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  • Age at first marriage, age at first sex, family size preferences, contraception and change in fertility among women in Uganda: analysis of the 2006–2016 period
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-16
    Paulino Ariho; Allen Kabagenyi

    Uganda’s fertility was almost unchanging until the year 2006 when some reductions became visible. Compared to age at first marriage and contraceptive use, age at sexual debut and family size preferences are rarely examined in studies of fertility decline. In this study, we analyzed the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to change in fertility in Uganda between 2006 and 2016. Using data from the 2006 and 2016 Uganda Demographic and Health Survey (UDHS), we applied a nonlinear multivariate decomposition technique to quantify the contribution of age at first marriage, age at first sex, family size preference and contraceptive use to the change in fertility observed during the 2006–2016 period. The findings indicate that 37 and 63% of the change in fertility observed between 2006 and 2016 was respectively associated with changing characteristics and changing fertility behavior of the women. Changes in proportion of women by; age at first marriage, age at first sex, family size preferences and contraceptive use were respectively associated with 20.6, 10.5 and 8.4% and 8.2% of the change in fertility but only fertility behavior resulting from age at first sex was significantly related to the change in fertility with a contribution of 43.5%. The study quantified the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to the change in fertility observed between 2006 and 2016. We highlight that of the four factors, only age at sexual debut made a significant contribution on the two components of the decomposition. There is need to address the low age at first sex, accessibility, demand for family planning services and youth-friendly family planning services to young unmarried women such that they can achieve their desired fertility. The contribution of other factors such as education attainment by women and place of residence and their relationship with changes in fertility calls for addressing if further reduction in fertility is to be realised.

  • Qualitative exploration of the acceptability of a postnatal pelvic floor muscle training intervention to prevent urinary incontinence
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-17
    Aileen Grant; Sinead Currie

    Childbirth is a major risk factor for urinary incontinence (UI). As a result, pelvic floor muscle training (PFMT) is commonly recommended during and after pregnancy to prevent the onset of UI. PFMT is often classed as a physical activity (PA) behaviour, hence PA guidelines for postnatal women encourage PFMT alongside aerobic activities. However, postnatal lifestyle interventions tend to overlook PFMT which can be detrimental to women’s health and future health risks, including urinary incontinence. This study aimed to explore perceptions and acceptability of a postnatal physical activity and PFMT intervention with postnatal women in Scotland. We recruited women who had given birth within the last 5 years by displaying posters in health centres and community centres in Stirling and through Facebook. Data was gathered via online and face-to-face focus groups, that were audio recorded and transcribed verbatim. Analytic themes were initially organised under related concepts derived from the topic guide and thematic analysis conducted. Subsequent analysis was by the Framework technique. A total of seven online and face-to-face focus group discussions with 31 women identified there was a clear intention behaviour gap for engagement in PA, with both psychological and logistical barriers identified such as motivation and childcare. This was distinct from PFMT where there was a feeling of helplessness around not knowing how to perform a correct PFMT contraction subsequently resulting in women not adhering to PFMT guidance. Women felt there was no accessible PFMT advice available through the NHS. Some participants had received PFMT advice after childbirth and spoke of the Squeezee app being useful in adhering to a PFMT regimen but they did require additional teaching on how to do correct contractions. There was need for clarity and practical support for PFMT in the postnatal period with an approved intervention incorporating an accessible app being suggested by participants. Women would like to be trained on postnatal PFMT but face barriers to accessing adequate information and education on how to do a PFMT contraction. An intervention combining PFMT training and an app would be the most useful for their needs and circumstances.

  • Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-16
    Gavin George; Cherie Cawood; Adrian Puren; David Khanyile; Annette Gerritsen; Kaymarlin Govender; Sean Beckett; Mary Glenshaw; Karidia Diallo; Kassahun Ayalew; Andrew Gibbs; Tarylee Reddy; Lorna Madurai; Tendesayi Kufa-Chakezha; Ayesha B. M. Kharsany

