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Cardiometabolic health across menopausal years is linked to white matter hyperintensities up to a decade later 更年期的心脏代谢健康与十年后的白质高密度有关
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-21 DOI: 10.3389/fgwh.2023.1320640
Louise S. Schindler, Sivaniya Subramaniapillai, Ananthan Ambikairajah, Claudia Barth, Arielle Crestol, I. Voldsbekk, D. Beck, T. Gurholt, A. Topiwala, S. Suri, Klaus P. Ebmeier, O. Andreassen, Bogdan Draganski, L. Westlye, A. D. de Lange
The menopause transition is associated with several cardiometabolic risk factors. Poor cardiometabolic health is further linked to microvascular brain lesions, which can be detected as white matter hyperintensities (WMHs) using T2-FLAIR magnetic resonance imaging (MRI) scans. Females show higher risk for WMHs post-menopause, but it remains unclear whether changes in cardiometabolic risk factors underlie menopause-related increase in brain pathology.In this study, we assessed whether cross-sectional measures of cardiometabolic health, including body mass index (BMI) and waist-to-hip ratio (WHR), blood lipids, blood pressure, and long-term blood glucose (HbA1c), as well as longitudinal changes in BMI and WHR, differed according to menopausal status at baseline in 9,882 UK Biobank females (age range 40–70 years, n premenopausal = 3,529, n postmenopausal = 6,353). Furthermore, we examined whether these cardiometabolic factors were associated with WMH outcomes at the follow-up assessment, on average 8.78 years after baseline.Postmenopausal females showed higher levels of baseline blood lipids (HDL β=0.14, p<0.001, LDL β=0.20, p<0.001, triglycerides β=0.12, p<0.001) and HbA1c (β=0.24, p<0.001) compared to premenopausal women, beyond the effects of age. Over time, BMI increased more in the premenopausal compared to the postmenopausal group (β=−0.08, p<0.001), while WHR increased to a similar extent in both groups (β=−0.03, p=0.102). The change in WHR was however driven by increased waist circumference only in the premenopausal group. While the group level changes in BMI and WHR were in general small, these findings point to distinct anthropometric changes in pre- and postmenopausal females over time. Higher baseline measures of BMI, WHR, triglycerides, blood pressure, and HbA1c, as well as longitudinal increases in BMI and WHR, were associated with larger WMH volumes (β range = 0.03–0.13, p≤0.002). HDL showed a significant inverse relationship with WMH volume (β=−0.27, p<0.001).Our findings emphasise the importance of monitoring cardiometabolic risk factors in females from midlife through the menopause transition and into the postmenopausal phase, to ensure improved cerebrovascular outcomes in later years.
绝经过渡期与多种心脏代谢风险因素有关。心血管代谢健康状况不佳还与脑部微血管病变有关,这种病变可通过 T2-FLAIR 磁共振成像(MRI)扫描检测出白质高密度(WMH)。女性在绝经后出现 WMH 的风险较高,但目前仍不清楚心脏代谢风险因素的变化是否是与绝经有关的脑部病变增加的原因。在这项研究中,我们评估了 9,882 名英国生物库女性(年龄范围为 40-70 岁,绝经前人数 = 3,529 人,绝经后人数 = 6,353 人)的心血管代谢健康横断面指标,包括体重指数(BMI)和腰臀比(WHR)、血脂、血压和长期血糖(HbA1c),以及 BMI 和 WHR 的纵向变化是否因基线时的绝经状态而有所不同。此外,我们还研究了这些心脏代谢因素是否与基线后平均 8.78 年的随访评估中的 WMH 结果相关。与绝经前女性相比,绝经后女性的基线血脂水平更高(高密度脂蛋白 β=0.14,p<0.001;低密度脂蛋白 β=0.20,p<0.001;甘油三酯 β=0.12,p<0.001),HbA1c(β=0.24,p<0.001)也更高,这超出了年龄的影响。随着时间的推移,绝经前组别与绝经后组别相比,BMI 的增加幅度更大(β=-0.08,p<0.001),而两组的 WHR 增加幅度相似(β=-0.03,p=0.102)。然而,只有绝经前组的腰围增加才导致了 WHR 的变化。虽然总体而言,各组的体重指数(BMI)和腰围(WHR)变化较小,但这些研究结果表明,绝经前和绝经后女性的人体测量指标随着时间的推移会发生明显变化。较高的 BMI、WHR、甘油三酯、血压和 HbA1c 基线测量值以及 BMI 和 WHR 的纵向增长与较大的 WMH 体积相关(β 范围 = 0.03-0.13,p≤0.002)。我们的研究结果强调了监测女性从中年到绝经过渡期以及绝经后阶段的心血管代谢风险因素的重要性,以确保改善晚年的脑血管预后。
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引用次数: 0
Menstruation-related symptoms are associated with physical activity and midpoint of sleep: a pilot study 月经相关症状与体力活动和睡眠中点相关:一项试点研究
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-20 DOI: 10.3389/fgwh.2023.1260645
Hazuki Masuda, Shima Okada
Menstruation-related symptoms (MRSs) significantly impact women's health and contribute to economic burdens worldwide. Current interventions, primarily pharmacological ones, have limitations and side effects that underscore the need for alternative management strategies. This study explores the association between MRSs and lifestyle factors, specifically physical activity and sleep timing across menstrual cycle phases, to inform non-pharmacological intervention development.Fourteen female students from Ritsumeikan University, Japan, with regular menstrual cycles (25–38 days), not on hormonal treatment or engaged in shift work, participated in this observational study. Using a Fitbit Inspire 2, total daily energy expenditure (TDEE) and sleep timing were monitored over a complete cycle. Menstrual cycle phases were defined based on ovulation day, predicted using home luteinizing hormone tests. Participants completed daily electronic questionnaires rating MRSs using a modified menstrual distress questionnaire. Data were analyzed using a generalized linear mixed model with a gamma distribution and logarithmic link function, examining the relationship of TDEE and