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Influence of intimate partner violence and male involvement on maternal healthcare services utilisation in Nigeria 亲密伴侣暴力和男性参与对尼日利亚孕产妇保健服务利用率的影响
Pub Date : 2024-03-15 DOI: 10.3389/fgwh.2024.1353117
O. Adetutu, F. Oyinlola, T. E. Oyelakin, F. L. Ofili
Low maternal health care services utilisation, especially antenatal care attendance and skilled birth attendance, has been documented to be responsible for maternal mortality and morbidity in Nigeria. While available evidence suggests mixed findings on uptake of maternal health care services in the context of abusive spousal relationships, male involvement in household and health decision-making has been established to promote uptake of maternal health care services. Yet, studies which consider mediating influence of intimate partner violence on male involvement and maternal health care services uptake are sorely missing in Nigeria. We hypothesised that maternal health care services uptake in abusive marital unions has implications for male involvement in pregnancy care and this has been largely overlooked in Nigeria.This study extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The 2018 NDHS is a nationally representative secondary data which collected population, demographic and health information on women, men and households in Nigeria. The secondary data used a two-stage stratified and multistage sampling technique to collect information from the respondents. In this study, data were extracted for women who were sexually active, within the reproductive age (15–49 years) and not pregnant in five years prior the survey (n = 7,847).The results indicated (77%) antenatal care attendance and (47%) skilled delivery. The mediating influence of IPV on male involvement resulted in women who experienced sexual violence more likely to use heath facility for antenatal care (OR = 3.20; C.I: 1.20–8.50). Women whose partners were involved in health decision making had lower odds of antenatal care attendance (OR = 0.64; C.I: 0.44–0.94). Also, women whose partners were involved in spending their earnings had lower probability of antenatal care attendance (OR = 0.72; C.I: 0.55–0.96). Yet, the mediating influence of intimate partner violence on male involvement resulted in a lower likelihood of use of skilled delivery for emotionally abused women (OR = 0.58; C.I: 0.39–0.85). Women whose partners were involved in spending their earnings had higher odds of using skilled delivery (OR = 2.15; C.I: 1.79–2.56). Yet, women whose partners were involved in their health decision-making had lower odds of using skilled delivery (OR = 0.46; C.I: 0.34–0.62).This study held the philosophical stance that intimate partner violence mediated the influence of male involvement on maternal health care uptake while intimate partner violence had an inconsistent influence on maternal health care uptake. Policies and interventions should aim at addressing deep-rooted gender norms which promote IPV and limit male involvement in pregnancy care in Nigeria. Programme and policy interventions should focus on enhancing socioeconomic status of women.
在尼日利亚,孕产妇保健服务利用率低,特别是产前保健服务和熟练助产服务利用率低,已被证实是造成孕产妇死亡和发病的原因。虽然现有证据表明,在配偶施虐的情况下,孕产妇接受医疗保健服务的情况参差不齐,但男性参与家庭和健康决策已被证实可促进孕产妇接受医疗保健服务。然而,在尼日利亚,考虑到亲密伴侣暴力对男性参与和孕产妇保健服务接受度的中介影响的研究非常缺乏。我们假设,在虐待性婚姻关系中,孕产妇医疗保健服务的摄取会对男性参与孕期保健产生影响,而这一点在尼日利亚在很大程度上被忽视了。本研究从 2018 年尼日利亚人口与健康调查(NDHS)中提取数据。2018 年尼日利亚人口与健康调查是一项具有全国代表性的二级数据,收集了尼日利亚女性、男性和家庭的人口、人口统计和健康信息。二级数据采用了两阶段分层多阶段抽样技术来收集受访者的信息。在这项研究中,提取了调查前五年内性生活活跃、处于育龄期(15-49 岁)且未怀孕的妇女(n = 7 847)的数据,结果表明(77%)接受了产前护理,(47%)进行了熟练分娩。IPV 对男性参与的中介影响导致遭受过性暴力的妇女更有可能使用医疗机构进行产前护理(OR = 3.20;C.I:1.20-8.50)。其伴侣参与健康决策的妇女接受产前护理的几率较低(OR = 0.64;C.I:0.44-0.94)。此外,伴侣参与收入支出的妇女接受产前检查的几率也较低(OR = 0.72;C.I:0.55-0.96)。然而,亲密伴侣暴力对男性参与的中介影响导致遭受情感虐待的妇女使用熟练接生的可能性较低(OR = 0.58;C.I:0.39-0.85)。其伴侣参与花费其收入的妇女使用熟练接生的几率更高(OR = 2.15;C.I:1.79-2.56)。本研究认为,亲密伴侣暴力是男性参与孕产妇保健的中介,而亲密伴侣暴力对孕产妇保健的影响并不一致。在尼日利亚,政策和干预措施应旨在解决助长亲密伴侣暴力和限制男性参与孕期保健的根深蒂固的性别规范问题。方案和政策干预措施应侧重于提高妇女的社会经济地位。
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引用次数: 0
