Geographic variation and factors associated with female genital mutilation among reproductive age women in Ethiopia: A national population based survey

Background: Female genital mutilation (FGM) is a common traditional practice in developing nations including Ethiopia. It poses complex and serious long-term health risks for women and girls and can lead to death. In Ethiopia, the geographic distribution and factors associated with FGM practices are poorly understood. Therefore, we assessed the spatial distribution and factors associated with FGM among reproductive age women in the country. Method: We used population based national representative surveys. Data from two (2000 and 2005) Ethiopian demographic and health surveys (EDHS) were used in this analysis. Briefly, EDHS used a stratified, two-stage cluster sampling design. A total of 15,367 (from EDHS 2000) and 14,070 (from EDHS 2005) women of reproductive age (15-49 years) were included in the analysis. Three outcome variables were used (prevalence of FGM among women, prevalence of FGM among daughters and support for the continuation of FGM). The data were weighted and descriptive statistics (percentage change), bivariate and multivariable logistic regression analyses were carried out. Multicollinearity of variables was assessed using variance inflation factors (VIF) with a reference value of 10 before interpreting the final output. The geographic variation and clustering of weighted FGM prevalence were analyzed and visualized on maps using ArcGIS. Z-scores were used to assess the statistical difference of geographic clustering of FGM prevalence spots. Result: The trend of FGM weighted prevalence has been decreasing. Being wealthy, Muslim and in higher age categories are associated with increased odds of FGM among women. Similarly, daughters from Muslim women have increased odds of experiencing FGM. Women in the higher age categories have increased odds of having daughters who experience FGM. The odds of FGM among daughters decrease with increased maternal education. Mass media exposure, being wealthy and higher paternal and maternal education are associated with decreased odds of women's support of FGM continuation. FGM prevalence and geographic clustering showed variation across regions in Ethiopia. Conclusion: Individual, economic, socio-demographic, religious and cultural factors played major roles in the existing practice and continuation of FGM. The significant geographic clustering of FGM was observed across regions in Ethiopia. Therefore, targeted and integrated interventions involving religious leaders in high FGM prevalence spot clusters and addressing the socio-economic and geographic inequalities are recommended to eliminate FGM. © 2016 Setegn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

An ethnographic investigation of maternity healthcare experience of immigrants in rural and urban Alberta, Canada

Background: Canada is among the top immigrant-receiving nations in the world. Immigrant populations may face structural and individual barriers in the access to and navigation of healthcare services in a new country. The aims of the study were to (1) generate new understanding of the processes that perpetuate immigrant disadvantages in maternity healthcare, and (2) devise potential interventions that might improve maternity experiences and outcomes for immigrant women in Canada. Methods: The study utilized a qualitative research approach that focused on ethnographic research design and data analysis contextualized within theories of organizational behaviour and critical realism. Data were collected over 2.5 years using focus groups and in-depth semistructured interviews with immigrant women (n = 34), healthcare providers (n = 29), and social service providers (n = 23) in a Canadian province. Purposive samples of each subgroup were generated, and recruitment and data collection – including interpretation and verification of translations – were facilitated through the hiring of community researchers and collaborations with key informants. Results: The findings indicate that (a) communication difficulties, (b) lack of information, (c) lack of social support (isolation), (d) cultural beliefs, e) inadequate healthcare services, and (f) cost of medicine/services represent potential barriers to the access to and navigation of maternity services by immigrant women in Canada. Having successfully accessed and navigated services, immigrant women often face additional challenges that influence their level of satisfaction and quality of care, such as lack of understanding of the informed consent process, lack of regard by professionals for confidential patient information, short consultation times, short hospital stays, perceived discrimination/stereotyping, and culture shock. Conclusions: Although health service organizations and policies strive for universality and equality in service provision, personal and organizational barriers can limit care access, adequacy, and acceptability for immigrant women. A holistic healthcare approach must include health informational packages available in different languages/media. Health care professionals who care for diverse populations must be provided with training in cultural competence, and monitoring and evaluation programs to ameliorate personal and systemic discrimination

Migrant health in French Guiana: Are undocumented immigrants more vulnerable?

<p>Abstract</p> <p>Background</p> <p>Few data exist on the health status of the immigrant population in French Guiana. The main objective of this article was to identify differences in its health status in relation to that of the native-born population.</p> <p>Methods</p> <p>A representative, population-based, cross-sectional survey was conducted in 2009 among 1027 adults living in Cayenne and St-Laurent du Maroni. Health status was assessed in terms of self-perceived health, chronic diseases and functional limitations. The migration variables were immigration status, the duration of residence in French Guiana and the country of birth. Logistic regression models were conducted.</p> <p>Results</p> <p>Immigrants account for 40.5% and 57.8% of the adult population of Cayenne and St-Laurent du Maroni, respectively. Most of them (60.7% and 77.5%, respectively) had been living in French Guiana for more than 10 years. A large proportion were still undocumented or had a precarious legal status. The undocumented immigrants reported the worst health status (OR = 3.18 [1.21-7.84] for self-perceived health, OR = 2.79 [1.22-6.34] for a chronic disease, and OR = 2.17 [1.00-4.70] for a functional limitation). These differences are partially explained by socioeconomic status and psychosocial factors. The country of birth and the duration of residence also had an impact on health indicators.</p> <p>Conclusion</p> <p>Data on immigrant health are scarce in France, and more generally, immigrant health problems have been largely ignored in public health policies. Immigrant health status is of crucial interest to health policy planners, and it is especially relevant in French Guiana, considering the size of the foreign-born population in that region.</p

Searching for sex- and gender-sensitive tuberculosis research in public health: finding a needle in a haystack

