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Health Science Reports Oct 2023Despite the fact that public health measures such as social isolation can help control the coronavirus disease 2019 (Covid-19) pandemic, these procedures may contribute...
BACKGROUND AND AIMS
Despite the fact that public health measures such as social isolation can help control the coronavirus disease 2019 (Covid-19) pandemic, these procedures may contribute to elevated levels of stress and escalate various forms of violence against women. The current study aimed to estimate the prevalence of domestic violence and identify factors associated with domestic violence during the Covid-19 lockdown among married women attending healthcare centers in Iran.
METHODS
This cross-sectional study, conducted between 2020 and 2021, focused on a sample of 5317 married women who sought healthcare services within urban centers across five major cities in Iran. Sampling was done through a multistage cluster method. The Revised Conflict Tactics Scales (CTS2) were used to assess levels of violence. The collected data was analyzed using descriptive and inferential statistics, including independent sample -test, Chi-square, and multiple logistic regression) with the SPSS software version 22.
RESULTS
During the Covid-19 lockdown, psychological violence was reported by 66.7% of women (95% confidence interval [CI], 65.44%-67.98%), physical violence by 44.8% (95% CI, 43.43%-46.10%), sexual violence by 28.8% (95% CI, 27.60%-30.03%), and injury by 24.5% (95% CI, 23.39%-25.70%). The multiple logistic regression showed several significant factors associated with domestic violence. These included low levels of social support ( < 0.001), shorter duration of marriage ( < 0.001), unemployment of both women ( < 0.007) and their spouses ( < 0.001), poor economic status ( < 0.001), as well as substance abuse by the husband, including alcohol ( < 0.001) and drug abuse ( < 0.01), and smoking ( < 0.01).
CONCLUSION
The findings highlighted the magnitude of domestic violence against women during the Covid-19 lockdown. It is crucial to implement comprehensive strategies that encompass preventive and responsive measures to address domestic violence not only during lockdowns but also in the post-lockdown period.
PubMed: 37829503
DOI: 10.1002/hsr2.1627 -
SSM - Population Health Dec 2023This study examines the association between parental engagement and subsequent delayed marriage of adolescent girls and, secondarily, to assess whether parental...
Is parental engagement associated with subsequent delayed marriage and marital choices of adolescent girls? Evidence from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey in Uttar Pradesh and Bihar, India.
OBJECTIVE
This study examines the association between parental engagement and subsequent delayed marriage of adolescent girls and, secondarily, to assess whether parental engagement is positively associated with girls' involvement in marital decision-making regarding husband selection.
METHODS
The study used longitudinal survey data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) in Uttar Pradesh and Bihar, India. We analysed 6168 unmarried adolescent girls aged 15-19 years at wave 1 (2015-16) who were interviewed in wave 2 (2018-19). Our outcomes were delayed marriage of girls (unmarried vs. married at 20-22 vs. married at 18-19 vs. married at <18) and, among those married at <18 years, girls' involvement in husband selection (alone vs. with parents vs. not involved). Parental discussion around school performance, friendships, menstruation, pregnancy, free time, and personal issues were the exposure variables. We applied unadjusted and adjusted multinomial regression models to assess associations between our exposure variables and each outcome variable.
RESULTS
From wave 1 to wave 2, 1551 girls (31.2%) married; 567 girls (12.5%) married as minors (<18 years). We found that parental discussion around school performance (relative risk ratio [RRR]: 1.33), friendship (RRR: 1.37) and personal matters (RRR: 1.29) were positively associated with remaining unmarried relative to early marriage of girls. However, discussion with parents about menstruation was negatively associated with marriage at 20-22 (RRR: 0.67) and remaining unmarried (RRR: 0.80), compared to early marriage. Discussing school performance was negatively associated with marriage at 18-19 (RRR: 0.62) and at 20-22 (RRR: 0.50), relative to early marriage. Discussing personal issues with parents was positively associated with joint parent-girl decision-making regarding husband selection, relative to parents alone selecting the husband (RRR: 1.43).
