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- Åsling Monemi, Kajsa, 1960-
(författare)
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The Impact of Violence Against Women on Child Growth, Morbidity and Survival : Studies in Bangladesh and Nicaragua
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore the impact of physical, sexual and emotional violence against women of reproductive age and the level of controlling behaviour in marriage on child health and survival in two different cultural settings: Bangladesh and Nicaragua. Data were acquired from four quantitative community-based studies. In two studies, a cohort including a prospective two year follow-up of 3164 mother-infant pairs in rural Bangladesh was investigated. A third study was a case-referent study in Nicaragua including mothers of 110 cases of under-five deaths and 203 referents, and in a forth study an other cohort of 1048 rural Bangladeshi women and their 2691 children was followed until 5 years of age. Maternal exposure to any form of violence, including physical, sexual, emotional, and controlling behaviour was independently associated with lower body size at birth, increased risk of stunting and under-weight at 24 months of age, slower growth velocity during the first two years of life and a higher incidence of diarrhoeal episodes and respiratory tract infections. In the Nicaraguan setting, the children of women who experienced any history of physical violence had a two-fold increase in risk of death before the age of 5 years, and those whose mothers experienced both physical and sexual violence had a six-fold increase in risk of death. In Bangladesh, an association between violence against women and under-five mortality was found among daughters of educated mothers who were exposed to severe physical violence or a high level of controlling behaviour in marriage. In all four studies, lifetime violence experience among participating mothers was high (37-69%), and the timing was less relevant than the exposure to violence per se. In conclusion, this investigation revealed that violence against women severely affects child health and survival. The findings are especially relevant in a context of high level of child under-nutrition, morbidity and under-five mortality. Efforts for protecting women from all forms of violence are needed as part of the interventions for improved child health.
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| 2. |
- Pérez, Wilton, 1979-
(författare)
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Millennium Development Goals in Nicaragua : Analysing progress, social inequalities, and community actions
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The world has made important efforts to meet the Millennium Development Goals (MDG) by 2015. However, it is still insufficient and inequalities prevail in the poorest settings. We tracked selected MDG, barriers for their achievement, and community actions that help to accelerate the pace of their accomplishment in two Nicaraguan communities (León and Cuatro Santos).In the first two studies we track the progress of MDG4 (reduce child mortality) using the under-five mortality rate. Inequalities in mortality were mainly assessed by means of maternal education, but other social stratifications were performed on rural-urban residence and sub-regional comparisons between both communities. The last two studies describe community interventions in Cuatro Santos and their association with progress toward MDG1 (poverty reduction). Participation in interventions and poverty were visualized geographically in this remote rural community between 2004 and 2009. Other selected MDG targets were also tracked.These communities will possibly meet MDG4 even before 2015. In León, MDG progress has been accompanied by a decline in child mortality. Despite social inequalities with regard to mortality persisting in education and places of residence, these have decreased. However, it is crucial to reduce neonatal mortality if MDG4 is to be achieved. For example, in León the percentage of under-five deaths in the neonatal period has doubled from 1970 to 2005. In the remote rural area of Cuatro Santos, progress has been accelerated and no child mortality differences were observed despite the level of a mother’s education.Cuatro Santos has also progressed in the reduction of poverty and extreme poverty. The participation of the population in such community interventions as microcredit, home gardening, technical training, safe drinking water, and latrines has increased. Microcredit was an intervention that was unequally distributed in this rural area, where participation was lower in poor and extremely poor households than in non-poor households. In those households that transitioned from poor to non-poor status, microcredit, home gardening, and technical training were associated with this transition. Furthermore spatial analysis revealed that clusters of low participation in interventions overlapped with clusters of high poverty households.
