| 1. |
- Amogne, Minilik Demissie, et al.
(författare)
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Prevalence and correlates of physical violence and rape among female sex workers in Ethiopia : a cross-sectional study with respondent-driven sampling from 11 major towns
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:7, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study examined the prevalence and correlates of physical violence and rape among female sex workers (FSWs) in Ethiopia.DESIGN: A cross-sectional study using respondent-driven sampling technique.SETTING: Eleven major towns in Ethiopia.PARTICIPANTS: 4900 FSWs.MAIN OUTCOME MEASURES: The prevalence of experiences of physical beating and rape.RESULTS: Among FSWs, 17.5% reported physical beating within the last year and 15.2% reported rape since they started selling sex. FSWs aged 35+ years (AOR 0.59, 95% CI 0.38 to 0.92) were less exposed to physical beating than those aged 15-24 years. FSWs working on the street (AOR 1.92, 95% CI 1.53 to 2.39), in red-light houses (AOR 1.63, 95% CI 1.12 to 2.38) and in local drinking houses (AOR 1.35, 95% CI 1.02 to 1.78) experienced more physical beating than FSWs working in bars/hotels. FSWs who consumed alcohol four or more days in a week (AOR 1.92, 95% CI 1.21 to 3.04), and who chewed khat frequently experienced more physical violence. Rape was associated with having a low monthly income, drinking alcohol four or more days per week (AOR 2.33, 95% CI 1.47 to 3.7), experience of heavy episodic drinking in a month (AOR 1.71, 95% CI 1.24 to 2.38) and chewing khat 3-4 days per week (AOR 2.15, 95% CI 1.55 to 2.98). Condom breakage was more frequent among FSWs who reported both physical beating (AOR 1.51, 95% CI 1.25 to 1.84) and rape (AOR 1.26, 95% CI 1.03 to 1.55).CONCLUSION: FSWs in Ethiopia are vulnerable to physical and sexual violence, and the risk increases when they are younger, street-based and high consumers of alcohol or khat. Therefore, targeted efforts are needed for prevention and harm reduction.
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| 2. |
- Arunda, Malachi Ochieng, et al.
(författare)
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Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda : analysis of cross-sectional, demographic and health surveys data
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:12, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DESIGN: A population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SETTING: Countrywide, Kenya and Uganda.PARTICIPANTS: Most recent live births of 24 502 mothers within 1-59 months prior to the 2014-2016 Demographic and Health Surveys.OUTCOMES: Care-seeking continuum and neonatal mortality.RESULTS: Overall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.CONCLUSION: Strategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother's continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.
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| 3. |
- Asamoah, Benedict Oppong, et al.
(författare)
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Inequality trends in maternal health services for young Ghanaian women with childbirth history between 2003 and 2014
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To achieve universal coverage of reproductive healthcare and drastic reduction in maternal mortality, adequate attention and resources should be given to young women. This study therefore aimed to examine the inequality trends in the use of antenatal care (ANC) services and skilled birth attendance (SBA) within a subgroup of Ghanaian women aged 15-24 years between 2003 and 2014. Design: This is a cross-sectional study that used data from the Ghana Demographic and Health Surveys (DHS) 2003, 2008 and 2014. We applied regression-based total attributable fraction (TAF) as an index for measuring multiple dimensions of inequality in the use of ANC and SBA. Setting: Ghana. Participants: Young women aged 15-24 years with at least one previous birth experience in the past 5 years prior to the surveys. Main outcome measures: ANC visits and skilled attendance at birth. Results: Urbanicity-related, education-related and wealth-related inequality in non-use of SBA declined between 2003 and 2008, but increased between 2008 and 2014. A consistent decline was observed in urbanicity-related inequality in non-use of four or more ANC visits from 2003 through 2008 to 2014. A similar reduction was observed for education-related inequality in relation to the same outcome. In contrast, wealth-related inequality in ANC usage increased over time. Conclusions: The rise in urbanicity-related, education-related and wealth-related inequality in the usage of SBA between 2008 and 2014 threatens the sustainability of the general progress made in the usage of maternal health services in Ghana within the same period.
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| 4. |
- Nakiganda, Lydia Jacenta, et al.