CONCLUSIONS
Parental engagement on school performance, friendship, and personal issues in early adolescence may help delay marriage and support marital choice for girls in India.
PubMed: 37860704
DOI: 10.1016/j.ssmph.2023.101523 -
World Neurosurgery Feb 2024This study was aimed to investigate the effects of marital status on overall survival (OS) and cancer-specific survival (CSS) in patients with glioblastoma (GBM) and to...
BACKGROUND
This study was aimed to investigate the effects of marital status on overall survival (OS) and cancer-specific survival (CSS) in patients with glioblastoma (GBM) and to develop nomograms for predicting prognosis in GBM patients.
METHODS
All patients were selected from the Surveillance, Epidemiology, and End Results cancer registry program. We used propensity score matching to balance the baseline characteristics of married and unmarried patients. The effects of marital status on OS and CSS were then assessed using Kaplan-Meier curves and Cox proportional hazard regression, and the magnitude of each factor was visualized in the form of forest maps. The impact of marriage on the survival of GBM patients was further explored by stratifying several demographic factors. Finally, the nomograms were constructed and verified based on Cox proportional risk regression model.
RESULTS
A total of 17,517 patients with GBM (11,818 married patients, 67.5%) were enrolled in the study cohort. After propensity score matching, there were 5699 patients in both the married and unmarried groups. Multivariate Cox regression analysis showed that both married and single patients had better OS (married: hazard ratio [HR] 0.824, 95% confidence interval [CI]: 0.788-0.862, P < 0.001; single: HR 0.764, 95% CI: 0.722-0.808, P < 0.001) and CSS (married: HR 0.833, 95% CI: 0.796-0.872, P < 0.001; single: HR 0.761, 95% CI: 0.718-0.806, P < 0.001) than divorced, separated, and widowed patients.
CONCLUSIONS
Marital status was an independent prognostic factor in patients with GBM. The nomograms constructed in this study could help medical professionals to provide personalized prognostic assessment and treatment decisions for patients with GBM.
Topics: Humans; Prognosis; Glioblastoma; SEER Program; Marital Status; Marriage; Kaplan-Meier Estimate
PubMed: 38061540
DOI: 10.1016/j.wneu.2023.11.145 -
AJOG Global Reports Aug 2023Research on fertility and reproductive health has expanded rapidly. However, questions regarding the association between women empowerment and fertility in terms of the... (Review)
Review
INTRODUCTION
Research on fertility and reproductive health has expanded rapidly. However, questions regarding the association between women empowerment and fertility in terms of the reproductive health status in Bangladesh remain unanswered. This study aimed to address these questions through a systematic literature review.
METHODS
In this review study, the PubMed, Scopus, Banglajol, and Google Scholar databases were searched systematically and screened in terms of the inclusion and exclusion criteria. Data from 15 articles included in this review were extracted for further assessment.
RESULTS
Fifteen studies with a total of 212,271 participants from Bangladesh met our selection criteria. Most of the articles were conducted on ever-married women aged 15 to 49 years using nationally representative Bangladesh Demographic and Health Survey data. The major religions were Islam (86.8%-90.2%) and Hinduism (10%-13%). The age of women at first marriage varied from 14 to 20 years, and the age at first birth ranged from 16 to 22 years. The fertility rate in Bangladesh has reduced remarkably over the period from 1975 to 2022. After controlling for other social and health factors, the study found that empowerment factors such as women's education, working status, involvement in household decision-making, participation in economic decision-making, and freedom in movement influenced the fertility and reproductive health status in Bangladesh.
CONCLUSION
As an initial step, this study found a negative relationship between women's empowerment and the control of fertility and reproductive health. Greater policy focus should be directed toward women empowerment factors to improve the fertility situation and reproductive health status in Bangladesh and other countries with similar sociodemographic profiles.
