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Yimam JA, Luslseged S, Tura JB, Bedassa BB, Wariso FB, Rameto MA, Abdella S. Determinants of depressive and alcohol use disorders among female sex workers in Ethiopia: evidence from a national bio-behavioral survey, 2020. BMC Psychiatry 2024; 24:344. [PMID: 38714984 PMCID: PMC11075289 DOI: 10.1186/s12888-024-05799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Female sex workers (FSWs) face an elevated risk of developing mental health disorders and alcohol use disorders (AUD), which in turn increase their vulnerability to HIV and other sexually transmitted infections (STIs) and other negative outcomes. To effectively address both of these health issues, it is crucial to understand the shared key determinants underlying these illnesses, which is a substantial knowledge gap in Ethiopia and elsewhere in the world. Therefore, this study aimed to identify the common key determinants of depression and AUD among FSWs in Ethiopia using a bivariate multivariable ordinal logistic model. METHODS We analyzed cross-sectional biobehavioral data collected in 2020 from 16 cities and major towns in Ethiopia using the respondent-driven sampling (RDS) technique, which involved a total of 6,085 FSWs. FSWs who had lived at the study sites for at least a month before the study period were deemed eligible for recruitment. Major depressive disorder (DD) and AUD were screened using the Patient Health Questionnaire (PHQ9) and alcohol use disorder identification test (AUDIT), respectively. We used descriptive statistics to summarize study population characteristics and bivariate multivariable ordinal logistic regression (BMOLR) to identify common determinants of DD and AUD combined and their nonnormal correlation. RESULTS Among 6085 FSWs screened for DD and AUD, 13.5% and 4.0% have met the criteria for moderate and severe depressive disorder, respectively, and 20.3% and 34.7% have met the AUDIT criteria for harmful or hazardous behavior and alcohol dependence, respectively. FSW with experience of inconsistent condom use, condom failure, violence, mobility, use of any drugs, non-paying partners, abortion, and selling sex for more than five years were associated with an increase in the severity of both disorders. A high average income from selling sex and the number of paying partners reduced the severity of depression and increased the level of alcohol dependence. Being HIV positive and ever having anal sex were associated only with an increase in depression. CONCLUSION Major DD and AUD are prevalent among FSWs in Ethiopia. The findings revealed that common key determinants, which exacerbated the severity of both disorders, were also risk factors for HIV and other STIs. Consequently, integrated STI strategies are essential in the screening, referral, and treatment of depression and AUD. Intervention packages should encompass determinants of depression and AUD, including condom utilization, drug use, mobility between towns, abortion, violence, and counseling services. Additionally, strategies to ensure economic security should be incorporated.
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Affiliation(s)
- Jemal Ayalew Yimam
- Department of statistics, College of Natural Science, Wollo University, Kombolcha, Ethiopia.
| | - Sileshi Luslseged
- College of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jaleta Bulti Tura
- TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Feyiso Bati Wariso
- TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Saro Abdella
- TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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2
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Nabayinda J, Witte SS, Kizito S, Nanteza F, Nsubuga E, Sensoy Bahar O, Nabunya P, Ssewamala FM. The impact of an economic empowerment intervention on intimate partner violence among women engaged in sex work in southern Uganda: A cluster randomized control trial. Soc Sci Med 2024; 348:116846. [PMID: 38581814 DOI: 10.1016/j.socscimed.2024.116846] [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: 09/18/2023] [Revised: 02/20/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
Women engaged in sex work (WESW) are at heightened risk of experiencing intimate partner violence (IPV) compared to women in the general population. This study examines the impact of an economic empowerment intervention on IPV among WESW in Southern Uganda. We used data from 542 WESW in Southern Uganda recruited from 19 HIV hotspots between June 2019 and March 2020. Eligible participants were 18+ years old, engaged in sex work-defined as vaginal or anal sexual intercourse in exchange for money, alcohol, or other goods, reported at least one episode of unprotected sexual intercourse in the past 30 days with a paying, casual, or regular sexual partner (spouse, main partner). We analyzed data collected at baseline, 6, and 12months of follow up. To examine the impact of the intervention on IPV, separate mixed-effects logistic regression models were run for each type of IPV (physical, emotional, and sexual) as experienced by participants in the last 90 days. Results show that the intervention was efficacious in reducing emotional and physical IPV as evidenced by a statistically significant intervention main effect for emotional IPV, χ2(1) = 5.96, p = 0.015, and a significant intervention-by-time interaction effect for physical IPV, χ2(2) = 13.19, p < 0.001. To qualify the intervention impact on physical IPV, pairwise comparisons showed that participants who received the intervention had significantly lower levels of physical IPV compared to those in the control group at six months (contrasts = -0.12 (95% CI: -0.22, -0.02), p = 0.011). The intervention, time, and intervention-by-time main effects for sexual IPV were not statistically significant. Our findings suggest economic empowerment interventions as viable strategies for reducing emotional IPV among WESW. However, it is also essential to understand the role of interventions in addressing other forms of IPV especially for key populations at high risk of violence, HIV, and STI. The study was registered at ClinicalTrials.gov, ID: NCT03583541.
