Frontiers in global women's health最新文献

Introduction: Stillbirth remains a major public health issue in low- and middle-income countries (LMICs). Ghana's 2021 stillbirth rate (21.4 per 1,000 births) exceeds the United Nations Sustainable Development Goal (SDG) target of 12 per 1,000 births by 2030. Unclean household cooking fuels have been associated with adverse pregnancy outcomes, including stillbirth. In Ghana, women conduct about 64% of household cooking, often in poorly ventilated settings with particulate levels above World Health Organization (WHO) guidelines. We assessed the association between household cooking fuel type and stillbirth among Ghanaian women.

Methods: We conducted a cross-sectional analysis using data from the 2022 Ghana Demographic and Health Survey. The sample included 10,654 women aged 15-49 years with ≥1 recorded pregnancy. The primary exposure was household cooking fuel (clean vs. unclean per WHO guidelines). Outcomes were (1) stillbirth, defined as fetal loss at ≥7 months' gestation, and (2) stillbirth rate per 1,000 total births. Survey-weighted bivariate screening (p < 0.05) identified candidate covariates for inclusion in multivariable, survey-weighted logistic regression models. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were reported. Given the cross-sectional design, estimates reflect associations, not causation.

Results: The overall stillbirth rate was 15.85 per 1,000 births. Unclean cooking fuel use was associated with 44% higher odds of stillbirth (AOR: 1.44; 95% CI: 1.05-1.99; p = 0.0258). Other factors associated with higher odds were age ≥30 years (AOR: 2.17; 95% CI: 1.59-2.95; p < 0.001), moderate-to-poor health (AOR: 1.78; 95% CI: 1.39-2.28; p < 0.001), and alcohol consumption (AOR: 1.43; 95% CI: 1.06-1.93; p = 0.0195).

Discussion: In this nationally representative sample, unclean cooking fuel use was associated with increased odds of stillbirth. Expanding access to clean fuels and leveraging antenatal care services for culturally responsive clean-energy counseling may help reduce stillbirth risk. Prospective studies with exposure monitoring are needed to establish temporality.

Objective: Endometriosis (EMT) is a prevalent gynecological disorder characterized by chronic pain, menstrual irregularities, and infertility. This study aims to evaluate the global burden of EMT from 1990 to 2021 and to project trends up to 2050.

Methods: Data from the Global Burden of Disease (GBD) 2021 database were utilized to analyze mortality, incidence, prevalence, and disability-adjusted life years (DALYs). Trends were assessed using age-standardized rates (ASR) and estimated annual percentage change (EAPC). Future burdens were projected using ARIMA and exponential smoothing models.

Results: In 2021, there were 3,447,126 new cases of EMT reported globally. The age-standardized incidence rate (ASIR) experienced a decline of 1.07% from 1990 to 2021, while the age-standardized prevalence rate (ASPR) decreased by 0.95%. The incidence of EMT peaked among women aged 20-24 years, whereas mortality rates increased with advancing age. Projections suggest that by 2050, EMT-related deaths will rise to 68 cases, and the number of disability-adjusted life years (DALYs) will increase to 2,260,948, despite ongoing declines in both ASIR and ASPR.

Conclusion: Although the incidence and prevalence rates of EMT are declining, the disease burden remains significant among women of reproductive age. The anticipated rise in mortality and disability-adjusted life years (DALYs) in the future underscores the necessity for targeted public health policies. This study provides evidence to inform global prevention strategies. Future research should investigate the effects of population aging and lifestyle changes on the burden of EMT.

Introduction: This study examined the impact of maternal adverse childhood experiences (ACEs) on their children's overall quality of life (QoL), focusing on the mediating role of maternal QoL and the moderating role of maternal self-esteem. Understanding these intergenerational pathways can provide valuable insights for designing interventions that promote family well-being.

Methods: A secondary data analysis was conducted using data from the 2018 National Child Life Experience Survey in South Korea. Participants included 930 mothers who had experienced at least one type of childhood adversity. A descriptive and correlational research design was employed, and statistical analyses were performed using the PROCESS macro to test mediation and moderation effects.