Facilitating childbirth choice for positive postnatal mental health well-being among women: a Namibian case study 为妇女产后积极的心理健康选择提供便利:纳米比亚案例研究
Pub Date : 2024-03-15 DOI: 10.3389/fgwh.2024.1277611
S. Mlambo, H. Amukugo
Childbirth affects women in a myriad of ways including feelings of tiredness, being overwhelmed, stressed, and having baby blues, and if not attended to, this can lead to postpartum depression, which is a mental condition that can have disastrous effects. Childbirth can affect the mental and physical status of a woman and having supportive midwives who guide women by giving adequate information is an issue of critical concern for a positive birth experience. The World Health Organisation (WHO) has emphasised the need to facilitate childbirth choices for women as a means of having a safe and memorable experience as the experience in childbirth affects the psychological status of a woman. Some women may experience worry and anxiety during labour and childbirth, which may be exacerbated by bias and a lack of childbirth choice facilitation during pregnancy. A negative childbirth experience may lead to negative psychological distress and postpartum depression, which will interfere with the bond between the mother, baby, and family. Midwives, thus, need to understand the emotional aspects that are attached to childbirth and be able to facilitate and support the emotional as well as the psychosocial needs of women under their care. However, there is a dearth of empirical evidence within the Namibian context that can provide direction and context-specific solutions to the present challenge. The current study followed a qualitative research design with an exploratory approach with one-on-one interviews with 10 midwives who were purposively selected. The midwives' experiences in this study depicted their zeal towards the issue at hand; however, what stood out were some barriers in the facilitation of childbirth choices (theme 1) as they expressed the shortages of staff, the timing of information, information sharing, and cultural influences as some of their experiences in facilitating childbirth. Furthermore, midwives shared a lack of provision for childbirth choice (theme 2) as the rights of women were not observed, and a lack of women-centred care despite protocols and guidelines being there, and yet they are not adhered to. In conclusion, midwives as primary caregivers actively need to provide unbiased childbirth information to achieve positive postpartum health. Initiating childbirth choices early in pregnancy gives women the time to weigh options and clearing of any misconceptions relating to childbirth types as well as reducing anxiety and fear of birth, which could lead to postpartum depression and by extension, the mental well-being of the women. Facilitating childbirth choices is critical in positive birth experiences and the management of childbirth as well as crafting guidelines and policy formulation that ensure a mentally healthy woman and society.
分娩对妇女的影响是多方面的,包括疲惫、不知所措、压力过大、婴儿忧郁症等,如果不加以注意,可能会导致产后抑郁症,这是一种可能产生灾难性影响的精神疾病。分娩会影响妇女的精神和身体状况,要想获得积极的分娩体验,助产士的支持和指导是至关重要的。世界卫生组织(WHO)强调,由于分娩经历会影响妇女的心理状态,因此有必要为妇女的分娩选择提供便利,使其获得安全、难忘的分娩经历。一些妇女在分娩和生产过程中可能会感到担忧和焦虑,而怀孕期间的偏见和缺乏分娩选择便利可能会加剧这种担忧和焦虑。负面的分娩经历可能会导致负面的心理困扰和产后抑郁,从而影响母亲、婴儿和家庭之间的联系。因此,助产士需要了解与分娩相关的情感因素,并能够促进和支持所护理妇女的情感和社会心理需求。然而,在纳米比亚的情况下,能够为目前的挑战提供方向和针对具体情况的解决方案的实证证据十分匮乏。目前的研究采用了定性研究设计,探索性地对 10 名助产士进行了一对一访谈。助产士们在本研究中的经历表明了她们对当前问题的热忱;然而,突出的是在促进分娩选择方面的一些障碍(主题 1),因为她们表示,人手不足、信息时间、信息共享和文化影响是她们在促进分娩方面的一些经历。此外,助产士们还认为,由于妇女的权利没有得到尊重,因此缺乏对分娩选择的规定(主题 2),而且尽管有协议和指南,但却没有得到遵守,因此缺乏以妇女为中心的护理。总之,助产士作为主要护理人员,需要积极提供公正的分娩信息,以实现积极的产后健康。在孕早期开始选择分娩方式,可以让妇女有时间权衡各种选择,消除对分娩类型的误解,减少对分娩的焦虑和恐惧,因为这可能会导致产后抑郁,进而影响妇女的心理健康。为分娩选择提供便利对于积极的分娩体验和分娩管理以及制定确保妇女和社会心理健康的指导方针和政策至关重要。
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引用次数: 0
Saudi women's perspectives on postpartum depression 沙特妇女对产后抑郁症的看法
Pub Date : 2024-03-14 DOI: 10.3389/fgwh.2024.1326130
Asmahan Alsulami, Abeer Orabi, Shahrazad M Timraz
