The relationship of women's status and empowerment with skilled birth attendant use in Senegal and Tanzania.

BackgroundMaternal mortality remains unacceptably high in sub-Saharan Africa with 179,000 deaths occurring each year, accounting for 2-thirds of maternal deaths worldwide. Progress in reducing maternal deaths and increasing Skilled Birth Attendant (SBA) use at childbirth has stagnated in Africa. Although several studies demonstrate the important influences of women's status and empowerment on SBA use, this evidence is limited, particularly in Africa. Furthermore, few studies empirically test the operationalization of women's empowerment and incorporate multidimensional measures to represent the potentially disparate influence of women's status and empowerment on SBA use across settings.MethodsThis study examined the relationship of women's status and empowerment with SBA use in two African countries--Senegal and Tanzania--using the 2010 Demographic and Health Surveys (weighted births n = 10,688 in SN; 6748 in TZ). Factor analysis was first conducted to identify the structure and multiple dimensions of empowerment. Then, a multivariate regression analysis was conducted to examine associations between these empowerment dimensions and SBA use.ResultsOverall, women's status and empowerment were positively related to SBA use. Some sociodemographic characteristics showed similar effects across countries (e.g., age, wealth, residence, marital relationship, parity); however, women's status and empowerment influence SBA use differently by setting. Namely, women's education directly and positively influenced SBA use in Tanzania, but not in Senegal. Further, each of the dimensions of empowerment influenced SBA use in disparate ways. In Tanzania women's higher household decision-making power and employment were related to SBA use, while in Senegal more progressive perceptions of gender norms and older age at first marriage were related to SBA use.ConclusionsThis study provides evidence of the disparate influences of women's status and empowerment on SBA use across settings. Results indicate that efforts to increase SBA use and to reduce maternal mortality through the improvement of women's status and empowerment should focus both on improving girls' education and delaying marriage, as well as transforming gender norms and decision-making power. However, given the multi-dimensional and contextual nature of women's status and empowerment, it is critical to identify key drivers to increase SBA use in a given setting for contextually tailored policy and programming

Health inequity in pandemic anxiety about COVID-19 infection and socioeconomic consequences in Japan: A structural equation modeling approach

BACKGROUND: Health inequity in relation to COVID-19 infection and socioeconomic consequences is a major global concern. Mental health issues in vulnerable populations have received special attention in research and practice during the COVID-19 pandemic. However, there is limited evidence on the nature of the anxieties experienced as a result of COVID-19, and how such concerns vary across demographic groups. AIM: This study examines anxiety among the working population of Japan (aged 18–59), in terms of both COVID-19 infection and socioeconomic consequences, using an internationally validated tool, the Pandemic Anxiety Scale (PAS). METHODS: Data were collected using an online survey (n = 2,764). The analyses included an exploratory factor analysis (EFA), a confirmatory factor analysis (CFA), and structural equation modeling (SEM), followed by validation of the Japanese version of the PAS. RESULTS: A two-factor latent variable model shows the multidimensionality of anxiety in regard to the COVID-19 pandemic and the disparity across population groups in predicting the two defined anxiety dimensions. Several path coefficients showed somewhat unexpected and/or unique results from Japan compared with previous European studies. Specifically, self-reported health status was not significantly related to disease anxiety, and those who were not in paid employment reported lower consequence anxiety. The SEM results showed a greater number of significant exogenous variables for consequence anxiety compared to disease anxiety, highlighting disparities in pandemic anxiety by socioeconomic status in regard to socioeconomic consequences of the pandemic. CONCLUSION: In contrast to existing European studies, evidence from the current study suggests contextual patterns of health inequity. Due to the prolonged socioeconomic consequences of the pandemic, multidisciplinary research on mental health issues and the quality of life remains an important research agenda in exploring socioeconomic measures in context, towards addressing inequity concerns

The crystal structure of the plant small GTPase OsRac1 reveals its mode of binding to NADPH oxidase

This research was originally published in Journal of Biological Chemistry. Ken-ichi Kosami, Izuru Ohki, Minoru Nagano, Kyoko Furuita, Toshihiko Sugiki, Yoji Kawano, Tsutomu Kawasaki, Toshimichi Fujiwara, Atsushi Nakagawa, Ko Shimamoto and Chojiro Kojima. The crystal structure of the plant small GTPase OsRac1 reveals its mode of binding to NADPH oxidase. Journal of Biological Chemistry. 2014; 289, 28569-28578. © the American Society for Biochemistry and Molecular Biology

Investigating Pathways Linking Women's Status and Power to Skilled Birth Attendant Use at Childbirth in Senegal and Tanzania

Background. Maternal mortality remains unacceptably high in lower- and middle-income countries, with 289,000 women dying every year due to causes related to pregnancy and childbirth. Although the vast majority of deaths are preventable, progress in reducing maternal deaths has stagnated, especially in sub-Saharan Africa. The use of a Skilled Birth Attendant (SBA) at childbirth has been identified as a key intervention to prevent maternal deaths, yet SBA use continues to be limited in Africa. Method. This study examined the mechanisms and complex pathways linking women's status and power to SBA use in the two distinct African countries - Senegal and Tanzania. This study used the Demographic and Health Survey Datasets in 2010, and conducted regression analysis, mediation analysis, and structural equation modeling. The study sample included all births occurred in the last five years (weighted n=10,688 in SN; 6,748 in TZ) to currently married women (weighted n=7,033 in SN; 4,445 in TZ). Women's education is examined as a proxy of women's status. The structure and multiple dimensions of power were identified in both countries as: age at first marriage, household decision-making power, perceptions of gender norms against violence, and perceptions for sex negotiation. Results. Overall, there is a significant relationship of SBA use with women's status and power, yet the results demonstrated the disparate influences of women's education on SBA use - directly and indirectly in Tanzania, and indirectly in Senegal. Multiple dimensions of power influence SBA use as a direct and mediating determinant. However, the significant dimensions differ by country: decision-making in Tanzania; perceptions of gender norms against violence and for sex negotiation and age at first marriage in Senegal. The influence of sociodemographic characteristics (e.g., employment, household wealth) also showed variations across settings.Discussion. This study provides valuable insights in to the potential causal pathways and mechanisms by which women's status and power influence SBA use. Moreover, this study confirms the importance of identifying and using analytic techniques to appropriately model the multidimensional and contextual nature of women's status and power. The results highlighted the need for culturally and contextually tailored policy and program interventions to support advancements in gender equity and women's empowerment, as a means of improving maternal health in Africa

