Frontiers in global women's health最新文献

Objective: This analysis describes the use patterns of web-based virtual triage (VT) by pregnant patients before and during the first two years of the COVID-19 pandemic, and how the pandemic influenced frequency of VT use, nature of symptoms reported, and the associated implications for maternal healthcare delivery.

Methods: An online survey of 36,910 patients who reported pregnancy was completed between January 1, 2019 and June 30, 2022. The data were segmented into six month periods to allow comparative analyses of usage frequency and changes in initial complaints over the study period, with particular emphasis on the early months of the COVID-19 pandemic. Descriptive statistics and trend analyses were used to identify significant shifts in symptom reporting and user demographics.

Results: A marked increase in the utilization of VT by pregnant women during the pandemic occurred. The percentage of pregnant users grew from 0.32% in the first half of 2019 to 0.85% in late 2021, with the greatest rise (213%) in the first six months of 2020. The most common symptoms reported were abdominal pain, headache, nausea, back pain, fatigue and cough. Pre-pandemic, VT use focused on prospective mothers learning about the potential causes of typical symptoms occurring during pregnancy, but during the pandemic there was a substantial increase in reporting symptoms associated with acute respiratory infections such as cough, nasal congestion, and dyspnea.

Conclusions: The COVID-19 pandemic significantly influenced the use of VT by pregnant women, with a shift towards addressing concerns related to respiratory symptoms and potential COVID-19 exposure. These findings underline the significant role of digital health tools in maintaining access to health information during times of crisis and highlight the evolving needs of pregnant patients in such settings.

Persistent staffing shortages in health care driven by years of inadequate funding and deficiencies in human resources planning, which overlooked the impacts of population aging, have converged into a crisis in health care settings. An essential consequence of the widespread and growing staffing shortfalls in health care has been increased pressure on nurses to work longer hours. The present rapid review has two major objectives: (1) to systematically review and synthesize evidence considering the health and human consequences of excessive work hours, work-related fatigue and associated occupational health and safety hazards; and, (2) to identify policies and practices that demonstrate efficacy in managing or mitigating the adverse effects of occupational fatigue. Findings show that shifts lasting longer than 12 h elevate the risk of occupational fatigue, leading to several fatigue-based hazards. Despite governmental restrictions on long work hours and occupational fatigue in safety-critical industries such as transport, aviation, and nuclear sectors, health care remains largely unregulated in this regard. Ensuring safe and high-quality care over the long term requires implementing adequate regulatory supports for work hour limits for nurses. These measures not only improve workplace satisfaction but also enhance patient outcomes, ultimately fostering a healthier and more resilient health care system.

Background: Women's empowerment has been a global priority, as countries can achieve significant growth and economic development by empowering women. Understanding the individual and community-level factors that influence women's empowerment is crucial for policymakers to develop effective policies and to improve women's empowerment.

Method: A community-based cross-sectional survey was conducted in 11 administrative regions of Ethiopia. The analysis included a weighted sample of 7,108 married women of reproductive age (15-49 years) from the 2,016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to examine the individual and community-level factors associated with women's empowerment. In the final model, significant variables were identified using a p-value of <0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI).

Results: The overall magnitude of women's empowerment was 23.7% (95% CI: 22.7-24.7). Only 30.9% of women reported participating in household decision-making, and 32.5% disagreed with all the reasons justifying wife-beating. At individual-level, factors positively associated with women's empowerment included secondary (AOR: 2.72 (1.77-4.23), and higher (AOR: 3.65 (1.81-7.34) education. However, belonging to the Muslim religion was negatively associated with women's empowerment (AOR: 0.63 (0.47-0.85). At the community level, wealthy communities were positively associated with women's empowerment (AOR: 1.60 (1.05-2.44). Conversely, residing in rural areas (AOR: 0.49 (0.29-0.83), and living in the Afar (AOR: 0.35 (0.17-0.70), Amhara (AOR: 0.45 (0.26-0.79), Oromia (AOR: 0.43 (0.26-0.73), South Nation Nationalities, and Peoples (SNNP) (AOR: 0.42 (0.24-0.75), and Gambella (AOR: 0.36 (0.20-0.66) regional states were negatively associated with women's empowerment.