Postpartum depression (PPD) is a serious disorder that affects women worldwide, making it a crucial public health concern and one of the most prevalent childbirth complications. Assessing the perspectives of Saudi women towards PPD is essential for addressing the issue and developing effective solutions. This study aimed to assess the knowledge and attitude of Saudi women about PPD in King Abdulaziz Medical City, Western Region.This study employed a descriptive cross-sectional research design and included 226 women recruited through convenience sampling at the Obstetrics and Gynaecology Outpatient Department in King Abdul-Aziz Medical City, Jeddah. Data were collected using a structured questionnaire with 3 main sections: socio-demographic characteristics, knowledge regarding risk factors and symptoms of PPD, and attitude about PPD.The mean score (SD) of the knowledge scale was 31.8 (6.2) with 53.5% of participants having a good level of knowledge about PPD. The mean score (SD) of the attitude scale was 27.1 (2.8) with 47.3% of participants having a positive attitude towards PPD. Significant differences were identified in the knowledge scale, where women who were postgraduates, working in the health sector and unpregnant scored higher in the knowledge scale compared to others (P = .008, P = .02, & P = .008, respectively).The findings of this study indicate that women's knowledge about PPD was generally good; however, many of them held negative attitudes towards PPD. These findings underscore the importance of proper education to improve mental health literacy and address prejudices and negative stereotypes related to PPD among Saudi women.
产后抑郁症(PPD)是一种影响全世界妇女的严重疾病,是一个重要的公共卫生问题,也是最普遍的分娩并发症之一。评估沙特妇女对产后抑郁症的看法对于解决这一问题和制定有效的解决方案至关重要。本研究旨在评估西部地区阿卜杜勒-阿齐兹国王医疗城的沙特妇女对 PPD 的认识和态度。本研究采用了描述性横断面研究设计,在吉达阿卜杜勒-阿齐兹国王医疗城的妇产科门诊部通过方便抽样的方式招募了 226 名妇女。数据采用结构式问卷收集,问卷包括 3 个主要部分:社会人口特征、有关 PPD 风险因素和症状的知识以及对 PPD 的态度。态度量表的平均分(标准差)为 27.1 分(2.8),47.3% 的参与者对 PPD 持积极态度。在知识量表中发现了显著差异,研究生、在卫生部门工作和未怀孕的女性在知识量表中的得分高于其他女性(分别为 P = .008、P = .02 和 P = .008)。这些调查结果表明,适当的教育对于提高沙特妇女的心理健康素养、消除与 PPD 相关的偏见和负面成见非常重要。
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引用次数: 0
Factors associated with postpartum hemorrhage in selected Southern Oromia hospitals, Ethiopia, 2021: an unmatched case-control study 2021 年埃塞俄比亚南奥罗米亚部分医院产后出血的相关因素:一项非匹配病例对照研究
Pub Date : 2024-03-14 DOI: 10.3389/fgwh.2024.1332719
Belda Negesa Beyene, Dube Jara Boneya, Shiferaw Gelchu Adola, Seboka Abebe Sori, Hirut Dinku Jiru, Nurye Sirage, Abdurazak Awol, Girma Tufa Melesse, Z. Wayessa, Ahmedteyib Jemalo, Abebaw Kebede, Derese Eshetu, Yesuneh Dejene
Around one-fourth of maternal deaths worldwide are attributed to hemorrhage. One of the prevalent types of maternal hemorrhage is postpartum hemorrhage. In spite of this, there is very little data on postpartum hemorrhage. Thus, the intention of this study was to determine factors associated with postpartum hemorrhage among mothers who gave birth in the selected Southern Oromia hospitals in Ethiopia.An institutional-based, unmatched case-control study was employed on a sample of 333 (83 cases and 250 controls) mothers who gave birth from March 1–30, 2021. Standardized and pretested check-lists were used to retrieve data from patients' cards, delivery registration, and operation registration logbooks. Epi Data Version 3.1 was used to enter data, while SPSS Version 25 was used for analysis. Multi-variable logistic regressions were used to identify the determinants of postpartum haemorrhage with a 95% confidence interval and p-value less than 0.05.Mothers who have no antenatal care follow-up (AOR = 1.94, 95% CI = 1.03, 3.64), had pre-partum anemia (AOR = 5.68, 95% CI = 3.13, 10.32), hypertensive disorder during pregnancy (AOR = 3.3, 95% CI = 1.13, 9.64), intrauterine fetal death (AOR = 4.21, 95% CI = 1.68, 10.58), and genital tract trauma during delivery (AOR = 3.23, 95% CI = 1.52, 6.89) were found as determinants of postpartum haemorrhage.The study showed that factors such as lack of antenatal care, pre–partum anemia, pregnancy–related hypertension, intrauterine fetal death and genital tract trauma during delivery were responsible for postpartum hemorrhage. The early introduction of antenatal care services for all mothers plays a crucial role in reducing postpartum hemorrhage.