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| 3. |
- Ugarte Guevara, William J., 1979-
(författare)
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Averting HIV and AIDS epidemic in Nicaragua : Studies of prevalence, knowledge, attitudes, and behavior
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to obtain an understanding of the dynamics of the HIV epidemic by estimating prevalence and exploring the relationship between HIV-related knowledge, attitudes, behavior, and HIV status in Nicaragua. Structured questionnaires were administered to adults from a health and demographic surveillance system in León, Nicaragua (Papers I–III). In-depth interviews and a survey were conducted among men who have sex with men (MSM, Paper IV). Blood sampling for HIV was carried out among 2,204 men and women (Paper I). Bivariate and multivariate analyses, including adjusted prevalence ratio (Papers I, II, IV), factor analysis, Cronbach’s alpha, and hierarchical regression analysis (Paper III) were performed. Thematic analysis was used with qualitative data (Paper IV).The prevalence of HIV in the general population was 0.35% (95% CI, 0.17–0.73). Those who have taken a HIV test were more likely to be females, younger, living in an urban setting, have a higher level of education, be married or cohabiting, and have no religious affiliation. HIV-related knowledge was lower among members of the general population than among MSM. Unprotected sex was reported more times with regular partners than with casual partners. Findings suggested that consistency of condom use and emotional attachment (steady relations) were inversely related. Stigma and discrimination were reported high in the general population; they appeared to be negatively associated with HIV-related knowledge, self-perception of HIV risk, HIV testing, and willingness to disclose HIV status in the event of being HIV-positive. Findings demonstrated an increasing tolerance towards same-sex attractions. MSM have a better understanding of HIV transmission than men and women of the general population. Although seven out of ten MSM and six out of ten women were concerned about becoming infected with HIV, inconsistent condom use was common.This study confirmed that Nicaragua has a low prevalence but high risk for HIV infection and transmission. Results underscore that social, behavioral, and cultural factors contribute to retard progress in achieving the Millennium Development Goals on reducing gender inequality and combating HIV/AIDS. Addressing these challenges depends not only on successful behavior change interventions, but requires a culturally gender-appropriate strategy.
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| 4. |
- Ziaei, Shirin
(författare)
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Women’s status and child nutrition : Findings from community studies in Bangladesh and Nicaragua
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The importance of women’s status for child nutrition has recently been recognized. However, pathways through which women’s status can affect their caretaking practices and child nutrition have not been fully determined. The aim of this thesis was to evaluate associations between aspects of women’s status – including exposure to domestic violence and level of autonomy and social support – with their level of stress, feeding practices and child nutritional status in two different cultural settings: Bangladesh and Nicaragua.Data were acquired from population-based studies. For Study I we used data from the Bangladesh 2007 Demographic and Health Survey, and Study II was embedded in the 2009 Health and Demographic Surveillance System conducted in Los Cuatro Santos, rural Nicaragua. Studies III and IV were part of the MINIMat study, conducted in rural Bangladesh. In-person interviews were conducted and validated questionnaires were used in each of the studies. Anthropometric characteristics of the children were recorded based on standardized World Health Organization techniques.In Bangladesh, we found women with lifetime experience of domestic violence to be more likely to report emotional distress during pregnancy, cease exclusive breastfeeding before 6 months and have a stunted child. Further, we found a negative association between experience of domestic violence and duration of excusive breastfeeding to be mitigated with breastfeeding counseling. In Nicaragua, a lower level of maternal autonomy was associated with more appropriate breastfeeding practices such as higher odds of exclusive breastfeeding and longer continuation of breastfeeding. Further, a maternal lower level of social support was associated with better child nutritional status.In conclusion, this investigation showed that different dimensions of women’s status were associated with their feeding practices and child nutritional status and also revealed that the strength and direction of these associations may vary by the child’s age, setting and other contextual factors. These findings suggest that women’s status might have an important public health impact on child health and its role should be considered in programs and policies aiming to improve child health and nutrition.
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| 5. |
- Karlén, Niklas
(författare)
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Changing Commitments : US Support to Rebels in Syria and Nicaragua
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The provision of external state support to non-state actors in civil wars is a dynamic process. The calculus of state sponsors varies over time, which means that assistance provided to the armed opposition fluctuates. This is rarely recognized in existing research, which has focused more on the initiation of support and its subsequent effects on conflict dynamics. While we know many of the motives behind decisions to provide support, we know less about why state sponsorship of rebels changes over time. To address this, I propose a theoretical argument that is able to account for policy adjustments over time. The theory builds on the notion that leaders change their support commitment when there is adverse feedback and that support increases as long as the causes of policy failure can be attributed to external actors, while cutbacks occur when failure is attributed to the state sponsor’s own actions. The latter prompts domestic audiences to act in order to force leaders to back down. Process tracing is used to explore the value of this framework in within-case analyses of the United States’ support commitments to insurgent groups in Nicaragua during the 1980s and in Syria during the 2010s. The study demonstrates the utility of focusing on shifts in leaders’ perceptions rather than structural features of the international system or rebel behavior to understand temporal variation in external support.
