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Social media provides support and education for pregnant people when healthcare does not. 社交媒体为孕妇提供了支持和教育,而医疗保健却没有。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-28 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1410831
Elissa Z Faro, Donna A Santillan, Meghan L Funk, Kara Boeldt, Mark K Santillan

Introduction: The use of social media for health-related reasons is growing, but there is a dearth of research on the mechanisms of support provided. Understanding how social media groups work could improve communications between providers and patients. Preeclampsia (PreE) is a hypertensive disease of pregnancy that has short- and long-term physical and psychosocial effects. The Preeclampsia, Eclampsia & HELLP Syndrome Survivors Global Support Network (PEHSS) Facebook group is an online, international, moderated support group that provides evidence-based information and community support. Our study aimed to (1) characterize the forms of social support and types of information sought and provided from the perspective of the group moderators and members, and (2) describe group members' experiences of patient care. We triangulated interview and survey findings to identify gaps in care, ultimately to inform in improvements in care delivery.

Methods: We began with 30-45-minute semi-structured interviews with PEHSS moderators exploring experiences and perceptions of membership; preliminary findings were member-checked with additional moderators. Interviews were analyzed using template and matrix analysis. Based on emergent themes, we conducted an online, validated patient experience survey with PEHSS members that was analyzed using descriptive statistics.

Results: Emotional and social support, mental health, resources and education, and personal health advocacy emerged as major themes in the 12 interviews. 1,148 PEHSS members responded to the survey. 68% of survey participants wanted to be more involved in the decisions about their care and treatment and over 30% felt they were not informed about danger signals post discharge while approximately half reported always feeling treated with respect and dignity while in the hospital. Geographic analysis showed differences in experiences of communication with providers within and outside the US.

Discussion: The triangulated results from interviews and surveys indicated a need for better communication with providers and the ability for patients to have more input on their care. The survey results indicate a global issue in providing support for people with hypertensive disorders of pregnancy during their hospitalization. The needs currently supported through communities on social media highlight opportunities to address critical gaps in care.

导言:出于健康原因使用社交媒体的情况越来越多,但缺乏对所提供支持机制的研究。了解社交媒体群体的运作方式可以改善医疗服务提供者和患者之间的沟通。子痫前期(PreE)是一种妊娠期高血压疾病,具有短期和长期的生理和社会心理影响。先兆子痫,子痫和HELLP综合征幸存者全球支持网络(PEHSS) Facebook小组是一个在线,国际,温和的支持小组,提供循证信息和社区支持。本研究的目的是:(1)从小组主持人和成员的角度描述社会支持的形式和寻求和提供的信息类型;(2)描述小组成员的病人护理经历。我们对访谈和调查结果进行了三角分析,以确定护理方面的差距,最终为改善护理提供信息。方法:我们开始与PEHSS主持人进行30-45分钟的半结构化访谈,探讨会员的经历和看法;初步的发现是由额外的版主对成员进行检查的。访谈采用模板和矩阵分析进行分析。基于紧急主题,我们对PEHSS成员进行了在线验证的患者体验调查,并使用描述性统计进行了分析。结果:情感和社会支持、心理健康、资源和教育、个人健康倡导是12个访谈的主要主题。1148名PEHSS成员参与了调查。68%的调查参与者希望更多地参与有关他们的护理和治疗的决定,超过30%的人认为他们在出院后没有被告知危险信号,而大约一半的人报告说,在医院里总是感到受到尊重和尊严。地理分析显示,与美国境内外供应商沟通的经验存在差异。讨论:访谈和调查的三角结果表明,需要与提供者进行更好的沟通,并使患者能够对他们的护理有更多的投入。调查结果表明,为妊娠高血压病患者住院期间提供支持是一个全球性问题。目前通过社交媒体社区支持的需求突出了解决护理方面严重差距的机会。
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引用次数: 0
Mobile health (mHealth) interventions for health promotion during the perinatal period in India: a scoping review. 印度围产期促进健康的移动保健(mHealth)干预措施:范围审查
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-27 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1427285
Zara Small, Sophie Elizabeth Thompson, Ankita Sharma, Sreya Majumdar, Sudhir Raj Thout, Devarsetty Praveen, Jane Elizabeth Hirst

Introduction: Perinatal and maternal mortality rates remain high in India compared to global levels, and there is significant heterogeneity in outcomes across Indian states. Many mobile health (mHealth) interventions have been developed to improve maternal and infant health outcomes in India, however it is unclear how mHealth can best support women in this culturally and resource diverse setting. Therefore, we aimed to identify mHealth interventions targeting women and their families in the perinatal period in India, identify barriers and facilitators to their uptake, and future research directions.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines for scoping reviews was used for study selection and screening and the mHealth evidence reporting and assessment checklist was used for evaluating mHealth interventions. PubMed, CINAHL, Global Health, and ACM digital library were searched for records up to 2 April 2023. Studies were included where women who were pregnant, planning for a child, or in the 12 months after delivery, and their families, living in India received health advice via a technological medium.

Results: 1,783 records were screened, 29 met the inclusion criteria, describing 22 different mHealth interventions. Most frequent behavioural targets for interventions were breastfeeding, antenatal nutrition, and infant healthcare. Most interventions communicated to women through one-way communication methods, most frequently SMS. Participants reported positive views of mHealth, reported facilitators included group communication, use of non-maternal informative content, and a pictorial information format. Reported barriers included household responsibilities, technical difficulties, difficulty accessing a phone and difficulty understanding, or misinterpreting messages.