the midpoint of sleep time (MS time) with MRS severity.The following observations were noted: first, MRS severity, except for behavioral change symptoms, significantly increased during the menstrual and luteal phases compared to the follicular phase. Second, delayed MS time was associated with reduced pain, concentration symptoms, water retention, and negative affect during the menstrual phase and reduced negative affect during the luteal phase. Finally, an increase in TDEE was associated with reduced concentration symptoms, autonomic reaction symptoms, and negative affect during the menstrual and luteal phases and reduced water retention only during the luteal phase. This study provides insights into the relationship between MRSs and TDEE/MS time, suggesting potential non-therapeutic approaches for symptom management, though further research is needed to substantiate these findings for practical applications.
月经相关症状(MRSs)严重影响妇女的健康,并在全球范围内造成经济负担。目前的干预措施(主要是药物干预)存在局限性和副作用,这凸显了对替代管理策略的需求。日本立命馆大学的 14 名女学生参加了这项观察性研究,她们的月经周期规律(25-38 天),没有接受激素治疗,也没有从事轮班工作。研究人员使用 Fitbit Inspire 2 监测了一个完整周期内的每日总能量消耗(TDEE)和睡眠时间。月经周期阶段根据排卵日确定,并通过家庭黄体生成素测试进行预测。参与者每天填写电子问卷,使用改良的月经困扰问卷对 MRS 进行评分。采用伽马分布和对数连接函数的广义线性混合模型对数据进行了分析,研究了TDEE和睡眠时间中点(MS时间)与MRS严重程度的关系。其次,MS 时间的延迟与月经期疼痛、注意力集中症状、水潴留和负面情绪的减少以及黄体期负面情绪的减少有关。最后,TDEE 的增加与月经期和黄体期注意力集中症状、自律神经反应症状和负面情绪的减少有关,而只与黄体期水钠潴留的减少有关。这项研究深入揭示了 MRS 与 TDEE/MS 时间之间的关系,为症状管理提供了潜在的非治疗方法,但还需要进一步的研究来证实这些发现的实际应用价值。
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引用次数: 0
Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030 世界卫生组织 2030 年免疫议程在线学习计划的性别分析
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-12 DOI: 10.3389/fgwh.2023.1230109
Boetumelo Julianne Nyasulu, Shirin Heidari, Michela Manna, Jhilmil Bahl, Tracey Goodman
Vaccine-preventable diseases pose a significant threat to children under five globally, creating disparities in immunization coverage. Despite its cost-effectiveness and life-saving potential, immunization faces challenges in achieving equitable coverage. Gender inequalities deeply influence access to healthcare, affecting immunization rates. This study examines the action plans submitted by participants of the World Health Organization's (WHO) IA2030 Scholar Level 1 certification course in 2021. A qualitative analysis was conducted on a subset of 111 action plans that scored above 75%, employing narrative thematic analysis to categorize and explore gender incorporation and identified barriers based on the IA2030 Gender Guide. Among the 111 analyzed action plans, gender considerations were present in almost all plans, underscoring the effectiveness of integrating gender perspectives in the course curriculum. The most frequently cited barriers included low education and health literacy, issues related to accessing quality immunization services, gendered dynamics in decision-making within households, and limited access to resources and mobility, predominantly impacting women. The findings confirm that gender inequalities significantly contribute to suboptimal immunization coverage. An intersectional approach, recognizing diverse social markers impacting immunization, is vital to address disparities effectively. Moreover, the need for gender-sensitive data and deeper understanding of intersectional dynamics was emphasized. The study highlights the importance of gender-transformative interventions, including community engagement and efforts targeting both men and women to enhance immunization coverage. While acknowledging limitations, such as potential biases in peer evaluations and the need for wider inclusivity in gender perspectives, this analysis underscores the significance of mainstreaming gender in immunization capacity-building programs. The integration of gender considerations not only raises awareness but also equips professionals to create more gender-responsive immunization programs. Continuous efforts to incorporate gender perspectives can lead to more effective, equitable, and gender-transformative immunization initiatives at various levels.
疫苗可预防疾病对全球五岁以下儿童构成重大威胁,造成免疫接种覆盖率的差异。尽管免疫接种具有成本效益和挽救生命的潜力,但在实现公平覆盖方面仍面临挑战。性别不平等深深地影响着医疗保健的获得,也影响着免疫接种率。本研究探讨了世界卫生组织(WHO)2021 年 IA2030 奖学金一级认证课程参与者提交的行动计划。对得分超过 75% 的 111 份行动计划子集进行了定性分析,采用叙事性主题分析法,根据《IA2030 性别指南》对性别融入情况和已识别的障碍进行分类和探讨。在分析的 111 项行动计划中,几乎所有计划都考虑到了性别问题,这突出表明将性别观点纳入课程设置的有效性。最常提到的障碍包括教育和卫生知识普及率低、与获得优质免疫服务有关的问题、家庭内部决策中的性别动态以及获得资源和流动性有限,这些障碍主要影响到妇女。研究结果证实,性别不平等是造成免疫接种覆盖率不理想的重要原因。采取交叉方法,认识到影响免疫接种的各种社会因素,对于有效解决差异问题至关重要。此外,研究还强调了对性别敏感数据和深入了解交叉动态的必要性。研究强调了改变性别的干预措施的重要性,包括社区参与和针对男性和女性的努力,以提高免疫覆盖率。这项分析承认存在一些局限性,如同行评估中可能存在的偏见,以及需要更广泛地纳入性别观点,但同时强调了将性别观点纳入免疫接种能力建设计划主流的重要性。纳入性别因素不仅能提高人们的认识,还能使专业人员有能力制定更多促进性别平等的免疫计划。不断努力将性别观点纳入其中,可以在各个层面采取更有效、更公平、更能改变性别的免疫接种措施。
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引用次数: 0
The determinants of postpartum contraceptive use in Nigeria 尼日利亚产后避孕药具使用的决定因素
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-12 DOI: 10.3389/fgwh.2023.1284614
Obinna Princewill Anyatonwu, K. Nwoku, Håkan Jonsson, F. Namatovu