全世界约四分之一的孕产妇死亡是由大出血造成的。产后出血是产妇出血的常见类型之一。尽管如此,有关产后出血的数据却很少。因此,本研究旨在确定在埃塞俄比亚选定的南奥罗米亚州医院分娩的产妇中与产后出血相关的因素。本研究以机构为基础,对 2021 年 3 月 1 日至 30 日分娩的 333 名产妇(83 名病例和 250 名对照)进行了非匹配病例对照研究。研究人员使用经过预先测试的标准化核对表,从患者卡、分娩登记簿和手术登记簿中检索数据。使用 Epi Data 3.1 版输入数据,并使用 SPSS 25 版进行分析。使用多变量逻辑回归确定产后出血的决定因素,置信区间为 95%,P 值小于 0.05。94,95% CI = 1.03,3.64)、产前贫血(AOR = 5.68,95% CI = 3.13,10.32)、妊娠期高血压紊乱(AOR = 3.3,95% CI = 1.13,9.64)、胎儿宫内死亡(AOR = 4.研究表明,缺乏产前护理、产前贫血、妊娠期高血压、胎儿宫内死亡和分娩时生殖道外伤等因素是导致产后出血的原因。尽早为所有产妇提供产前护理服务对减少产后出血起着至关重要的作用。
{"title":"Factors associated with postpartum hemorrhage in selected Southern Oromia hospitals, Ethiopia, 2021: an unmatched case-control study","authors":"Belda Negesa Beyene, Dube Jara Boneya, Shiferaw Gelchu Adola, Seboka Abebe Sori, Hirut Dinku Jiru, Nurye Sirage, Abdurazak Awol, Girma Tufa Melesse, Z. Wayessa, Ahmedteyib Jemalo, Abebaw Kebede, Derese Eshetu, Yesuneh Dejene","doi":"10.3389/fgwh.2024.1332719","DOIUrl":"https://doi.org/10.3389/fgwh.2024.1332719","url":null,"abstract":"Around one-fourth of maternal deaths worldwide are attributed to hemorrhage. One of the prevalent types of maternal hemorrhage is postpartum hemorrhage. In spite of this, there is very little data on postpartum hemorrhage. Thus, the intention of this study was to determine factors associated with postpartum hemorrhage among mothers who gave birth in the selected Southern Oromia hospitals in Ethiopia.An institutional-based, unmatched case-control study was employed on a sample of 333 (83 cases and 250 controls) mothers who gave birth from March 1–30, 2021. Standardized and pretested check-lists were used to retrieve data from patients' cards, delivery registration, and operation registration logbooks. Epi Data Version 3.1 was used to enter data, while SPSS Version 25 was used for analysis. Multi-variable logistic regressions were used to identify the determinants of postpartum haemorrhage with a 95% confidence interval and p-value less than 0.05.Mothers who have no antenatal care follow-up (AOR = 1.94, 95% CI = 1.03, 3.64), had pre-partum anemia (AOR = 5.68, 95% CI = 3.13, 10.32), hypertensive disorder during pregnancy (AOR = 3.3, 95% CI = 1.13, 9.64), intrauterine fetal death (AOR = 4.21, 95% CI = 1.68, 10.58), and genital tract trauma during delivery (AOR = 3.23, 95% CI = 1.52, 6.89) were found as determinants of postpartum haemorrhage.The study showed that factors such as lack of antenatal care, pre–partum anemia, pregnancy–related hypertension, intrauterine fetal death and genital tract trauma during delivery were responsible for postpartum hemorrhage. The early introduction of antenatal care services for all mothers plays a crucial role in reducing postpartum hemorrhage.","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140242278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prevalence and predictors of men's involvement in pregnancy care in Modakeke, Southwest Nigeria 尼日利亚西南部 Modakeke 地区男性参与孕期保健的普遍性和预测因素
Pub Date : 2024-03-14 DOI: 10.3389/fgwh.2024.1337094
Aminat Omolara Akinyemi, Elhakim Adekunle Ibrahim
Maternal mortality in developing countries remains a major public health concern and lack of men's support for their spouse during pregnancy contributes to this adverse outcome. This study examined the level and determinants of men's involvement in pregnancy care in Modakeke, Southwest Nigeria.A community-based cross-sectional, mixed-methods study involving quantitative and qualitative data. A multistage sampling strategy was used to select the study participants. The study involved 414 male respondents interviewed using a structured interviewer-administered questionnaire. The interview was complemented with one focus group discussion facilitated using an unstructured interview guide. Quantitative data were analyzed using descriptive and inferential analytical techniques while qualitative data were explored using thematic content analysis.Findings revealed a 55% level of involvement in pregnancy care among the participants. However, involvement rates were higher among those who were younger, married, from monogamous family, with secondary or tertiary education, low-income earners, and holding positive perception about nontraditional gender