Discussion: We conclude that mHealth interventions are acceptable to women in India during the perinatal period. However, current interventions lack evidence of long term behavioural change and fail to report on features important in sustainability and scalability, namely network infrastructure, data security and interoperability. We propose the need for a framework to understand existing cultural beliefs and support structures to avoid early intervention failure. Future research should investigate multimodal mHealth interventions for behavioural change, identify the appropriate frequency and format of mHealth messages, and address access limitations such as shared mobile phone ownership, and illiteracy rates.

导言:与全球水平相比,印度的围产期和孕产妇死亡率仍然很高,而且印度各邦的结果存在显著的异质性。印度已经开发了许多移动保健(mHealth)干预措施,以改善孕产妇和婴儿的健康结果,但尚不清楚移动保健如何在这种文化和资源多样化的环境中最好地支持妇女。因此,我们旨在确定针对印度围产期妇女及其家庭的移动健康干预措施,确定其采用的障碍和促进因素,以及未来的研究方向。方法:系统评价和荟萃分析的首选报告项目和乔安娜布里格斯研究所的范围审查指南用于研究选择和筛选,移动健康证据报告和评估清单用于评估移动健康干预措施。检索截至2023年4月2日的PubMed、CINAHL、Global Health和ACM数字图书馆的记录。研究包括生活在印度的怀孕、计划生育或分娩后12个月内的妇女及其家人通过技术媒介获得健康建议。结果:筛选了1783份记录,其中29份符合纳入标准,描述了22种不同的移动健康干预措施。干预措施最常见的行为目标是母乳喂养、产前营养和婴儿保健。大多数干预措施是通过单向通信方法向妇女传达的,最常见的是短信。参与者报告了对移动医疗的积极看法,报告的促进因素包括群体沟通、使用非孕产妇信息内容和图像信息格式。报告的障碍包括家庭责任、技术困难、使用电话困难、理解困难或误解信息。讨论:我们得出的结论是,印度妇女在围产期可以接受移动健康干预措施。然而,目前的干预措施缺乏长期行为改变的证据,也未能报告可持续性和可扩展性的重要特征,即网络基础设施、数据安全和互操作性。我们建议需要一个框架来理解现有的文化信仰和支持结构,以避免早期干预失败。未来的研究应调查行为改变的多模式移动健康干预措施,确定移动健康信息的适当频率和格式,并解决诸如共享移动电话所有权和文盲率等访问限制。
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引用次数: 0
Time to antenatal care booking and its predictors among pregnant women in East Africa: a Weibull gamma shared frailty model using a recent demographic and health survey. 东非孕妇产前保健预约时间及其预测因素:使用最近的人口和健康调查的Weibull gamma共享脆弱性模型。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-27 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1457350
Abel Endawkie, Shimels Derso Kebede, Kaleab Mesfin Abera, Eyob Tilahun Abeje, Ermias Bekele Enyew, Chala Daba, Lakew Asmare, Fekade Demeke Bayou, Mastewal Arefaynie, Anissa Mohammed, Abiyu Abadi Tareke, Awoke Keleb, Natnael Kebede, Yawkal Tsega

Background: Antenatal care (ANC) is an important component of maternal and child healthcare. The World Health Organization (WHO) recommends that pregnant women book their ANC contact at or before 12 weeks of gestational age. However, in East Africa, evidence on whether the WHO recommendations have been followed is limited. Therefore, this study aimed to determine the time to ANC booking and its predictors among pregnant women in East Africa.

Method: This study was conducted among 86,662 pregnant women in East Africa. The time to ANC booking was estimated using the Kaplan-Meier (K-M) survival estimate. A Weibull gamma shared frailty model was used to determine the predictors of time to the first ANC visit. An adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported.

Result: The median time to ANC booking among pregnant women in East Africa was 4 ± 2 months. Maternal education at the primary (AHR = 1.01, 95% CI: 1.02-1.25), secondary (AHR = 1.03, 95% CI: 1.02-1.05), and higher level (AHR = 1.40, 95% CI: 1.30-1.50); husband's education level at the primary (AHR = 1.08, 95% CI: 1.06-1.09), secondary (AHR = 1.12, 95% CI: 1.10-1.13), and higher (AHR = 1.08, 95% CI: 1.07-1.10) levels as compared to with no education; a middle-class wealth status (AHR = 1.66, 95% CI: 1.60-1.70), being rich (AHR: 1.60, 95% CI: 1.56-1.73), high community-level maternal literacy (AHR = 1.05, 95% CI: 1.04-1.06), high community-level poverty (AHR = 0.99, 95% CI: 0.98-0.99), previous Cesarean section (CS) (AHR = 1.35, 95% CI: 1.33-1.39), and unwanted pregnancy (AHR = 0.74, 95% CI: 0.72-0.77) were predictors of the time to ANC booking.