Postpartum contraception is vital for maternal and child health, and reduces the risk of infant mortality. The Health Belief Model (HBM) is a widely accepted framework for exploring health behaviors, such as contraceptive use. Therefore, this study aimed to investigate the factors influencing postpartum contraceptive use in Nigeria and to contextualize the findings within the framework of the HBM.This study was a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted in Nigeria (NDHS). In total, 28,041 women were included in this study. Self-reported contraceptive use was the outcome, while the explanatory variables included maternal age, place of residence, region of residence, religion, marital status, educational level, household wealth quintiles, knowledge of the ovulatory cycle, decision-maker for health care, and distance to health care facilities. Descriptive statistics and multivariate logistic regression were used to summarize and identify factors influencing postpartum contraceptive use. The HBM was used to discuss the main findings.The prevalence of postpartum contraceptive use in Nigeria is 27%. Our findings showed that the odds of using contraceptives during the postpartum period were higher among women who knew their ovulation cycles, lived in urban areas in the southern region, had no distance barriers to health care, and were 25–49 years old. Education, wealth, and marital status also increase the odds of contraceptive use. However, women who lived in the northeast and northwest regions or shared decision-making with their partners had lower odds.This study highlights the need for region-specific and age-focused interventions to increase contraceptive use in Nigeria. Additionally, increasing accessibility and affordability of contraceptives for younger and economically disadvantaged women, along with promoting women's autonomy in decision-making, can further enhance contraceptive use across Nigeria.
产后避孕对母婴健康至关重要,可降低婴儿死亡风险。健康信念模型(HBM)是一个广为接受的框架,用于探讨避孕药具使用等健康行为。因此,本研究旨在调查影响尼日利亚产后避孕药具使用的因素,并在健康信念模型的框架内对调查结果进行分析。共有 28,041 名妇女参与了这项研究。自我报告的避孕药具使用情况是研究结果,而解释变量包括产妇年龄、居住地、居住地区、宗教信仰、婚姻状况、教育水平、家庭财富五分位数、排卵周期知识、保健决策者以及与保健设施的距离。采用描述性统计和多元逻辑回归来总结和确定影响产后避孕药具使用的因素。在尼日利亚,产后避孕药具的使用率为 27%。我们的研究结果表明,知道自己排卵周期、居住在南部地区城市、没有医疗保健方面的距离障碍、年龄在 25-49 岁之间的妇女在产后使用避孕药具的几率更高。教育程度、财富和婚姻状况也会增加使用避孕药具的几率。这项研究强调,有必要在尼日利亚采取针对特定地区和年龄的干预措施,以提高避孕药具的使用率。此外,提高年轻妇女和经济弱势妇女避孕药具的可获得性和可负担性,同时促进妇女在决策中的自主权,可以进一步提高尼日利亚全国的避孕药具使用率。
{"title":"The determinants of postpartum contraceptive use in Nigeria","authors":"Obinna Princewill Anyatonwu, K. Nwoku, Håkan Jonsson, F. Namatovu","doi":"10.3389/fgwh.2023.1284614","DOIUrl":"https://doi.org/10.3389/fgwh.2023.1284614","url":null,"abstract":"Postpartum contraception is vital for maternal and child health, and reduces the risk of infant mortality. The Health Belief Model (HBM) is a widely accepted framework for exploring health behaviors, such as contraceptive use. Therefore, this study aimed to investigate the factors influencing postpartum contraceptive use in Nigeria and to contextualize the findings within the framework of the HBM.This study was a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted in Nigeria (NDHS). In total, 28,041 women were included in this study. Self-reported contraceptive use was the outcome, while the explanatory variables included maternal age, place of residence, region of residence, religion, marital status, educational level, household wealth quintiles, knowledge of the ovulatory cycle, decision-maker for health care, and distance to health care facilities. Descriptive statistics and multivariate logistic regression were used to summarize and identify factors influencing postpartum contraceptive use. The HBM was used to discuss the main findings.The prevalence of postpartum contraceptive use in Nigeria is 27%. Our findings showed that the odds of using contraceptives during the postpartum period were higher among women who knew their ovulation cycles, lived in urban areas in the southern region, had no distance barriers to health care, and were 25–49 years old. Education, wealth, and marital status also increase the odds of contraceptive use. However, women who lived in the northeast and northwest regions or shared decision-making with their partners had lower odds.This study highlights the need for region-specific and age-focused interventions to increase contraceptive use in Nigeria. Additionally, increasing accessibility and affordability of contraceptives for younger and economically disadvantaged women, along with promoting women's autonomy in decision-making, can further enhance contraceptive use across Nigeria.","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"97 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008241","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
The impact of a blended multidisciplinary training for the management of obstetric haemorrhage in Mbeya, Tanzania 多学科混合培训对坦桑尼亚姆贝亚产科出血管理的影响
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-07 DOI: 10.3389/fgwh.2023.1270261