PubMed: 37396340
DOI: 10.1016/j.xagr.2023.100239 -
BMJ Open Nov 2023This study was designed to identify the patterns, prevalence and risk factors of intimate partner violence (IPV) against female adolescents and its association with...
Patterns, prevalence and risk factors of intimate partner violence and its association with mental health status during COVID-19: a cross-sectional study on early married female adolescents in Khulna district, Bangladesh.
OBJECTIVES
This study was designed to identify the patterns, prevalence and risk factors of intimate partner violence (IPV) against female adolescents and its association with mental health problems.
DESIGN
Cross-sectional survey.
SETTINGS
Dumuria (subdistrict) under the Khulna district of Bangladesh.
PARTICIPANTS
A total of 304 participants were selected purposively based on some specifications: they must be female adolescents, residents of Dumuria and married during the COVID-19 pandemic when under 18 years of age.
OUTCOME MEASURES
By administering a semi-structured interview schedule, data were collected regarding IPV using 12 five-point Likert scale items; a higher score from the summation reflects frequent violence.
RESULTS
The findings suggest that the prevalence of physical, sexual and emotional IPV among the 304 participants, who had an average age of 17.1 years (SD=1.42), was 89.5%, 87.8% and 93.7%, respectively, whereas 12.2% of the participants experienced severe physical IPV, 9.9% experienced severe sexual IPV and 10.5% experienced severe emotional IPV. Stepwise regression models identified age at marriage (p=0.001), number of miscarriages (p=0.005), education of spouse (p=0.001), income of spouse (p=0.016), age gap between spouses (p=0.008), marital adjustment (p<0.001) and subjective happiness (p<0.001) as significant risk factors. Hierarchical regression, however, indicated that age at marriage (p<0.001), age gap between spouses (p<0.001), marital adjustment (p<0.001) and subjective happiness (p<0.001) had negative associations with IPV, while the number of miscarriages (p<0.001) had a positive relationship. Pearson's correlation showed that IPV was significantly associated with depression, anxiety and stress.
CONCLUSION
During the COVID-19 pandemic, an increase in IPV and mental health problems among early married adolescents was documented. To reduce physical and mental harm and to assure their well-being, preventive and rehabilitative measures should be devised.
Topics: Pregnancy; Humans; Adolescent; Female; Cross-Sectional Studies; Spouse Abuse; Marriage; Prevalence; Bangladesh; Abortion, Spontaneous; Pandemics; COVID-19; Intimate Partner Violence; Risk Factors; Health Status
PubMed: 37977869
DOI: 10.1136/bmjopen-2023-072279 -
International Health Sep 2023Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) remains one of the most significant public health challenges globally, particularly in...
BACKGROUND
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) remains one of the most significant public health challenges globally, particularly in sub-Saharan Africa (SSA). Although HIV testing is a vital step for both prevention and treatment, its uptake is still low in SSA. We therefore examined HIV testing in SSA and its individual/household and community factors among women of reproductive age groups (15-49 y).
METHODS
Demographic and Health Survey data collected between 2010 and 2020 from 28 SSA countries were used for this analysis. We analysed the coverage of HIV testing and individual/household and community factors on 384 416 women in the reproductive age groups (15-49 y). Bivariate and multivariable multilevel binary logistic regression analysis were conducted to select candidate variables and to identify significant explanatory variables associated with HIV testing and the results were presented using adjusted odd ratios (AORs) at 95% confidence intervals (CIs).
RESULTS
The pooled prevalence of HIV testing among women of reproductive age in SSA was 56.1% (95% CI 53.7 to 58.4), with the highest coverage found in Zambia (86.9%) and the lowest in Chad (6.1%). Age (45-49 y; AOR 0.30 [95% CI 0.15 to 0.62]), women's education level (secondary; AOR 1.97 [95% CI 1.36 to 2.84]) and economic status (richest; AOR 2.78 [95% CI 1.40 to 5.51]) were some of the individual/household factors associated with HIV testing. Similarly, religion (no religion; AOR 0.58 [95% CI 0.34 to 0.97]), marital status (married; AOR 0.69 [95% CI 0.50 to 0.95]) and comprehensive knowledge of HIV (yes; AOR 2.01 [95% CI 1.53 to 2.64]) were significantly associated individual/household factors for HIV testing. Meanwhile, place of residence (rural; AOR 0.65 [95% CI 0.45 to 0.94]) was found to be a significant community-level factor.
