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

Determinants of health facility utilization for childbirth in rural western Kenya: cross-sectional study

Background: Skilled attendance at delivery is recognized as one of the most important factors in preventing maternal death. However, more than 50% of births in Kenya still occur in non-institutional locations supported by family members and/or traditional birth attendants (TBAs). To improve this situation, a study of the determinants of facility delivery, including individual, family and community factors, was necessary to consider effective intervention in Kenya.Methods: This study was conducted to identify the factors which influence the place of delivery in rural western Kenya, and to recommend ways to improve women\u27s access to skilled attendants at delivery. A community-based cross-sectional survey was carried out from August to September 2011 in all 64 sub-locations which were covered by community health workers (CHWs). An interviewer-administered questionnaire on seventeen comprehensive variables was administered to 2,560 women who had children aged 12-24 months.Results: The response rate was 79% (n = 2,026). Of the respondents, 48% of births occurred in a health facility and 52% in a non-institutional location. The significant determinants of facility delivery examined using multivariate analysis were: maternal education level, maternal health knowledge, ANC visits, birth interval, economic status of household, number of household members, household sanitation practices and traveling time to nearest health facility.Conclusions: The results suggest that the involvement of TBAs to promote facility delivery is still one of the most important strategies. Strengthening CHWs\u27 performance by focusing on a limited number of topics and clear management guidance might also be an effective intervention. Stressing the importance of regular attendance at ANC (at least four times) would be effective in enhancing motivation for a facility delivery. Based on our findings, those actions to improve the facility delivery rate should focus more on pregnant women who have a low education level, poor health knowledge and short pregnancy spacing. In addition, women with low economic status, a large number of family members and a long distance to travel to a health facility should also be targeted by further interventions

Predictive risk factors for liver abscess rupture: A prospective study of 138 cases

Introduction: Liver abscess is a serious condition due to its complications. The most frequent complication is rupture. Our aim is to determine the predictive risk factors of liver abscess rupture at the Saint Louis Regional Hospital Center.Material and methods: This is a prospective descriptive and analytical study over the period of 1st January 2016 to 28th February 2019. We included liver abscess records regardless of age. An univariate and then multivariate analysis according to a Cox model allowed us to determine the factors associated with the occurrence of rupture.Results: We collected 138 cases with 78 cases of amoebic abscess (55.3%) and 60 cases of pyogenic abscess (42.6%). We had 36 cases of rupture (26%), including 29 cases in the peritoneal cavity. The mean age was 28 years ± 18. The sex ratio (M:F) was 3.7. There were 35.5% (n= 49) of patients aged under 15 years. The mean consultation time was 18.8 days ± 4.5. The localization was the right lobe in 76.7%, the left lobe in 9.3% and bi lobar in 14%. The mean diameter of abscesses was 8 cm ± 7.5 (Range: 3.7; 16 cm). The abscesses were unique in 85.5% of cases, and sub-capsular in 15.2% of case. Gas was present in 5.7% of cases. The commonest germ found was Staphylococcus aureus in 14.5% of patients. The predictive risk factors of rupture found after univariate analysis were: diameter (p &lt;0.001), age less than 15 years (OR= 4.3; p&lt;0.001), pyogenic origin of abscesses (OR= 4.3, p &lt;0.001), undernutrition (OR=2.3, p= 0.038), jaundice (OR = 4.5, p = 0.009) , left-lobe localization (OR= 7, p = 0.002), subcapsular localization (OR=8.6, p &lt;0.001); the presence of gas (p &lt;0.001). Multivariate analysis identified 5 variables considered as independent risk factors for rupture: the pyogenic origin (HR= 22.51, p&lt;0.001); age less than 15 years (HR= 2,296, p= 0.049); abscess diameter (HR= 1.411, p= 0.004); left lobe localization (HR= 18.68, p &lt;0.001) and sub-capsular localization (HR= 2.689, p= 0.017).Conclusion: In our study, predictive risk factor for liver abscess rupture were: pyogenic origin, age less than 15 years, abscess diameter, left-lobe and subcapsular localization. The knowledge of these factors allows early and appropriate treatment to avoid complications.</p