Bernard Mbwele, Amani Twaha, Kasia Maksym, Matthew Caputo, Delfina D. Mkenda, Helen Halpern, Sylvia Berney, Elias A. Kaminyoge, Mpoki S. Kaminyoge, Mandeep Kaler, Soha Sobhy, Sara L. Hillman
The Maternal Mortality Rate (MMR) in Tanzania is 78 times higher than that of the UK. Obstetric haemorrhage accounts for two-thirds of these deaths in Mbeya, Tanzania. A lack of healthcare providers' (HCPs') competencies has been the key attribute. This study measured the impact on HCP's competencies from a blended training programme on obstetric haemorrhage.A “before and after” cohort study was undertaken with HCPs in 4 hospitals in the Mbeya region of Tanzania between August 2021 and April 2022. A multidisciplinary cohort of 34 HCPs (doctors, nurses, midwives, anaesthetists and radiologists) were enrolled on a blended face-to-face and virtual training course. The training was delivered by a multidisciplinary team (MDT) from London, UK, assisted by local multidisciplinary trainers from Mbeya, Tanzania and covered anaesthetic, obstetrics, haematology and sonographic use.There were 33 HCP in the cohort of trainees where 30/33 (90.9%) of HCPs improved their Anaesthesia skills with a mean score improvement of 26% i.e., 0.26 (−0.009 −0.50), 23 HCPs (69.7%) improved obstetric skills 18% i.e., 0.18 (−0.16 to 0.50), 19 (57.6%), (57.6%) improved competences in Haematology 15%.i.e., 0.15 (−0.33 to 0.87), 20 out of 29 HCPs with ultrasound access (68.8%) improved Sonographic skills 13%.i.e., 0.13 (−0.31 to 0.54). All 33 HCPs (100%) presented a combined change with the mean score improvement of difference of 25% i.e., 0.25 (0.05–0.66). The deaths attributed to obstetric haemorrhage, the mortality rate declined from 76/100,000 to 21/100,000 live births. Actual number of deaths due to obstetric haemorrhage declined from 8 before training to 3 after the completion of the training.This comprehensive blended training on anaesthetic surgical, haematological, and sonographic management of obstetric haemorrhage delivers a significant positive impact on the detection, management and outcomes of obstetric haemorrhage.
坦桑尼亚的产妇死亡率(MMR)是联合王国的78倍。在坦桑尼亚姆贝亚,产科出血占这些死亡的三分之二。缺乏医疗保健提供者(HCPs)的能力一直是关键因素。本研究测量了产科出血混合培训项目对HCP能力的影响。在2021年8月至2022年4月期间,对坦桑尼亚姆贝亚地区4家医院的医务人员进行了“前后”队列研究。由34名HCPs(医生、护士、助产士、麻醉师和放射科医生)组成的多学科队列参加了一个混合面对面和虚拟培训课程。培训由英国伦敦的一个多学科小组(MDT)提供,由坦桑尼亚Mbeya的当地多学科培训人员协助,涵盖麻醉、产科、血液学和超声使用。在受训队列中有33名HCP,其中30/33 (90.9%)HCP提高了麻醉技能,平均得分提高26%,即0.26(- 0.009 - 0.50),23名HCP(69.7%)提高了18%,即0.18(- 0.16 - 0.50),19名(57.6%),(57.6%)血液学能力提高了15%,即。, 0.15(- 0.33至0.87),29名接受超声治疗的HCPs中有20名(68.8%)超声技能提高了13%,即。, 0.13(−0.31 ~ 0.54)。所有33个HCPs(100%)均出现综合变化,平均评分改善幅度为25%,即0.25(0.05-0.66)。由于产科出血造成的死亡,死亡率从每10万活产76人下降到每10万活产21人。因产科出血而死亡的实际人数从培训前的8人减少到培训完成后的3人。产科出血的麻醉、外科、血液学和超声管理方面的综合混合培训对产科出血的发现、管理和结果产生了重大的积极影响。
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引用次数: 0
Post-traumatic stress disorder following childbirth: a neglected cause 分娩后创伤后应激障碍:一个被忽视的原因
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-07 DOI: 10.3389/fgwh.2023.1273519
Areeba Ahsan, Abdullah Nadeem, Ashna Habib, A. Basaria, R. Tariq, N. Raufi
Post-traumatic stress disorder (PTSD) following childbirth is a significant mental health risk for women globally. However, it remains a neglected cause, particularly in low-income countries like Pakistan. This paper explores the unique challenges faced by women in such settings, including limited access to healthcare and social support, cultural norms, and stigma surrounding mental health. The diagnosis and causes of postpartum PTSD are discussed, along with its effects on both mothers and their infants. The lack of awareness and training among healthcare professionals in recognizing and treating postpartum PTSD is highlighted as a major barrier to adequate care. To address these challenges, the paper proposes a comprehensive approach, including raising public awareness, providing mental health support and resources, and integrating postpartum mental health into medical education. Trauma-focused therapies are recommended for effective treatment. The paper concludes with the need for more research in low-income countries and emphasizes the importance of understanding and supporting women with postpartum PTSD to improve their well-being and maternal and child health.
分娩后的创伤后应激障碍(PTSD)是全球妇女面临的重大心理健康风险。然而,它仍然是一个被忽视的原因,特别是在像巴基斯坦这样的低收入国家。本文探讨了妇女在这种情况下面临的独特挑战,包括获得医疗保健和社会支持的机会有限,文化规范以及围绕心理健康的污名。讨论了产后创伤后应激障碍的诊断和原因,以及它对母亲和婴儿的影响。缺乏认识和培训的卫生保健专业人员在认识和治疗产后创伤后应激障碍是突出的一个主要障碍,以充分的护理。为了应对这些挑战,本文提出了一种综合的方法,包括提高公众意识,提供心理健康支持和资源,并将产后心理健康纳入医学教育。创伤为重点的治疗被推荐为有效的治疗。论文的结论是需要在低收入国家进行更多的研究,并强调理解和支持产后创伤后应激障碍妇女的重要性,以改善她们的福祉和母婴健康。
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引用次数: 0
Knowledge and practice of obstetric care providers on prevention of obstetric fistula 2023: an institution-based cross-sectional study. 产科护理人员对预防产科瘘管病的认识和实践 2023:一项基于机构的横断面研究。
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-30 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1234013
Solomon Seyife Alemu, Mahlet Tesfaye Agago, Eshetu Yisihak Ukumo, Tesfahun Simon Hadero

