An investigation of the association between household biomass fuel smoke exposure, anaemia and stunting in children aged 12-59 months participating in the 2006-2007 Swaziland Demographic and Health Survey

Background Indoor air pollution due to use of biomass fuels (BMF) for household cooking and heating is a known risk factor of morbidity and mortality in children under the age of five years. A recent study in India suggested an association between biomass fuel smoke exposure anaemia and stunting among children under the age of five. The aim of this study was to investigate the association between BMF use, stunting and anaemia in children aged 12-59 months who participated in the 2006-2007 Swaziland Demographic and Health Survey (SDHS), whilst adjusting for potential confounders. Methods The study was cross-sectional and based on secondary data analysis of data collected through the household and women’s questionnaires in the 2006-2007 SDHS, which employed a multistage random sampling. Anthropometric measurements taken in the SDHS and the World Health Organization (WHO) 2006 Multi-Centre Child growth reference standards were used to ascertain children’s health status and the stunting outcome variable. A child, whose height-for-age ratio was below three standard deviations (SD) from the median of the WHO reference population in terms of height-for-age, was severely stunted or short for his/her age. A child, whose height-for-age ratio was between three and two SD below the median of the WHO reference population in terms of height-for-age, was mildly stunted. The exposure to BMF smoke variable was ascertained indirectly by type of fuel used for cooking. The exposure was a three category variable of cleaner fuel, outdoor BMF and indoor BMF use. All statistical analysis was done in STATA version 10. The relationship between BMF use and stunting or anaemia was determined using multinomial logistic regression analyses, whilst adjusting for potential confounding factors, identified in previous research. Results Of the 1612 children included in the study, 37% were anaemic. Nineteen percent were mildly and 18% were moderate to severely anaemic. Indoor BMF use, child age, low birth weight, mother’s age at birth, iron supplementation during pregnancy and mother’s anaemia status was significantly associated with child anaemia in univariate analysis. Outdoor BMF exposure, low birth weight, child age, mother’s anaemia status and wealth index was associated with child anaemia after adjusting for potential confounding. Overall 31% of children were stunted. Twenty percent were mildly stunted and 11% were moderate to severely stunted. Child sex, age, birth order, preceding birth interval, low birth weight, diarrhoea in preceding two weeks, anaemia status, iron supplementation during pregnancy, mother’s age at birth ,mother’s body mass index, mother’s education, wealth index, indoor BMF exposure and household crowding were each independently associated with stunting in univariate analysis. Only child sex, low birth weight and child age were significantly associated with stunting after adjusting for potential confounding. There was no evidence of an association between indoor BMF smoke exposure and child stunting after adjusting for all potential confounding factors. Conclusion This study did not find sufficient evidence to suggest that indoor BMF use is a statistically significant risk factor for anaemia or stunting in children aged 12-59 months participating in the 2006-2007 SDHS. There was however an evidence that, use of BMF outdoors significantly confers a protective effect against moderate to severe anaemia. Prospective research into these potential relationships are necessary, particularly the collection of primary data and accurate measurement of exposure to smoke emitted during BMF use for cooking and heating

Biomass fuel use for household cooking in Swaziland : is there an association with anaemia and stunting in children aged 6–36 months?

BACKGROUND : This study is the second to investigate the association between the use of biomass fuels (BMF) for household cooking and anaemia and stunting in children. Such fuels include coal, charcoal, wood, dung and crop residues. METHODS : Data from the 2006–2007 Swaziland Demographic and Health Survey (a cross-sectional study design) were analysed. Childhood stunting was ascertained through age and height, and anaemia through haemoglobin measurement. The association between BMF use and health outcomes was determined in multinomial logistic regression analyses. Various confounders were considered in the analyses. RESULTS : A total of 1150 children aged 6–36 monthswere included in the statistical analyses, of these 596 (51.8%) and 317 (27.6%)were anaemic and stunted, respectively. BMFusewas not significantly associated with childhood anaemia in univariate analysis. Independent risk factors for childhood anaemia were child’s age, history of diarrhoea and mother’s anaemia status. No significant association was observed between BMF use and childhood stunting, after adjusting for child’s gender, age, birth weight and preceding birth interval. CONCLUSION : This study identified the need to prioritize anaemia and stunting as health outcomes and introduction of public health intervention in Swaziland. Further research is needed globallyon the potential effects ofBMFuse on childhood anaemia and stunting.http://www.elsevier.com/locate/trstmhhb201