Investigating pathways linking women's status and empowerment to skilled attendance at birth in Tanzania: A structural equation modeling approach.

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa where use of a skilled birth attendant (SBA) at delivery has remained low. Despite the recognized importance of women's empowerment as a key determinant of maternal and newborn health, evidence from sub-Saharan Africa is more limited. Using data from the 2010 Tanzania Demographic and Health Survey (n = 4,340), this study employs a robust method-structural equation modeling (SEM)-to investigate the complex and multidimensional pathways through which women's empowerment affects SBA use. The results show that women's education and household decision-making are positively associated with SBA use. However, not all empowerment dimensions have similar effects. Attitudes towards sex negotiation and violence as well as early marriage are not significant factors in Tanzania. Mediation analysis also confirms the indirect effect of education on SBA use only through household decision-making. The findings underscore the utility of structural equation modeling when examining complex and multidimensional constructs, such as empowerment, and demonstrate potential causal inference to better inform policy and programmatic recommendations

The relationship of women's status and empowerment with skilled birth attendant use in Senegal and Tanzania.

BackgroundMaternal mortality remains unacceptably high in sub-Saharan Africa with 179,000 deaths occurring each year, accounting for 2-thirds of maternal deaths worldwide. Progress in reducing maternal deaths and increasing Skilled Birth Attendant (SBA) use at childbirth has stagnated in Africa. Although several studies demonstrate the important influences of women's status and empowerment on SBA use, this evidence is limited, particularly in Africa. Furthermore, few studies empirically test the operationalization of women's empowerment and incorporate multidimensional measures to represent the potentially disparate influence of women's status and empowerment on SBA use across settings.MethodsThis study examined the relationship of women's status and empowerment with SBA use in two African countries--Senegal and Tanzania--using the 2010 Demographic and Health Surveys (weighted births n = 10,688 in SN; 6748 in TZ). Factor analysis was first conducted to identify the structure and multiple dimensions of empowerment. Then, a multivariate regression analysis was conducted to examine associations between these empowerment dimensions and SBA use.ResultsOverall, women's status and empowerment were positively related to SBA use. Some sociodemographic characteristics showed similar effects across countries (e.g., age, wealth, residence, marital relationship, parity); however, women's status and empowerment influence SBA use differently by setting. Namely, women's education directly and positively influenced SBA use in Tanzania, but not in Senegal. Further, each of the dimensions of empowerment influenced SBA use in disparate ways. In Tanzania women's higher household decision-making power and employment were related to SBA use, while in Senegal more progressive perceptions of gender norms and older age at first marriage were related to SBA use.ConclusionsThis study provides evidence of the disparate influences of women's status and empowerment on SBA use across settings. Results indicate that efforts to increase SBA use and to reduce maternal mortality through the improvement of women's status and empowerment should focus both on improving girls' education and delaying marriage, as well as transforming gender norms and decision-making power. However, given the multi-dimensional and contextual nature of women's status and empowerment, it is critical to identify key drivers to increase SBA use in a given setting for contextually tailored policy and programming

Examining the mechanisms by which women’s status and empowerment affect skilled birth attendant use in Senegal: a structural equation modeling approach

Abstract Background Despite the reduction in maternal deaths globally, maternal mortality rates remain unacceptably high, particularly in some regions of the world. In sub-Saharan Africa, maternal mortality rates have even increased recently, with 201,000 deaths in 2015 as compared to 179,000 in 2013. Use of a skilled birth attendant (SBA) at delivery has remained low, despite evidence of the effectiveness of SBAs in reducing maternal deaths. Women’s empowerment is increasingly recognized as a key determinant of maternal health care-seeking and outcomes, yet empirical examinations of the linkages between women’s empowerment and delivery care use are particularly limited, especially from sub-Saharan Africa. Methods Using data from the 2010 Senegal Demographic and Health Survey (n = 7451), in this study we employed structural equation modeling (SEM) to investigate the complex and multidimensional pathways by which three women’s empowerment domains (household decision-making, attitudes towards violence, and sex negotiation) directly and indirectly affect SBA use. Results Although variations were observed across measures, many of the women’s status and empowerment measures were positively related to SBA use. Notably, women’s education demonstrated a substantial indirect effect: higher education was related to older age at first marriage, which was associated with higher levels of empowerment and SBA use. In addition to age at first marriage, gender-role attitudes (e.g., progressive attitudes towards violence and sex negotiation) were significant mediators in the relationship between education and SBA use. However, household decision-making was not significantly associated with SBA use. Conclusions Findings indicate significant effects of women’s education, early marriage, and some dimensions of women’s empowerment on SBA use. SEM was particularly useful in examining the complex and multidimensional constructs of women’s empowerments and their effects. This study informs policy recommendations and programmatic efforts to reduce maternal mortality in sub-Saharan Africa by strengthening support for women’s access to higher education, delaying marriage and childbearing among girls and young women, and supporting more equitable gender norms