Frontiers in global women's health最新文献

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.

Introduction: Recently, there has been growing evidence on self-stigma and personal recovery in people with psychotic spectrum disorders. However, despite the influence of sex on mental health and the social component of self-stigma and recovery, the evidence regarding self-stigma, personal recovery, and sex is limited and inconsistent. This research aims to study the role of sex in the effect that self-stigma has on the personal recovery of people with psychotic spectrum disorders.

Methods: A sample of 118 patients with a psychosis diagnose participated in the study (55.9% men). They were recruited from 9 clinical centers in Spain. Data were collected through the Internalized Stigma of Mental Illness and the Recovery Assessment Scale.

Results: The effect of self-stigma on personal recovery differed according to the sex of the person. Specifically, in women, personal recovery decreased as self-stigma and alienation increased. Also, a higher self-stigma was associated with a lower personal confidence, hope and symptom control. In contrast, in men, a higher alienation was associated with higher personal confidence, hope and success orientation. These results were adjusted for educational level, comorbidity, number of psychotic episodes, and the time between symptom onset and treatment initiation.

Discussion: These findings highlight the urgent need to explore further the role of sex on recovery and to have a sex-sensitive approach in policies and interventions in this population. This would benefit their recovery and, in consequence, their quality of life. Future studies should expand the sample and explore other factors that could be influencing the process of recovery and self-stigma.

Background: This study aimed to evaluate the prevalence and associated factors of depressive and anxiety symptoms among Chinese pregnant women during the middle period of COVID-19.

Methods: From May to August 2021, a cross-sectional online survey was conducted among pregnant women in Shijiazhuang, Hebei Province. The data collected included demographic characteristics (age, occupation, region, parity, number of fetuses, pregnancy-related disorders, education level, awareness of common symptoms, attention to the epidemic, and frequency of temperature measurement). We recruited participants using a convenience sampling approach. Depression and anxiety were assessed using self-depression rating scale (SDS) and a self-rating anxiety scale (SAS). A univariate and multivariable binomial logistic regression model was applied to identify risk factors for depression and anxiety.

Results: Cronbach's α coefficients for SDS and SAS were 0.837 and 0.826, respectively. Among 1,036 participants, the prevalence of depressive and anxiety symptoms was 59.8% (620 cases) and 6.7% (69 cases), respectively. Factors associated with depression included the number of fetuses (OR = 2.98, 95% CI 1.22-7.31), education level (OR = 0.58, 95% CI 0.45-0.75), attention to the epidemic (OR = 0.65, 95% CI 0.42-0.91), and frequency of temperature measurement (OR = 0.62, 95% CI 0.41-0.93). Factors associated with anxiety included parity (OR = 0.51, 95% CI 0.31-0.83), attention to the epidemic (OR = 2.14, 95% CI 1.18-3.89), and frequency of temperature measurement (OR = 2.86, 95% CI 1.08-7.52). Multivariate binomial logistic regression analysis indicated that a higher education level was an associated factor for depression (adjusted OR = 0.52, 95% CI 0.38-0.70). However, the parity (adjusted OR = 0.46, 95% CI 0.26-0.82) and pregnancy-related disorders (adjusted OR = 2.55, 95% CI 1.46-4.45) were independent associated factors for anxiety.

Conclusion: Pregnant women with lower education levels, primipara status, and pregnancy-related disorders were association with higher levels of depression and anxiety during the middle period of COVID-19. These findings suggest the need for targeted interventions to support the mental health of pregnant women during pandemics.

Introduction: Ethiopian women in prison face unique and exacerbated issues that are not adequately addressed by the criminal justice system, especially when it comes to gender responsive social work services. This study uses a qualitative phenomenological design to investigate the lived experiences of women who are incarcerated in the Amhara region at Kobo Prison. The study focuses on the ways in which social work interventions affect the psychosocial well-being and empowerment of these women.

Methods: Seven participants were specifically chosen from among the roughly 70 female inmates housed at Kobo Prison to offer a range of viewpoints on the experiences of incarceration. Owing to COVID-19 limitations, open-ended written questionnaire that participants filled out in private were used to collect data, guaranteeing confidentiality. An inductive thematic approach was used to manually analyze the responses.

Results: Findings indicate that incarcerated women face significant barriers including inadequate mental health support, lack of childcare provisions, and insufficient protection from gender based violence, and limited access to vocational and educational opportunities. The informal, underfunded, and frequently gender-insensitive social work services provided in prisons increase women's vulnerabilities and impede their rehabilitation. Notwithstanding these obstacles, counseling services and skill building exercises turned out to be crucial facilitators of empowerment and resilience.

Discussion: The study emphasizes how important it is to establish gender responsive social work programs that are specifically designed to meet the needs of Ethiopian women who are incarcerated. By putting women's voices front and center, the study adds important knowledge to the little studied field of correctional social work in low-income settings and offers data to support program development and policy changes. In the end, the results support comprehensive, gender-sensitive strategies to enhance the wellbeing and social reintegration of women who are incarcerated.