Results: Higher levels of maternal ACEs were significantly associated with lower QoL in both mothers and their children. Maternal QoL partially mediated this relationship, indicating that adverse childhood experiences affect children's well-being indirectly through maternal health. Moreover, maternal self-esteem moderated the negative effects of maternal ACEs on children's QoL, serving as a psychological protective factor.

Discussion: These findings highlight the critical importance of maternal psychological health in mitigating the intergenerational transmission of adversity. Strengthening maternal self-esteem and emotional well-being could buffer the negative impact of early adversity on families. Public health and nursing strategies that integrate mental health promotion and family-based interventions are essential to improve long-term outcomes for children in families affected by maternal ACEs.

Introduction: Understanding quality of life (QOL) and changes in pain severity over time is important to quantify cancer patients' treatment outcomes. However, this information is limited, especially in lower-middle-income countries. This study aimed to prospectively assess QOL, QOL domains, and pain severity over time in patients with advanced breast cancer in Indonesia.

Methods: Women with advanced breast cancer (n = 160) who were referred to the palliative oncology unit were enrolled in the study. They completed the European Organization for Research and Treatment of Cancer QOL Questionnaire for advanced cancer patients (EORTC QLQ-C15-PAL) and the visual analog scale (VAS) for pain severity at three assessment points, namely, at baseline (T0) and at 3- (T1) and 6-month (T2) follow-ups. The repeated-measures analysis of variance model was used to assess changes over time after adjusting for age, place of residence, marital status, and Karnofsky Performance Status score. Change over time was classified into three groups, namely, deterioration, improvement, or a small difference.

Results: The descriptive analysis showed that the patients' EORTC QLQ-C15-PAL mean scores for overall QOL and the functional scales (physical and emotional functioning) were fair to good at all assessment points (range: 60-70 points) and substantially better at T0 compared to T1 and T2. In addition, most of the scores for the symptom scales of the EORTC QLQ-C15-PAL indicated lessening symptom burden (<10 points), except for pain and fatigue (20-30 points). At the same time, overall QOL, emotional functioning, fatigue, dyspnea, appetite loss, constipation, and VAS score remained stable over time. Exceptions were found for physical functioning (a medium to large deterioration with scores of -16.5 and -19.8 points, respectively) and insomnia (a medium improvement with a score of -13.4 points), with clinically relevant changes.

Conclusions: Our findings from a 6-month longitudinal study show that palliative oncology treatment benefitted patients with advanced breast cancer in this health facility across several symptom scales.

Introduction: Menstrual hygiene management is an important public health component to promote reproductive health, especially in rural areas of low-and middle-income countries (LMICs). Present study assessed the menstrual hygiene practices, the disposal methods and associated health effects among school students, college students, and community women in rural setting of a Health Demographic Environmental Surveillance System (HDESS) in Odisha, India.

Methods: A cross-sectional survey was carried out in March-May 2023 using three cohorts of participants, namely school students, college students, and community women aged between 14 and 49 years and currently experiencing cycles of menstruation. The study used a multi-stage random sampling method with a descriptive analysis comparing patterns of sanitary pad use, its disposal practice and complications linked to the use of pads. Continuous variables such as age and cost incurred on menstrual products were reported using mean and standard deviation. The chi-squared value was used to determine possible associations and affirm the statistical significance, p-value (<0.05).

Results: Among 622 participants, 541 (86.9%) reported using sanitary pads. Cloth users rated their experience as "excellent" (48.7%), while dissatisfaction was highest among government-provided pad users (29.7%). Self-procured pad users reported the highest "manageable" experience (44.9%). The most common method of disposing the sanitary materials was by burying (40.2%). Approximately 68.32% of participants reported menstruation related health issues whilst 23.9% reported sanitary pad-related issues. About 16.8% of the participants reported of menstrual irregularities, school students being the most (44.8%).