roles. Multivariate logistic regression estimates indicated significantly lower odds of involvement among unmarried men than the married but increased odds among those who had secondary or higher education relative to the uneducated, and among those whose partners received antenatal care from multiple providers compared to from health facilities only. Furthermore, significantly reduced odds of involvement were associated with holding nonpositive perceptions towards accompanying spouse to antenatal care clinic and being involved in general pregnancy care as opposed to holding positive perception. Perceived challenges undermining male involvement as highlighted during focus group discussion include time constraints due to job demands, prohibitive sociocultural norms, rebuke and unconducive health facility environment.The level of involvement in pregnancy care is suboptimal among the study participants with considerable sociodemographic, socioeconomic and sociocultural dimensions. Enhancing men's involvement in pregnancy care requires community-based awareness-raising interventions that emphasize crosscutting benefits of male partner's participation in pregnancy-related care and address known sociocultural barriers impeding active involvement.
发展中国家的孕产妇死亡率仍然是一个重大的公共卫生问题,而男性在怀孕期间对配偶缺乏支持则是造成这一不良后果的原因之一。本研究探讨了尼日利亚西南部莫达凯克地区男性参与孕期保健的程度和决定因素。这是一项基于社区的横断面混合方法研究,涉及定量和定性数据。研究采用多阶段抽样策略挑选参与者。这项研究采用了多阶段抽样策略,对 414 名男性受访者进行了访谈。除访谈外,还使用非结构化访谈指南进行了一次焦点小组讨论。定量数据采用描述性和推论性分析技术进行分析,定性数据则采用主题内容分析进行探讨。然而,年轻、已婚、来自一夫一妻制家庭、受过中等或高等教育、低收入者以及对非传统性别角色持积极看法的人的参与率更高。多变量逻辑回归估计结果表明,未婚男性参与的几率明显低于已婚男性,但受过中等或高等教育的男性参与的几率高于未受过教育的男性,而且其伴侣在多家医疗机构接受产前护理的几率高于仅在医疗机构接受产前护理的几率。此外,对陪同配偶去产前检查诊所和参与一般孕期保健持有非积极看法的男性参与几率明显低于持有积极看法的男性。焦点小组讨论中强调的影响男性参与的挑战包括工作需求导致的时间限制、禁止性的社会文化规范、斥责和不利的医疗机构环境。要提高男性对孕期保健的参与度,就必须采取基于社区的提高认识干预措施,强调男性伴侣参与孕期保健的跨领域益处,并消除阻碍男性积极参与的已知社会文化障碍。
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引用次数: 0
International support for abortion education in medical schools: results of a global online survey to explore abortion willingness, intentions, and attitudes among medical students in 85 countries 国际社会对医学院堕胎教育的支持:85 个国家医学生堕胎意愿、意向和态度的全球在线调查结果
Pub Date : 2024-03-11 DOI: 10.3389/fgwh.2024.1253658
Eglė Janušonytė, Tamara Fetters, Gabriela Cipriano, Iheb Jemel, Cecilia Espinoza
Access to safe abortion has been recognized as a fundamental human right and important public health priority. Medical schools provide a rare opportunity to expose medical students to comprehensive sexual and reproductive health (SRH) topics and normalize abortion care early in a physician's career.This cross-sectional descriptive study used an online survey to explore abortion content in medical curricula and medical student intentions, attitudes, and beliefs regarding abortion provision among 1,699 medical students from 85 countries.Results demonstrate positive attitudes towards abortion provision, with 83% reporting that “access to safe abortion is every woman's right”. Students also reported a relatively high willingness to provide abortion professionally despite few opportunities to learn about this care. Only one-third of students surveyed reported having taken a gynecology course (n = 487; 33%); among these, one-third said they had no content on abortion care in their programs thus far (n = 155; 32%), including instruction on postabortion care. Among the two-thirds of students who had some content on abortion care (n = 335), either on induced abortion, postabortion care (PAC), or both, 55% said content was limited to one lecture and only 19% reported having an opportunity to participate in any practical training on abortion provision. Despite most students having no or very limited didactic and practical training on abortion, 42% intended to provide this care after graduation. Three-quarters of student respondents were in favor of mandatory abortion education in medical curricula.The findings of this study offer new evidence about abortion care education in medical curricula around the globe, indicating that there is no lack of demand or interest in increasing medical knowledge on comprehensive abortion care, merely a lack of institutional will to expand course offerings and content.
