Frontiers in global women's health最新文献

Introduction: The intersectionality of sexism, transphobia, and adverse childhood experiences (ACE) on the mental health of transgender adults is poorly understood. We assessed whether the known association between ACE and depression was modified (or differed) by adult transgender identity and by assigned sex at birth, which we used as a proxy for adults' biological (e.g., hormonal changes) and social (e.g., sexism) experiences in childhood.

Methods: Data from a representative sample of 519 transgender and 127,214 cisgender US adults was retrieved from the 2019 and 2020 Behavioral Risk Factor Surveillance System surveys. The sample was stratified by assigned sex at birth. Adjusted, sample-weighted Poisson regressions and relative excess risk due to interaction (RERI) were used to assess whether transgender identity modified the association between ACE and depression within strata of assigned sex at birth.

Results: We found 42.4% of transgender compared to 24.9% of cisgender adults experienced 3+ ACE. The association between ACE and depression was stronger for transgender compared to cisgender adults, regardless of assigned sex at birth. However, transgender adults assigned female at birth with 1-2 ACE had a combined risk of depression that was higher than would be expected from the sum of the two risks alone (RERI test of interaction for transgender with 1-2 ACE vs. cisgender with zero ACE: 1.91 [95% confidence interval 0.47-3.36]; p = 0.009). The tests of interaction were not statistically significant (p > 0.05) for those assigned male at birth.

Discussion: Transgender adults may benefit more from depression interventions informed by and addressing childhood trauma than their cisgender counterparts, particularly for transgender adults who were assigned female at birth. Our findings suggest a need for greater and improved data collection of gender, experiences associated with assigned sex at birth, and ACE as these relate to the transgender community. This will allow for a better understanding of the intersecting influences of sexism, transphobia, and ACE on adult depression and for identifying particularly vulnerable sub-populations in need of support.

Background: Physical activity and proper nutrition during pregnancy are crucial for maternal and fetal health. However, many pregnant women fail to meet recommended guidelines. This study aimed to assess the effectiveness of an educational intervention based on the Health Belief Model (HBM) in improving these behaviors.

Methods: A pre-post with control quasi-experimental study was conducted among 200 pregnant women (100 experimental and 100 control) in Shiraz, Iran. The intervention group attended eight weekly 50-minute educational sessions based on the HBM. Physical activity and nutritional performance were assessed using validated questionnaires at baseline and three months post-intervention. Data were analyzed using paired and independent t-tests, with effect sizes and 95% confidence intervals reported.

Results: The intervention significantly improved physical activity (mean score: 29.25 ± 4.42 vs. 12.28 ± 4.36, p < 0.001) and nutritional performance across all food groups (p < 0.001) in the experimental group compared to the control group. Key constructs of the HBM, including perceived sensitivity, severity, benefits, self-efficacy, and cues to action, showed significant increases with notable effect sizes and 95% confidence intervals, while perceived barriers significantly decreased (p < 0.001).

Conclusions: The educational intervention based on the HBM effectively improved physical activity and nutritional performance among pregnant women. Integrating such programs into routine prenatal care is recommended, with emphasis on personalized counseling, regular follow-ups, and spousal involvement to sustain behavioral changes and promote maternal and fetal health.

Background: The burden of non-communicable diseases (NCDs) increasing at an alarming rate in Ethiopia. NCDs affect reproductive-age women and cause significant threats to future generations. Screening is an important aspect leading to early diagnosis, treatment and preventing the risk of complications and future mortality. However, less attention has been paid in the post-pandemic era of COVID-19. Therefore, this study aims to assess awareness of NCD screening and associated factors among reproductive-age women in the Gofa and Basketo zones.

Methods: A community-based cross-sectional study design was undertaken, employing a multistage cluster sampling method to select participants from the designated zones. Multivariate logistic regression was conducted using Statistical Package for the Social Sciences (SPSS) software. Associations were deemed statistically significant if the p-value was ≤0.05.

Results: The awareness level for screening NCDs among women was found to be 54.8%. Specifically, the percentages for awareness of hypertension (HTN), diabetes, cervical cancer, and breast cancer screenings were 52.7%, 42.4%, 38.1%, and 34.8% respectively. However, the study revealed that only 43.0%, 9.4%, 16.2%, and 20.7% of the participants had undergone screening for HTN, diabetes, breast cancer, and cervical cancer respectively. High awareness of NCD screening was significantly associated with urban residence (AOR: 1.68, 95% CI: 1.63, 1.73), Gofa zone residence (AOR: 2.04, 95% CI: 1.95, 2.13), being able to read and write (AOR: 1.06, 95% CI: 1.02, 1.11), having primary (AOR: 1.13, 95% CI: 1.09, 1.16) and secondary school education (AOR: 1.11, 95% CI: 1.00, 1.14), being in the age group of 25-34 (AOR: 1.45, 95% CI: 1.41, 1.49) and ≥35 years (AOR: 1.22, 95% CI: 1.18, 1.26), being married (AOR: 1.25, 95% CI: 1.16, 1.35) and single women (AOR: 1.31, 95% CI: 1.18, 1.43), government employees (AOR: 1.65, 95% CI: 1.54, 1.77), having larger family sizes (>4) (AOR: 1.11, 95% CI: 1.05, 1.12) and having a family member diagnosed with NCD (AOR: 1.16, 95% CI: 1.11, 1.22).