Discussion: The use of disposable sanitary pads appear to be the most common menstrual hygiene management practice in rural areas. Awareness, shame, and costs could be barriers to accessing sanitary pads along with poor environmental impact when disposing of these using improper methods. Reform the policy by introducing awareness of overall health implications linked to menstrual hygiene and access to low-cost menstrual management products could promote reproductive health. Also, government partnerships with NGOs to implement village-level menstrual waste management systems, subsidies for eco-friendly pad production, and mandatory disposal education in school health programs could mitigate the problem.

Reproductive politics lie at the intersection of gender, power, and governance, shaping women's autonomy through laws, policies, and cultural norms. Historically, colonialism and population control initiatives marginalized women, particularly in the Global South, fostering distrust in healthcare systems. Feminist movements advocate for reproductive justice, yet economic and nationalistic interests continue to influence access to care. Governments regulate reproduction to control demographics, labor markets, and national power. Pronatalist and antinatalist policies, such as China's One-Child Policy, have led to coercive interventions, disproportionately affecting marginalized communities. Reproductive politics also shape masculinity, fatherhood, and state-controlled family structures. Global reproductive policies reflect ideological struggles, from restrictive abortion laws in Poland and the U.S. to progressive approaches in Nepal and Vietnam. Socioeconomic barriers further limit access to contraception, maternal healthcare, and fertility treatments. Achieving reproductive justice requires inclusive policies, healthcare reform, and recognition of reproductive rights as fundamental to gender equality.

Background and aim: This pilot study aimed to explore the feasibility and effects of auricular acupuncture called NADA, according to the principles of the National Acupuncture Detoxification Association. Previous studies have reported the effects of NADA on stress, anxiety, and sleep. Given the high levels of stress, anxiety, and psychological distress commonly experienced by parents of infants admitted to the Neonatal Intensive Care Unit (NICU), the study sought to determine whether NADA could serve as a stress-relieving intervention.

Method: The pilot study was conducted as an observational cross-sectional study for 6 months from October 2019. The "Nada in NICU" pilot project involved 41 parents (33 women and 8 men) who received between 3 and 16 NADA interventions during their child's NICU hospitalization. Data were collected through a questionnaire assessing sleep, stress/restlessness, and physical well-being. Participants were also given the option to add free-text comments in the questionnaire regarding their experiences with the NADA treatment. Quantitative data were analyzed using mixed regression, while qualitative data were thematically analyzed to identify recurring themes.

Findings: The results indicated a statistically significant reduction in stress, sleep disturbances, and physical discomfort post-NADA intervention, with a mean difference in sleep scores of -1.951. Qualitative feedback generated an overall theme, "An increased feeling of calmness," and two themes, "A psychological booster," reflecting parents' experiences of enhanced mental clarity and emotional regulation and "Bodily calmness," highlighting improved physical relaxation and sleep quality. Parents universally regarded NADA as a relevant and beneficial intervention during their NICU stay.

Background: Recent research suggests that attention-deficit/hyperactivity disorder (ADHD) is a risk factor for suboptimal cognitive and emotional aging. Due to menopause, women may be more vulnerable to these outcomes than men. This study quantifies age-related changes in the association between self-reported ADHD symptoms and cognitive and emotional complaints, comparing men and women.

Methods: Participants were 118 community adults aged 19-79 years (78.0% women). Most had a self-reported ADHD diagnosis (71.2%) or clinically significant ADHD symptoms (78.0%). All completed the self-report Connors Adult ADHD Rating Scale, the Cognitive Failures Questionnaire, the Barkley Deficits in Executive Functioning Scales and the Difficulties in Emotion Regulation Scale. Gender-stratified general linear models predicted cognitive and emotional difficulties from ADHD symptoms, testing age as a moderator.

Results: ADHD symptoms showed moderate to strong correlations with all cognitive (.39 < r < .68) and emotional outcomes (.21 < r < .64). In men, the association between ADHD symptoms and cognitive (B = -0.009, p = .021, η _p ² = .23) and emotional impulsivity (B = -0.017, p = .012, η _p ² = .28) was less pronounced in older than younger participants. Theses patterns were not observed in women. In older women, the association between ADHD symptoms and self-reported cognitive failures was slightly weaker than in younger women (B = -0.017, p = .030, η _p ² = .05). Although this interaction was not statistically significant in men, the effect was of similar medium-sized magnitude (η _p ² = .08). All associations survived adjustments for depression and anxiety symptoms.