Reflections on the process, challenges, and lessons learned conducting remote qualitative research on Violence against women during COVID-19 pandemic lockdown in South Africa

Background: Violence against women (VAW) research is a sensitive topic, which has been conducted mainly using face-to-face methods. The COVID-19 pandemic lockdown and restrictions on movement presented an opportunity to conduct VAW research using remote methods. We discuss how we adapted methods, reflect on lessons learned, and make recommendations highlighting key considerations when conducting remote research on a sensitive topic of VAW. Methods: We designed and conducted an exploratory qualitative study using remote methods with 18 men and 19 women, aged 18 years and older, who lived with their partner or spouse during lockdown in South Africa. The aim of the study was to explore experiences of COVID-19 lockdown, and its link to women and children’s experiences of violence in the homes. Data presented in this paper draws from researchers’ reflections drawn from debriefing sessions during the research process, and from participants’ interview transcripts. Findings: Remote recruitment of participants took longer than anticipated, and we had to re-advertise the study. We could not ensure safety and privacy during interviews. Regardless of all the safety and privacy measures we put in place during the research process, some participants had an adult person present in the room during interviews, and the researchers had no control over interruptions. Rapport was difficult to establish without an in-person connection, which limited disclosure about violence experience (amongst women) and perpetration (amongst men). Conclusions: Given the methodological and ethical challenges which limited disclosure of VAW remotely, we conclude that telephone interviews used in our study impacted on the quality of study data. Therefore, we do not recommend VAW research to be conducted remotely, unless it is essential and participants are already known to the interviewer and trust has been established

Livelihoods of young women with and without disabilities in KwaZulu-Natal during COVID-19

Background: Persons with disabilities are more likely to have poorer livelihood outcomes, including food insecurity. Inequalities are heightened for young women with disabilities, especially in times of crisis. Objectives: To understand the livelihood experience of young South African women with and without disabilities during the coronavirus pandemic (COVID-19). Method: We conducted a longitudinal study with 72 young women with and without disabilities enrolled in tertiary institutions in eThekwini, South Africa. We undertook a series of in-depth interviews collecting quantitative and qualitative data, prompting participants’ experiences during the COVID-19 pandemic, including living arrangements, impact on education, access to resources and food security. Results: Participants reported livelihood changes related to living arrangements, education, income, and social connectedness during the pandemic. Social grants (old-age pension, child support, disability grant) and student stipends were critical financial resources to ensure food security. Participants with disabilities were more likely to experience food insecurities and moderate hunger, with their households having less access to mitigating resources such as land or livestock. Deaf participants also reported social isolation. Conclusion: The study shows that social protection mechanisms mitigated the financial impact of the lockdown for all recipients but that participants with disabilities still struggled more than others to ensure food security. These additional challenges may be related to pre-existing inequalities, with participants with disabilities and their households having less access to natural resources and financial stability. Contribution: This paper focuses on young women with and without disabilities and provides insight into the similarities and differences in their experiences

Reflections on the process, challenges, and lessons learned conducting remote qualitative research on Violence against women during COVID-19 pandemic lockdown in South Africa

