BACKGROUND: Anemia in women of reproductive age is a major public health challenge for low- and middle-income countries with a long-term negative impact on the health of women, their children, and the economic growth of the society. Even though the world health organization targeted a 50% global reduction of anemia among women of reproductive age by 2025, with the current trend it is unlikely to achieve this goal. OBJECTIVE: This study aimed to assess the prevalence and associated factors of anemia among women of reproductive age in eastern Africa. METHODS: A secondary data analysis, using demographic and health survey (DHS) data of 10 eastern African countries, was conducted. For our study, a total weighted sample of 101524 women of reproductive age was used. We employed a multilevel mixed-effects generalized linear model (using Poisson regression with robust error variance). Both unadjusted and adjusted prevalence ratios with their 95% confidence interval were reported. RESULTS: The prevalence of anemia in eastern Africa was 34.85 (95%CI: 34.56-35.14) ranging from 19.23% in Rwanda to 53.98% in Mozambique. In the multivariable multilevel analysis, being older age, having primary and above education, being from households with second to highest wealth quantiles, being currently working, not perceiving distance as a big problem, use of modern contraceptive methods, and rural residence was associated with a lower prevalence of anemia. While, being married and divorced/separated/widowed, women from female-headed households, women from households with unimproved toilet facility and unimproved water source, ever had of a terminated pregnancy, having high parity, and being from large household size was associated with a higher prevalence of anemia. CONCLUSION: The prevalence of anemia in eastern Africa was relatively high. Both individual level and community level factors were associated with the prevalence of anemia in women of reproductive age. Therefore, giving special attention to those women who are at a higher prevalence of anemia such as younger women, those who are from households with low socioeconomic status, unimproved toilet facility, and source of drinking water, as well as pregnant women could decrease anemia in women of reproductive age.
BACKGROUND: Early marriage is a global public health problem that is mainly practiced in South Asia, Latin America, and sub-Saharan Africa including Ethiopia. It raises the risk of early childbearing of women, higher rates of divorce, and an increased risk of maternal and child death. However, little is known about the spatial distribution and determinants of early marriage in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of early marriage among ever-married women in Ethiopia. METHODS: A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was conducted. A total weighted sample of 11,646 reproductive-age married women were included in the analysis. To identify significant hotspot areas of early marriage the Bernoulli model was fitted using SaTScan version 9.6 software. Additionally, to explore the spatial distributions of early marriage across the country ArcGIS version 10.1 statistical software was used. For the determinant factors, the multilevel logistic regression model was fitted. Deviance was used for model comparison and checking of model fitness. In the multivariable multilevel analysis, Adjusted Odds Ratio (AOR) with 95% CI was used to declare significant determinants of early marriage. RESULTS: The finding of this study revealed that the spatial distribution of early marriage was significantly varied across the country with Global Moran's I = 0.719 and p value < 0.001. The primary clusters were detected in Tigray, Amhara, and Afar regions. Both individual and community-level factors were associated with early marriage. Having no formal education (AOR = 4.25, 95% CI 3.13-5.66), primary education (AOR = 3.37, 95% CI 2.80-4.92), secondary education (AOR = 1.75, 95% CI 1.32-2.33), and a decision made by parents (AOR = 1.88, 95% CI 1.68-2.09) were individual-level factors associated with higher odds of early marriage. Among the community-level factors, the region was significantly associated with early marriage. Thus, living in Afar (AOR = 1.82, 95%CI 1.37-2.42), Amhara (AOR = 1.77, 95% CI 1.38-2.77), and Gambela (AOR = 1.44, 95% CI 1.09-190) was associated with higher odds of early marriage. Whereas, living in Addis Ababa (AOR = 0.50, 95% CI 0.36-0.68) was associated with a lower chance of early marriage. CONCLUSION: The spatial distribution of early marriage was significantly varied in Ethiopia. Women's education, women's autonomy, and region were found to be the significant determinants of early marriage. Therefore, public health interventions targeting those identified significant hotspot areas of early marriage are crucial to reduce the incidence of early marriage and its consequence. In addition, enhancing women's education and empowering them to make their own choices are vital for changing the customs of the community and eliminating early marriage in Ethiopia.
Adugnaw Zeleke Alem, Yigizie Yeshaw, Sewnet Adem Kebede et al.