安全堕胎已被公认为一项基本人权和重要的公共卫生优先事项。这项横断面描述性研究采用在线调查的方式,对来自 85 个国家的 1699 名医学生进行了调查,以了解医学课程中的人工流产内容以及医学生对提供人工流产服务的意向、态度和信念。结果显示,医学生对提供人工流产服务持积极态度,83% 的学生表示 "获得安全人工流产服务是每位女性的权利"。学生们还表示,尽管很少有机会了解人工流产护理,但他们提供专业人工流产服务的意愿相对较高。只有三分之一的受访学生表示曾修读过妇科课程(n = 487;33%);其中三分之一的学生表示他们的课程中迄今为止没有关于人工流产护理的内容(n = 155;32%),包括人工流产后护理的指导。有三分之二的学生(n = 335)学习过人工流产、流产后护理 (PAC) 或两者方面的内容,其中 55% 的学生表示,这些内容仅限于一次讲座,只有 19% 的学生表示有机会参加任何有关人工流产提供的实践培训。尽管大多数学生没有接受过或接受过非常有限的人工流产教学和实践培训,但仍有 42% 的学生打算在毕业后提供这种护理。这项研究的结果为全球医学课程中的人工流产护理教育提供了新的证据,表明在增加全面人工流产护理的医学知识方面并不缺乏需求或兴趣,只是缺乏扩大课程设置和内容的机构意愿。
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引用次数: 0
Postpartum Care Program in Japan. 日本产后护理计划。
Pub Date : 2024-03-08 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1333758
Shunji Suzuki
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引用次数: 0
Neurovascular coupling is altered in women who have a history of brain injury from intimate partner violence: a preliminary study 有亲密伴侣暴力脑损伤史的妇女的神经血管耦合发生了改变:一项初步研究
Pub Date : 2024-03-01 DOI: 10.3389/fgwh.2024.1344880
Colin Wallace, J. Smirl, S. Adhikari, K. E. Jones, Matt Rieger, Krystal Rothlander, P. van Donkelaar
Intimate partner violence (IPV) is a global health crisis with 30% of women over the age of 15 experiencing at least one event in their lifetime. Brain injury (BI) due to head impacts and/or strangulation is a common but understudied part of this experience. Previous research has shown BI from other injury mechanisms can disrupt neurovascular coupling (NVC). To gain further insight into whether similar changes occur in this population, we assessed NVC responses in women with a history of IPV-BI.NVC responses were measured for the middle and posterior cerebral arteries (MCA, PCA) using transcranial Doppler ultrasound while participants performed a complex visual search task. The lifetime history of previous exposure to IPV-BI was captured using the Brain Injury Severity Assessment (BISA) along with measures of post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and demographic information. Initial analyses of NVC metrics were completed comparing participants who scored low vs. high on the BISA or did or did not experience non-fatal strangulation followed by a stepwise multiple regression to examine the impact of PTSD, anxiety, and depression on the relationship between the NVC metrics and IPV-BI.Baseline and peak cerebral blood velocity were higher and the percentage increase was lower in the PCA in the low compared to the high BISA group whereas no differences between the groups were apparent in the MCA. In addition, those participants who had been strangled had a lower initial slope and area under the curve in the PCA than those who had not experienced strangulation. Finally, the stepwise multiple regression demonstrated the percentage increase in the PCA was significantly related to the BISA score and both depression and anxiety significantly contributed to different components of the NVC response.This preliminary study demonstrated that a lifetime history of IPV-BI leads to subtle but significant disruptions to NVC responses which are modulated by comorbid depression and anxiety. Future studies should examine cerebrovascular function at the acute and subacute stages after IPV episodes to shed additional light on this experience and its outcomes.
