Assessing knowledge, attitude, and practice of emergency contraception: a cross-sectional study among Ethiopian undergraduate female students

Background: Emergency contraception (EC) is a type of modern contraception which is indicated after unprotected sexual intercourse when regular contraception is not in use. The importance of EC is evident in preventing unintended pregnancies and its ill consequences like unintended child delivery or unsafe abortion, which are the most common causes of maternal mortality. Therefore, EC need to be available and used appropriately as a backup in case regular contraception is not used, misused or failed. Knowing that Ethiopia is one of the countries with highest maternal mortality rate, this study aimed to assess the knowledge, attitude and practice of EC, and to further elucidate the relationship between these factors and some socioeconomic and demographic characteristics among female undergraduate students of Addis Ababa University (AAU). This information will contribute substantially to interventions intended to combat maternal mortality. Methods: A Cross-sectional quantitative study among 368 AAU undergraduate students was conducted using self-administered questionnaire. Study participants were selected by stratified random sampling. Data was entered and analyzed using SPSS Version 17. Results were presented using descriptive statistics, cross-tabulation and logistic regression. Results: Among the total participants (n = 368), only 23.4% were sexually active. Majority (84.2%) had heard of EC; 32.3% had a positive attitude towards it. The main source of information reported by the respondents was Media (69.3%). Among those who were sexually active, about 42% had unprotected sexual intercourse. Among those who had unprotected sexual intercourse, 75% had ever used EC. Sexually active participants had significantly better attitude towards EC than sexually inactive participants (crude OR 0.33(0.15-0.71)); even after adjusting for possible confounders such as age, region, religion, ethnicity, marital status, department and family education and income (adj. OR 0.36(0.15-0.86)). Conclusions: The study showed high EC awareness and usage in contrast to other studies in the city, which could be due to the fact that university students are relatively in a better educational level. Therefore, it is highly recommended that interventions intended to combat maternal mortality through contraceptive usage need to be aware of such information specific to the target groups

Are time-trends of smoking among pregnant immigrant women in Sweden determined by cultural or socioeconomic factors?

<p>Abstract</p> <p>Background</p> <p>The widening socioeconomic gap in smoking during pregnancy remains a challenge to the Swedish antenatal care services. However, the influence of cultural factors in explaining the socioeconomic differences in smoking during pregnancy is not clear among the immigrant women. The aim of this study was to investigate whether the development of smoking prevalence among pregnant immigrant women in Sweden followed the trajectory which could be expected from the stages of the global smoking epidemic model in the women's countries of origin, or not.</p> <p>Methods</p> <p>Delivery data on pregnancies in Sweden from 1982 to 2001 was collected from the Swedish Medical Birth Registry. From a total of 2,224,469 pregnant women during this period, all immigrant pregnant women (n = 234,731) were selected to this study. A logistic regression analysis and attributable fraction were used to investigate the association between smoking during pregnancy and the socioeconomic differences among immigrant women.</p> <p>Results</p> <p>Overall, the prevalence of smoking among pregnant immigrant women decreased from 30.3% in 1982 to 11.0% in 2001, albeit with remarkable differences between educational levels and country of origin. The greatest decline of absolute prevalence was recorded among low educated women (27,9%) and among other Nordic countries (17,9%). In relative terms, smoking inequalities increased between educational levels regardless of country of origin. The odds ratios for low educational level for women from other Nordic countries increased from 4.9 (95% CI 4.4-5.4) in 1982 to 13.4 (95% CI 11.2-16.2) in 2001, as compared to women with high education in the same group. Further, the total attributable fraction for educational difference increased from 55% in 1982 to 62% in 2001, demonstrating the strong effect of educational attainment.</p> <p>Conclusions</p> <p>Our hypothesis that the socioeconomic time trend of smoking based on the stage of the world wide tobacco epidemic model related to country of origin of the immigrant women was not supported by our analyses. Our findings does not support a call for specific "culture sensitive" antismoking policies or interventions in Sweden or similar countries, but reinforce the existing evidence with a focus on women with a low educational level, regardless of cultural background.</p

Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study

BACKGROUND: Ghana's maternal mortality ratio remains high despite efforts made to meet Millennium Development Goal 5. A number of studies have been conducted on maternal mortality in Ghana; however, little is known about how the causes of maternal mortality are distributed in different socio-demographic subgroups. Therefore the aim of this study was to assess and analyse the causes of maternal mortality according to socio-demographic factors in Ghana.METHODS: The causes of maternal deaths were assessed with respect to age, educational level, rural/urban residence status and marital status. Data from a five year retrospective survey was used. The data was obtained from Ghana Maternal Health Survey 2007 acquired from the database of Ghana Statistical Service. A total of 605 maternal deaths within the age group 12-49 years were analysed using frequency tables, cross-tabulations and logistic regression.RESULTS: Haemorrhage was the highest cause of maternal mortality (22.8%). Married women had a significantly higher risk of dying from haemorrhage, compared with single women (adjusted OR = 2.7, 95%CI = 1.2-5.7). On the contrary, married women showed a significantly reduced risk of dying from abortion compared to single women (adjusted OR = 0.2, 95%CI = 0.1-0.4). Women aged 35-39 years had a significantly higher risk of dying from haemorrhage (aOR 2.6, 95%CI = 1.4-4.9), whereas they were at a lower risk of dying from abortion (aOR 0.3, 95% CI = 0.1-0.7) compared to their younger counterparts. The risk of maternal death from infectious diseases decreased with increasing maternal age, whereas the risk of dying from miscellaneous causes increased with increasing age.CONCLUSIONS: The study shows evidence of variations in the causes of maternal mortality among different socio-demographic subgroups in Ghana that should not be overlooked. It is therefore recommended that interventions aimed at combating the high maternal mortality in Ghana should be both cause-specific as well as target-specific