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| 6. |
- Valladares, Eliette, et al.
(författare)
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HIV community prevalence and testing practices in León, Nicaragua
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Our objective was to determine the HIV prevalence, testing practices, and HIV-related behaviors in a general population sample in the municipality of Leon, Nicaragua. We performed a cross-sectional community-based study of 2,204 males and females ages 18 to 69, from a health and demographic surveillance system. A behavior survey and blood sampling for HIV were also carried out. Seven of 1,960 individuals who provided biological samples (0.35%; CI 0.18–0.67) were HIV positive. The predicted prevalence of HIV among non-participants was about 11% higher than the observed prevalence but it was not significantly different. The major obstacle to HIV testing seemed to be the fear of being diagnosed HIV positive. This is the first study to determine HIV prevalence among the general population in Nicaragua. Our findings confirmed that this population has a low prevalence but high risk for HIV infection. Prevention strategies are essential to maintain this figure.
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| 7. |
- Pérez, Wilton, et al.
(författare)
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Community development actions to achieve the Millennium Development Goals : An analysis based on a surveillance site in Cuatro Santos, Nicaragua
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundAccording to preliminary data, the remote rural area of Cuatro Santos, Nicaragua has shown improvements in almost all Millennium Development Goals (MDG), while a set of interventions have been running in the area. This study describes the progress toward a set of MDG, as well as the geographical disparities encountered in reaching MDG1.MethodsWe investigated selected MDG prospectively and retrospectively in 2004 and 2009, and prepared a descriptive analysis of MDG and community interventions by proportions, rates, and ratios. In order to determine any geographical disparities in progress toward MDG1 among the households receiving interventions, we used a spatial scan test (SaTScan®) to identify unique non-random spatial clusters of poverty and interventions, and a retrospective model to identify multiple clusters in a defined geographic area. Multinomial logistic regression analyses were also performed to examine the participation of single interventions on the poverty clusters that were identified by the spatial cluster analysis technique.ResultsDescriptive analysis indicated that poverty and under-five mortality declined in Cuatro Santos. Education showed no wide inequality by gender. Access to drinking water and sanitation has risen, but is not universal. Spatial analyses identified a sizeable cluster of poor households located in the northeast part of Cuatro Santos with a high probability of receiving one or more intervention. However, none reached this area. More detailed analyses of the relations between the single interventions and the poverty clusters showed that almost all interventions were positively related to the low poverty clusters (OR > 1), and negatively connected to the high-poverty clusters (OR > 1).ConclusionsThe Cuatro Santos area of Nicaragua has reached several millennium targets, and scaling up of community actions has accelerated the trend towards fulfilling MDG without increasing inequality. However, a geographical analysis reveals that areas of high poverty barely reached by interventions remain. Therefore, continuous surveillance is important to prioritize segments of the population with more social needs.
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| 10. |
- Contreras, Mariela, 1979-
(författare)
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Child nutrition in rural Nicaragua : Population-based studies in a transitional society
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Emerging favourable as well as unfavourable nutrition patterns are observed in societies undergoing rapid social and economic change. The aim of this thesis is to analyse the associations between household and maternal resources and infant and young child feeding habits and nutritional status in rural Nicaragua, a low-income transitional society.All households (n=1,500) in Los Cuatro Santos with at least one child (0-3 y) were visited to collect information on feeding of the youngest child. Children´s anthropometry was also measured using standardised World Health Organisation (WHO) techniques. Validated instruments were used to assess household and maternal resources. All instruments had been adapted to the local context and piloted in a nearby community. The education of the mother showed more independent variation in the studied outcomes. The odds for exclusive breastfeeding were highest in infants aged 0 to 5 months of mothers with the lowest education. Further, children aged 6 to 35 months with lowest educated mothers were less likely to consume highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs). They were also less likely to be exposed to a double burden of suboptimal feeding (concurrent unmet WHO recommended feeding practices and consumption of HP snacks or SSBs). However, children aged 6 to 35 months were more prone to infrequently meet dietary diversity and to more shortness. Children in the same age group with lower educated mothers were also shorter in households with the lowest housing quality.Higher level of maternal education contributed both favourably and unfavourably to child feeding and nutrition. This was reflected in more and less frequent practice of the WHO feeding indicators, but also in more frequent children´s consumption of HP snacks and SSBs. Higher maternal education was associated with taller children, even in households with the lowest housing quality.
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