DATA AVAILABITY STATEMENT: The datasets analysed in the study are available from the corresponding author on reasonable request.BACKGROUND: Violence against women (VAW) research is a sensitive topic, which has been conducted mainly using face-to-face methods. The COVID-19 pandemic lockdown and restrictions on movement presented an opportunity to conduct VAW research using remote methods. We discuss how we adapted methods, reflect on lessons learned, and make recommendations highlighting key considerations when conducting remote research on a sensitive topic of VAW. METHODS: We designed and conducted an exploratory qualitative study using remote methods with 18 men and 19 women, aged 18 years and older, who lived with their partner or spouse during lockdown in South Africa. The aim of the study was to explore experiences of COVID-19 lockdown, and its link to women and children’s experiences of violence in the homes. Data presented in this paper draws from researchers’ reflections drawn from debriefing sessions during the research process, and from participants’ interview transcripts. FINDINGS: Remote recruitment of participants took longer than anticipated, and we had to re-advertise the study. We could not ensure safety and privacy during interviews. Regardless of all the safety and privacy measures we put in place during the research process, some participants had an adult person present in the room during interviews, and the researchers had no control over interruptions. Rapport was difficult to establish without an in-person connection, which limited disclosure about violence experience (amongst women) and perpetration (amongst men). CONCLUSIONS: Given the methodological and ethical challenges which limited disclosure of VAW remotely, we conclude that telephone interviews used in our study impacted on the quality of study data. Therefore, we do not recommend VAW research to be conducted remotely, unless it is essential and participants are already known to the interviewer and trust has been established.The South African Medical Research Council and the DST – NRF Centre of Excellence (CoE) in Human Development.https://bmcpublichealth.biomedcentral.com/School of Health Systems and Public Health (SHSPH)SDG-05:Gender equalitySDG-16:Peace,justice and strong institution

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning

Purpose: Calls for “mutuality” in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. // Methods: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. // Results: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators’ needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. // Conclusion: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept

Mental ill health and factors associated with men’s use of intimate partner violence in Zimbabwe

Abstract Background Over the years, researchers have relied on data from women victims to understand the profile on male perpetrators of intimate partner violence (IPV). IPV studies with male participants in the general population are still emerging in Africa. The contribution of mental ill health to IPV perpetration in the general population that has been documented elsewhere is emergent. Notwithstanding, research with male perpetrators is essential to informing effective prevention programmes and interventions. To contribute to the emerging literature on male perpetrators, we conducted a study to estimate the prevalence and factors associated with IPV perpetration by men in heterosexual relationships. We also modelled pathways to IPV perpetration using data from Zimbabwe. Methods Data were collected through a nationwide survey employing a random and multi-staged sampling method. We recruited and administered a structured questionnaire to 2838 men aged 18 years and above. IPV was measured using an adapted WHO Domestic Violence Questionnaire. Determinants of IPV measured included child abuse, alcohol abuse, post-traumatic stress disorder (PTSD), depressive symptoms, personal gender attitudes and risky sexual behaviours. Multivariate regression modelling was used to assess factors associated with IPV perpetration. Structural equation modelling was used to explore the underlying pathways to recent IPV perpetration. Results Forty one percent of men had perpetrated IPV in their lifetime and 8.8% percent of men perpetrated IPV in the 12 months before the survey. Older, more educated men, men who binge drank, men who were abused as children or experienced other life traumatic experiences were more likely to perpetrate IPV in lifetime. Depressive symptoms and sexual relationship power (were also associated with lifetime IPV perpetration. IPV perpetration in the last 12 months was associated with binge drinking, PTSD and sexual relationship power. The pathways to IPV perpetration in the last 12 months from child abuse to recent IPV were mediated by comorbid PTSD symptoms, depression binge drinking and sexual relationship power. Conclusions IPV perpetration was associated with child abuse history, mental ill health, sexual relationship power and personal gender attitudes. Interventions to reduce IPV need to engage men to address gender inequality, mental ill health and reduce alcohol consumption

Women's child abuse, mental ill health and IPV

Data from a household survey with a representative sample of women from Gauteng Province of South Africa in 2010

Social support factors associated with psychological resilience among women survivors of intimate partner violence in Gauteng, South Africa