BACKGROUND: Optimal pregnancy spacing is an important incidence in reproductive women's health. Short or long pregnancy spacing leads to the greatest health, social and economic problems such as increase in maternal and infant mortality and morbidity, and adverse pregnancy outcomes. The aim of this study is to assess the mean of pregnancy spacing and associated factors of pregnancy spacing among women of reproductive age group with recurrent event analysis. METHODS: The fertility history of 1350 women aged 15-49 years was collected in this cross-sectional study. The women were selected through multistage random sampling method from a list of clinics in 2018. Some predictors were collected from their records and others were collected by face-to-face interview. The recurrent event survival analysis was used to explore the effect of predictors on pregnancy spacing. The R software program was used for analysis. RESULTS: There were nine predictors that had significant effect on pregnancy spacing. These predictors included the age of mother at marriage, mother's BMI, contraception use, breast feeding duration of the previous child, the education level of husband, the sex preference of the mother, presence of abortion or stillbirth in the preceding pregnancies, income sufficiency, and mother's awareness of optimum pregnancy interval. The most influential predictors; contraception use (HR = 2.34, 95%CI = 1.23 to 2.76, P < 0.001) and income sufficiency (HR = 2.046, 95%CI = 1.61 to 3.02, P = 0.018) lead to longer and son preference of mother (HR = 2.231, 95%CI = 1.24 to 2.81, P = 0.023) lead to shorter pregnancy spacing. CONCLUSION: The up to date contraception tool should be at hand for couples to manage their pregnancy intervals. The unfavorable economic situation of a family leads to long pregnancy spacing. Despite the relative equality of the status of girls and boys in today's societies, the desire to have a son child is still an important factor in shorter pregnancy spacing. The benefit of optimal pregnancy spacing should be more announced.
Tania Dehesh, Elaheh Salarpour, Neda Malekmohammadi et al.
INTRODUCTION: A socio-demographic analysis of marriage and family requires conducting deep studies penetrating the essence of the processes among the population. The issue of birth-rate, as a basic factor that determines the reproduction of the population, takes a central position in the demographic studies. The study of the influence of the mothers' reproductive behaviour on their daughters' repro-ductive attitude is of an undisputed interest. This study deals with mothers' realized plans as a factor in their daughters' family planning. MATERIALS AND METHODS: This cross-sectional study was carried out in 2018 through a direct group anonymous inquiry among 395 female students. The statistical processing of the data was made with descriptive, alternative, correlation and variance analyses. RESULTS: The students' reproductive behaviour is statistically significantly dependent on their mothers' realized family plans. Moth-ers' education and the real number of children are statistically significant factors for their daughters' views about the ideal and planned number of children. CONCLUSION: This study of the reproductive behaviour of the students advances the knowledge in the field by revealing that it is statisti-cally significantly dependent on their mothers' realized plans.
BACKGROUND: Forensic Odontology (FO) still strives for recognition in some countries such as Pakistan. Natural and man-made disasters, along with child abuse cases and age estimation for child marriages and juvenile imprisonments in Pakistan justify its applicability. AIMS: This study investigated the awareness, information, training, practice and interest in FO in dental professionals in Pakistan. Another aim was to design tools to deliver primary knowledge about FO and emphasize the importance of dental records. METHODOLOGY: A 10 question paper-based survey was distributed among 560 dental professionals and postgraduates of 14 public dental institutes/hospitals in Pakistan. The results were quantitatively analyzed by graphs using Microsoft Excel (version 16.22). An educational video and an information leaflet were produced after the survey was undertaken to explain the scope of FO and the importance of dental records respectively. RESULTS: 476 dentists (51%♀, 49 %♂) aged 20 - 50+ years responded and 98.53% confirmed that FO was not taught in the dental schools. 66% were aware of the field and 62% were only informed. 99% were not trained and 89.7% were not working in this field; however, 89% were interested in training within Pakistan. Considering dental charts, 60.92% do not produce detailed charts but 55% maintain them and the majority do so manually. Radiographs were the most stored type. CONCLUSIONS: Most dentists are aware of the existence of FO, but they need to acknowledge the significance of dental record keeping and encourage implementation of FO. Regardless of the absence of any governing body for FO and negligible education, training and implementation in Pakistan, this field is gradually progressing. The authorities should introduce detailed guidelines for recording, managing and storing dental records. They should ensure the future acknowledgement of this subject in the education system and assign forensic odontologists to the Disaster Victim Identification (DVI) team.