Background: Obstetric fistula is a preventable devastating condition that is mostly caused by obstructed labour. About 22% of obstructed labor is complicated by obstetric fistula. Skilled birth attendants during delivery are essential for the prevention of obstetric fistula. However, little is known about the status of the knowledge and practice of obstetric fistula prevention in the Gamo zone.

Objective: We aimed to assess the knowledge, practice, and associated factors of obstetric caregivers on the prevention of obstetric fistula in public health facilities of the Gamo zone in southwest Ethiopia 2023.

Method: A cross-sectional study was employed among 372 obstetric caregivers in selected public health facilities of the Gamo zone in southwest Ethiopia from 1 December 2022 to 30 January 2023. Study participants were selected by a simple random sampling technique, and data were collected by using a pre-tested and self-administered questionnaire. The collected data were coded and entered into Epi-Data version 4.6 computer software and exported to SPSS version 27 for analysis purposes. Bivariable and Multivariable Logistic analyses were applied. The level of significance was declared at a P-value ≤0.05 and a 95% confidence interval.

Results: About 57% [95% CI (53.00-62.00)] of participants had good knowledge, and about 55.4% [95% CI (50.00-60.00)] of obstetric caregivers showed good practice for obstetric fistula prevention. The factors significantly associated with knowledge were service year [AOR = 2.50, 95% CI = (1.12-6.73)], types of a health facility [AOR = 1.99, 95% CI = (1.01-3.92)], age [AOR = 2.38, 95% CI = (1.03-5.49)], and in-service training [AOR = 4.61, 95% CI = (2.35-9.05)]. In-service training [AOR = 14.86, 95% CI = (12.75-18.73)], service year [AOR = 3.58, 95% CI = (1.24-10.29)], and knowledge [AOR: 13.24, 95% CI = (6.18-14.34)] were factors which were significantly associated with the practice of obstetric caregivers towards obstetric fistula prevention.

Conclusion: The knowledge and practice of obstetric caregivers on the prevention of obstetric fistula was low in public health facilities of the Gamo zone. In this study, practicing at a hospital was a factor significantly associated with the knowledge of obstetric caregivers. Having in-service training, advanced service year, and age were factors significantly associated with the knowledge and practice of obstetric caregivers. Regular in-service training of health professionals can enhance their knowledge and practice of obstetric fistula prevention.