Conclusion: The overall magnitude of women's empowerment in this study was low. Factors that positively influenced empowerment included attending secondary and higher education, as well as residing in communities with higher wealth status. On the other hand, being Muslim, residing in rural areas, and living in the Afar, Amhara, Oromia, SNNPR, Gambella, and Tigray regions were negatively associated with women's empowerment. As a result, the government of Ethiopia needs to design community-based women's empowerment strategies and involve women in income-generation activities that improve their participation in household decision-making to empower them.

Background: Decisions regarding mode of delivery in the context of a prior cesarean birth is complicated because both trial of labor after cesarean and elective repeat cesarean birth have risks and benefits.

Purpose: The objective of this study was to understand the perspective of women and obstetricians in Coatepeque, Guatemala, to guide the development of a decision aid about mode of birth for women with a history of prior cesarean.

Methods: We conducted in-depth semi-structured interviews with obstetricians at Coatepeque Hospital and women at the Center for Human Development in the southwest Trifinio region of Guatemala in February 2020. Using qualitative content analysis, we recorded, transcribed, translated, and analyzed qualitative data for the meaning of themes and concepts exploring the acceptability of counseling with a decision aid regarding mode of delivery.

Results: A total of 30 qualitative interviews were conducted with women and physicians. Three themes emerged from the qualitative interviews: Having a decision aid for women with a prior cesarean birth will be useful and helpful. Content of the decision aid should include benefits and risks for women and babies as well as figures. Women described the need of tailoring the content surrounding family's role in their decisions. They felt that a trusted provider from the healthcare system should facilitate the use of the decision aid for counseling.

Conclusions: These findings emphasize the support and need for innovative approaches to patient education around mode of delivery after a prior cesarean in the southwest region in Guatemala. There is a need to improve the educational information given to women regarding their mode of delivery after a cesarean birth. Finally, an effective decision aid needs to be tailored to not only the women's needs but also the engagement of the family unit for its successful implementation.

Background: Despite global efforts, inequities in vaccine uptake remain, influenced by socioeconomic, geographic, cultural, and gender-related factors. In Eastern Sudan, gender disparities are acknowledged, particularly in livelihoods, but their impact on vaccination uptake is unclear. This study aimed to assess the effect of gender-biased parental perceptions on under-immunization among children in Kassala, Eastern Sudan.

Methods: This study was a community-based cross-sectional in rural and urban districts of Kassala locality in Kassala State, Eastern Sudan in November 2022. Data were collected from parents using a pre-tested, structured questionnaire. The Chi-square or Fisher's exact test was conducted to assess the factors associated with under-immunization among children.

Results: Data were collected from 400 parents. Our data reveal that most children were fully vaccinated with the three doses of the pentavalent vaccine (83%), while 14% were partially vaccinated. Findings showed that about one in five parents perceived male vaccination as more important than female vaccination. This parental perception of gender-based importance in vaccination was significantly associated with under-immunization among children (p-value = 0.049). Additionally, males in our study are fully vaccinated 5% more often than females. Socio-economic factors, including mothers' education and households' income level, were also significantly associated with the vaccination status of the children.

Conclusion: This study shed light on the effect of gender norms and related determinants on equitable access to vaccinations for boys and girls alike. More research is needed to gain a better understanding of the gender norms related to vaccination and their long-term impact on immunization demand and resilience in this region.

Background: Intimate partner violence (IPV) is a significant public health problem, with serious consequences on women's physical, mental, sexual, and reproductive health, as well as birth outcomes. Women who encounter IPV are more likely to experience adverse birth outcomes such as low birth weight, premature delivery, and stillbirth. Although numerous studies are exploring the association between IPV and adverse birth outcomes, they merely used classical models and could not control for potential confounders. The purpose of this study was to ascertain whether there was a causation between IPV and adverse birth outcomes in sub-Saharan Africa (SSA) using a quasi-experimental statistical technique [i.e., propensity score matching (PSM) analysis].

Method: This study used the most recent (2015-22) Demographic and Health Survey (DHS) data from 20 SSA countries. A total weighted sample of 13,727 women was included in this study. IPV (i.e., sexual, physical, emotional, and at least one form of IPV) was the exposure/treatment variable and adverse birth outcomes (preterm delivery, low birth weight, stillbirth, and macrosomia) were the outcome variables of this study. PSM was employed to estimate the impact of IPV on adverse birth outcomes.

