Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study

Mihiretu Alemayehu, Mengistu Meskele School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Introduction: Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts. Methodology: A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multi-stage sampling. A survey was administered face-to-face through an interview format. EpiData v1.4.4.0 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P-value <0.2 in bivariate analysis were selected for multivariable regression. Finally, variables with P-value <0.05 in multivariable logistic regressions were identified as independent predictors. Odds ratios along with confidence intervals were used to determine the presence of association. Result: It was determined that 58.4% of women have autonomy, while 40.9% of study participants’ health care decisions were made by their husbands. The husband’s education (adjusted odds ratio [AOR] =1.91 [1.10, 3.32]), wealth index (AOR =0.62 [0.42, 0.92]), age (AOR =2.42 [1.35, 4.32] and AOR =7 [3.45, 14.22]), family size (AOR =0.53 [0.33, 0.85] and AOR =0.42 [0.23, 0.75]), and occupation (AOR =1.66 [1.14, 2.41]), were predictors of health care decision making autonomy. Conclusion: Even though every woman has the right to participate in her own health care decision making, more than two fifths of them have no role in making health care decisions about their own health. Husbands play a major role in making health care decisions about their wives. A comprehensive strategy needs to be implemented in order to empower women, as well as to challenge the traditional male dominance. Special attention has to be given to women living in rural areas in order to reduce their dependency through education and income generating activities. Keywords: decision making, women’s autonomy, health care decision, women’s empowerment, Wolaita, Dawro, Southern Ethiopi

Recent sexual violence exposure is associated with immune biomarkers of HIV susceptibility in women

Problem: HIV/AIDS and sexual violence act synergistically and compromise women\u27s health. Yet, immuno-biological mechanisms linking sexual violence and increased HIV susceptibility are poorly understood. Methods: We conducted a cross-sectional pilot study of HIV-uninfected women, comparing 13 women exposed to forced vaginal penetration within the past 12 weeks (Exposed) with 25 Non-Exposed women. ELISA assays were conducted for 49 biomarkers associated with HIV pathogenesis in plasma and cervicovaginal lavage (CVL). Differences between Exposed and Non-Exposed were analyzed by linear and logistic regression, using propensity score weighting to control for age, race, socioeconomic status, menstrual cycle, and contraceptive use. Results: In CVL, Exposed women had significantly reduced chemokines MIP-3α (p \u3c.01), MCP-1 (p \u3c.01), and anti-HIV/wound-healing thrombospondin-1 (p =.03). They also had significantly increased inflammatory cytokine IL-1α (p \u3c 0.01) and were more likely to have detectable wound-healing PDGF (p =.02). In plasma, Exposed women had reduced chemokines MIP-3α (p \u3c.01) and IL-8 (p \u3c.01), anti-inflammatory cytokine TGF-β (p =.02), anti-HIV/antimicrobial HBD–2 (p =.02), and wound-healing MMP-1 (p = 0.02). They also had increased thrombospondin-1 (p \u3c.01) and Cathepsin B (p =.01). After applying the stringent method of false discovery rate adjustment, differences for IL-1α (p =.05) and MCP-1 (p =.03) in CVL and MIP-3α (p =.03) in plasma remained significant. Conclusions: We report systemic and mucosal immune dysregulation in women exposed to sexual violence. As these biomarkers have been associated with HIV pathogenesis, dysregulation may increase HIV susceptibility