背景:产科瘘管病是一种可预防的破坏性疾病,主要由难产引起。大约 22% 的难产会并发产科瘘。熟练的助产士在分娩过程中的护理对于预防产科瘘管病至关重要。然而,人们对加莫地区预防产科瘘管病的知识和实践状况知之甚少:我们旨在评估 2023 年埃塞俄比亚西南部加莫地区公共医疗机构产科护理人员预防产科瘘管病的知识、实践和相关因素:方法:2022 年 12 月 1 日至 2023 年 1 月 30 日,在埃塞俄比亚西南部加莫地区选定的公共卫生机构中,对 372 名产科护理人员进行了横断面研究。研究参与者通过简单随机抽样技术选出,并使用预先测试的自填式问卷收集数据。收集的数据经编码后输入 Epi-Data 4.6 版计算机软件,并导出到 SPSS 27 版进行分析。应用了二变量和多变量逻辑分析。显著性水平以 P 值≤0.05 和 95% 的置信区间为标准:结果:约57%[95% CI (53.00-62.00)]的参与者对产科瘘有良好的认识,约55.4%[95% CI (50.00-60.00)]的产科护理人员对产科瘘的预防有良好的实践。与知识相关的因素包括服务年限[AOR = 2.50,95% CI = (1.12-6.73)]、医疗机构类型[AOR = 1.99,95% CI = (1.01-3.92)]、年龄[AOR = 2.38,95% CI = (1.03-5.49)]和在职培训[AOR = 4.61,95% CI = (2.35-9.05)]。在职培训[AOR = 14.86,95% CI = (12.75-18.73)]、服务年限[AOR = 3.58,95% CI = (1.24-10.29)]和知识[AOR:13.24,95% CI = (6.18-14.34)]与产科护理人员的产科瘘管病预防实践显著相关:结论:在加莫区的公立医疗机构中,产科护理人员对产科瘘管病预防的知识和实践水平较低。在本研究中,在医院执业与产科护理人员的知识水平有显著相关。接受过在职培训、工作年限较长和年龄与产科护理人员的知识和实践有明显关系。医护人员定期接受在职培训可以增强他们对产科瘘管病预防的知识和实践。
{"title":"Knowledge and practice of obstetric care providers on prevention of obstetric fistula 2023: an institution-based cross-sectional study.","authors":"Solomon Seyife Alemu, Mahlet Tesfaye Agago, Eshetu Yisihak Ukumo, Tesfahun Simon Hadero","doi":"10.3389/fgwh.2023.1234013","DOIUrl":"https://doi.org/10.3389/fgwh.2023.1234013","url":null,"abstract":"<p><strong>Background: </strong>Obstetric fistula is a preventable devastating condition that is mostly caused by obstructed labour. About 22% of obstructed labor is complicated by obstetric fistula. Skilled birth attendants during delivery are essential for the prevention of obstetric fistula. However, little is known about the status of the knowledge and practice of obstetric fistula prevention in the Gamo zone.</p><p><strong>Objective: </strong>We aimed to assess the knowledge, practice, and associated factors of obstetric caregivers on the prevention of obstetric fistula in public health facilities of the Gamo zone in southwest Ethiopia 2023.</p><p><strong>Method: </strong>A cross-sectional study was employed among 372 obstetric caregivers in selected public health facilities of the Gamo zone in southwest Ethiopia from 1 December 2022 to 30 January 2023. Study participants were selected by a simple random sampling technique, and data were collected by using a pre-tested and self-administered questionnaire. The collected data were coded and entered into Epi-Data version 4.6 computer software and exported to SPSS version 27 for analysis purposes. Bivariable and Multivariable Logistic analyses were applied. The level of significance was declared at a <i>P</i>-value ≤0.05 and a 95% confidence interval.</p><p><strong>Results: </strong>About 57% [95% CI (53.00-62.00)] of participants had good knowledge, and about 55.4% [95% CI (50.00-60.00)] of obstetric caregivers showed good practice for obstetric fistula prevention. The factors significantly associated with knowledge were service year [AOR = 2.50, 95% CI = (1.12-6.73)], types of a health facility [AOR = 1.99, 95% CI = (1.01-3.92)], age [AOR = 2.38, 95% CI = (1.03-5.49)], and in-service training [AOR = 4.61, 95% CI = (2.35-9.05)]. In-service training [AOR = 14.86, 95% CI = (12.75-18.73)], service year [AOR = 3.58, 95% CI = (1.24-10.29)], and knowledge [AOR: 13.24, 95% CI = (6.18-14.34)] were factors which were significantly associated with the practice of obstetric caregivers towards obstetric fistula prevention.</p><p><strong>Conclusion: </strong>The knowledge and practice of obstetric caregivers on the prevention of obstetric fistula was low in public health facilities of the Gamo zone. In this study, practicing at a hospital was a factor significantly associated with the knowledge of obstetric caregivers. Having in-service training, advanced service year, and age were factors significantly associated with the knowledge and practice of obstetric caregivers. Regular in-service training of health professionals can enhance their knowledge and practice of obstetric fistula prevention.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"4 ","pages":"1234013"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10720897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814303","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
A qualitative study to understand sociocultural beliefs around perinatal and neonatal health in rural areas of Mohali, Punjab, India. 一项定性研究,旨在了解印度旁遮普省莫哈利农村地区围绕围产期和新生儿健康的社会文化观念。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-30 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1147762
Alka Ahuja, Mona Duggal, Jane Y Liu, Preetika Sharma, Darshan Hosapatna Basavarajappa, Rashmi Bagga, Alison M El Ayadi, Ankita Kankaria, Vijay Kumar, Pushpendra Singh, Nadia G Diamond-Smith

Introduction: Globally, 600,000 mothers (15-49 years) die every year due to pregnancy and childbirth-related complications. Wide variations are seen in cultural practices and beliefs surrounding this period of a woman's life. The present study explores the cultural beliefs and practices of women and families during pregnancy and the postnatal period in order to understand what behavioral management strategies are required to improve maternal and infant outcomes during pregnancy and the postpartum period.

Methods: The study was conducted in a rural area of Punjab, from December 2019 to March 2021. A total of 20 women (up to 3 months postpartum, age >18 years, were interviewed.

Results: In general, women described eating varied and fairly healthy diets during pregnancy, especially nutritious warm food, following traditional practices. Other cultural practices included restrictions on movement and mobile phone use and the use of unsafe home remedies to promote infant safety and wellbeing, such as using gripe water, applying black pencil to the baby's eyes, and feeding the baby honey. A few were not inclined to engage with these and other cultural expectations, preferring instead to follow contemporary practices influenced by social media. These practices included being accompanied by a family member during delivery, celebrating the baby's birth regardless of sex, and early bathing post-delivery.

