Consequences of gender-based violence on female high school students in eastern Ethiopia

Gender-based violence (GBV) is a significant global public health problem and adversely impacts the physical and mental health of women. This study aimed to determine the consequences of GBV (including sexual, physical, emotional, and overall GBV) on female high school students in eastern Ethiopia. An institutional-based cross-sectional survey was conducted among 1,199 female high school students in eastern Ethiopia using a self-administered questionnaire. Descriptive statistics were calculated. Chi-square tests were used to analyse the data. This study revealed that more than half (55%) of the study participants had experienced any type of GBV during their lifetime. There were statistically significant differences between the educational status and childhood residence of participants who experienced and participants who did not experience sexual violence, physical violence, emotional violence, and any type of GBV in their lifetime (p<0.001). Students who had experienced sexual violence during their lifetime reported consequences of physical health, including swelling around genitalia (33.7%), unusual vaginal discharge (30.7%), and injury around the genitalia (23.9%). Mental health consequences included self-blame (35.7%), and anxiety (23.3%). Educational consequences included poor school performance (36.1%), absenteeism (34.6%), and dropout (28.9%). Students who had experienced any type of GBV during their lifetime reported consequences of physical violence, including poor school performance (18.7%), and withdrawal from school (9.0%). The main perpetrators of any type of GBV were reported to be family members, students, or boyfriends/husbands. GBV is a severe public health problem among female high school students. Primary and secondary prevention is vital to curb the consequences of GBV.   La violence basée sur le genre (VBG) est un problème de santé publique mondial important et a un impact négatif sur la santé physique et mentale des femmes. Cette étude visait à déterminer les conséquences de la VBG (y compris sexuelle, physique, émotionnelle et globale) sur les lycéennes de l'est de l'Éthiopie. Une enquête transversale en milieu institutionnel a été menée auprès de 1 199 lycéennes dans l'est de l'Éthiopie à l'aide d'un questionnaire auto-administré. Des statistiques descriptives ont été calculées. Des tests du chi carré ont été utilisés pour analyser les données. Cette étude a révélé que plus de la moitié (55 %) des participants à l'étude avaient subi tout type de VBG au cours de leur vie. Il y avait des différences statistiquement significatives entre le statut scolaire et la résidence d'enfance des participants qui ont subi et des participants qui n'ont pas subi de violence sexuelle, de violence physique, de violence émotionnelle et de tout type de VBG au cours de leur vie (p<0,001). Les élèves qui ont subi des violences sexuelles au cours de leur vie ont signalé des conséquences sur leur santé physique, notamment un gonflement autour des organes génitaux (33,7 %), des pertes vaginales inhabituelles (30,7%) et des blessures autour des organes génitaux (23,9 %). Les conséquences sur la santé mentale comprenaient l'auto-accusation (35,7%) et l'anxiété (23,3 %). Les conséquences sur l'éducation comprenaient de mauvais résultats scolaires (36, %), l'absentéisme (34,6 %) et le décrochage (28,9 %). Les élèves qui ont subi tout type de VBG au cours de leur vie ont signalé les conséquences de la violence physique, notamment de mauvais résultats scolaires (18,7 %) et le retrait de l'école (9,0 %). Les principaux auteurs de tout type de VBG seraient des membres de la famille, des étudiants ou des petits amis/maris. La VBG est un grave problème de santé publique chez les lycéennes. La prévention primaire et secondaire est vitale pour freiner les conséquences de la VBG

Barriers and facilitators to smoking cessation within pregnant Aboriginal and/or Torres Strait Islander women: an integrative review