Conclusion: The median time to ANC booking among pregnant women in East Africa is longer than the new WHO recommendation. Maternal and husband education, high community-level maternal literacy, a better household, community-level wealth index, and previous CS increase the likelihood of an early ANC booking. However, unwanted pregnancy lowers the likelihood of an early ANC booking. Therefore, strengthening systematic efforts to improve women's and their husbands' educational status, encouraging women's education in the community, providing economic support for women with low wealth status and poor communities, encouraging wanted pregnancy, and providing accessible counseling services for women with unwanted pregnancies will help to encourage early ANC booking among pregnant women in East Africa.

背景:产前保健(ANC)是妇幼保健的重要组成部分。世界卫生组织(世卫组织)建议孕妇在胎龄12周或之前预约ANC接触。然而,在东非,关于世卫组织的建议是否得到遵循的证据有限。因此,本研究旨在确定东非孕妇预约ANC的时间及其预测因素。方法:本研究在东非的86662名孕妇中进行。使用Kaplan-Meier (K-M)生存估计估计ANC预约的时间。使用威布尔伽马共享脆弱性模型来确定第一次ANC访问时间的预测因子。校正后的风险比(AHR)为95%可信区间(CI)。结果:东非孕妇预约ANC的中位时间为4±2个月。小学(AHR = 1.01, 95% CI: 1.02-1.25)、中学(AHR = 1.03, 95% CI: 1.02-1.05)和更高水平的母亲教育(AHR = 1.40, 95% CI: 1.30-1.50);与未受教育的妇女相比,丈夫的受教育程度在小学(AHR = 1.08, 95% CI: 1.06-1.09)、中学(AHR = 1.12, 95% CI: 1.10-1.13)和更高(AHR = 1.08, 95% CI: 1.07-1.10);中产阶级财富状况(AHR = 1.66, 95% CI: 1.60-1.70)、富裕(AHR: 1.60, 95% CI: 1.56-1.73)、高社区水平的产妇识字程度(AHR = 1.05, 95% CI: 1.04-1.06)、高社区水平的贫困(AHR = 0.99, 95% CI: 0.98-0.99)、既往剖宫产(CS) (AHR = 1.35, 95% CI: 1.33-1.39)和意外怀孕(AHR = 0.74, 95% CI: 0.72-0.77)是产前预约时间的预测因子。结论:东非孕妇预约ANC的中位时间比世卫组织的新建议要长。母亲和丈夫的教育程度、较高的社区水平的母亲识字率、较好的家庭、社区水平的财富指数以及以前的CS增加了早期ANC预约的可能性。然而,意外怀孕降低了早期预约ANC的可能性。因此,加强系统工作,提高妇女及其丈夫的教育地位,鼓励妇女在社区接受教育,为低财富地位和贫困社区的妇女提供经济支持,鼓励想要怀孕,并为意外怀孕的妇女提供无障碍咨询服务,将有助于鼓励东非孕妇早期预约ANC。
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引用次数: 0
Positive, Open, Proud: an adapted disclosure-based intervention to reduce HIV stigma. 积极,开放,自豪:一种基于披露的干预措施,以减少艾滋病毒的耻辱。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-27 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1469465
Tiffany Chenneville, Kristin Kosyluk, Kemesha Gabbidon, Molly Franke, Dylan Serpas, Jerome T Galea

HIV stigma among people living with HIV (PLWH) is well documented and linked to adverse physical and mental health outcomes among this population. Further, stigma may affect HIV disclosure decisions, which has important individual and public health implications. For women, HIV stigma and disclosure may be compounded by gender-based discrimination and violence. Despite the ill effects of HIV stigma, particularly for women, few evidence-based disclosure interventions to reduce stigma among PLWH exist. However, there is strong evidence for the efficacy of Honest, Open, Proud (HOP), a disclosure-based stigma-reduction intervention for people with mental illness. Given that mental illness and HIV are similar in that they are both stigmatized yet concealable conditions, we propose using the ADAPT-ITT model to adapt HOP into Positive, Open, Proud, a disclosure-based stigma-reduction intervention for PLWH, describing its unique potential for women living with HIV.

艾滋病毒感染者(PLWH)对艾滋病毒的耻辱感有充分的记录,并与该人群中不良的身心健康结果有关。此外,耻辱可能影响艾滋病毒披露的决定,这对个人和公共卫生都有重要影响。对妇女来说,艾滋病毒的耻辱和披露可能因基于性别的歧视和暴力而加剧。尽管艾滋病毒污名的不良影响,特别是对妇女来说,很少有循证披露干预措施,以减少艾滋病毒感染者的污名。然而,有强有力的证据表明,诚实,开放,骄傲(HOP)的有效性,这是一种基于披露的精神疾病患者减少耻辱的干预措施。鉴于精神疾病和艾滋病毒的相似之处是它们都是耻辱但可隐藏的条件,我们建议使用adapt - itt模型将HOP改编为积极,开放,骄傲,一种基于披露的PLWH耻辱减少干预措施,描述其对感染艾滋病毒的女性的独特潜力。
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引用次数: 0
Late initiation of antenatal care and associated factors among pregnant women attending antenatal clinic at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia: a cross-sectional study. 埃塞俄比亚东部Hiwot Fana综合专科医院产前门诊孕妇开始产前护理晚及相关因素:一项横断面研究。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-27 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1431876
Bayisa Dibaba, Miressa Bekena, Tariku Dingeta, Eshetu Refisa, Habtamu Bekele, Shambel Nigussie, Eyobel Amentie

Background: Late initiation of antenatal care (ANC) is a major public health concern. If women initiate ANC late, they do not get adequate care, reducing the chances of early detection of pregnancy-related complications. However, there is a lack of data related to the initiation of antenatal care in the study area.

