Women’s empowerment under the lens of global health equity: Literature review of challenges, best practices, and societal impact

Introduction: Women’s empowerment refers to strengthening the social, economic, and educational powers of women. Numerous global initiatives have been implemented to enable women to make decisions about their health and lives. The purpose of this literature review was to review women’s health barriers, related best practices, and their impacts on women's empowerment in the global context. Methods: We comprehensively searched databases: PubMed, CINAHL, and Google Scholar and key program websites. To expand our review, we used a snowball strategy to scan articles, documents, reports, and research outputs of global programs and best practices to overcome barriers. Also, we screened publications posted on websites of organizations working on women’s empowerment and monitoring the Sustainable Development Goals progress. Results: Findings suggest significant advancements have been made in the status of women's health over the past two decades. However, the COVID-19 pandemic has aggravated health barriers, impeding, and even reversing progress, which has resulted in widening women’s inequity in access to health care services worldwide. Conclusions: Findings suggest that successful and sustainable programs should have a multisectoral, multilevel and multistakeholder, diversified interventions approach with social empowerment, as well as the need for legislative enforcement against discrimination and harmful practices towards women.

Prevalence of physical activity and sedentary-related behaviors among adolescents: data from the Qatar National School Survey

OBJECTIVES

To investigate the prevalence of physical activity (PA) and sedentary behaviors among adolescents in Qatar by selected demographic characteristics.

STUDY DESIGN

Cross-sectional study.

METHODS

A total of 5862 students (2938 boys and 2924 girls) in the age group 12-17 years were included in the analyses. PA and sedentary-related measures were obtained from the self-reported survey questions.

RESULTS

Only 35.4% of students were performing 60 min of PA ≥3 days/week. The proportion of students with >2 hr screentime ranged from 43% to 57% (weekdays) and 50% to 62.5% (weekends). Girls had less odds of being physically active than the boys (odds ratio [OR] = 0.61, P < 0.001). Qatari students were less likely to be physically active than non-Qataris (OR = 0.79, P < 0.001). Age was inversely correlated with PA ([r = -0.113, P < 0.001 for participation with sports team] and [r = -0.139, P < 0.001 for school physical education classes]). Participation in sports teams positively correlated with 60 min of PA number of days in a week (r = 0.317, P < 0.001).

CONCLUSIONS

The study describes insufficient PA among youth as a public health issue of concern in the State of Qatar that requires multipronged health promotion initiatives.

The prevalence and characteristics of overweight and obesity among students in Qatar

OBJECTIVES

To estimate the prevalence of overweight and obesity using World Health Organisation (WHO) cut-offs for the body mass index (BMI) among students of the general population living in Qatar in the period 2015-2016.

STUDY DESIGN

Cross-sectional study.

METHODS

The study includes 164,963 students aged 5-19 years. The body weight and height were measured to calculate the BMI. The WHO standard cut-offs were used to categorise the BMI into severe thinness (BMI z-score <-3), thinness (BMI z-score ≥-3 to <-2), normal (BMI z-score ≥-2 to <1), overweight (BMI z-score ≥+1 to <+2) and obese (BMI z-score >+2).

RESULTS

Overweight and obesity prevalence was 44.8% and 40.4% among males and females and 45.6% and 40.9% among Qatari and non-Qatari students, respectively. Odds of obesity and overweight status were significantly higher among 10-14 and 15-19 age groups than 5-9 years age group (P < 0.001). By sex, males had 1.48 times higher odds of having obesity than females (P < 0.001), and Qatari nationals had 1.4 times higher odds of obesity than non-Qataris (P < 0.001). Although non-Qatari males also had higher odds of being overweight than females (odds ratio [OR] = 1.05, P = 0.0006), the opposite was seen among Qatari students (OR = 0.95, P = 0.01).

CONCLUSION

The result of this survey provides evidence of a high prevalence of overweight and obese students living in Qatar. Therefore, preventive strategies are essential in this population to lower the incidence of being overweight and obesity.

Oral Health Status of 12- and 15-Year-Old Students in Qatar: Findings From the National Oral Health Survey