Bilkis Vissandjee,1 Assia Mourid,2 Christina A Greenaway,3 Wendy E Short,4 Jodi A Proctor5 1Faculty of Nursing, Public Health Research Institute, Universit&eacute; de Montr&eacute;al, Montr&eacute;al, Montr&eacute;al, QC, Canada; 2Allied Health Library, Universit&eacute; de Montr&eacute;al, Montr&eacute;al, QC, Canada; 3Department of Medicine, McGill University, Division of Infectious Diseases, Jewish General Hospital, Montr&eacute;al, QC, Canada; 4Faculty of Humanities and Social Sciences, School of Social Sciences, University of Queensland, St Lucia, QLD, Australia; 5School of Social Work, McGill University, Montr&eacute;al, QC, Canada Abstract: Despite broadening consideration of sex- and gender-based issues in health research, when seeking information on how sex and gender contribute to disease contexts for specific health or public health topics, a lack of consistent or systematic use of terminology in health literature means that it remains difficult to identify research with a sex or gender focus. These inconsistencies are driven, in part, by the complexity and terminological inflexibility of the indexing systems for gender- and sex-related terms in public health databases. Compounding the issue are authors&rsquo; diverse vocabularies, and in some cases lack of accuracy in defining and using fundamental sex&ndash;gender terms in writing, and when establishing keyword lists and search criteria. Considering the specific case of the tuberculosis (TB) prevention and management literature, an analysis of sex and gender sensitivity in three health databases was performed. While there is an expanding literature exploring the roles of both sex and gender in the trajectory and lived experience of TB, we demonstrate the potential to miss relevant research when attempting to retrieve literature using only the search criteria currently available. We, therefore, argue that for good clinical practice to be achieved; there is a need for both public health researchers and users to be better educated in appropriate usage of the terminology associated with sex and gender. In addition, public health database indexers ought to accept the task of developing and implementing adequate definitions of sex and gender terms so as to facilitate access to sex- and gender-related research. These twin advances will allow clinicians to more readily recognize and access knowledge pertaining to systems of redress that respond to gendered risks that compound existing health inequalities in disease management and control, particularly when dealing with already complex diseases. Given the methodological and linguistic challenges presented by the multidimensional and highly contextual nature of definitions of sex and gender, it will be important that this review task be undertaken using a multidisciplinary approach. Keywords: sex, gender, tuberculosis, literature search, indexing, databases, terminological accuracy, keywords searc

Gender dynamics and sexual norms among youth in Mali in the context of HIV/AIDS prevention

Socially constructed ideas of gender norms and values attached to sexuality need to be considered when aiming to build the young people’s capacity to adopt HIV preventive behaviours. We conducted ten focus groups and sixteen individual interviews to explore sexual norms among youth in Bamako. Premarital sex, multiple partnering, condomuse and transactional sex were discussed. The findings suggest that young people’s sexual norms are shaped by kin or authoritative elders as well as by external influences coming from Western culture. Sexual norms are differentially constructed by men and women and are in contradiction with those of older generations. Views on premarital sex, condom use and transactional sex generated controversy among men and women, as well as among more sexually conservative or progressive youth. However, there was general rejection of multiple partnerships. Empowering youth to pursue open debates on sexuality may be an avenue for HIV/AIDS prevention in Mali (Afr J Reprod Health 2008; 12[3]:173-184)

Traitement du diabète : auto-traitement, utilisation des services de santé et recherche d'information chez les immigrants récents de Toronto

Introduction Notre objectif était d'explorer les pratiques d'auto-traitement, l'utilisation des services de santé et la recherche d'information sur le diabète de type 2 chez les adultes des deux sexes issus de quatre communautés d'immigrants récents de Toronto. Méthodologie Un questionnaire structuré a été adapté au contexte canadien et traduit en 4 langues. En tout, 184 participants atteints du diabète de type 2 (130 immigrants récents et 54 sujets nés au Canada) ont été recrutés tant en milieu communautaire qu'en milieu hospitalier. Résultats Les immigrants récents étaient significativement moins nombreux que les sujets nés au Canada àvérifier régulièrement leur glycémie et l'état de leurs pieds et significativement plus nombreux que les sujets nés au Canada à être non-fumeurs, à faire régulièrement de l'activité physique et à réduire leur apport alimentaire en graisses. Les immigrants récents avaient significativement moins souvent recours à un spécialiste, à un autre dispensateur de soins et à un diététiste et déclaraient en moins grand nombre consulter des diététistes, des infirmières et des organisations pour diabétiques comme sources d'information sur le diabète. Des différences importantes ont été observées selon le sexe et le pays d'origine. Conclusion Les observations semblent indiquer que les stratégies de prévention et de prise en charge du diabète destinées aux immigrants récents doivent tenir compte des barrières linguistiques, financières, informationnelles et systémiques qui nuisent à l'accès à l'information et aux soins. </sec

Self-management, health service use and information seeking for diabetes care among recent immigrants in Toronto

Introduction Our objective was to explore self-management practices, health services use and information-seeking for type 2 diabetes care among adult men and women from four recent immigrant communities in Toronto. Methods A structured questionnaire was adapted for the Canadian context and translated into 4 languages. A total of 184 participants with type 2 diabetes—130 recent immigrants and 54 Canadian-born—were recruited in both community and hospital settings. Results Recent immigrants were significantly less likely than the Canadian-born group to perform regular blood glucose and foot checks and significantly more likely than the Canadian-born group to be non-smokers, participate in regular physical activity and reduce dietary fat. Recent immigrants were significantly less likely than the Canadian-born group to use a specialist, alternative provider and dietician and less likely to report using dieticians, nurses and diabetes organizations as sources of diabetes-related information. Important differences were observed by sex and country of origin. Conclusion Findings suggest that diabetes prevention and management strategies for recent immigrants must address linguistic, financial, informational and systemic barriers to information and care. </sec