Results: The average treatment effects (ATE) of sexual, physical, emotional, and at least one form of IPV were 0.031, 0.046, 0.084, and 0.025, respectively. Sexual, physical, emotional, and at least one form of IPV increased adverse birth outcomes by 3.1%, 4.6%, 8.4%, and 2.5%, respectively. Findings from the average treatment effect on treated (ATT) showed that women who experienced sexual, physical, emotional, and at least one form of IPV had an increased risk of adverse birth outcomes by 3.6%, 3.7%, 3.3%, and 3.0%, respectively, among treated groups.

Conclusion: This study demonstrates a causal relationship between IPV and adverse birth outcomes in SSA countries, indicating a need for programs and effective interventions to mitigate the impact of IPV during pregnancy to reduce related adverse pregnancy outcomes. Furthermore, we suggest further research that investigates the causal effect of IPV on adverse birth outcomes by incorporating additional proximal variables not observed in this study.

Background: Poor maternal nutrition during pregnancy is a common cause of poor maternal and infant outcomes. Micronutrient deficiencies are common among pregnant women in low- and middle-income countries, including sub-Saharan Africa. Pregnant women are recommended to take micronutrients like iron or folic acid and deworming medication during pregnancy. Therefore, this study was conducted to assess micronutrient intake and its associated factors among pregnant women in three countries using the most recent demographic and health survey.

Methods: We used data from the most recent demographic and health surveys, which were carried out between 2019 and 2022 in three sub-Saharan African countries. The study included a weighted sample of 13,568 reproductive-age women who had given birth within the five years prior to the survey. Utilizing multilevel logistic regression, the factors associated with the dependent variable were identified. Model comparison and fitness were assessed using the deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Ultimately, factors were deemed statistically significant if they had a p-value less than 0.05.

Results: The pooled prevalence of micronutrient intake among pregnant women during pregnancy of last birth was 77.56% (95% CI: 76.85%-78.25%). Factors like age [AOR = 1.78; 95% CI (1.14, 2.77)], educational status [AOR = 1.49; 95% CI (1.23, 1.79)], marital status [AOR = 0.66; 95% CI (0.58, 0.75)], working status [AOR = 1.17; 95% CI (1.01, 1.34)], media exposure [AOR = 1.20; 95% CI (1.05, 1.38)], preceding birth interval [AOR = 1.17; 95% CI (1.01, 1.34)], number of ANC visits [AOR = 1.65; 95% CI (1.29, 2.10)], and residence [AOR = 1.19; 95% CI (1.03, 1.37)] were significantly associated with micronutrient intake among pregnant women.

Conclusions: More than three-fourths of the study subjects were micronutrient supplemented during their pregnancy. Improving women's education, disseminating nutrition information through media, providing more attention to young pregnant women who live in rural areas, increasing the number of ANC visits, and women's empowerment are strongly recommended.

Background: Obstetric violence during labor and delivery is one of the main reasons that women do not seek care from health caregivers in health facilities. Developing respectful maternity care services for women is the most important approach to ensure better newborn and maternal outcomes.

Objective: This study aimed to assess the magnitude of obstetric violence and associated factors among women who gave birth at public hospitals in Addis Adaba city administration, Ethiopia.

Methods: An institution-based cross-sectional study was carried out among 409 mothers who had given birth at two public hospitals (Gandhi Memorial Hospital and Abebech Gobena Mothers and Children's Health Hospital) in Addis Ababa, Ethiopia, from 1 to 30 May 2023. A systematic sampling method was applied and data were collected using a structured face-to-face interview questionnaire and entered into EpiData 3.1. The data were analyzed using Statistical Package for Social Science version 25. Bi-variable and multivariate analyses were performed. Statistical significance was declared at a P-value <0.05.

Results: In total, 318 mothers [77.8% with a 95% CI (73.64-81.96)] had experienced obstetric violence in the study settings. Being more educated [Adjusted Odds Ratio (AOR) = 6.43; 95% CI 2.92-14.17], having ≥4 antenatal care contacts (AOR = 3.59; 95% CI 1.91-6.75), being multiparous (AOR = 2.65; 95% CI 1.32-5.32), induction of labor (AOR = 3.39; 95% CI 1.69-6.79), vaginal delivery (AOR = 0.25; 95% CI 0.11-0.62), and female birth attendants AOR = 2.42, 95% CI (1.31-4.47) were significantly associated with obstetric violence.

Conclusion: More than three-fourths of the participants experienced obstetric violence. Thus, stakeholders need to develop interventions by taking all risk factors of obstetric violence into account.