Background The national oral health survey-Qatar was carried out in 2011 in an attempt to establish the baseline information about oral health status among youth. This article describes the oral health status of 12 and 15-year-old students in Qatar. Methods Cross-sectional survey data were analyzed for 12 (N=1060) and 15 (N=1064) year-old students. The caries status based on decayed, missing, filled teeth or DMFT=0 (no caries) & DMFT≥1 (caries present). Mean indices among nationalities and sex were compared by student’s t-test. Analysis of variance (ANOVA) was used to compare means by the type of the school. Logistic regression was used to examine associations among available variables. Results In the overall sample, 53.3% (n=565) of 12-year-olds and 55.4% (n=589) of 15-year-olds had varying levels of dental caries. The odds of dental caries were higher among girls compared to boys aged 12 years (OR=1.3, CI=1.0-1.6, P=0.05) as well as 15 years old (OR=1.28, CI=1.01-1.6, P=0.04) respectively. By nationality, Qatari students had a higher mean DMFT value (1.3 ± 1.2) compared to non-Qataris (0.82 ± 1.1). The public/independent attendees had higher mean DMFT values (1.31 ± 1.2) compared to the other two school categories. Fifteen-year-old students had lower odds (OR=0.81, CI- 0.68-0.97, P=0.02) of gingival bleeding and higher odds (OR=1.68, CI=1.4-2.1, P<0.001) of calculus compared to 12-year-olds. Dental fluorosis was found among 15% of 12 years old and 16.6% of 15 years old. The odds of fluorosis were higher among 15 years old but this relationship was not significant (OR=1.1, CI=0.88-1.4, P=0.36). Lower odds of bleeding teeth (OR=0.81, CI=0.68-0.97, P=0.02) and higher odds of calculus were found among 15 years old (OR=1.68, CI=1.4-2.1, P<0.001) compared to 12 years. Conclusions The results provide directions to further strengthen the oral health strategies through various evidence-based interventions.Background

Obesity and Related Factors Among Children and Adolescents in Qatar

Overweight and obesity are major public health issues worldwide impacting millions of people. The prevalence of increased body weight among children and adolescents is becoming a global phenomenon. The State of Qatar is also experiencing the effects of obesity pandemic among adults and younger populations. In order to examine obesity and overweight parameters, a literature review was carried out using key scientific databases. Furthermore, this mini-review examines the selected factors that could be associated with obesity and overweight situation among children and adolescents living in Qatar. The results showed that the obesity is indeed a major public health issue among youth in Qatar.

An Overview of Food Patterns and Diet Quality in Qatar: Findings from the National Household Income Expenditure Survey

Introduction

Availability of accurate data pertaining to a population’s dietary patterns and associated health outcomes is critical for proper development and implementation of related policies. This article is a first attempt to share the food patterns, amounts and diet quality among households (HH) in Qatar.

Methods

Data from the 2012-2013 Qatar National Household Income and Expenditure Survey (HIES) was used. This cross-sectional survey included 3723 HH (1826 Qatari HH and 1897 non-Qatari HH). Dietary data on monthly amounts food items available at HH according to the nationality was used. The food items were expressed in terms of grams per capita per day and aggregated into groups to examine the food patterns, energy, and adequacy.

Results

The overall average amount of purchased food at HH in Qatar was 1885 g/capita/day. Qatari HH purchased more food (2118 g/capita/day) versus non-Qataris (1373 g/capita/day); however, the percentages of the amounts purchased by food types were similar among both nationalities. Average daily energy (kcal) per capita was almost double among Qatari HH (4275 kcal) vs. non-Qatari HH (2424 kcal). The food items under subsidy program for Qatari citizens provided 1753 kcal/capita/day and accounted for 41% of total daily energy. Proteins (29.2), fats (39.2), sodium (3.3), and vitamin C (32.5) had higher than recommended levels of nutrient density (grams per 1000 kcal). Calcium (227), vitamin A (302.3), fiber (2.0), and carbohydrates (132.6) had lower than recommended levels of nutrient energy density (g/1000 kcal).

Conclusions

The study predicts unhealthy dietary habits among HH in Qatar and provides useful information for policy makers and healthcare community.

Situation of Diabetes and Related Factors Among Qatari Adults: Findings From a Community-Based Survey

Background

Diabetes mellitus (DM) is a prominent public health problem in Qatar with one of the highest prevalence in the Gulf Cooperation Council region. Obesity continues to be a challenging public health problem in Qatar along with other social determinants contributing to the high DM prevalence.

Objective

This paper examines the data from Qatar National STEPS survey (2012) to determine diabetes prevalence among Qatari adults and identify the effect of both generalized and central obesity on it. The article also describes the contribution of selected social and demographic factors on diabetes prevalence in Qatar.

Methods

Secondary data analysis of 1471 Qatari adults (18-64 years) from STEP 3 component of the 2012 STEPS Survey was executed. Multivariate binary logistic regression analysis was carried out to assess the role of social and biomedical factors in the prevalence of DM.

Results

Among participants, 18.97% (279/1471) of the study population had DM. Both generalized (OR 1.8, P=.005) and central obesity (OR 1.9, P<.001) were significantly associated with DM when adjusted for various respondent characteristics. Older age (P<.001), marital status of ever married (P<.001), and lower educational status (P=.01) were associated with DM. Hypertension (OR 1.5, P=.003 total cholesterol level ≥190 mg/dL (OR 2.2, P<.001) and triglyceride level ≥150 mg/dL (OR 3.6, P<.001) were significantly associated with DM among the study participants. Although family history of DM was significantly associated with development of DM (OR 1.7, P=.01), parental consanguinity was not associated with DM (OR 0.96, P=.80).

Conclusions

The DM prevalence in Qatar seems to be highly associated with obesity; however, various additional population characteristics and comorbidity factors should also require attention and should be incorporated while developing intervention strategies.