Objectives: To assess the prevalence of late initiation of antenatal care and identify associated factors among pregnant women attending antenatal care at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia.

Methods: An institutional-based cross-sectional study design was conducted among 454 pregnant women. All eligible participants during the study period were included. Data were collected via face-to-face interviews, were entered into Epi Data version 4.3, and analyzed using SPSS version 22 software. The results are presented using texts and tables. Logistic regression with the 95% confidence interval (CI) was used to identify factors associated with the late initiation of antenatal care. Statistical significance was declared at P < 0.05.

Results: The prevalence of late-initiation antenatal care in this study was 59.5% (95% CI 54.6-63.4). Age range of 30-34 years [adjusted odds ratio (AOR) 2.7, 95% CI 1.69-13.1] and age ≥35 years (AOR 4.2, 95% CI 1.92-9.84), rural residency (AOR 2.92, 95% CI 1.59-5.39), unplanned pregnancy (AOR 2.3, 95% CI 1.35-8.11), inability to make the decision to start ANC (AOR 2.14, 95% CI 1.18-3.89), multigravidity (AOR 1.9, 95% CI 1.13-12.4), wrong perception on the time of antenatal care initiation (AOR 5.8, 95% CI 3.71-9.34), lack of previous ANC experience (AOR 2.01, 95% CI 1.14-5.81), and more than 10 km distance from the hospital (AOR 1.36, 95% CI 0.62-2.95) were associated with late initiation antenatal care in this study.

Conclusion: More than half of the study participants were initiated into ANC after the 12th week of gestation. Moreover, rural residence, unplanned pregnancy, age ≥30 years, lack of previous antenatal care, inability to make decisions, and wrong perception on the time of initiation of ANC were found to be associated with late initiation of ANC. Educating women and involving partners and family members in discussions about ANC were recommended to build a supportive environment for pregnant mothers.

背景:产前保健(ANC)的晚启动是一个主要的公共卫生问题。如果妇女开始ANC较晚,她们得不到充分的护理,减少了早期发现妊娠相关并发症的机会。然而,在研究区域缺乏与产前护理相关的数据。目的:评估在埃塞俄比亚东部Hiwot Fana综合专科医院接受产前护理的孕妇中延迟开始产前护理的患病率,并确定相关因素。方法:采用基于机构的横断面研究设计,对454名孕妇进行调查。研究期间所有符合条件的参与者均被纳入。数据采用面对面访谈的方式收集,录入Epi Data 4.3版,使用SPSS 22版软件进行分析。结果以文本和表格的形式呈现。采用95%可信区间(CI)的Logistic回归来确定与产前护理开始较晚相关的因素。结果:本研究中延迟产前护理的患病率为59.5% (95% CI为54.6-63.4)。年龄范围为30-34岁[调整优势比(AOR) 2.7, 95% CI 1.69-13.1],年龄≥35岁(AOR 4.2, 95% CI 1.92-9.84),农村居住(AOR 2.92, 95% CI 1.59-5.39),意外怀孕(AOR 2.3, 95% CI 1.35-8.11),无法决定是否开始产前护理(AOR 2.14, 95% CI 1.18-3.89),多胎(AOR 1.9, 95% CI 1.13-12.4),对开始产前护理时间的错误认识(AOR 5.8, 95% CI 3.71-9.34),缺乏产前护理经验(AOR 2.01, 95% CI 1.14-5.81),在本研究中,距离医院超过10公里(AOR 1.36, 95% CI 0.62-2.95)与开始产前护理较晚相关。结论:超过一半的研究参与者在妊娠12周后开始使用ANC。此外,农村居住、意外怀孕、年龄≥30岁、缺乏产前保健、无法做出决定以及对ANC开始时间的错误认识与ANC开始晚有关。建议对妇女进行教育,并让伴侣和家庭成员参与有关非人分娩的讨论,以便为孕妇建立一个支持性的环境。
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引用次数: 0
Prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa: a multilevel analysis. 撒哈拉以南非洲育龄妇女产前间隔短的流行率和终止妊娠的决定因素:一项多水平分析。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-27 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1471187
Alebachew Ferede Zegeye, Tadesse Tarik Tamir, Enyew Getaneh Mekonen, Masresha Asmare Techane, Bewuketu Terefe, Belayneh Shetie Workneh

Background: Termination of pregnancy is one of the biggest five causes of maternal mortality in countries with low and middle incomes. Although termination of pregnancy is hazardous, its prevalence and determinates are not well studied in developing countries. Therefore, this study aims to assess the prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa.

Methods: Data from the most recent Demographic and Health Surveys, which covered 21 Sub-Saharan African countries from 2015 to 2022, were used for secondary data analysis. The study used a total of 283,785 women. Stata 14 was used to analyze the data. The determinants of termination of pregnancy were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with termination of pregnancy were declared significant at p-values < 0.05. The result was interpreted using the confidence interval and adjusted odds ratio. The best-fit model was determined to be the one with the highest log likelihood ratio and the lowest deviance.