Conclusions: Nearly half of the study population had no awareness of NCD screening and the vast majority had poor screening practice. Strengthening the provision of behavioral change communication strategies through trained health professionals based on the audience's segmentation by age, educational and economic status is needed.

Background: Adverse birth outcomes are unfavorable outcomes of pregnancy that are particularly common in low- and middle-income countries. At least one ultrasound is recommended to predict adverse birth outcomes in early pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. According to our search of the literature, there is no validated risk prediction model for predicting adverse birth outcomes in Ethiopia. Hence, we developed and validated a model and risk score to predict adverse birth outcomes using maternal characteristics during pregnancy for use in resource-limited settings.

Methods: A retrospective follow-up study was conducted from 1 January 2016 to 31 May 2021, and a total of 910 pregnant women were included in this study. Participants were selected using a simple random sampling technique. Stepwise, backward multivariable analysis was conducted. The model's accuracy was assessed using density plots, discrimination, and calibration. The developed model was assessed for internal validity using bootstrapping techniques and evaluated for clinical utility using decision curve analysis across various threshold probabilities.

Results: Premature rupture of Membrane, number of fetuses, residence, pregnancy-induced hypertension, antepartum hemorrhage, hemoglobin level, and labor onset remained in the final multivariable prediction model. The area under the curve of the model was 0.77 (95% confidence interval: 0.73-0.812). The developed risk prediction model had a good performance and was well-calibrated and valid. The decision curve analysis indicated the model provides a higher net benefit across the ranges of threshold probabilities.

Conclusion: In general, this study showed the possibility of predicting adverse birth outcomes using maternal characteristics during pregnancy. The risk prediction model using a simplified risk score helps identify high-risk pregnant women for specific interventions. A feasible score would reduce neonatal morbidity and mortality and improve maternal and child health in low-resource settings.

Background: Gender-Based Violence (GBV) is one of the major problems that women and girls encountered during the conflict between the Ethiopian federal government and the Tigray People's Liberation Front (TPLF). However, there is a gap in evidence regarding gender-based violence resulting from the ongoing conflict in these areas. Therefore, this study assessed the prevalence of GBV and its contributing factors in the conflict-affected northeastern Amhara region of Ethiopia.

Methods: A community-based cross-sectional study was conducted from July 7th to September 30th, 2023, among 597 women and girls who lived in the three most conflict-affected districts (Wadla, Lay-Gaynt, and Meket) in northeastern Amhara regional state of Ethiopia. GBV was assessed using the WHO multi-country study on women's health and domestic violence against women questionnaire, which has 13 items and measures three violence domains (emotional, physical, and sexual). A binary logistic regression analysis was conducted. We used Adjusted Odds Ratios (AOR) with their respective 95% Confidence Intervals (CI) and a p-value of <0.05 to identify statistically significant factors.

Results: The overall prevalence of gender-based violence was 39.0% (95%CI: 35.2-43.6); 36.7% were experienced emotional, 15.4% physical, and 8.9% sexual violences. The burden is higher among individuals who are divorced, substance users, have low social support, or have participated in the war.

Conclusions: Two-fifths of women and girls in conflict-affected areas of the northeastern Amhara region experienced violence. Thus, collaboration between healthcare providers and policymakers is needed to enhance care for victims, including the provision of social support and substance use mitigation.

Background: The time during labor and delivery is crucial for the survival of both women and their infants, as complications that occur during this period can significantly increase the risk of morbidity and mortality. In developing nations, women of reproductive age and their infants are still at risk of morbidity and death from complications associated with pregnancy and childbirth. Morbidity and death from complications of pregnancy and childbirth can be prevented through the utilization of quality care during labor and delivery. However, there is limited evidence on the magnitude and factors associated with quality intrapartum care in East Africa. Therefore, this study assessed the magnitude and associated factors of quality intrapartum care among women in East Africa.

Methods: In this study, we used the most recent Demographic and Health Survey (DHS) dataset from 2015 to 2023, covering 11 East African countries. STATA version 18 software was used for data analysis. Multi-level modeling was applied due to the hierarchical or nested structure of DHS data. Variables with a p-value of less than 0.25 in the bivariate multi-level logistic regression model were included in the multivariable multi-level logistic regression analysis. Variables with p-values less than 0.05 were considered significant factors associated with receiving quality intrapartum care.