Background: Climate change significantly affects Uganda's economy and human well-being, with disproportionate impacts on the sexual and reproductive health (SRH) services of women and girls. However, SRH remains largely absent from climate change policy frameworks. This study examines the extent to which SRH is integrated into Uganda's climate policy frameworks and explores stakeholder perceptions of the impacts of climate change on SRH to provide insights for more inclusive and integrated policies.

Methods: The study used a mixed-methods approach, combining policy document analysis with primary qualitative data. Key documents reviewed included climate change and health policies, strategies, plans, and national medium- and long-term development frameworks. Forty purposively selected key informants and 24 focus group discussions with 321 participants in Buikwe District were conducted. Qualitative data were analyzed using content analysis to identify key themes and gaps.

Results: Uganda's climate policy frameworks acknowledge the gender-differentiated impacts of climate change and highlight the importance of SRH services but fall short of outlining concrete actions to address SRH within climate adaptation and mitigation strategies. Key informants highlighted limited stakeholder awareness and weak institutional coordination as major barriers to integrating SRH into climate action. Community respondents noted that climate extremes degrade critical infrastructure, disrupt access to SRH services and increase vulnerabilities, including a heightened risk of gender-based violence.

Conclusions: The impact of the climate crisis on SRH is increasingly evident, particularly for women and girls, yet Uganda's key climate policies still exhibit lack of concrete actions to address SRH vulnerabilities. Prioritizing SRH within climate adaptation efforts, especially through resilient health systems and livelihood support such as climate resilient agricultural training and vocational programs for women and girls is key to advancing both gender and health equity, and climate resilience in Uganda. This should be supported by robust gender disaggregated data, stronger institutional coordination, and inclusive, community-led planning.

Introduction: Maternal sepsis is a leading cause of maternal mortality. In Australia, it is the third most common cause of maternal death despite a low overall maternal death rate (5.8 per 100,000 births). The objective of this study was to examine risk factors for maternal pyrexia, infection and sepsis, adherence to WHO maternal antibiotic prophylaxis guidelines and resistance patterns in women with Group B Streptococcus (GBS).

Methods: We conducted a retrospective observational cohort study using routinely collected data from four hospitals providing maternity care in New South Wales, Australia, including pathology data from one hospital. Women who gave birth between January 1, 2018, and December 31, 2020, were included. Definitions for pyrexia, infection, and sepsis were based on medical notes and the obstetrically modified Sequential Organ Failure Assessment criteria. We used multivariable logistic regression to identify risk factors and descriptive statistics to evaluate antibiotic prophylaxis adherence and resistance.

Results: Out of 23,016 women, 2,650 (11.5%) experienced pyrexia, infection, or sepsis. Women with pyrexia, infection, or sepsis were more likely to report a history of substance use and less likely to receive influenza vaccination. Hospital-based (non-continuity) midwifery care, nulliparity, and emergency Caesarean section and instrumental vaginal birth were associated with increased risk of pyrexia, infection, or sepsis. Documented adherence to antibiotic prophylaxis guidelines was suboptimal, with 35% of Caesarean sections and 29% of severe perineal tear cases documented as receiving antibiotics. In the subset of women with available pathology data, GBS screening was performed in 72.6% of cases, with 19.4% testing positive. Resistance to erythromycin (33.4%) and clindamycin (30.9%) was high, though no resistance to penicillin or ampicillin was observed.

Conclusion: Demographic and labour/birth factors conveying an increased risk of pyrexia, infection or sepsis were broadly in line with previous studies. Adherence to WHO prophylaxis guidelines was poorly documented and increased rates of antibiotic resistance to erythromycin and clindamycin were observed. Ongoing monitoring of resistance patterns and improving guideline adherence is important to optimise care.

Introduction: Providing care of preterm infants in the NICU is a significant source of psychological and emotional stress for both infants and parents. The purpose of the study was to investigate the relationship between gestational age (GA) and maternal stress levels in the neonatal intensive care unit (NICU) setting and to identify additional demographic and clinical factors that may contribute to or exacerbate maternal stress during the infant's NICU hospitalization.

Materials and methods: This observational, cross-sectional prospective study included 247 mothers of preterm infants. Maternal stress and worry were assessed using the PSS: NICU questionnaires. PSS: NICU items were organized into three subscales: Sights and Sounds (S1), Infant Appearance and Behavior (S2), and Parental Role Alteration (S3).

Results: Moderate/high NICU-related stress among mothers of preterm infants was more common when infants were born before 32 weeks (p = 0.031), in cases of neonatal seizures (p = 0.027), sepsis (p = 0.032), and invasive ventilation (p = 0.027). Logistic regression showed that gestational age under 32 weeks and neonatal seizures significantly increased the risk of moderate/high maternal stress (OR = 2.90, 95% CI: 1.26-6.68, p = 0.012; OR = 9.83, 95% CI: 1.19-80.80, p = 0.033, respectively).