SMOKING AND SMOKING CESSATION IN A HEALTH EQUITY PERSPECTIVE IN SWEDEN – AN EPIDEMIOLOGICAL STUDY IN THE ADULT POPULATION

The widening inequalities in smoking are one of the growing public health challenges in western countries, where smoking and smoking cessation patterns are unequally distributed among the populations. Inequalities in smoking and smoking cessation are closely associated with factors such as socioeconomic status, psychosocial and cultural factors. In Sweden, individuals with low socioeconomic status, low social capital, and immigrants have been reported to smoke more, to stop smoking to a lesser extent, and to have higher risks of exposure to environmental tobacco smoke (ETS) compared to their counterparts. The overall aim of this thesis has been to assess the impact of socioeconomic and demographic factors on smoking and smoking cessation in order to fill knowledge gaps for future policy formulation and implementation of effective measures to decrease tobacco smoking at the population level, as well as to decrease the socially inequitable distribution of smoking. The study populations of this thesis are based on data from the Medical Birth Registry (MBR) in Sweden (Studies I & II), the Scania Public Health Survey (SPHS) 2000, Study III), and the Scania Public Health Cohort (SPHC) 2000–2005 (Study IV). In Study I, registry data indicating educational level and smoking status at the first antenatal visit in all pregnancies from 1982 to 2001 was analysed to assess the impact of educational level on smoking during pregnancy. In Study II, immigrant pregnant women were selected from the same population as Study I in order to investigate whether smoking among pregnant immigrant women in Sweden follows the epidemic model in the women’s countries of origin. For both studies, prevalences, odds ratios based on prevalences and total attributable fractions were compared for five-year intervals. In Study III, vocationally active individuals between the ages of 18 and 65 were selected from SPHS 2000 to assess the association between sociodemographic factors and exposure to ETS. This association was measured by means of logistic regression analysis. Study IV followed up baseline smokers for five years to assess the impact of social capital on smoking cessation. Cox’s proportional hazard regression was used to measure this association. Overall, smoking prevalence declined dramatically in absolute terms, but in relative terms inequalities in smoking increased between pregnant women with different educational attainment regardless of country of origin. Similarly, the exposure to environmental tobacco smoke has been shown to be concentrated among people with low socioeconomic status. Moreover, low education and low trust have been shown to act as independent factors influencing smoking cessation. Further, a low level of social participation acts synergistically with low education in preventing smoking cessation. Total attributable fraction has been suggested as an appropriate measure of inequalities and preferably could be used in policy making. To tackle increasing inequalities in smoking, integrative policies in tobacco control ought to consider investing in low socioeconomic groups rather than cultural patterns, where there exists less likelihood of stopping smoking and a higher risk of ETS exposure. Including aspects of social capital in smoking cessation may also benefit the overall tobacco control policies

Socioeconomic and demographic differences in exposure to environmental tobacco smoke at work: the Scania Public Health Survey 2000

Background: A study was undertaken to investigate the sociodemographic distribution of workplace exposure to environmental tobacco smoke (ETS) in a Swedish working population sample. Methods: 8,270 individuals were assessed by questionnaire in the Scania Public Health Survey. The influence of sociodemographic factors on ETS exposure at work was investigated by multivariable regression analysis. Results: Individuals under 25 years old were at highest risk of ETS exposure. Male skilled manual workers and female unskilled manual workers had higher adjusted odds ratios (OR 4.0, 95% CI: 3.1-5.3 and OR 3.2, 95% CI: 2.2-4.7, respectively) of ETS exposure than non-manual high-level employees. Conclusions: ETS should be recognized as a factor contributing to health inequalities. Women of childbearing age need protective strategies

Smoking behavior and sociodemographic differences among young people: Further evidence from southern Sweden based on public health survey data.

Aims: Tobacco-smoking behaviours of young people between the age of 18 and 25 years are less understood than those of middle-aged people. The aim of this study is to contribute to improved knowledge of some of the factors that are associated with smoking and cessation among young people. Methods: We use the most recently available public health survey data from the southern region of Skåne in Sweden to analyze these factors. The survey is a cross-sectional study with a total sample size of 28,198 individuals with 2801 in the age category of interest. We apply statistical measures of association between smoking and gender and also model the relationship between smoking and smoking cessation and the role of a set of sociodemographic determinants by means of logistic regression to estimate odds ratios. Results: The findings include significant differences between the younger age group and the older group with respect to the odds of smoking and method of cessation. We also find differences between young women and men with regard to smoking prevalence, intensity and cessation methods. In particular, young women attempt to quit smoking by means of unassisted methods to a significantly higher extent than do young men. Conclusions: There are significant differences between young people and older individuals with respect to a range of smoking behaviours. There are also strong gender effects within the group of young people. Policy development and anti-smoking interventions need to take such differences into consideration for improved effectiveness

Misclassified Maternal Deaths among East African Immigrants in Sweden

Abstract is not availabl