CONCLUSION
More than half of married women in SSA have been tested for HIV, with between-country variations. Both individual/household factors were associated with HIV testing. Stakeholders should therefore consider all above-mentioned factors to plan an integrated approach to enhancing HIV testing through health education, sensitization, counselling and empowering older and married women, those with no formal education, those who do not have comprehensive HIV/AIDS knowledge and those in rural areas.
Topics: Humans; Female; HIV; Acquired Immunodeficiency Syndrome; Marital Status; Marriage; HIV Testing; Health Surveys
PubMed: 37099414
DOI: 10.1093/inthealth/ihad031 -
Biomedicines Jan 2024Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore... (Review)
Review
Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.
PubMed: 38255215
DOI: 10.3390/biomedicines12010110 -
BMJ Open Apr 2024In South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the...
Life skills and reproductive health empowerment intervention for newly married women and their families to reduce unintended pregnancy in India: protocol for the TARANG cluster randomised controlled trial.
INTRODUCTION
In South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the effectiveness of these interventions in reproductive and sexual autonomy and contraception has not been examined.
METHODS AND ANALYSIS
A two-arm, parallel, cluster randomised controlled trial will evaluate the impact of TARANG (Transforming Actions for Reaching and Nurturing Gender Equity and Empowerment), a life skills and reproductive health empowerment group-based intervention for newly married women, compared with usual services in the community in rural and tribal Rajasthan, India. TARANG will also provide light-touch sessions to husbands and mothers-in-law of newly married women. We will test the impact of TARANG in 80 village clusters among 800 eligible households comprising newly married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy within 1 year at the time of enrolment, their husbands and mothers-in-law who consent to participate. Women in the intervention villages will receive 14 sessions over a 6-month period, while husbands and mothers-in-law will receive 1 and 4 sessions (respectively) each. Three rounds of surveys will be collected over 18 months. Control villages will receive the intervention after the endline surveys. Primary outcomes include rate of unintended pregnancy and modern contraceptive use. We plan to start recruitment of participants and data collection in April 2024. We will estimate unadjusted and adjusted intention-to-treat effects using survival analysis and mixed models.
ETHICS AND DISSEMINATION
Study protocols have been reviewed and approved by the human subjects review boards at the University of California, San Francisco, and the Centre for Media Studies, India (IRB00006230) and ACE Independent Ethics Committee, Bangalore (NET0062022). Results will be disseminated in international peer-reviewed journals and conferences, to stakeholders including local government and non-governmental organisations, and directly to the communities and individuals that participated in the intervention.
TRIAL REGISTRATION NUMBER
NCT06024616.
Topics: Humans; Female; India; Pregnancy; Empowerment; Adult; Young Adult; Adolescent; Reproductive Health; Pregnancy, Unplanned; Family Planning Services; Randomized Controlled Trials as Topic; Marriage; Contraception; Rural Population; Contraception Behavior; Male
PubMed: 38688674
DOI: 10.1136/bmjopen-2024-086778 -
BMC Women's Health Dec 2023A demonstrated technique to enhance reproductive health and economic progress is through ensuring that family planning services are accessible universally. Those studies...
Individual and community level factors associated with modern contraceptive utilization among married women in the emerging region of Ethiopia: a multilevel mixed effects analysis of the 2019 Ethiopia Mini-Demographic and health survey.