Results: In Sub-Saharan Africa, one in ten women with short birth intervals experienced pregnancy termination. Individual factors, including the sex of the preceding birth (AOR = 1.21, 95% CI: 1.05, 1.40), maternal age (AOR = 1.57, 95% CI: 1.27, 1.95), pregnancy complications (AOR = 1.28, 95% CI: 1.09, 1.49), No ANC visits (AOR = 2.29, 95% CI: 1.26, 4.14), previous cesarean section delivery (AOR = 1.74, 95% CI: 1.32, 2.30), <6 months of breastfeeding (AOR = 1.56, 95% CI: 1.35, 1.81), traditional contraception usage (AOR = 1.67, 95% CI: 1.13, 2.46), poor wealth status (AOR = 1.50, 95% CI: 1.22, 1.85), and community-level factors such as urban residence (AOR = 1.31, 95% CI: 1.06, 1.62) had higher odds of pregnancy termination.

Conclusions: This study concludes that termination of pregnancy rates among women with short preceding birth interval is high. The study identified that both individual and community-level variables were determinants of termination of pregnancy. Therefore, the ministries of health in Sub-Saharan African countries should give attention to those women who underutilize antenatal care services and to women from urban areas while designing policies and strategies targeting reducing termination of pregnancy rates.

背景:终止妊娠是低收入和中等收入国家孕产妇死亡的五大原因之一。虽然终止妊娠是危险的,但发展中国家对其流行程度和决定因素的研究并不充分。因此,本研究旨在评估撒哈拉以南非洲生育间隔较短的育龄妇女终止妊娠的患病率和决定因素。方法:使用2015年至2022年覆盖21个撒哈拉以南非洲国家的最新人口与健康调查数据进行二次数据分析。这项研究共调查了283785名女性。使用Stata 14对数据进行分析。采用多水平混合效应logistic回归模型确定终止妊娠的决定因素。与终止妊娠相关的重要因素在p值上被宣布为显著结果:在撒哈拉以南非洲,十分之一的生育间隔较短的妇女经历了终止妊娠。个体因素包括前产性别(AOR = 1.21, 95% CI: 1.05, 1.40)、产妇年龄(AOR = 1.57, 95% CI: 1.27, 1.95)、妊娠并发症(AOR = 1.28, 95% CI: 1.09, 1.49)、无ANC就诊(AOR = 2.29, 95% CI: 1.26, 4.14)、既往剖宫产(AOR = 1.74, 95% CI: 1.32, 2.30)。结论:本研究认为,前产间隔较短的妇女终止妊娠率较高。研究发现,个人和社区层面的变量都是终止妊娠的决定因素。因此,撒哈拉以南非洲国家的卫生部在制定旨在降低终止妊娠率的政策和战略时,应注意那些未充分利用产前保健服务的妇女和城市地区的妇女。
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引用次数: 0
Risk factors for failed fistula closure in Addis Ababa at fistula centre, central Ethiopia. 埃塞俄比亚中部亚的斯亚贝巴瘘管中心瘘管闭合失败的危险因素。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-21 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1460227
Tadesse Mamo Dejene, Asrat Kassaw Belachew, Michael Amera Tizazu, Sadat Mohammed Yesuf

Background: Obstetric Fistula leads to fecal and urine incontinence in women and girls. Surgical repair is the cornerstone of care. Failure to repair an obstetric fistula exposes women not only to repeated surgery but also to ongoing incontinence and its sequela, depression, and social exclusion. Which impacts the nation's health intervention programs and socioeconomic burden.

Objective: To determine factors associated with failed fistula closure in women who underwent Fistula Closure at the Hamlin Fistula Center in Addis Ababa, central Ethiopia, between February 10, 2018, and December 28, 2020.

Methods: Women who underwent Fistula Closure between February 10, 2018, and December 28, 2020 were included in a case-control study that was conducted between May and June 2021. In total, 417 study participants (139 cases and 280 controls) were selected using a systematic random sampling technique. Two professional midwife data collectors and one BSC nurse for the supervisory assessment of women's medical cards utilized a structured questionnaire to collect data. SPSS version 25 was used to enter, clean, and analyze the data. During data analysis, bivariate and multivariate regression models were used. A p-value of less than 0.05 indicates a significant correlation.

Results: Forty-nine patients (35.3%) and 133 controls (47.8%) who were older than 26 years were at repair while they were (14-19 years old). The factors that contributed to failure of fistula closure included age at repair (14-19 years old) [AOR = 2.1, 95% CI (0.94-4.89)], prior fistula attempts (9.6, rural residence [AOR = 2.69, 95% CI (1.36-5.35)], height <150 cm [AOR = 1.80, 95% CI (0.99-3.59)], labor duration longer than 2 days [AOR = 1.89, 95% CI (0.99-3.59)], delivery by cesarean section [AOR = 1.88, 95% CI (1.04-3.89)], damaged urethra [AOR = 2.02, 95% CI (1.04-3.89)], diameter of fistula >3 cm, mild vaginal scar [AOR = 3.20, 95% CI (1.24-8.29)], moderate and severe vaginal scar [AOR = 5.49, 95% CI (1.92-15.75)], and completion of ANC [AOR = 0.20 (0.11, 0.38)].