Although post-traumatic stress disorder (PTSD) in adolescent pregnancy has been reported at high rates in the limited research in this area, no studies have evaluated gestation as trauma in teens. This study, aimed to evaluate PTSD in this high risk group. All pregnant adolescents who presented to our obstetrics and gynaecology clinics in a one-year period were invited to participate in the study. Adolescents with a history of domestic or dating violence, rape, and sexual abuse were excluded. PTSD was rated using the Child Post-Traumatic Stress Disorder-Reaction Index. When the pregnant adolescents and control group were compared, various severities of PTSD were observed in nearly two-thirds of the study group. Although there was clinically significant PTSD among 23.3% of the controls, PTSD was more frequently seen in adolescents with pregnancy compared with their healthy peers. Educating adolescents about birth control methods and preventing child marriages will be protective in this respect.Impact statementWhat is already known on this subject? Teen pregnancy has significant psychosocial and economic impacts for adolescents, their offspring, and the community in terms of education and employment, increased risk of abuse and neglect, and the physical and emotional well-being of the offspring. Pregnancy and birth-related risks are also higher than in adults. In this context, pregnancy itself may be accepted as trauma for adolescents.What do the results of this study add? There has been limited research on PTSD in pregnant teens and is mainly associated with traumatic childhood events. This is the first study to examine pregnancy-related PTSD and related conditions in this group.What are the implications of these findings for clinical practice and/or further research? The prevalence of pregnancy related-PTSD in pregnant teens can be considered high and alarming, considering the fact that most of them had never been treated for it at all. Healthcare providers serving this population need to be trained to recognise the core symptoms of PTSD, and should direct adolescents for professional assistance if needed. Strategies such as higher quality sexual health education and greater access to reproductive health services to reduce adolescent pregnancy and marriage are also imperative.
Aslı Sürer Adanir, Arif Önder, Gül Alkan Bülbül et al.
OBJECTIVE: Women in South Asia, including Nepal, have some of the poorest nutritional indicators globally, leading to poor maternal and child health outcomes. Nepal also suffers from high levels of household food insecurity, and newly married women are at high risk. Intra-household relationships may mediate the relationship between food insecurity and women's nutrition in Nepal for newly married women. Our aim is to understand how newly married, preconception, women's food consumption changes when she enters her husband's home, compared with her natal home. We also explore whether relationship quality with husbands and mothers-in-law mediates the association between food insecurity and eating less high-quality food, using structural equation modelling. DESIGN: Cross-sectional survey data. SETTING: Rural Nepal in 2018. PARTICIPANTS: Data were collected from 200 newly married, preconception women. RESULTS: Women had poor diet quality, and most ate fewer high-quality foods important for pregnancy in their marital, compared with natal, home. Higher quality relationships with mothers-in-laws mediated the association between food insecurity and a woman eating fewer high-quality foods in her marital, compared with natal, home. Relationship quality with husbands was not associated with changes in food consumption. CONCLUSIONS: Preconception, newly married women in Nepal are eating less high-quality foods important for women's health during the preconception period - a key period for avoiding adverse maternal and infant health outcomes. Relationships with mothers-in-law are key to women's access to high-quality food, suggesting that interventions aiming to improve maternal and child nutrition should target all household members.
Nadia Diamond-Smith, Jacqueline Shieh, Mahesh Puri et al.
STUDY QUESTION: Is maternal polycystic ovary syndrome (PCOS) associated with increased risks for a broad spectrum of psychiatric and mild neurodevelopmental disorders in offspring? SUMMARY ANSWER: Maternal PCOS and/or anovulatory infertility is independently, and jointly with maternal obesity, perinatal problems, cesarean delivery and gestational diabetes, associated with increased risks in offspring for almost all groups of psychiatric and mild neurodevelopmental disorders with onset in childhood or adolescence. WHAT IS KNOWN ALREADY: Maternal PCOS was previously associated with autism spectrum disorder, attention-deficit/hyperactivity disorders and possibly developmental delay in offspring. Few studies have investigated the association between maternal PCOS and other psychiatric and neurodevelopmental disorders in offspring. STUDY DESIGN, SIZE, DURATION: This was a population-based cohort study in Finland including all live births between 1996 and 2014 (n = 1 105 997). After excluding births to mothers with symptoms similar to PCOS, a total of 1 097 753 births by 590 939 mothers remained. Children were followed up until 31 December 2018, i.e. up to the age of 22 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: National registries were used to link data of the included births and their mothers. Data from 24 682 (2.2%) children born to mothers with PCOS were compared with 1 073 071 (97.8%) children born to mothers without PCOS. Cox proportional hazards modeling was used to evaluate the hazard ratio (HR) and 95% CI for the risk of neuropsychiatric disorders in relation to maternal PCOS. Stratified analyses were performed to test the independent role of PCOS and the joint effects of PCOS with maternal obesity, perinatal problems, cesarean delivery, gestational diabetes and use of fertility treatment. The analysis was adjusted for maternal age, country of birth, marriage status at birth, smoking, parity, psychiatric disorders, prescription of psychotropic N05/N06 during pregnancy and systemic inflammatory diseases when applicable. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 105 409 (9.8%) children were diagnosed with a neurodevelopmental or psychiatric disorder. Firstly, maternal PCOS was associated with any psychiatric diagnosis (HR 1.32; 95% CI 1.27-1.38) in offspring. Particularly, the risk was increased for sleeping disorders (HR 1.46; 95% CI 1.27-1.67), attention-deficit/hyperactivity disorders and conduct disorders (HR 1.42; 95% CI 1.33-1.52), tic disorders (HR 1.42; 95% CI 1.21-1.68), intellectual disabilities (HR 1.41; 95% CI 1.24-1.60), autism spectrum disorder (HR 1.40; 95% CI 1.26-1.57), specific developmental disorders (HR 1.37; 95% CI 1.30-1.43), eating disorders (HR 1.36; 95% CI 1.15-1.61), anxiety disorders (HR 1.33; 95% CI 1.26-1.41), mood disorders (HR 1.27; 95% CI 1.18-1.35) and other behavioral and emotional disorders (ICD-10 F98, HR 1.49; 95% CI 1.39-1.59). In short, there was no significant difference between sexes. The results were robust when restricting the analyses to the first-born children or births to mothers without psychiatric diagnosis or purchase of psychotropic medication. Secondly, stratified analysis according to maternal BMI showed that the risk of any neuropsychiatric disorder was increased in offspring to normal-weight mothers with PCOS (HR 1.20; 95% CI 1.09-1.32), and markedly higher in those to severely obese mothers with PCOS (HR 2.11; 95% CI 1.76-2.53) compared to offspring to normal-weight mothers without PCOS. When excluding perinatal problems, mothers with PCOS were still associated with increased risks of any neuropsychiatric disorders in offspring (HR 1.28; 95% CI 1.22-1.34) compared to mothers without PCOS. However, an additional increase was observed for PCOS in combination with perinatal problems (HR 1.99; 95% CI 1.84-2.16). Likewise, excluding cases with maternal gestational diabetes (HR 1.30; 95% CI 1.25-1.36), cesarean delivery (HR 1.29; 95% CI 1.23-1.35) or fertility treatment (HR 1.31; 95% CI 1.25-1.36) did not eliminate the associations. LIMITATIONS, REASONS FOR CAUTION: The register-based prevalence of PCOS was lower than previously reported, suggesting that this study may capture the most severe cases. To combine anovulatory infertility with PCOS diagnosis as PCOS exposure might introduce diagnostic bias. It was not feasible to distinguish between subtypes of PCOS. Furthermore, familial factors might confound the association between maternal PCOS and neuropsychiatric disorders in offspring. Maternal BMI was available for birth cohort 2004-2014 only and there was no information on gestational weight gain. WIDER IMPLICATIONS OF THE FINDINGS: This study provides further evidence that maternal PCOS and/or anovulatory infertility, independently and jointly with maternal obesity, perinatal problems, gestational diabetes and cesarean delivery, implies a broad range of adverse effects on offspring neurodevelopment. These findings may potentially help in counseling and managing pregnancies. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the joint research funding of Shandong University and Karolinska Institute (SDU-KI-2019-08 to X.C and C.L.), THL Finnish Institute for Health and Welfare: Drug and pregnancy project [M.G.], the Swedish Research Council [2014-10171 to C.L.], the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institute Stockholm County Council [SLL20170292 to C.L.], the Swedish Brain Foundation [FO2018-0141 and FO2019-0201 to C.L.]. X.C. was supported by the China Scholarship Council during her training in Karolinska Institute. L.K. was supported by the China Scholarship Council for his PhD study in Karolinska Institute. The authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER: N/A.
Xinxia Chen, Linghua Kong, Terhi T Piltonen et al.
Interracial couples cohabit at higher rates than same-race couples, which is attributed to lower barriers to interracial cohabitation relative to intermarriage. This begs the question of whether the significance of cohabitation differs between interracial and same-race couples. Using data from the 2006-2017 National Survey of Family Growth, we assessed the meaning of interracial cohabitation by comparing the pregnancy risk, pregnancy intentions, and union transitions following a pregnancy among women in interracial and same-race cohabitations. The pregnancy and union transition behaviors of women in White-Black cohabitations resembled those of Black women in same-race cohabitations, suggesting that White-Black cohabitation serves as a substitute to marriage and reflecting barriers to the formation of White-Black intermarriages. The behaviors of women in White-Hispanic cohabitations fell between those of their same-race counterparts or resembled those of White women in same-race cohabitations. These findings suggest that White-Hispanic cohabitations take on a meaning between trial marriage and substitute to marriage and support views that Hispanics with White partners are a more assimilated group than Hispanics in same-race unions. Results for pregnancy intentions deviated from these patterns. Women in White-Black cohabitations were less likely than Black women in same-race cohabitations to have an unintended pregnancy, suggesting that White-Black cohabitations are considered marriage-like unions involving children. Women in White-Hispanic cohabitations were more likely than White and Hispanic women in same-race cohabitations to have an unintended pregnancy, reflecting possible concerns about social discrimination. These findings indicate heterogeneity in the significance of interracial cohabitation and continuing obstacles to interracial unions.