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Affiliation(s)
- Josephine Nabayinda
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Susan S Witte
- Columbia University, School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Samuel Kizito
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Flavia Nanteza
- International Center for Child Health and Development (ICHAD), Masaka Office, Uganda
| | - Edward Nsubuga
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Proscovia Nabunya
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Fred M Ssewamala
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA.
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Rosen JG, Knox JR, Rucinski KB, Mcingana M, Mulumba N, Comins CA, Shipp L, Makama S, Beckham SW, Hausler H, Baral SD, Schwartz SR. Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis. J Acquir Immune Defic Syndr 2024; 95:222-230. [PMID: 38032752 PMCID: PMC10922222 DOI: 10.1097/qai.0000000000003356] [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: 12/23/2022] [Accepted: 09/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. SETTING A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). METHODS We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga . We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL). RESULTS Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only , HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86). CONCLUSION HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Justin R. Knox
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Katherine B. Rucinski
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - Carly A. Comins
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Lillian Shipp
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Siyanda Makama
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - S. Wilson Beckham
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Harry Hausler
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Stefan D. Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sheree R. Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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Beattie TS, Adhiambo W, Kabuti R, Beksinska A, Ngurukiri P, Babu H, Kung’u M, Nyamweya C, Mahero A, Irungu E, Muthoga P, Seeley J, Kimani J, Weiss HA, Kaul R. The epidemiology of HIV infection among female sex workers in Nairobi, Kenya: A structural determinants and life-course perspective. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001529. [PMID: 38190358 PMCID: PMC10773933 DOI: 10.1371/journal.pgph.0001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/26/2023] [Indexed: 01/10/2024]
Abstract
High HIV prevalence among female sex workers (FSWs) is heavily influenced by structural determinants (e.g. criminalisation of sex work; violence) and significant life events (e.g. orphanhood, teenage pregnancy). This study aims to understand the epidemiology of HIV among FSWs in Nairobi, Kenya using a structural determinants and life-course perspective. Baseline cross-sectional survey data were collected June-December 2019 for the Maisha Fiti study with 1003 FSWs (aged 18-45 years). Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression with a hierarchical modelling approach. HIV prevalence was 28.0%, and increased with age (<25 years 5.7%, 25-34 years 19.0%, ≥35 years 40.6%). In adjusted analyses, HIV seroprevalence was associated with childhood and adolescence including violence from militia or soldiers (AOR = 1.60; 95%CI:1.00-2.53), young age at sexual debut (≤15 years old vs. ≥18 years AOR = 0.57; 95%CI:0.39-0.84) and teenage pregnancy (AOR = 1.37; 95%CI:1.00-1.88). For adulthood the factors included lower SES score (lowest vs. highest tertile AOR = 0.63; 95%CI:0.40-0.98); reduced housing insecurity (AOR = 0.52; 95%CI:0.54-0.79); lower alcohol/drug use score (AOR = 0.44; 95%CI:0.31-0.61); and a longer duration of selling sex (0-5 years vs. ≥11 years AOR = 2.35; 95%CI:1.44-3.82). Among HIV-negative FSWs, prevalence of HIV risk factors was high (recent hunger 32.3%; internalised 67.7% and experienced 66.0% sex work stigma; recent police arrest 30.1%; recent physical or sexual violence 65.6%, condomless last sex intimate partner 71.1%; harmful alcohol or substance use 49.1%). Only 24.6% of HIV-negative FSWs reported taking PrEP. Taken together, adverse events in childhood and adolescence were associated with increased odds of living with HIV, and were more strongly associated with HIV serostatus than adulthood structural or behavioural risk factors. HIV-negative FSWs remain at high risk of HIV acquisition. This study highlights the importance of addressing adverse events throughout the life course to reduce HIV risk, and the need to continue multi-level HIV prevention and treatment efforts.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
- UNITID, University of Nairobi, Nairobi, Kenya