Background: Women’s experiences of intimate partner violence (IPV) increase their risk for mental ill health. However, some women exposed to IPV and adversity are psychologically resilient and function well despite these exposures. Objectives: We conducted a study to investigate the factors that are associated with psychological resilience among abused women, using data collected in a household survey conducted in Gauteng province of South Africa. Methods: Data is from a cross-sectional study. A multi-stage random sampling approach was used to select a sample of 501 women. The World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence Questionnaire was used to measure lifetime experience of physical and sexual IPV. Only 189 women who had experienced lifetime IPV were included in this secondary analysis. Resilience was measured as scoring below the threshold for the Centre for Epidemiological Studies Depression Scale and the Harvard Trauma Questionnaire. Other explanatory factors measured included child sexual abuse, non-partner rape, other traumatic life events, social support indicators, binge drinking and socio-demographic variables. Multivariable regression analysis was used to test factors associated with resilience. Results: Forty two percent of women scored below the threshold for post-traumatic stress disorder (PTSD) or depressive symptoms at the time of the survey and so were categorized as resilient. Social support indicators were associated with increased resilience. Women who perceived that their communities were supportive and they would easily find money in an emergency were more likely to be resilient. Women who binge drank, experienced severe IPV in the past 12 months, received negative reactions to disclosure and utilized medical or psychosocial services were less likely to be resilient. Conclusion: Social support indicators including social connectedness, stronger network ties and perceived supportive communities are key factors in fostering resilience among abused women. Interventions should aim to promote stronger and supportive social networks and increase women’s utilization of formal support services

Structural Pathways between Child Abuse, Poor Mental Health Outcomes and Male-Perpetrated Intimate Partner Violence (IPV).

BACKGROUND:Violent trauma exposures, including child abuse, are risk factors for PTSD and comorbid mental health disorders. Child abuse experiences of men exacerbate adult male-perpetrated intimate partner violence (IPV). The relationship between child abuse, poor mental health and IPV perpetration is complex but research among the general population is lacking. This study describes the relationship and pathways between history of child abuse exposure and male-perpetrated IPV while exploring the potentially mediating effect of poor mental health. METHODS:We analysed data from a randomly selected, two-stage clustered, cross-sectional household survey conducted with 416 adult men in Gauteng Province of South Africa. We used multinomial regression modelling to identify associated factors and Structural Equation Modelling (SEM) to test the primary hypothesis that poor mental health (defined as abusing alcohol or having PTSD or depressive symptoms) mediates the relationship between child abuse and IPV perpetration. RESULTS:Eighty eight percent of men were physically abused, 55% were neglected, 63% were emotionally abused and 20% were sexually abused at least once in their childhood. Twenty four percent of men had PTSD symptoms, 24% had depressive symptoms and 36% binge drank. Fifty six percent of men physically abused and 31% sexually abused partners at least once in their lifetime. Twenty two percent of men had one episode and 40% had repeat episodes of IPV perpetration. PTSD symptomatology risk increased with severity of child trauma and other trauma. PTSD severity increased the risk for binge drinking. Child trauma, other trauma and PTSD symptomatology increased the severity of depressive symptoms. PTSD symptomatology was comorbid with alcohol abuse and depressive symptoms. Child trauma, having worked in the year before the survey, other trauma and PTSD increased the risk of repeat episodes of IPV perpetration. Highly equitable gender attitudes were protective against single and repeat episodes of IPV perpetration. There was a direct path between the history of child trauma and IPV perpetration and three other indirect paths showing the mediating effects of PTSD, other trauma and gender attitudes. CONCLUSIONS:Child trauma is a risk factor for both poor mental health and male-perpetrated IPV among men in Gauteng. Male-perpetrated IPV in these settings should be explained through a combination of the Trauma, Feminist, and Intergenerational Transmission of Family Violence theories. Prevention interventions for male- perpetrated IPV in South Africa need to incorporate strategies and therapies to address poor mental health conditions