Frontiers in global women's health最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.