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology and International Health, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rupert Kaul
- Department of Immunology, University of Toronto, Ontario, Canada
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5
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Shah P, Kabuti R, Beksinska A, Nyariki E, Babu H, Kungu M, Jama Z, Ngurukiri P, Kaul R, Kyegombe N, Medley GF, Devries K, Seeley J, Weiss HA, Beattie TS, Kimani J. Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya. BMJ Open 2023; 13:e078618. [PMID: 38114279 DOI: 10.1136/bmjopen-2023-078618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya. BACKGROUND Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation. DESIGN Building on previous qualitative research with this cohort, analysis of behavioural-biological cross-sectional data using hierarchical logistic regression. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural-biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling. RESULTS Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66). CONCLUSIONS Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karen Devries
- Department of Population Health, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Helen Anne Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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6
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Jewkes R, Milovanovic M, Otwombe K, Hlongwane K, Hill N, Mbowane V, Gray G, Coetzee J. Understanding drivers of female sex workers' experiences of external/enacted and internalised stigma: findings from a cross-sectional community-centric national study in South Africa. CULTURE, HEALTH & SEXUALITY 2023; 25:1433-1448. [PMID: 36592099 DOI: 10.1080/13691058.2022.2160014] [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: 08/05/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023]
Abstract
To deepen our understanding of sex work stigma, and to its drivers and their interrelation, we conducted an analysis using structural equation modelling of the South African National Sex Worker Survey. We enrolled 3005 women in sex work using multi-stage sampling across all South Africa's provinces. Experience of external/enacted and internalised stigma was widespread. Non-partner rape, intimate partner violence and partner controlling behaviour (often expressions of external/enacted stigma) compounded internalised stigma. These experiences of violence, other manifestations of external/enacted stigma and food insecurity, were key drivers of internalised stigma, and often had an impact on mental health. We found that considerable protection against stigma emanated from viewing sex work positively. This resistance to stigma provided opportunities to shift the narrative. Reducing sex workers' exposure to external/enacted stigmatising behaviour, including by enabling more to work indoors, and providing greater protection from partner violence and rape, are critical for better health and well-being. Ending the criminalisation of sex work is foundational for safer working conditions and better health outcomes for sex workers, similarly providing adequately funded mental and physical health and social care through sex work specific programmes.
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Affiliation(s)
- Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Naomi Hill
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Hillbrow, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Jenny Coetzee
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
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7
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Gizamba JM, Wilson JP, Mendenhall E, Ferguson L. A review of place-related contextual factors in syndemics research. Health Place 2023; 83:103084. [PMID: 37437495 DOI: 10.1016/j.healthplace.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
This review investigates the extent to which a place-based approach has been used to conceptualize context, as well as the place-related contextual factors explored in studies that explicitly invoked a syndemic framework. The literature search focused on 29 peer-reviewed empirical syndemic studies. Only 11 studies used a place-based approach to define and measure contextual factors and the spatial context was denoted using administrative boundaries such as census tracts, counties, and countries. A narrow range of place-related contextual factors were explored and most of them were related to social and economic factors that were used to define a place. Methodological gaps like a paucity of multilevel studies and studies using a place-based approach to measure context were identified. Future syndemics research should leverage multidimensional geospatial approaches to decipher the role of place-related contextual factors in syndemic dynamics.