Conclusion: Some cognitive and emotional difficulties associated with ADHD symptoms were worse in younger than in older men, but age moderation was not observed in women. The cross-sectional design precludes any conclusions about causality, and it is possible that these results may be explained by greater self-disclosure in women than in men. Results are also interpreted cautiously in the context of relatively small sample size. Altogether, results support the need for a gender-specific lens when considering the lifespan impacts of ADHD symptoms and point to women as a potentially vulnerable segment of the ADHD population regarding cognitive and emotional aging.

Background: Maternal mortality remains a critical concern in low-income countries, where low utilization of institutional delivery services is a contributing factor. This study investigates the influence of individual and community-level factors on institutional delivery among women in Somaliland, a region with a high maternal mortality rate.

Methods: This cross-sectional study used data from the 2020 Somaliland Demographic and Health Survey (SDHS), a nationally representative survey of 3804 women aged 15-49. We employed descriptive statistics and Chi-square tests to examine bivariate associations and multi-level binary logistic regression to assess the impact of individual and community-level factors on the place of delivery.

Results: Only 30.8% of deliveries occurred in health institutions. Bivariate analyses showed significant associations between institutional delivery and maternal age, education (χ² = 328.534, p < 0.001), husband's education (χ² = 362.669, p < 0.001), wealth (χ² = 787.937, p < 0.001), region (χ² = 50.760, p < 0.001), and parity (χ² = 65.227, p < 0.001). Multilevel analysis revealed that 50% of the variance in place of delivery was attributable to community level factors (Model I). Higher maternal education was significantly associated with increased odds of institutional delivery (AOR = 8.87, p < 0.05), while nomadic residence (AOR = 0.28, p < 0.05), residing in Sanaag region (AOR = 0.36, p < 0.05), high parity (five or more children) (AOR = 0.52, p < 0.05), not intending to use contraceptives (AOR = 0.62, p < 0.05), and wanting the pregnancy later (AOR = 0.79, p < 0.05) were significantly associated with decreased odds of institutional delivery. Women in the highest wealth quintile were significantly more likely to deliver in a health facility (AOR = 18.71, p < 0.05).

Conclusion: The study highlights the complex interplay of individual and community-level factors influencing the utilization of institutional delivery in Somaliland. Interventions to promote health facility deliveries must address socioeconomic disparities, improve women's education, ensure accessibility of healthcare for nomadic communities, reduce regional variations, promote family planning and reproductive health services, and take into consideration the impact of parity on health seeking behaviors.

Background: Sub-Saharan Africa has the highest rate of maternal death due to pregnancy-related complications. The delayed onset of Antenatal care (ANC) is a major underlying factor for maternal mortality. The overall well-being and health of pregnant women and their fetuses greatly depend on the timely initiation of ANC care. This study aims to identify the top predictors of delayed antenatal care initiation in East Africa, including Ethiopia, to provide input for policymakers.

Methodology: We employed secondary data from the Demographic Health Surveys conducted across ten East African countries between 2016 and 2023. After preprocessing the data, which included cleaning and feature selection through Recursive Feature Elimination, we addressed class imbalance using Synthetic Minority Over-sampling Technique (SMOTE). We then applied seven supervised learning algorithms to develop a robust machine learning model. The LGBM Classifier emerged as the top performer for predicting delayed antenatal care initiation, achieving accuracy of 75%, an AUC score of 81%, an F1 score of 78%, a recall of 79%, and a precision of 77%. Additionally, we employed association rule mining to further analyze.

Result: Home delivery, low household income, a large number of household members, unemployment, being a younger woman, not using family planning methods, low educational level, and rural residence are predictors of delayed antenatal care initiation.

Conclusion: The prevalence of late antenatal care (ANC) initiation is high (65%). Promote family planning utilization, targeted health literacy campaigns, youth-friendly programs, expand mobile clinics, and promote skilled birth attendance to increase timely ANC initiation are recommended.