Objective: To synthesise primary research regarding the facilitators and barriers to smoking cessation amongst Aboriginal and/or Torres Strait Islander women during pregnancy.Design: An integrative review.Review methods: A systematic search of peer-reviewed literature from five databases published from January 2008 to April 2018. Articles were reviewed using the approach outlined by Whittemore and Knafl, with the identified themes collated and synthesised according to study characteristics and barriers and facilitators of smoking cessation.Findings: Of the 310 papers retrieved, nine studies were included within the review (five quantitative and four qualitative). The quality of the studies were ascertained via Joanna Briggs Institute checklists for cross sectional analysis, randomized controlled trials, and qualitative research. The overall quality of the research was deemed acceptable. Two facilitators to smoking cessation within the studied population were identified: 'support to quit' and ' information and advice', while four barriers to smoking cessation within pregnant Aboriginal and/or Torres Strait Islander women were identified: ' smoking prevalence', 'high daily stress', ' ambivalence regarding adverse effects of smoking', and 'attitudes, knowledge and training of the healthcare professional'.Conclusions: Social and familial influences and daily stress have a strong impact on whether a woman feels she can quit smoking during pregnancy. However, in this study, information and advice regarding potential adverse effects of smoking on the foetus, or lack thereof, from health professionals either facilitated cessation of smoking in pregnancy or was a barrier to quitting. Likewise, a lack of awareness from midwives and doctors on smoking cessation strategies, such as nicotine replacement therapy, was a barrier for women.Implications for practice: The findings indicate that education regarding the adverse effects of smoking in pregnancy, as well as strategies on smoking cessation from midwives, doctors, and Aboriginal Health Workers within the antenatal period may have a positive effect on current smoking rates among pregnant Aboriginal and/or Torres Strait Islander women. Involving the partner/support person and family of the woman in this education may have a greater impact on smoking cessation rates through the woman gaining social and familial support in her decision to quit. Thus, healthcare workers require additional professional development to provide information and knowledge within a culturally competent manner. Successful smoking cessation programs for Aboriginal and Torres Strait Islander women during pregnancy could have measurable impacts on mortality rates for Indigenous infants and significantly contribute to 'Closing the Gap'

Effectiveness of pharmacotherapy for smoking cessation: protocol for umbrella review and quality assessment of systematic reviews

Abstract Background In the long term, smoking cessation can decrease the risk of cancer, stroke, and heart attacks and improve overall survival. The aim of the proposed umbrella review is to summarize existing systematic reviews that assessed the effects of pharmacological interventions for smoking cessation and to evaluate the methodological quality of previously conducted systematic reviews. Methods Databases such as the Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHIL PsychINFO Web of Science, Conference Papers Index, Scopus, and Google Scholar will be used to retrieve reviews. Systematic reviews which included only randomized control trials will be considered in this review. The primary outcome will be prolonged abstinence from smoking for a minimum of 6 months follow-up, and the secondary outcome will be point abstinence rate from smoking of less than 6 months follow-up but more than 7 days. Methodological quality of the included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool, which contains 16 domains. Two authors will screen the titles and abstracts of all reviews obtained by the search strategy, assess the full text of selected articles for inclusion, and extract data independently. The quality appraisal will be also assessed by two authors (AM, CC) independently, and Cohen’s Kappa statistic will be used to assess inter-ratter agreement. The findings of the study will be narrated qualitatively to describe the effect of different pharmacotherapy on smoking cessation. Discussion The World Health Organization recommends treatment of tobacco dependence as one approach in its comprehensive tobacco control policy. To date, many trials and systematic reviews have been conducted to assess the effectiveness of pharmacotherapy for smoking cessation. Therefore, the findings of the umbrella review will improve clinical decision-making and be used as a baseline for future studies. Systematic review registration PROSPERO CRD4201708090

Determinants of intimate partner violence against women in Ethiopia: A multi-level analysis.

Intimate partner violence (IPV) continues to be a major public health problem globally. Although Ethiopia has a high prevalence of IPV, previous studies in this country have only investigated individual-level determinants of IPV within small geographic areas. The current study aimed to identify the individual-, relationship-, community-, and societal-level determinants of IPV directed against women in Ethiopia since women are predominantly affected. A retrospective analysis of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) was conducted. A sample of 3,897 married women of reproductive age (15-49 years) who participated in the domestic violence module of the survey were included in the analysis. Three-level mixed-effects multilevel logistic regression models were used to estimate the individual-, relationship-, community-, and societal-level determinants of IPV. Variability at the community- and societal-level were also assessed. About 1,328 (34.1%) of 3,897 participants reported experiencing IPV (a composite measure of physical, sexual and emotional abuse). In adjusted models, the odds of lifetime IPV experience were higher among women who were older, were married before the age of 18 years, witnessed inter-parental violence during their childhood, had a partner who drank alcohol, and lived in a community with high IPV accepting norms. Alternatively, the odds of IPV were lower among women who had decision-making autonomy in the household, had the same or lower educational attainment as their partner, and lived in a community with low proportions of educated women. These findings reveal that although individual-level factors were significant determinants of IPV, higher level factors, including female education and IPV acceptance in the community, were also important influences on this major public health issue in Ethiopia. These findings suggest combined interventions at different levels may reduce IPV in this country