(författare)
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Cross-sectional study on the prevalence and predictors of pregnancy among women living in HIV discordant relationships in a rural Rakai cohort, Uganda
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study examines the prevalence of pregnancy in serodiscordant couples and identifies predictors associated with pregnancy in rural Rakai, Uganda. Study design A population-based cross-sectional study that used data from the Rakai Community Cohort Study (RCCS). Setting and participants: We used data from the RCCS survey round 17 (2015-2016), which included 488 women in serodiscordant relationships. This study was conducted in Rakai district, located in south-western Uganda. Primary outcomes: Pregnancy status. Statistical analysis Multivariable modified Poisson regression using stepwise selection was used to determine characteristics and behaviours associated with pregnancy status. Results: The prevalence of pregnancy was 12% in women among serodiscordant couples. HIV-negative women in serodiscordant couples had a slightly higher pregnancy prevalence rate (13.6%) compared with HIV-positive women in serodiscordant couples (11%). Factors significantly associated with higher prevalence of pregnancy were; younger age 15-24 years (prevalence risk ratio (PRR)=4.04; 95% CI 1.72 to 9.50), middle age 25-34 years (PRR=2.49; 95% CI 1.05 to 5.89), Christian religion (PRR=2.26; 95% CI 1.41 to 3.63) and inconsistent condom use in the last 12 months (PRR=4.38, 95% CI 1.09 to 17.53). Neither HIV status nor HIV status disclosure was significantly associated with risk of getting pregnant. Conclusion: Nearly 12% of women in serodiscordant relationships were pregnant, highlighting the need for integrated services to prevent unintended pregnancies and reduce conceptional related risks for those choosing to conceive. Association with younger age and inconsistent condom use suggests a role for early and continued couple-based conception counselling.
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| 5. |
- Ross, Michael W., et al.
(författare)
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Social networks of men who have sex with men and their implications for HIV/STI interventions : Results from a cross-sectional study using respondent-driven sampling in a large and a small city in Tanzania
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:11
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Men who have sex with men (MSM) in sub-Saharan Africa remain hidden and hard to reach for involvement in HIV and sexually transmitted infection (STI) services. The aim of the current study was to describe MSM social networks in a large and a small Tanzanian city in order to explore their utility for peer-based healthcare interventions. Methods: Data were collected through respondent-driven sampling (RDS) in Dar es Salaam (n=197) and in Tanga (n=99) in 2012 and 2013, using 5 and 4 seeds, respectively. All results were adjusted for RDS sampling design. Results: Mean personal network size based on the number of MSM who were reported by the participants, as known to them was 12.0±15.5 in Dar es Salaam and 7.6±8.1 in Tanga. Mean actual RDS network size was 39.4±31.4 in Dar es Salaam and 25.3±9.7 in Tanga. A majority (97%) reported that the person from whom they received the recruitment coupon was a sexual partner, close friend or acquaintance. Homophile in recruitment patterns (selective affiliation) was present for age, gay openness, and HIV status in Dar es Salaam, and for sexual identification in Tanga. Conclusions: The personal network sizes and existence of contacts between recruiter and referral indicate that it is possible to use peer-driven interventions to reach MSM for HIV/STI interventions in larger and smaller sub-Saharan African cities. The study was reviewed and approved by the University of Texas Health Science Center's Institutional Review Board (HSC-SPH-10-0033) and the Tanzanian National Institute for Medical Research (NIMR/HQ/R.8a/Vol. IX/1088).
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| 6. |
- Song, Yi, et al.
(författare)
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25-year trends in gender disparity for obesity and overweight by using WHO and IOTF definitions among Chinese school-aged children : a multiple cross-sectional study
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:9, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We sought to explore 25-year trends of gender disparity in the prevalence of obesity and overweight both in urban and rural areas among Chinese children from 1985 to 2010.METHODS: Data included 1 280 239 children aged 7-18 years enrolled in the Chinese National Survey on Students's Constitution and Health (CNSSCH), which is the largest nationally representative sample of school-aged children in China. Obesity and overweight were defined according to both WHO and the International Obesity Task Force (IOTF) definitions. Logistic regression was used to estimate the prevalence OR (POR) of gender for obesity and overweight prevalence in different surveys.RESULTS: The prevalence of obesity increased (WHO definition: from 0.10% to 4.3%; IOTF definition: from 0.03% to 2.2%) over the past 25 years in urban and rural areas among Chinese children and it was much higher among boys than girls at each survey point (p<0.01). The increasing trend was significant in all age subgroups (p<0.01). Although the prevalence of obesity continuously increased in boys and girls, the changing pace was more rapid in boys than in girls. PORs of boys versus girls for obesity also increased over time, and the estimates of PORs were higher in urban areas than in rural areas at each survey point.CONCLUSIONS: The gradually increasing gender disparity in urban and rural areas suggests that the prevalence of obesity and overweight in boys, and especially in urban boys, contributes to a large and growing proportion of obese and overweight children.
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