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Affiliation(s)
| | - John P Wilson
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, USA
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8
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Khamis AA, Idris A, Abdellatif A, Mohd Rom NA, Khamis T, Ab Karim MS, Janasekaran S, Abd Rashid RB. Development and Performance Evaluation of an IoT-Integrated Breath Analyzer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1319. [PMID: 36674075 PMCID: PMC9859467 DOI: 10.3390/ijerph20021319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Although alcohol consumption may produce effects that can be beneficial or harmful, alcohol consumption prevails among communities around the globe. Additionally, alcohol consumption patterns may be associated with several factors among communities and individuals. Numerous technologies and methods are implemented to enhance the detection and tracking of alcohol consumption, such as vehicle-integrated and wearable devices. In this paper, we present a cellular-based Internet of Things (IoT) implementation in a breath analyzer to enable data collection from multiple users via a single device. Cellular technology using hypertext transfer protocol (HTTP) was implemented as an IoT gateway. IoT integration enabled the direct retrieval of information from a database relative to the device and direct upload of data from the device onto the database. A manually developed threshold algorithm was implemented to quantify alcohol concentrations within a range from 0 to 200 mcg/100 mL breath alcohol content using electrochemical reactions in a fuel-cell sensor. Two data collections were performed: one was used for the development of the model and was split into two sets for model development and on-machine validation, and another was used as an experimental verification test. An overall accuracy of 98.16% was achieved, and relative standard deviations within the range from 1.41% to 2.69% were achieved, indicating the reliable repeatability of the results. The implication of this paper is that the developed device (an IoT-integrated breath analyzer) may provide practical assistance for healthcare representatives and researchers when conducting studies involving the detection and data collection of alcohol consumption patterns.
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Affiliation(s)
- Abd Alghani Khamis
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Aida Idris
- Department of Management, Faculty of Business and Economics, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Abdallah Abdellatif
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Taha Khamis
- Center for Applied Biomechanics (CAB), Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Sayuti Ab Karim
- Centre of Advanced Manufacturing and Material Processing (AMMP), Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Shamini Janasekaran
- Centre for Advanced Materials and Intelligent Manufacturing, Faculty of Engineering, Built Environment & IT, SEGi University Sdn Bhd, Petaling Jaya 47810, Malaysia
| | - Rusdi Bin Abd Rashid
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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9
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Panneh M, Gafos M, Nyariki E, Liku J, Shah P, Wanjiru R, Wanjiru M, Beksinska A, Pollock J, Jama Z, Babu H, Kaul R, Seeley J, Bradley J, Kimani J, Beattie T. Mental health challenges and perceived risks among female sex Workers in Nairobi, Kenya. BMC Public Health 2022; 22:2158. [PMID: 36418973 PMCID: PMC9685887 DOI: 10.1186/s12889-022-14527-5] [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: 05/26/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) in Kenya are at an increased risk of violence, poverty, police arrest, and problematic alcohol and other substance use, all of which are linked to poor mental health and suicidal ideation. Despite the psychological stressors experienced by FSWs, there is no published qualitative methods research investigating their mental health experiences in Kenya. In this paper, we draw on data from in-depth interviews to examine FSWs' lifetime mental health experiences and perceived risk factors. METHODS We used baseline in-depth interviews of the Maisha Fiti longitudinal study of FSWs in Nairobi. We randomly selected 40 FSWs from 1003 FSWs who attended a baseline behavioural-biological interview as part of the Maisha Fiti study. The interview guide was semi-structured, and participants were asked to detail their life stories, including narrating specific events such as entry into sex work, experiences of violence, mental health experiences, and use of alcohol and other substances. Interviews were recorded in Kiswahili/ English and transcribed in English. Data were coded and thematically analysed in Nvivo (v.12). RESULTS Results indicated that the majority of participants understood 'mental health' as 'insanity', 'stress', 'depression', and 'suicide'; nevertheless, a number described mental health symptomatically, while a few believed that mental health problems were caused by witchcraft. Interestingly, poverty, low levels of education, poor job opportunities, a lack of family support, harmful gender norms, intimate partner violence and subsequent relationship breakdowns, and family bereavement all contributed to poor mental health and subsequent entry into sex work. In addition, the consequences of sex work such as sexual risks, and ongoing violence from police and clients, further exacerbated poor mental health. CONCLUSIONS There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for 'at-risk' populations such as FSWs should enhance coping strategies and help-seeking efficacy.
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Affiliation(s)
- Mamtuti Panneh
- LSHTM, Department for Global Health and Development, London, UK.
| | - Mitzy Gafos
- LSHTM, Department for Global Health and Development, London, UK
| | - Emily Nyariki
- LSHTM, Department for Global Health and Development, London, UK
| | - Jennifer Liku
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Pooja Shah
- LSHTM, Department for Global Health and Development, London, UK
| | - Rhoda Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | | | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- LSHTM, Department for Global Health and Development, London, UK
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Janet Seeley
- LSHTM, Department for Global Health and Development, London, UK
| | - John Bradley
- MRC International Statistics and Epidemiology Group, Department for Infectious Disease Epidemiology, LSHTM, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tara Beattie
- LSHTM, Department for Global Health and Development, London, UK
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