Discussion: It can be concluded that while many traditional practices are still followed in India, there are new beliefs and behaviors arising from an intersection between culture and technology. Developing strategies that acknowledge older beliefs and modern approaches is essential to promoting better antenatal and postpartum care.

导言:全球每年有 60 万名母亲(15-49 岁)死于与怀孕和分娩有关的并发症。围绕妇女一生中的这一时期,文化习俗和信仰存在很大差异。本研究探讨了妇女和家庭在孕期和产后的文化信仰和习俗,以了解需要采取哪些行为管理策略来改善孕期和产后的母婴结局:研究于 2019 年 12 月至 2021 年 3 月在旁遮普省的一个农村地区进行。共采访了 20 名妇女(产后 3 个月以内,年龄大于 18 岁):总体而言,妇女描述了她们在怀孕期间按照传统习俗进食的多样化和相当健康的饮食,尤其是营养丰富的温热食物。其他文化习俗包括限制行动和使用手机,以及使用不安全的家庭疗法来促进婴儿的安全和健康,如使用苦瓜水、用黑铅笔涂抹婴儿的眼睛和给婴儿喂蜂蜜。少数人不愿意接受这些和其他文化期望,而更愿意遵循受社交媒体影响的现代做法。这些做法包括分娩时有家人陪伴、庆祝婴儿出生(不论性别)以及产后尽早洗澡:讨论:可以得出的结论是,虽然印度仍然沿袭着许多传统习俗,但在文化与技术的交汇中也产生了一些新的信仰和行为。制定既承认古老信仰又采用现代方法的策略对于促进更好的产前和产后护理至关重要。
{"title":"A qualitative study to understand sociocultural beliefs around perinatal and neonatal health in rural areas of Mohali, Punjab, India.","authors":"Alka Ahuja, Mona Duggal, Jane Y Liu, Preetika Sharma, Darshan Hosapatna Basavarajappa, Rashmi Bagga, Alison M El Ayadi, Ankita Kankaria, Vijay Kumar, Pushpendra Singh, Nadia G Diamond-Smith","doi":"10.3389/fgwh.2023.1147762","DOIUrl":"10.3389/fgwh.2023.1147762","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, 600,000 mothers (15-49 years) die every year due to pregnancy and childbirth-related complications. Wide variations are seen in cultural practices and beliefs surrounding this period of a woman's life. The present study explores the cultural beliefs and practices of women and families during pregnancy and the postnatal period in order to understand what behavioral management strategies are required to improve maternal and infant outcomes during pregnancy and the postpartum period.</p><p><strong>Methods: </strong>The study was conducted in a rural area of Punjab, from December 2019 to March 2021. A total of 20 women (up to 3 months postpartum, age >18 years, were interviewed.</p><p><strong>Results: </strong>In general, women described eating varied and fairly healthy diets during pregnancy, especially nutritious warm food, following traditional practices. Other cultural practices included restrictions on movement and mobile phone use and the use of unsafe home remedies to promote infant safety and wellbeing, such as using gripe water, applying black pencil to the baby's eyes, and feeding the baby honey. A few were not inclined to engage with these and other cultural expectations, preferring instead to follow contemporary practices influenced by social media. These practices included being accompanied by a family member during delivery, celebrating the baby's birth regardless of sex, and early bathing post-delivery.</p><p><strong>Discussion: </strong>It can be concluded that while many traditional practices are still followed in India, there are new beliefs and behaviors arising from an intersection between culture and technology. Developing strategies that acknowledge older beliefs and modern approaches is essential to promoting better antenatal and postpartum care.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"4 ","pages":"1147762"},"PeriodicalIF":2.3,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10720706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814274","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
Disrespect and abuse during childbirth in East Hararghe Zone public health facilities, eastern Ethiopia: a cross-sectional study. 埃塞俄比亚东部东哈拉盖区公共医疗机构分娩时的不尊重和虐待行为:一项横断面研究。
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-30 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1237098
Ahmedin Aliyi Usso, Hassen Abdi Adem, Addisu Alemu, Aminu Mohammed

Background: Compassionate and respectful maternity care during childbirth has been identified as a potential strategy to prevent and reduce maternal mortality and morbidity. Despite its importance, there is a paucity of information on the level of disrespect and abuse meted out to mothers in eastern Ethiopia. This study assesses the level of disrespect and abuse suffered by women during childbirth, and the associated factors, in public health facilities in the rural East Hararghe Zone in eastern Ethiopia.

Methods: A cross-sectional study was conducted among 530 women who gave birth in 20 public health facilities in the East Hararghe Zone during the period between 1 April and 30 April 2020. Data were collected using a validated questionnaire. Bivariable and multivariable binary logistic regression analyses were employed to identify the factors associated with disrespect and abuse during childbirth. Adjusted odds ratio (AOR) (95% CI) was used to report this association, and statistical significance was set at P < 0.05.

Results: Overall, 77% (95% CI: 73%-81%) of women reported at least one type of disrespect and abuse during childbirth in the East Hararghe Zone public health facilities. In this study, factors such as households having an average monthly income of below 57.22 USD (AOR = 2.29, 95% CI: 1.41-3.71), mothers residing at more than 30 min away from a nearby health facility (AOR = 2.10, 95% CI: 1.30-3.39), those not receiving antenatal care (AOR = 4.29, 95% CI: 2.17-8.52), and those giving birth during nighttime (AOR = 2.16, 95% CI: 1.37-3.41) were associated with at least one type of disrespect and abuse during childbirth.

