Frontiers in global women's health最新文献

Background: Violence against women is both a human rights violation and a significant reproductive health issue, causing substantial morbidity. It's a pervasive global public health concern, particularly prevalent in developing regions like sub-Saharan Africa. Ethiopia faces this issue extensively despite its preventable nature, persisting as a significant challenge within the country.

Objective: The study aimed to identify the extent and factors associated with sexual violence among women, children, and adolescent girls during the 2022 armed conflict in Northern Ethiopia.

Method: A community-based cross-sectional study combined quantitative and phenomenological methods. We used multistage and snowball sampling, involving 574 individuals along with 10 in-depth interviews and 3 focus group discussions (FGDs). Statistical analysis relied on Stata version 16 and open code version 4.03. Quantitative analysis employed multivariable binary logistic regression, while qualitative data underwent thematic analysis.

Result: The study found a 9.76% prevalence of sexual violence, with 2.4% experiencing rape during the conflict. Prostitutes faced a fourfold increased risk (AOR: 4.2, 95% CI: 1.3, 10.9). Living in areas with attacks raised the risk 2.7 times (AOR: 2.7, 95% CI: 1.1, 6.2), and a monthly income of 2,001-4,000 ETB increased it 2.5 times (AOR: 2.5, 95% CI: 1.1, 5.7). The impacts included psychosocial effects, stigma, and fear of humiliation, divorce, and displacement.

Conclusion: Approximately one in ten women experienced sexual violence during the conflict. Factors such as being a prostitute, having a lower income, and living in attacked villages were significant predictors of this violence. The main impacts included psychosocial effects, external blame, and stigma, fear of humiliation, divorce, and displacement.

Background: Disclosure of oral pre-exposure prophylaxis (PrEP) use for HIV prevention may improve adherence to PrEP; however, disclosure can be challenging and may result in stigma. Here, we describe disclosure of PrEP use among young women enrolled in a contraceptive study.

Methods: In this qualitative study, we conducted semi-structured, in-depth, face-to-face interviews with 13 women aged 18-25 years who initiated oral PrEP for HIV prevention during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. Interviews were conducted in 2021 with women from Durban, South Africa. In this analysis, we explore women's experiences of PrEP disclosure including whether they disclosed PrEP use, who they disclosed to and the reaction to disclosure, and the impact of disclosure on PrEP use. Interviews were conducted in English, audio-recorded and transcribed. Data were analysed thematically.

Results: All women disclosed oral PrEP use to at least one individual, with some women disclosing to multiple individuals including family, friends, partners and community members. Few women did not disclose oral PrEP use to their partner due to anticipating a negative reaction from the partner, feeling that the partner would assume the woman has HIV and is taking antiretroviral therapy and fear that the partner would associate PrEP use with the woman having other partners. Reactions to oral PrEP disclosure were generally supportive or neutral, however, few women reported negative reactions that included distrust in the efficacy of PrEP to prevent HIV, discouraging the woman from using oral PrEP because of the assumption that PrEP is HIV treatment, and concern about the woman having oral PrEP side effects. Negative reactions to disclosure generally did not impact on oral PrEP use. Supportive disclosures sometimes resulted in reminders for oral PrEP dosing.

Conclusion: Our findings indicate that women are willing to disclose their PrEP use to at least one other person when supported. These study findings may contribute to future PrEP counselling guidelines and strategies.

Background: Allowing women to have a companion of their choice during labor and delivery is a cost-effective strategy to enhance the quality of maternal care and promote a positive birth experience. Due to the limited studies on women's preferences for labour companionship, this study aimed to assess the desire for labour companionship and its associated factors among pregnant women attending ante-natal care at public health facilities in Debre Berhan City.

Method: A facility-based cross-sectional study was conducted from August 1-30, 2022. A face-to-face questionnaire administered was used to collect data. Then, entered into Epi-Data version 4.6 and exported to SPSS version 25 for data analysis. In multivariable logistic regression analysis, variables with P < 0.05 with AOR and 95% CI were considered statistically significant.

Result: Of 408 participants, 68.6% [95% CI: 63.8, 73.9] of pregnant women desired to have companionship in labour. Women who were living in urban [AOR: 2.32; 95% CI: 1.336, 4.022], had secondary level of education [AOR: 0.39; 95% CI: 0.207, 0.726], being pregnant for the first time [AOR: 1.88; 95% CI: 1.197, 2.945], women who had a good knowledge towards labour companion [AOR: 2.4; 95% CI: 1.522, 3.797] were statistically significant with desire on labour companionship.

Conclusion: The magnitude of desire towards labour companionship in this study area was found high. Place of residence, educational attainment, number of pregnancies (gravidity), and level of knowledge about labour companions significantly contribute to women's desire for labour companionship. Therefore, to increase the desire for labor companions; antenatal education about its benefits should emphasized, particularly in rural areas and among less-educated communities. Providing tailored support for primigravida women and underserved populations can also help to integrate labor companionship into maternal care.

