 2012 and the South African Demographic and Health Survey (DHS) 2016. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of hypertension across South Africa’s nine provinces while controlling for the latent effects of geographical location. Hypertension prevalence was 38.4% in the SANHANES in 2012 and 48.2% in the DHS in 2016. The risk of hypertension was significantly high in KwaZulu-Natal and Mpumalanga in the 2016 DHS, despite being previously nonsignificant in the SANHANES 2012. In both survey years, hypertension was significantly higher among males, the coloured population group, urban participants and those with self-reported high blood cholesterol. The odds of hypertension increased non-linearly with age, body mass index (BMI), waist circumference. The findings can inform decision making regarding the allocation of public resources to the most affected areas of the population.

Analysing Normative Influences on the Prevalence of Female Genital Mutilation/Cutting among 0-14 Years Old Girls in Senegal: A Spatial Bayesian Hierarchical Regression Approach

BACKGROUND

Female genital mutilation/cutting (FGM/C) is a harmful traditional practice affecting the health and rights of women and girls. This has raised global attention on the implementation of strategies to eliminate the practice in conformity with the Sustainable Development Goals (SDGs). A recent study on the trends of FGM/C among Senegalese women (aged 15-49) which examined how individual- and community-level factors affected the practice, found significant regional variations in the practice. However, the dynamics of the practice among girls (0-14 years old) is not fully understood. This paper attempts to fill this knowledge gap by investigating normative influences in the persistence of the practice among Senegalese girls, identify and map 'hotspots'.

METHODS

We do so by using a class of Bayesian hierarchical geospatial modelling approach implemented in R statistical software (R Foundation for Statistical Computing, Vienna, Austria) using R2BayesX package. We employed Markov Chain Monte Carlo (MCMC) techniques for full Bayesian inference, while model fit and complexity assessment utilised deviance information criterion (DIC).

RESULTS

We found that a girl's probability of cutting was higher if her mother was cut, supported FGM/C continuation or believed that the practice was a religious obligation. In addition, living in rural areas and being born to a mother from Diola, Mandingue, Soninke or Poular ethnic group increased a girl's likelihood of being cut. The hotspots identified included Matam, Tambacounda and Kolda regions.

CONCLUSIONS

Our findings offer a clearer picture of the dynamics of FGM/C practice among Senegalese girls and prove useful in informing evidence-based intervention policies designed to achieve the abandonment of the practice in Senegal.