Conclusion: More than three in every four women who gave birth in the East Hararghe Zone public health facilities were disrespected and abused during childbirth. Encouraging all pregnant women to pay attention to antenatal care visits and improving the quality of healthcare service during nighttime in all health facilities will be essential for preventing and reducing disrespect and abuse and its negative consequences.

背景:在分娩过程中提供富有同情心和尊重产妇的护理被认为是预防和降低孕产妇死亡率和发病率的潜在策略。尽管其重要性不言而喻,但有关埃塞俄比亚东部产妇所遭受的不尊重和虐待程度的信息却很少。本研究评估了埃塞俄比亚东部东哈拉盖区农村地区公共医疗机构中妇女在分娩过程中遭受的不尊重和虐待程度以及相关因素:本研究对 2020 年 4 月 1 日至 4 月 30 日期间在东哈拉盖区 20 家公共医疗机构分娩的 530 名妇女进行了横断面研究。数据通过有效问卷收集。采用二变量和多变量二元逻辑回归分析来确定与分娩期间不尊重和虐待相关的因素。采用调整后的几率比(AOR)(95% CI)来报告这种关联,统计显著性设定为 P 结果:总体而言,77%(95% CI:73%-81%)的妇女报告在东哈拉盖区公共医疗机构分娩时至少受到过一种不尊重和虐待。39)、未接受产前护理(AOR = 4.29,95% CI:2.17-8.52)和夜间分娩(AOR = 2.16,95% CI:1.37-3.41)的产妇在分娩过程中至少与一种不尊重和虐待行为有关:结论:在东哈拉盖区的公立医疗机构中,每四名产妇中就有三人以上在分娩时受到不尊重和虐待。鼓励所有孕妇重视产前检查,提高所有医疗机构夜间医疗服务质量,对于预防和减少不尊重和虐待行为及其负面影响至关重要。
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引用次数: 0
Maternal age extremes and adverse pregnancy outcomes in low-resourced settings. 在资源匮乏的环境中,孕产妇的极端年龄与不良妊娠结局。
Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-28 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1201037
Paul Nyongesa, Osayame A Ekhaguere, Irene Marete, Constance Tenge, Milsort Kemoi, Carla M Bann, Sherri L Bucher, Archana B Patel, Patricia L Hibberd, Farnaz Naqvi, Sarah Saleem, Robert L Goldenberg, Shivaprasad S Goudar, Richard J Derman, Nancy F Krebs, Ana Garces, Elwyn Chomba, Waldemar A Carlo, Musaku Mwenechanya, Adrien Lokangaka, Antoinette K Tshefu, Melissa Bauserman, Marion Koso-Thomas, Janet L Moore, Elizabeth M McClure, Edward A Liechty, Fabian Esamai

Introduction: Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest.

Objective: To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries.

Patients and methods: We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20-24, 25-29, 30-35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20-24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed.

Results: We analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02-1.11) for perinatal mortality and 1.13 (1.06-1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49-1.67) for perinatal mortality, and 1.30 (1.20-1.41) for neonatal mortality, compared to pregnancy in women 20-24 years. This pattern was overall similar in all regions, even in the <18 and 18-19 age groups.

Conclusion: The maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation.

导言:青春期(35 岁)妊娠具有不良风险,在不良妊娠后果负担最重的中低收入国家,有必要对青春期妊娠进行严格审查:目的:描述六个国家中与极端孕龄相关的妊娠(孕产妇、围产期和新生儿)不良后果的发生率:我们对 2010 年至 2020 年期间在刚果民主共和国、危地马拉、印度、肯尼亚、巴基斯坦和赞比亚开展的一项基于人群的队列研究中前瞻性收集的数据进行了历史队列分析。研究对象包括孕妇及其新生儿。我们描述了与这些孕产妇年龄组(35 岁)的妊娠相关的患病率和不良妊娠结局。通过拟合泊松模型,得出了各孕产妇年龄组与 20-24 岁参照组相比,每种不良妊娠结局的相对风险和 95% 的置信区间,并对地点、孕产妇年龄、奇偶数、多胎妊娠、孕产妇教育、产前护理和分娩地点进行了调整。此外,还按地区进行了分析:我们分析了 602,884 例分娩,其中 13% (78,584 例)为青少年,5% (28,677 例)为高龄产妇。孕产妇总死亡率(MMR)为每 10 万例活产 147 例死亡,并随着孕产妇年龄的增加而增加:青少年组为 83 例,高龄产妇组为 298 例。在所有地区,AMA 组的产妇死亡率最高。青春期妊娠与围产期死亡率的调整相对风险(aRR)为 1.07(1.02-1.11),与新生儿死亡率的调整相对风险(aRR)为 1.13(1.06-1.19)。相比之下,与 20-24 岁女性怀孕相比,AMA 与孕产妇死亡率的 aRR 相关,分别为 2.55(1.81-3.59)、1.58(1.49-1.67)和 1.30(1.20-1.41)。这一模式在所有地区总体类似,甚至在结论中也是如此:在所评估的低收入和中等收入国家中,孕产妇死亡率很高,而且随着孕产妇年龄的增加而增加。虽然急性乳腺炎的发病率较低,但它与孕产妇的不良死亡率风险较高有关,而且与青春期一样,与围产期不良死亡率有关,但地区差异很小。
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引用次数: 0
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Frontiers in global women's health
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