Maternal health factors as risks for postnatal depression: a prospective longitudinal study

Purpos

Regardless of where they give birth, women living in non-metropolitan areas are less likely to have an epidural than their metropolitan counterparts

Question: Can differences in Australian birth intervention rates be explained by women's residence at the time of childbearing?. Methods: Data were collected prospectively via surveys in 1996, 2000, 2003, 2006 and 2009 from women, born between 1973 and 1978, of the Australian Longitudinal Study on Women's Health. Analysis included data from 5886 women who had given birth to their first child between 1994 and 2009. Outcome measures were self-report of birth interventions: pharmacological pain relief (epidural and spinal block analgesia, inhalational analgesia and intramuscular injections), surgical births (an elective or emergency caesarean section) and instrumental births (forceps and ventouse). Findings: Primiparous women residing in non-metropolitan areas of Australia experienced fewer birth interventions than women residing in metropolitan areas: 43% versus 56% received epidural analgesia; 8% versus 11% had elective caesarean sections; and 16% versus 18% had emergency caesarean sections. Differences in maternal age and private health insurance status at first birth accounted for differences in surgical birth rates but did not fully explain differences in epidural analgesia. Conclusion: Non-metropolitan women had fewer birth interventions, particularly epidural analgesia, than metropolitan women. Differences in maternal age and private health insurance do not fully explain the differences in epidural analgesia rates, suggesting care provided to labouring women may differ by area of residence. The difference in epidural analgesia rates may be due to lack of choice in maternity services, however it could also be due to differing expectations leading to differences in birth interventions for primiparous women living in metropolitan and non-metropolitan areas

Poor adherence to national and international breastfeeding duration targets in an Australian longitudinal cohort

Objectives: To report on the proportion and characteristics of Australian infants who are fed, and mothers who feed, in accordance with the national and international breastfeeding duration targets of six, 12 and 24 months. Furthermore, to examine the longitudinal breastfeeding duration patterns for women with more than one child. Methods: Breastfeeding duration data for 9773 children have been self-reported by a national sample of 5091 mothers aged 30–36 years in 2009, participating in the Australian Longitudinal Study on Women’s Health. Results: Only 60% of infants received the minimum recommended 6 months of breast milk, irrespective of breastfeeding exclusivity. Less than 30% of infants received any breast milk at 12 months, and less than 3% were breastfed to the international target of 24 months. Young, less educated, unmarried or low-income women were at an increased risk of premature breastfeeding cessation. For women with three or more children, nearly 75% of women who breastfed their first child for at least six months reached this breastfeeding duration target for their next two children. Conclusion: While national breastfeeding rates are typically evaluated in relation to the infant, a novel component of our study is that we have assessed maternal adherence to breastfeeding duration targets and the longitudinal feeding practices of women with more than one child. Separate evaluations of maternal and infant breastfeeding rates are important as they differ in their implications for public health policy and practice

Association between preconception maternal stress and offspring birth weight: findings from an Australian longitudinal data linkage study

Objective Examine the relationship between preconception stress and offspring birth weight.Setting Population-based cohort study linked with state-based administrative perinatal data.Participants 6100 births from 3622 women from the 1973–1978 cohort of the Australian Longitudinal Study of Women’s Health who (1) recorded a singleton birth between January 1997 and December 2011; (2) returned at least one follow-up survey within 3 years of conception; and (3) had complete data on perceived stress prior to conception.Primary outcome measures Linear generalised estimating equations were used to examine the relationship between preconception stress and a continuous measure of birth weight, exploring differences based on birth order and stress chronicity. The minimal sufficient adjustment set of covariates was determined by a directed acyclic graph.Results For all births, there was no relationship between moderate/high acute or chronic stress and offspring birth weight in grams. Among first births only, there was a trend towards a relationship between moderate/high chronic stress and offspring birth weight. Offspring sex was associated with birth weight in all models, with female babies born lighter than male babies on average, after adjusting for covariates (p<0.0001).Conclusions Effects of preconception stress on birth weight was largely driven by time to conception. With the timing of stress critical to its impact on obstetrical outcomes, preconception care should involve not only reproductive life planning but the space to provide interventions at critical periods so that optimal outcomes are achieved