亲密伴侣暴力(IPV)是一场全球性的健康危机,30% 的 15 岁以上女性一生中至少经历过一次亲密伴侣暴力。头部撞击和/或勒死造成的脑损伤(BI)是这一经历中常见的一部分,但研究不足。先前的研究表明,其他受伤机制导致的脑损伤会破坏神经血管耦合(NVC)。为了进一步了解这一人群是否会发生类似的变化,我们评估了有 IPV-BI 史的女性的 NVC 反应。在参与者执行复杂的视觉搜索任务时,我们使用经颅多普勒超声波测量了大脑中动脉和后动脉(MCA、PCA)的 NVC 反应。使用脑损伤严重程度评估(BISA)以及创伤后应激障碍(PTSD)、焦虑、抑郁、药物使用和人口统计学信息等测量方法,记录了受试者生前遭受 IPV-BI 侵害的历史。在完成了对 NVC 指标的初步分析后,对 BISA 得分低与高或是否经历过非致命性扼颈的参与者进行了比较,随后进行了逐步多元回归,以研究创伤后应激障碍、焦虑和抑郁对 NVC 指标与 IPV-BI 之间关系的影响。此外,曾被勒死的参与者的 PCA 初始斜率和曲线下面积均低于未被勒死的参与者。最后,逐步多元回归表明,PCA 的百分比增加与 BISA 评分有显著关系,抑郁和焦虑对 NVC 反应的不同部分有显著影响。这项初步研究表明,IPV-BI 的终生史会导致 NVC 反应发生微妙但显著的破坏,而这种破坏会受到合并抑郁和焦虑的调节。未来的研究应考察 IPV 事件发生后急性和亚急性阶段的脑血管功能,以进一步揭示这种经历及其结果。
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引用次数: 0
Prevalence of persistent hypertension following pregnancy complicated by hypertensive disorders in low- and middle-income countries: a systematic review 中低收入国家妊娠并发高血压疾病后持续高血压的患病率:系统性审查
Pub Date : 2024-03-01 DOI: 10.3389/fgwh.2024.1315763
M. Mukosha, Abigail Hatcher, W. Mutale, M. Lubeya, Jamie L. Conklin, Benjamin H Chi
Hypertensive disorders of pregnancy can lead to persistent hypertension (pHTN) in the months and even years following delivery. However, its prevalence in low- and middle-income countries (LMICs) is not well characterized.To synthesize available evidence on the pHTN prevalence following a pregnancy complicated by hypertensive disorders of pregnancy in LMICs.PubMed, CINAHL Plus, Global Health (EBSCOhost), and Scopus from inception through a search date of July 12, 2022, and updated on January 2, 2024.Cross-sectional studies and cohort studies reporting pHTN prevalence were eligible.We conducted a narrative synthesis of data and categorized reported prevalence time points into several broader categories. We used the Newcastle-Ottawa checklist to assess the risk of bias. The protocol is registered in PROSPERO (CRD42022345739).We reviewed 1,584 abstracts and identified 22 studies that reported pHTN between 2000 and 2023 from 14 LMICs. The overall prevalence of pHTN ranged between 6.9% and 62.2%, with the highest prevalence noted within African studies and the lowest in South American studies. Estimates at different follow-up periods postpartum were 6.9%–42.9% at six weeks, 34.0%–62.2% at three months, 14.8%–62.2% at six months, 12.7%–61.2% at 12 months, and 7.5%–31.8% at more than 12 months. The quality score of the selected studies ranged from 50% to 100%.The extant literature reports a high prevalence of pHTN in LMICs following a pregnancy complicated by hypertensive disorders. To reduce long-term complications of pHTN, programs should emphasize early screening and linkages to long-term care for at-risk women.https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=345739, PROSPERO (CRD42022345739)
妊娠期高血压疾病可导致产后数月甚至数年内出现持续性高血压(pHTN)。综述中低收入国家妊娠期高血压并发症(pHTN)发病率的现有证据。PubMed、CINAHL Plus、Global Health (EBSCOhost) 和 Scopus 的检索日期为 2022 年 7 月 12 日,更新日期为 2024 年 1 月 2 日。我们对数据进行了叙述性综合,并将报告的患病时间点分为几大类。我们使用纽卡斯尔-渥太华核对表来评估偏倚风险。我们查阅了 1,584 篇摘要,确定了 22 项研究,这些研究报告了 2000 年至 2023 年期间来自 14 个低收入国家的 pHTN。pHTN 的总体患病率介于 6.9% 和 62.2% 之间,其中非洲研究的患病率最高,南美研究的患病率最低。产后不同随访期的估计值分别为:6 周时 6.9%-42.9%,3 个月时 34.0%-62.2%,6 个月时 14.8%-62.2%,12 个月时 12.7%-61.2%,12 个月以上时 7.5%-31.8%。所选研究的质量得分从 50%到 100%不等。现有文献报道,在低收入国家,妊娠合并高血压疾病后,pHTN 的发病率很高。为减少 pHTN 的长期并发症,相关计划应强调早期筛查和为高危妇女提供长期护理。https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=345739, PROSPERO (CRD42022345739)