Conclusion and recommendation: Age at the time of repair, Residence, Height, duration of labor, mode of delivery, completion of ANC, damaged urethra, fistula diameter >3 cm, previous fistula attempts, and vaginal scar are factors related to failure of fistula closure. By focusing on these areas, we can significantly improve the outcomes for patients undergoing fistula repair and lower the likelihood of failed closures in the future. Community-based health education regarding obstetric fistula and the importance of seeing a doctor as soon as possible during labor to lower the risk of obstructed delivery, boost antenatal care completion, and shorten the length of labor are all necessary to prevent failed fistula closure in comparable patients in the future.

背景:产科瘘导致妇女和女童大便和尿失禁。手术修复是护理的基石。产科瘘修复失败不仅会使妇女面临重复手术,还会导致持续的尿失禁及其后遗症、抑郁和社会排斥。这影响了国家的健康干预计划和社会经济负担。目的:确定2018年2月10日至2020年12月28日期间在埃塞俄比亚中部亚的斯亚贝巴Hamlin瘘管中心接受瘘管闭合的妇女瘘管闭合失败的相关因素。方法:在2018年2月10日至2020年12月28日期间接受瘘管闭合的妇女被纳入2021年5月至6月进行的病例对照研究。采用系统随机抽样技术,共选择417名研究参与者(139例病例和280例对照)。负责妇女医疗卡监督评估的两名专业助产士数据收集人员和一名平衡记分卡护士使用结构化问卷收集数据。使用SPSS version 25对数据进行录入、清理和分析。在数据分析中,采用双变量和多变量回归模型。p值小于0.05表示相关性显著。结果:年龄大于26岁的患者(14 ~ 19岁)有49例(35.3%)和133例(47.8%)处于修复期。导致瘘道闭合失败的因素包括修复年龄(14-19岁)[AOR = 2.1, 95% CI(0.94-4.89)]、既往瘘道尝试(9.6,农村户籍[AOR = 2.69, 95% CI(1.36-5.35)]、身高3 cm、轻度阴道瘢痕[AOR = 3.20, 95% CI(1.24-8.29)]、中重度阴道瘢痕[AOR = 5.49, 95% CI(1.92-15.75)]、完成ANC [AOR = 0.20(0.11, 0.38)]。结论与建议:修复时的年龄、居住地、身高、分娩时间、分娩方式、ANC完成情况、尿道损伤、瘘管直径bbb3cm、既往造瘘尝试、阴道瘢痕等均是导致瘘管闭合失败的因素。通过关注这些领域,我们可以显著改善患者进行瘘管修复的结果,并降低未来关闭失败的可能性。以社区为基础的产科瘘管病健康教育,以及在分娩过程中尽快就医的重要性,以降低难产的风险,提高产前护理的完成率,缩短分娩时间,都是预防未来类似患者瘘管闭合失败的必要条件。
{"title":"Risk factors for failed fistula closure in Addis Ababa at fistula centre, central Ethiopia.","authors":"Tadesse Mamo Dejene, Asrat Kassaw Belachew, Michael Amera Tizazu, Sadat Mohammed Yesuf","doi":"10.3389/fgwh.2024.1460227","DOIUrl":"10.3389/fgwh.2024.1460227","url":null,"abstract":"<p><strong>Background: </strong>Obstetric Fistula leads to fecal and urine incontinence in women and girls. Surgical repair is the cornerstone of care. Failure to repair an obstetric fistula exposes women not only to repeated surgery but also to ongoing incontinence and its sequela, depression, and social exclusion. Which impacts the nation's health intervention programs and socioeconomic burden.</p><p><strong>Objective: </strong>To determine factors associated with failed fistula closure in women who underwent Fistula Closure at the Hamlin Fistula Center in Addis Ababa, central Ethiopia, between February 10, 2018, and December 28, 2020.</p><p><strong>Methods: </strong>Women who underwent Fistula Closure between February 10, 2018, and December 28, 2020 were included in a case-control study that was conducted between May and June 2021. In total, 417 study participants (139 cases and 280 controls) were selected using a systematic random sampling technique. Two professional midwife data collectors and one BSC nurse for the supervisory assessment of women's medical cards utilized a structured questionnaire to collect data. SPSS version 25 was used to enter, clean, and analyze the data. During data analysis, bivariate and multivariate regression models were used. A <i>p</i>-value of less than 0.05 indicates a significant correlation.</p><p><strong>Results: </strong>Forty-nine patients (35.3%) and 133 controls (47.8%) who were older than 26 years were at repair while they were (14-19 years old). The factors that contributed to failure of fistula closure included age at repair (14-19 years old) [AOR = 2.1, 95% CI (0.94-4.89)], prior fistula attempts (9.6, rural residence [AOR = 2.69, 95% CI (1.36-5.35)], height <150 cm [AOR = 1.80, 95% CI (0.99-3.59)], labor duration longer than 2 days [AOR = 1.89, 95% CI (0.99-3.59)], delivery by cesarean section [AOR = 1.88, 95% CI (1.04-3.89)], damaged urethra [AOR = 2.02, 95% CI (1.04-3.89)], diameter of fistula >3 cm, mild vaginal scar [AOR = 3.20, 95% CI (1.24-8.29)], moderate and severe vaginal scar [AOR = 5.49, 95% CI (1.92-15.75)], and completion of ANC [AOR = 0.20 (0.11, 0.38)].</p><p><strong>Conclusion and recommendation: </strong>Age at the time of repair, Residence, Height, duration of labor, mode of delivery, completion of ANC, damaged urethra, fistula diameter >3 cm, previous fistula attempts, and vaginal scar are factors related to failure of fistula closure. By focusing on these areas, we can significantly improve the outcomes for patients undergoing fistula repair and lower the likelihood of failed closures in the future. Community-based health education regarding obstetric fistula and the importance of seeing a doctor as soon as possible during labor to lower the risk of obstructed delivery, boost antenatal care completion, and shorten the length of labor are all necessary to prevent failed fistula closure in comparable patients in the future.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"5 ","pages":"1460227"},"PeriodicalIF":2.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Women's empowerment and current contraceptive use in Pakistan: informed by theory of gender and power. 巴基斯坦妇女赋权和目前避孕药具的使用:以性别和权力理论为依据。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-21 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1360052
Bhavita Kumari, Mai Do, Aubrey Spriggs Madkour, Janna Marie Wisniewski