Key content: •Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but potentially lethal event.•Physiological changes in the coagulation system during pregnancy and puerperium would lead to a hypercoagulable state.•Diagnosis of PE in pregnancy remains a challenge due to physiological changes in pregnancy. There are no validated scoring systems for assessing pregnant/postpartum women with suspected PE. Massive PE should be suspected in all cases with haemodynamic instability in pregnancy.•The Management of massive pulmonary embolism should be timely and aggressive. Thrombolysis for massive PE during pregnancy and the postpartum period has shown to be associated with high maternal and fetal survival (94% and 88%). But other therapeutic options such as (catheter [or surgical] thrombectomy, ECMO) should be considered in the postpartum period, given the high risk of major bleeding with thrombolysis.•Thrombolysis remains the most-used and reasonably successful modality of treatment in pregnancy but should be avoided in the postpartum period as it can cause life-threatening haemorrhage. During the post-partum period, thrombectomy is the treatment of choice.

Learning objectives: •To understand the pathophysiology of massive PE.•To appreciate the treatment options in pregnancy and postpartum period and their pros and cons.•To understand the need for further work in this area especially in creating a validated algorithm for diagnosing PE in pregnancy and postpartum period.

Background: Women with perinatal depression and their children are at increased risk of poor health outcomes. Integrating evidence based non-stigmatizing interventions within existing health systems is crucial to reducing psychosocial distress during pregnancy and preventing perinatal depression. This study aimed to evaluate the feasibility of the World Health Organization (WHO) endorsed cognitive-behavior therapy-based Thinking Healthy Programme (THP), delivered by antenatal nurses in China.

Methods: A two-arm pilot randomized controlled pilot trial was conducted to assess the feasibility and of the adapted Chinese version of the Thinking Healthy Programme (THP) among various stakeholders. We recruited pregnant women between 25- and 34-weeks' gestation from two pregnancy schools within the two public sector Hospitals in Xian. Participants in the intervention group attended five face to face sessions of THP facilitated by antenatal nurses. This intervention used cognitive behavior therapy principles to offer psychoeducation, behavioral activation, problem-solving strategies, and social support. In the control group, participants received standard care, which included routine pregnancy education classes led by antenatal nurses. We assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) at baseline, after the intervention and 4-6 weeks post-intervention, along with evaluations of anxiety, perceived social support, and health-related quality of life.

Results: Among the 737 pregnant women screened, 267 (30.26%) scored ≥5 on the PHQ-9. Out of these, 85 were eligible and consented to participate, with 42 assigned to the intervention group and 43 to the control group. Eighty participants (94.1%) completed the final assessments. Our primary findings indicated that this nurse-delivered intervention was feasible to integrate into routine antenatal care and was well-received by both the women and the delivery agents. Although the study was not designed to detect differences between the intervention and control groups, we observed positive trends towards reductions in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. This trial is registered in the Chinese Clinical Trial Registry with the registration number ChiCTR1900028114.

Conclusions: We conclude that this intervention, grounded in the well-established WHO Thinking Healthy Programme, is both feasible and acceptable to stakeholders. It merits a definitive randomized trial to assess its effectiveness and cost-effectiveness across various settings.

Clinical trial registration: ChiCTR1900028114.

The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%-80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools-the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)-and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2-3 times a week, was 2.6% (95% CI 1.73%-3.85%), descriptively increased with age from 0.5% in 40-49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population.

Background: Prenatal vitamin and mineral supplements are commonly advised as clinical practice standard of care. In spite of Ethiopian government focus on maternal nutrition programmes targeting pregnant and lactating women, Micronutrient deficiencies are still quite common and are regarded as a serious public health issue and also little is known regarding utilization and barriers to prenatal vitamin use during pregnancy. This study aimed to assess utilization and associated factors of prenatal vitamins among pregnant women attending antenatal care at public hospitals in the south Gondar zone, 2024.

Methods: Multi center crossectional study design was conducted among 416 pregnant women from March 1 to May 30, 2024. Systematic sampling technique was used to select the study participants. Data was collected using Interviewer administered questionnaire. After data, SPSS version 26 software was used for analysis. Factors associated with utilization of prenatal vitamins were identified using bi-variable and multi variable logistic regression models. Statistical significance was declared at 95%CI and p-value < 0.05.

Result: In this study, we found that 87.5% (95% CI: 84.31, 90.34) of pregnant women did not use prenatal vitamins. Women not having formal education (AOR = 2.72, 95%CI: 1.44-5.15), being unplanned pregnancy (AOR = 2.58, 95%CI: 1.76-3.78), husband being decision maker in health care (AOR = 1.71, 95%CI:1.09-2.68), having poor knowledge (AOR = 3.27, 95%CI: 1.44-7.42) and unfavorable attitude (AOR = 3.63, 95%CI: 1.61-8.18) on prenatal vitamins were significantly associated with non-users of prenatal vitamins.

Conclusion: The proportion of non-users of prenatal vitamin were higher. Educational level of women, pregnancy plan, decision on health care, knowledge and attitude on prenatal vitamins had statistically significant with utilization of prenatal vitamins. Developing and implementing targeted educational programs to increase awareness about the importance and benefits of prenatal vitamins and encouraging women to take an active role in their healthcare decisions is recommended to improve the utilization of prenatal vitamins.