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引用次数: 0
Factors that influence married/partnered women's decisions to use contraception in Zambia. 影响赞比亚已婚/有伴侣妇女决定使用避孕药具的因素。
Pub Date : 2024-02-21 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1157097
Chilochibi Chiziba, Mwimba Chewe, Peter Hangoma

According to the Demographic and Health Surveys (DHSs), Zambia has shown an increasing trend in the percentage of married women using contraceptives in the last three decades. As of 2018, this percentage increased from 34.2% in 2001 to 40.8% in 2007 and from 45% in 2013 to 48% in 2018. Despite the increasing trend in contraceptive use, the unmet needs remain relatively high. The low percentage of contraception use translates into 20% of women of reproductive age who are either married/partnered and want to stop or delay childbearing but are not using contraception. This study analyzed factors other than availability that influence women's ability to make or influence the decision to use contraception using logistic regression using data from the Zambia 2013/2014 and 2018 DHSs. Furthermore, adjusted odds ratios and predicted probabilities were estimated using the fitted logistic regression. Data on 8,335 women were analyzed, and 13.7% (n = 1,145) had their husband as the sole decision maker for contraception use, while 86.3% (n = 7,189) made the decisions or participated in making the decision. Contrary to most literature, those with primary or secondary school education were less likely to decide than those without education. The data also associate women who contribute to daily household decisions to having a say in deciding to use contraception. Lastly, women using reversible contraception methods, other methods, hormonal methods, and fertility awareness were associated with less likelihood to decide on using contraceptives than those using barrier methods. Women with lower household decision-making powers are less likely to make or influence decisions to use contraception. Consequently, there is a need to prioritize such women in interventions aimed at increasing contraception use decision-making. Furthermore, more studies are required to investigate why uneducated women in Zambia are more likely to choose contraception. Also, the vast odds ratio difference between all other methods compared to barrier methods (condoms) indicates underlying factors that play a role, which warrants further studies.

根据人口与健康调查(DHS),在过去三十年中,赞比亚已婚妇女使用避孕药具的比例呈上升趋势。截至2018年,这一比例从2001年的34.2%增至2007年的40.8%,又从2013年的45%增至2018年的48%。尽管避孕药具使用率呈上升趋势,但未满足的需求仍然相对较高。避孕药具使用率低意味着有 20% 的育龄妇女要么已婚/已育,要么想要停止或推迟生育,但却没有使用避孕药具。本研究利用赞比亚 2013/2014 年和 2018 年人口与健康调查的数据,通过逻辑回归分析了影响妇女做出或影响其使用避孕药具决定的能力的其他因素。此外,还利用拟合的逻辑回归估算了调整后的几率比和预测概率。对8335名妇女的数据进行了分析,13.7%(n=1145)的妇女由丈夫作为避孕药具使用的唯一决策者,86.3%(n=7189)的妇女由丈夫做出决定或参与做出决定。与大多数文献相反,受过小学或中学教育的妇女比未受过教育的妇女更不可能做出决定。数据还显示,参与日常家庭决策的妇女在决定使用避孕药具方面也有发言权。最后,与使用屏障避孕法的妇女相比,使用可逆避孕法、其他方法、荷尔蒙避孕法和生育意识的妇女决定使用避孕药具的可能性较低。家庭决策权较低的妇女不太可能做出或影响使用避孕药具的决定。因此,有必要在旨在提高避孕药具使用决策的干预措施中优先考虑这类妇女。此外,还需要进行更多的研究,以调查为什么赞比亚未受过教育的妇女更有可能选择避孕。另外,与屏障避孕法(避孕套)相比,所有其他避孕法的几率相差悬殊,这表明有潜在的因素在起作用,需要进一步研究。
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引用次数: 0
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Frontiers in global women's health
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