Introduction: It is evident from the stagnant modern contraceptive rate and the growing population of Pakistan that the family planning (FP) programs in Pakistan have failed to deliver successfully. The study examines the association of domains of women's empowerment, following the Theory of Gender and Power, with the current use of contraceptive methods and how intimate partner violence (IPV) can moderate such associations in Pakistan.

Methods: Married women of reproductive age from the Pakistan DHS (2017-18) were included in the analysis (n = 14,502). Key independent variables were identified using Connell's Theory of Gender and Power operationalized by Wingood and DiClemente, and constructs were created using principal component analysis. Multinomial logistic regressions were conducted to assess the relationships of the three empowerment divisions (i.e., sexual division of labor, sexual division of power, and cathexis), to the current use of contraceptives.

Results: When all empowerment domains were included in the model along with covariates, education (sexual division of labor), sex negotiations (sexual division of power), and husband's fertility intentions (cathexis) remained significant in their associations with modern contraceptive use.

Conclusion: This is the first study in Pakistan to examine multi-faceted empowerment, applying Connell's theory of gender and power to identify key domains associated with contraceptive use. A multi-prong approach to FP programs that aims to improve specific domains of women's empowerment and to increase FP service use may be more likely to succeed than stand-alone programs.

引言:从巴基斯坦停滞不前的现代避孕率和不断增长的人口可以明显看出,巴基斯坦的计划生育(FP)项目未能成功实施。根据性别与权力理论,该研究考察了妇女赋权领域与目前使用避孕方法的关系,以及亲密伴侣暴力(IPV)如何在巴基斯坦缓和这种关系。方法:将2017-18年巴基斯坦DHS已婚育龄妇女纳入分析(n = 14,502)。使用康奈尔的性别与权力理论(由Wingood和DiClemente操作)确定关键的自变量,并使用主成分分析创建结构。采用多项逻辑回归来评估三个授权部门(即性别分工、性别权力分工和导管)与当前避孕药具使用的关系。结果:当所有授权领域与协变量一起包括在模型中时,教育(性别分工),性谈判(性别权力分工)和丈夫的生育意图(导管)仍然与现代避孕药具的使用有显著的关联。结论:这是巴基斯坦第一个研究多方面赋权的研究,应用康奈尔的性别和权力理论来确定与避孕措施使用相关的关键领域。计划生育项目采取多管齐下的方法,旨在改善妇女赋权的特定领域,增加计划生育服务的使用,可能比单独的项目更有可能取得成功。
{"title":"Women's empowerment and current contraceptive use in Pakistan: informed by theory of gender and power.","authors":"Bhavita Kumari, Mai Do, Aubrey Spriggs Madkour, Janna Marie Wisniewski","doi":"10.3389/fgwh.2024.1360052","DOIUrl":"10.3389/fgwh.2024.1360052","url":null,"abstract":"<p><strong>Introduction: </strong>It is evident from the stagnant modern contraceptive rate and the growing population of Pakistan that the family planning (FP) programs in Pakistan have failed to deliver successfully. The study examines the association of domains of women's empowerment, following the Theory of Gender and Power, with the current use of contraceptive methods and how intimate partner violence (IPV) can moderate such associations in Pakistan.</p><p><strong>Methods: </strong>Married women of reproductive age from the Pakistan DHS (2017-18) were included in the analysis (<i>n</i> = 14,502). Key independent variables were identified using Connell's Theory of Gender and Power operationalized by Wingood and DiClemente, and constructs were created using principal component analysis. Multinomial logistic regressions were conducted to assess the relationships of the three empowerment divisions (i.e., sexual division of labor, sexual division of power, and cathexis), to the current use of contraceptives.</p><p><strong>Results: </strong>When all empowerment domains were included in the model along with covariates, education (sexual division of labor), sex negotiations (sexual division of power), and husband's fertility intentions (cathexis) remained significant in their associations with modern contraceptive use.</p><p><strong>Conclusion: </strong>This is the first study in Pakistan to examine multi-faceted empowerment, applying Connell's theory of gender and power to identify key domains associated with contraceptive use. A multi-prong approach to FP programs that aims to improve specific domains of women's empowerment and to increase FP service use may be more likely to succeed than stand-alone programs.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"5 ","pages":"1360052"},"PeriodicalIF":2.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gender disparity in health-related quality of life among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis. 埃塞俄比亚艾滋病毒/艾滋病感染者健康相关生活质量中的性别差异:系统回顾和荟萃分析
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-20 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1471316
Derara Girma Tufa, Habteyes Hailu Tola, Hiwot Dejene Dissassa, Leta Adugna Geleta, Erean Shigign Malka, Addisu Waleligne Tadesse, Feyiso Bati Wariso, Getahun Fetensa

Introduction: Health-related quality of life (HRQoL) is a key outcome indicator in antiretroviral therapy program. In Ethiopia, primary studies on gender disparity in HRQoL among people living with HIV/AIDS (PLHA) are conflicting, with no pooled estimation. Therefore, this study aimed to investigate gender disparity in HRQoL among PLHA in Ethiopia.