Introduction: Promoting healthy lifestyle behaviors during pregnancy is a crucial health promotion strategy that could reduce pregnancy-related complications that may harm women and their fetuses. However, very few studies have assessed the prevalence of health-promoting lifestyle behaviors among pregnant women in Ethiopia. This study aimed to evaluate the extent and associated factors of health-promoting lifestyle behaviors among pregnant women in public health institutions in Debre Markos, northwest Ethiopia.

Methods: An institutional-based cross-sectional study was conducted among 275 pregnant women who were recruited using a systematic random sampling technique from 19 April to 19 May 2021. A face-to-face interview-administered questionnaire was used to collect the data. The data were analyzed using SPSS version 25. Multivariable binary logistic regression was used to identify the factors associated with the outcome variable. adjusted odds ratio (AOR), with a 95% confidence interval (CI) were used to measure the strength of the associations at a p-value <0.05.

Results: The average mean score for health-promoting lifestyle behaviors was 2.68 (±0.38). Factors such as rural residency (AOR = 0.29; 95% CI = 0.10-0.82), family size (≥5) (AOR = 0.25; 95% CI = 0.08-0.79), being the decision-maker for economic expenses (AOR = 0.34; 95% CI = 0.14-0.84), and average monthly income (AOR = 0.15; 95% CI = 0.04-0.59) were found to be significantly associated with health-promoting lifestyle behaviors during pregnancy.

Conclusion: Approximately two-thirds of participants demonstrated better (healthier) health-promoting lifestyle behaviors during their pregnancy. To reduce unhealthy lifestyle-related maternal morbidity and mortality in Ethiopia, it is important to encourage health-promoting activities through health education and antenatal care follow-up with an emphasis on women who reside in rural areas, and who have a high family size, low income level, and have husbands who are the primary decision-makers for their economic expenses.

During the COVID-19 pandemic, family planning services over the world have been disrupted. There are still uncertainties about the impact on access to contraception, particularly among marginalised populations. This study aimed to assess the effect of COVID-19 on women's access to contraception, focusing on those experiencing loss of income and self-isolation. The International Sexual Health and Reproductive Health (I-SHARE) survey collected data from 5,216 women in 30 countries. Multivariable logistic regression was conducted to assess the association between loss of income during the pandemic, self-isolation and reduced access to contraception. Women experiencing loss of income and those who had self-isolated had reduced access to contraception (respectively aOR 2.3 and 1.7, for both p < 0.001). Most women reported inaccessibility of health centres, fear of COVID-19, and stockouts as reasons for reduced access. This study highlights how socio-demographic differences may have impacted access to contraception during the pandemic. People experiencing income loss and self-isolation might have faced increased barriers to family planning during the pandemic. Contraception should be prioritised in times of crisis: when planning services, financial support, telehealth and other measures should be implemented in order to increase access and reduce inequalities.

Objective: To examine women's perceptions of modern menstrual hygiene methods (MMHM), such as tampons and menstrual cups, focusing on socio-demographic variations and special groups in the Coimbatore district of Tamil Nadu.

Methods: A qualitative study among women of reproductive age (15-49 years) group was conducted using Focus Group Discussions (FGDs) among twelve women subgroups independently in 2023.

Results: The present study involved 23 focus group discussions (FGDs) across various groups of women, including those in formal and informal sectors, urban and rural areas, school and college students, healthcare workers, women in sports, tribal women, transgender women, and female sex workers (FSW), with a total of 188 participants. The age range varied across groups, from 15 to 45 years. Over half of the participants were married (51.1%), and 68.7% were literate, though illiteracy was higher in the informal sector, rural, tribal areas, transgender women, and FSW groups. Sanitary pads were the most used menstrual hygiene method (88.3%), followed by cloth (4.8%), and modern methods like menstrual cups or tampons (1.6%). Notably, 70% of FSW and 28.6% of tribal women still used cloths. Menstrual hygiene choices were often influenced by family recommendations, school-based menstrual hygiene sessions, institutional policies, and social media. Regarding satisfaction, 27.1% were content with their menstrual hygiene method, citing accessibility, affordability, and leakage prevention. However, issues with pads included heat, rashes, and discomfort. A significant number (31.4%) shifted from cloth to pads recently, mainly due to leakage and lack of adequate washing facilities. Only 6.1% had tried modern menstrual methods, with tampons and menstrual cups being considered more suitable but less feasible, especially among tribal women. Participant concerns ranged from the potential health risks of sanitary pads to waste disposal challenges. Recommendations included public menstrual hygiene management (MHM) dispensers, better waste collection practices, and increased awareness through advertisements. Some participants advocated for the concept of free menstruation, emphasizing informed choices and accessibility for all.

Conclusion: The findings suggest that increasing access to modern menstrual hygiene products, coupled with comprehensive education and support, could improve acceptance and feasibility, especially for marginalized and underrepresented women.