Results: The prevalence of receiving quality intrapartum care in East Africa was 56.38% [95% confidence interval (CI): 56.03, 56.7]. Women with primary education [Adjusted Odds Ratio (AOR) = 1.39, 95% CI: 1.33, 1.46], secondary education (AOR = 1.62, 95% CI: 1.53, 1.62), and higher education (AOR = 1.46, 95% CI: 1.33, 1.60), those in the middle (AOR = 1.28, 95% CI: 1.23, 1.34) and rich (AOR = 1.36, 95% CI: 1.31, 1.43) wealth index categories, women with one (AOR = 1.17, 95% CI: 1.09, 1.25) or 2-4 (AOR = 1.22, 95% CI: 1.16, 1.28) living children, those who perceived the distance from the health facility as not a big problem (AOR = 1.28, 95% CI: 1.24, 1.33), and women living in Rwanda (AOR = 1.30, 95% CI: 1.19, 1.41) had higher odds of receiving quality intrapartum care. Residing in rural areas (AOR = 0.82, 95% CI: 0.78, 0.86), and being from Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Tanzania, Uganda, Zambia, or Zimbabwe, were factors negatively associated with receiving quality intrapartum care.

Conclusion and recommendations: Nearly half of the women in East African countries did not receive quality intrapartum care. Both individual and community-level variables were significantly associated with receiving quality intrapartum care in East Africa. Improving the quality of intrapartum care requires enhancing women's education, addressing socioeconomic challenges, and increasing access to health facilities through targeted interventions.

Objective: To assess the implementation of the "10 Steps for Successful Breastfeeding" and explore associations with any Breastfeeding (BF) and Exclusive Breastfeeding (EBF) initiation and continuation.

Methods: Implementation of the 10 Steps was assessed based on a consecutive sample of 568 mothers' self-reported experience across all public (N = 5) and 29 (of 35) private maternity clinics using the WHO/UNICEF BFHI questionnaire (Section 4) within the first 24-48 h after birth. BF and EBF were estimated within 48 h after birth as well as at 1st, 4th and 6th month based on a self-reported current status method. Associations with initiation and continuation of any BF and EBF up to the 6th month were explored in logistic regression after adjusting for potential confounders. Associations were explored with individual steps as well as the overall experience, operationalized as the sum score of full, partial or no implementation of each item, with the exception of Step 6 (exclusive breastfeeding).

Results: At mean score 6.2 (SD = 2.7), the overall 10 Steps experience was low (theoretical range 0-14), even among those who breastfed exclusively (M = 7.7, SD = 2.0). EBF and BF initiation and continuation showed a stepwise association with self-reported experience of the 10 Steps. Across quartiles of increasing scores within 48 h after birth, the prevalence of EBF was 7.5%, 14.4%, 19.0%, and 34.2%. Mothers who experienced full or partial implementation of Step 4 (i.e., early initiation with skin-to-skin) were more likely to continue BF and EBF up to the 4th month, while use of pacifiers (Step 9) was more likely to have an adverse effect on breastfeeding continuation and exclusivity.

Conclusion: The BFIH's "10 Steps" are associated with BF initiation while certain practices seem to be more strongly associated with exclusivity and continuation of breastfeeding up to the sixth month. While breastfeeding intention may determine the experience of the 10 Steps, this also suggests that maternity care practices can have a supportive role for mothers to succeed their intentions to BF and EBF.

Background: In low-income countries, women with disabilities face numerous challenges in accessing sexual and reproductive health services and experience high unintended pregnancy rates and adverse pregnancy outcomes, with 42% of cases ending in abortion. However, little is known about unintended pregnancy among women with disabilities in Ethiopia. Therefore, this study aimed to assess the prevalence of unintended pregnancy and associated factors among women with disabilities in the Central Regional State of Ethiopia.

Methods: A community-based cross-sectional study was conducted from December 2023 to February 2024, and multistage random sampling was used to enroll 572 study participants. The sample size was proportionally allocated to each zone, district and kebele. The Kobo Toolbox was used for data collection and cleaning, and the Statistical Package for Social Science version 26 was used for analysis. The multivariable analysis was used to identify the factors significantly associated with unintended pregnancy using an adjusted odds ratio (AOR), a 95% confidence interval (CI), and a p-value less than 0.05.

Results: The prevalence of unintended pregnancy was 43.8% (95% CI: 39.5, 47.8) in the Central Ethiopia Regional State, Ethiopia. The significantly associated factors were household size (AOR = 4.6, 95% CI: 2.6, 7.9), awareness of pregnancy intention (AOR = 2.4, 95% CI:1.4, 4.1), domestic violence (AOR = 5.9, 95% CI: 3.4, 10.4), accessibility of service (AOR = 2.4, 95% CI: 1.2, 5.4), discrimination by care providers (AOR = 2.1, 95% CI: 1.5, 2.9), disability-unfriendly health facility structure (AOR = 1.5, 95% CI: 1.2, 2.40), and negative community attitudes (AOR = 2.7, 95% CI: 1.7, 4.3). The overall direction of the associated variables' effect was positive.

Conclusion: This study sheds light on the need for disability-inclusive and sensitive healthcare services. Therefore, to achieve universal access to sexual and reproductive healthcare targeted under the Sustainable Development Goals, the Minister of Women and Social Affairs, Ministry of Health, Regional Health Bureau, and health facilities authorities should pay attention to improving awareness on pregnancy intention and domestic violence and ensuring accessible, inclusive, and equitable maternal health care for women with disabilities.