Methods: Studies were retrieved from PubMed, Web of Science, SCOPUS, Embase, MEDLINE, Science Direct, HINARI, and PsycINFO were systematically searched. In addition, Google Scholar, Google, journal homepages, bibliographies, and universities' research repositories in the country were searched by combining keywords and Medical Subject Headings (MeSH) terms with Boolean operators. Based on the primary study results, the average score of each domain was utilized as a cut-off point to classify HRQoL as poor or good. The Joanna Briggs Institute (JBI) checklist was used to assess study quality. A random-effects model was used to report the pooled estimates. Summary estimates are presented in forest plots and tables. The variation between studies was assessed using the Higgins heterogeneity test (I2). Funnel plot, Begg's test, and Egger's test were used to assess publication bias. Data were extracted using Microsoft Excel and exported to STATA 17 (Corporation, College Station, TX, USA) for analysis. The search results were managed using the EndNote X7 software.

Results: Fifteen studies with 4,867 PLHA were included. The pooled prevalence of poor HRQoL was 46.53% (95% CI: 41.96-51.10), 46.15% (95% CI: 37.05-55.24), and 36.21% (95% CI: 30.19-42.23) among PLHA, women, and men living with HIV, respectively. Moreover, a significant gender disparity in HRQoL was observed among Ethiopian women and men living with HIV. Women living with HIV were found to have 61% increased odds of poor HRQoL than men living with HIV in the country (OR = 1.61, 95% CI: 1.07, 2.15). No statistical evidence of a publication bias was observed.

Conclusion: Almost half of PLHA patients in Ethiopia had a poor HRQoL. Women living with HIV have higher odds of poor HRQoL than men living with HIV. This highlights the pressing need for gender-specific risk assessment approaches and treatment interventions aimed at optimizing HRQoL in HIV/AIDS settings.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023454810.

与健康相关的生活质量(HRQoL)是抗逆转录病毒治疗计划的关键结果指标。在埃塞俄比亚,关于艾滋病毒/艾滋病感染者(PLHA) HRQoL的性别差异的初步研究是相互矛盾的,没有汇总估计。因此,本研究旨在调查埃塞俄比亚PLHA中HRQoL的性别差异。方法:系统检索PubMed、Web of Science、SCOPUS、Embase、MEDLINE、Science Direct、HINARI和PsycINFO等网站的研究。此外,谷歌Scholar、谷歌、期刊主页、参考书目和国内大学的研究库通过将关键词和医学主题标题(MeSH)术语与布尔运算符结合起来进行搜索。根据初步研究结果,利用各域的平均分作为HRQoL差或好的分界点。采用乔安娜布里格斯研究所(JBI)检查表评估研究质量。随机效应模型用于报告汇总估计。在森林样地和表格中列出了概括性估计数。采用Higgins异质性检验评估研究间的差异(I2)。采用漏斗图、Begg检验和Egger检验评估发表偏倚。使用Microsoft Excel提取数据并导出到STATA 17 (Corporation, College Station, TX, USA)进行分析。使用EndNote X7软件对搜索结果进行管理。结果:纳入15项研究,共4867例PLHA。HIV感染者、女性和男性中HRQoL差的总患病率分别为46.53% (95% CI: 41.96-51.10)、46.15% (95% CI: 37.05-55.24)和36.21% (95% CI: 30.19-42.23)。此外,在感染艾滋病毒的埃塞俄比亚女性和男性中,观察到HRQoL的显著性别差异。女性艾滋病毒感染者HRQoL差的几率比男性艾滋病毒感染者高61% (OR = 1.61, 95% CI: 1.07, 2.15)。未观察到发表偏倚的统计证据。结论:埃塞俄比亚近一半的PLHA患者HRQoL较差。女性艾滋病毒感染者比男性艾滋病毒感染者的HRQoL差的几率更高。这凸显了迫切需要针对特定性别的风险评估方法和治疗干预措施,以优化艾滋病毒/艾滋病环境下的HRQoL。系统综述注册:https://www.crd.york.ac.uk/prospero/,标识符CRD42023454810。
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引用次数: 0
Editorial: Influence of intimate partner violence and male partner involvement in maternity care in low-and-middle income countries. 社论:中低收入国家亲密伴侣暴力和男性伴侣参与产妇护理的影响。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-18 eCollection Date: 2024-01-01 DOI: 10.3389/fgwh.2024.1513159
Guy-Lucien Whembolua, Daudet Ilunga Tshiswaka, Adi Chereni
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引用次数: 0
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Frontiers in global women's health
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