BACKGROUND
A demonstrated technique to enhance reproductive health and economic progress is through ensuring that family planning services are accessible universally. Those studies that used Ethiopia Demographic and Health Survey (EDHS) data did not assess individual and community-level factors in contraceptive utilization. Thus, the study employs a multilevel mixed effects analysis approach, which allows for the examination of individual and community-level factors that influence contraceptive utilization.
METHODS
This study analyzed the 2019 Ethiopia Min Demographic and Health Survey datasets. A total of 1916 married women in the 2019 surveys were included in the analysis. The data were analyzed using Stata version 17.0. The data were analyzed using Multi-level mixed-effect logistic regression to identify the individual and community-level factors associated with modern contraceptive utilization. An adjusted odds ratio with a 95% confidence interval was used to. Show the strength and direction of the association and statistical significance was declared at a P value less than 0.05.
RESULTS
Factors significantly associated with modern contraceptive utilization were; Muslim and protestant followers [AOR = 0.31, 95% CI: (0.134, 0.714)] and [AOR = 0.35, 95% CI: (0.173, 0.691)] respectively, women with no education (OR = 0.46; 95% CI: 0.293, 0.710), those women who belong to the poor and middle wealth of household [AOR = 0.35, 95% CI: (0.237, 0.527)] and [AOR = 0.56, 95% CI: (0.347, 0.919)] respectively, women who had one to five and greater than or equal to six living children [AOR = 11.36, 95% CI:(2.119, 60.918)] and [AOR = 7.44, 95% CI:(1.437, 38.547)]respectively, Women in clusters poor wealth status [AOR = 0.40, 95% CI: (0.183, 0.875)] and women who belong to the Somali region [AOR = 0.20, 95% CI: (0.0.070, 0.506)].
CONCLUSION
The study revealed that both individual and community-level factors determined modern contraceptive utilization. At the individual level, the religion of women, educational status, the wealth of the household, and the total number of living children were significantly associated with modern contraceptive utilization. At community-level factors, community wealth status and belonging to the Somali region were significantly associated with modern contraceptive utilization. The findings suggest that interventions aimed at increasing modern contraceptive utilization should target women with lower levels of education, those living in households with lower wealth, and those with larger families. Additionally, efforts should be made to improve access to modern contraceptives in communities with lower wealth status and in regions where traditional beliefs may hinder their use.
Topics: Child; Female; Humans; Contraceptive Agents; Ethiopia; Family Planning Services; Multilevel Analysis; Marriage; Surveys and Questionnaires; Islam; Contraception Behavior
PubMed: 38062400
DOI: 10.1186/s12905-023-02822-1 -
Social Science & Medicine (1982) Aug 2023Widowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Widowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya.
METHODS
We implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models.
RESULTS
The trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p < 0.01). Almost all widowed women (97.2%) self-identified as household heads compared to 10.8% of married women. Comparing widowed vs married women, reduction in food insecurity (-3.13, 95%CI -4.42, -1.84 vs. -3.08, 95%CI -4.15, -2.02), depressive symptoms (-0.21, 95%CI -0.36, -0.07 vs. -0.19, 95%CI -0.29, -0.08), internalized stigma (-0.33, 95%CI -0.55, -0.11 vs. -0.38, 95%CI -0.57, -0.19), and anticipated stigma (-0.46 95%CI -0.65, -0.28 vs. -0.35, 95%CI -0.50, -0.21) was similar for both groups. In contrast, improvements in social support (-2.22, 95%CI -3.85, -0.59 vs. -4.00, 95%CI -5.16, -2.84; p = 0.08) and reduction in enacted stigma (0.01, 95%CI -0.06, 0.08 vs. -0.14, 95%CI -0.20, -0.09; p < 0.01) were weaker for widowed than married women.
CONCLUSIONS
Our study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support.
Topics: Humans; Female; Adult; Middle Aged; Widowhood; Marriage; HIV Infections; Agriculture; Outcome Assessment, Health Care
PubMed: 37390805
DOI: 10.1016/j.socscimed.2023.116031