Conclusion: NICU-related stress among mothers of preterm infants significantly associated with gestational age below 32 weeks and exacerbated by neonatal seizures. These factors can help identify mothers at high risk who may need focused support in the NICU, considering both the infant's condition and the mother's psychological well-being.

Introduction: Disparate maternal health outcomes among non-Hispanic Black women stem from intricate, interrelated factors shaped by clinical, social, and structural influences. Traditional approaches often fall short in addressing these complexities, necessitating a shift toward systems thinking and community-driven solutions.

Methods and materials: This paper describes the lessons learned from the implementation of system dynamics group model building (SD GMB) workshops grounded in community-based participatory research (CBPR) principles in two separate projects focused on maternal health among Black women. We recruited 31 diverse stakeholders, including individuals with lived experience, and applied trauma-informed facilitation, wraparound support, and structured systems modeling activities. A descriptive analysis of workshop data was performed to accompany the identified lessons learned.

Results: Evaluation data from surveys and open-ended responses indicated high stakeholder satisfaction, increased capacity to apply systems thinking, and a shift from skepticism to agency. Stakeholders valued the inclusive design, reported meaningful learning, and expressed interest in future engagement. The workshops fostered transformative learning and generated actionable systems insights rooted in community experience.

Discussion: This work demonstrates how SD GMB, when integrated with CBPR, can build trust, elevate marginalized voices, and produce models that reflect structural realities. Future directions include quantifying the models, hosting learning labs to test interventions, and developing an open-access dashboard to simulate policy scenarios. These findings contribute to ongoing efforts to design more engaging, community-informed approaches to maternal health research and practice.

Background: Spontaneous abortion in the first trimester is a common adverse pregnancy outcome with significant implications for maternal health and public health practice. The description of associations with modifiable factors, including preconception care, can aid in planning strategies to improve pregnancy outcomes.

Methods: A retrospective analysis was conducted using data from 1,526 women, divided into two groups based on pregnancy outcomes: spontaneous abortion in the first trimester and live births. Binary and multivariate logistic regression analyses were performed to identify associations between factors (including preconception care) and the risk of spontaneous abortion in the first trimester.

Results: Age >35 years [[OR] = 2.02, 95% [CI] = 1.49-2.75], obesity [[OR] = 1.81, 95% [CI] = 1.12-2.91], and a history of spontaneous abortion [[OR] = 1.57, 95% [CI] = 1.01-2.43] were associated with higher odds of spontaneous abortion in the first trimester, whereas preconception care was associated with lower odds of spontaneous abortion in the first trimester [[OR] = 0.58, 95% [CI] = 0.45-0.75].

Conclusion: The findings may help clinicians stratify pregnant women who require additional monitoring and pre-pregnancy interventions. From a public health perspective, integrating preconception care into routine health services can enhance maternal and neonatal outcomes, reduce healthcare costs, and improve health equity by targeting vulnerable populations. However, the results should be interpreted as associations, and prospective studies are needed to assess the potential effects of preconception care on spontaneous abortion in the first trimester.

Background: Despite awareness of the benefits of facility-based deliveries, many women in Sub-Saharan Africa (SSA) still deliver outside healthcare settings, often without skilled birth attendants. Access to maternal healthcare encompasses affordability, physical accessibility, and acceptability.

Objective: This study aimed to explore the factors influencing maternal healthcare utilisation in South-South Nigeria, with a focus on identifying the "silences" surrounding women's access to care, and understanding the facilitators, barriers, and suggested improvements.

Methods: An exploratory qualitative design was adopted to investigate women's perceptions of the hidden factors influencing maternal healthcare utilisation. Data were collected from women of reproductive age (20-49 years) in one of the tertiary health hospitals in Nigeria. Eight semi-structured interviews were performed and transcribed. Data were analysed thematically using the Silences Framework.

Results: Three themes emerged: facilitators, barriers, and suggestions. Facilitators included women's recognition of skilled providers and the safety offered by emergency care. Despite dissatisfaction, many continued facility use due to trust in medical expertise. Barriers included negative staff attitudes, breaches of confidentiality, domestic violence, financial constraints, and systemic inefficiencies. Stigma further silenced discussion of sensitive issues, reinforcing under-utilisation. Some women turned to traditional birth attendants or private clinics, valuing compassion despite costs or risks. Suggestions centred on staff training in compassionate care, improved monitoring, better equipment, and stronger policies to uphold dignity and privacy.

Conclusion: The study emphasises the importance of addressing both systemic issues and interpersonal dynamics to improve maternal healthcare services. Women balance the perceived necessity of skilled care with negative experiences in formal facilities. While competence drives use, poor attitudes and systemic gaps reduce trust. Tackling both structural and interpersonal barriers is critical. Respectful, culturally sensitive care and stronger accountability are essential. These findings offer practical guidance for reforming maternal healthcare in Nigeria.