A 'High Risk' Lifestyle Pattern Is Associated with Metabolic Syndrome among Qatari Women of Reproductive Age: A Cross-Sectional National Study

This study investigated the effect of lifestyle patterns, as a combination of diet, physical activity and smoking, on Metabolic Syndrome (MetS) among Qatari women of childbearing age (n = 418), a population group particularly vulnerable to the health sequela of this syndrome. Using data from the National WHO STEPwise survey conducted in Qatar in 2012, Principal Component Factor Analysis was performed to derive lifestyle patterns with survey variables related to the frequency of consumption of 13 foods/food groups, physical activity levels, and smoking status. MetS was diagnosed using ATPIII criteria. Three lifestyle patterns were identified: 'High Risk' pattern, characterized by intakes of fast foods, sweets and sugar sweetened beverages, in addition to lower levels of physical activity and higher smoking prevalence; 'Prudent' pattern, driven mainly by higher intakes of fruits, vegetables, fish, and whole grains; and 'Traditional' pattern which included beans, meat, dairy products, and a low prevalence of smoking. Among these three lifestyle patterns, only the 'High Risk' was associated with MetS, whereby subjects belonging to the third tertile of this pattern's score had 2.5 times the odds of MetS compared to those belonging to the first tertile. The findings of this study demonstrated the synergy among high risk behaviors among Qatari women in increasing the odds of MetS; the latter being a major risk factor for cardiovascular diseases.

Study protocol: Mother and Infant Nutritional Assessment (MINA) cohort study in Qatar and Lebanon

Background

The Middle East and North Africa region harbors significant proportions of stunting and wasting coupled with surging rates of non-communicable diseases (NCDs). Recent evidence identified nutrition during the first 1000 days of life as a common denominator not only for optimal growth but also for curbing the risk of NCDs later in life. The main objective of this manuscript is to describe the protocol of the first cohort in the region to investigate the association of nutrition imbalances early in life with birth outcomes, growth patterns, as well as early determinants of non-communicable diseases. More specifically the cohort aims to1) examine the effects of maternal and early child nutrition and lifestyle characteristics on birth outcomes and growth patterns and 2) develop evidence-based nutrition and lifestyle guidelines for pregnant women and young children.

Methods/design

A multidisciplinary team of researchers was established from governmental and private academic and health sectors in Lebanon and Qatar to launch the Mother and Infant Nutritional Assessment 3-year cohort study. Pregnant women (n = 250 from Beirut, n = 250 from Doha) in their first trimester are recruited from healthcare centers in Beirut, Lebanon and Doha, Qatar. Participants are interviewed three times during pregnancy (once every trimester) and seven times at and after delivery (when the child is 4, 6, 9, 12, 18, and 24 months old). Delivery and birth data is obtained from hospital records. Data collection includes maternal socio-demographic and lifestyle characteristics, dietary intake, anthropometric measurements, and household food security data. For biochemical assessment of various indicators of nutritional status, a blood sample is obtained from women during their first trimester. Breastfeeding and complementary feeding practices, dietary intake, as well as anthropometric measurements of children are also examined. The Delphi technique will be used for the development of the nutrition and lifestyle guidelines.

Discussion

The Mother and Infant Nutritional Assessment study protocol provides a model for collaborations between countries of different socio-economic levels within the same region to improve research efficiency in the field of early nutrition thus potentially leading to healthier pregnancies, mothers, infants, and children.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0864-5) contains supplementary material, which is available to authorized users.

Lifestyle Patterns Are Associated with Elevated Blood Pressure among Qatari Women of Reproductive Age: A Cross-Sectional National Study

Women of childbearing age are particularly vulnerable to the adverse effects of elevated blood pressure (BP), with dietary and lifestyle habits being increasingly recognized as important modifiable environmental risk factors for this condition. Using data from the National STEPwise survey conducted in Qatar in year 2012, we aimed to examine lifestyle patterns and their association with elevated BP among Qatari women of childbearing age (18–45 years). Socio-demographic, lifestyle, dietary, anthropometric and BP data were used (n = 747). Principal component factor analysis was applied to identify the patterns using the frequency of consumption of 13 foods/food groups, physical activity level, and smoking status. Multivariate logistic regression analyses were used to evaluate the association of the identified lifestyle patterns with elevated BP and to examine the socio-demographic correlates of these patterns. Three lifestyle patterns were identified: a “healthy” pattern characterized by intake of fruits, natural juices, and vegetables; a “fast food & smoking” pattern characterized by fast foods, sweetened beverages, and sweets, in addition to smoking; and a “traditional sedentary” pattern which consisted of refined grains, dairy products, and meat in addition to low physical activity. The fast food & smoking and the traditional & sedentary patterns were associated with an approximately 2-fold increase in the risk of elevated BP in the study population. The findings of this study highlight the synergistic effect that diet, smoking and physical inactivity may have on the risk of elevated BP among Qatari women.