    Young women in sub-Saharan Africa remain at the epicentre of the HIV epidemic, with surveillance data indicating persistent high levels of HIV incidence. In South Africa, adolescent girls and young women (AGYW) account for a quarter of all new HIV infections. Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) is a strategy introduced by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) aimed at reducing HIV incidence among AGYW in 10 countries in sub-Saharan Africa by 25% in the programme’s first year, and by 40% in the second year. This study will assess the change in HIV incidence and reduction in risk associated behaviours that can be attributed to the DREAMS initiative in South Africa, using a population-based cross-sectional survey. Data will be collected from a household-based representative sample of AGYW (between the ages 12–24 years) in four high prevalence districts (more than 10% of the population have HIV in these districts) in South Africa in which DREAMS has been implemented. A stratified cluster-based sampling approach will be used to select eligible participants for a cross-sectional survey with 18,500, to be conducted over 2017/2018. A questionnaire will be administered containing questions on sexual risk behaviour, selected academic and developmental milestones, prevalence of gender based violence, whilst examining exposure to DREAMS programmes. Biological samples, including two micro-containers of blood and self-collected vulvovaginal swab samples, are collected in each survey to test for HIV infection, HIV incidence, sexually transmitted infections (STIs) and pregnancy. This study will measure trends in population level HIV incidence using the Limiting antigen (LAg) Avidity Enzyme Immuno-Assay (EIA) and monitor changes in HIV incidence. Ending the HIV/AIDS pandemic by 2030 requires the continual monitoring and evaluation of prevention programmes, with the aim of optimising efforts and ensuring the achievement of epidemic control. This study will determine the impact DREAMS interventions have had on HIV incidence among AGYW in a ‘real world, non-trial setting’.

  • Evaluation of apoptosis and angiogenesis in ectopic and eutopic stromal cells of patients with endometriosis compared to non-endometriotic controls
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-06
    Ali-Akbar Delbandi; Mahmoud Mahmoudi; Adel Shervin; Sahel Heidari; Roya Kolahdouz-Mohammadi; Amir-Hassan Zarnani

    Endometriosis is a chronic, painful, and inflammatory disease characterized by extra-uterine growth of endometrial tissues. Increased angiogenesis and resistance to apoptosis have been suggested to be involved in pathogenesis and development of endometriosis. The objective of this study was to examine apoptosis potential and angiogenesis contribution of eutopic (EuESCs) and ectopic (EESCs) endometrial stromal cells in patients with endometriosis compared to endometrial stromal cells from non-endometriotic controls (CESCs). Stromal cells were isolated by enzymatic digestion of ectopic (n = 11) and eutopic (n = 17) endometrial tissues from laparoscopically-confirmed endometriotic patients. Endometrial stromal cells of 15 non-endometriotic patients served as control. Following cell characterization by immunofluorescent staining and flow cytometry using a panel of antibodies, the total RNA was isolated from the cultured cells, and analyzed for the expression of genes involved in apoptosis (Bcl-2, Bcl-xL, Bax, and caspase-3) and angiogenesis [vascular endothelial growth factor-A (VEGF-A) and hepatocyte growth factor (HGF)] by Real-time PCR. Significantly higher gene expression levels of Bcl-2 and Bcl-xL were found in EESCs compared with EuESCs and CESCs (p < 0.01). The gene expression of Bax in EESCs, EuESCs, and CESCs was not statistically significant. Furthermore, EuESCs exhibited a significantly lower caspase-3 gene expression compared with CESCs (p < 0.01) or EESCs (p < 0.05). Regarding angiogenesis, VEGF-A gene expression in EESCs (p < 0.001) and EuESCs (p < 0.05) were significantly higher compared with those of CESCs. EESCs exhibited a significantly higher HGF gene expression compared with EuESCs (p < 0.05). These findings suggest reduced propensity to apoptosis and increased angiogenesis potential of EESCs, which may be involved in pathogenesis of endometriosis.

  • Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-06
    Judy Michael; Qaiser Iqbal; Sajjad Haider; Adnan Khalid; Naheed Haque; Rabia Ishaq; Fahad Saleem; Mohamed Azmi Hassali; Mohammad Bashaar

    The current study is aimed to assess menstruation-related knowledge and practices of adolescent females visiting a public health care institute of Quetta city, Pakistan. A questionnaire-based cross-sectional survey was conducted. Nine hundred and twenty three female adolescents attending general out-patient departments of Mohtarma Shaheed Benazir Bhutto Hospital Quetta, Balochistan, was approached for data collection. Based on the objectives of the study, descriptive analysis was conducted and SPSS v. 21.0 was used for the data analysis. Demographic characteristics revealed that the mean age of the respondents was 15 years. Mothers’ (67%) were the main source of menstruation-related information. Majority (77.7%) of our respondents never had a class or session regarding menstruation-related education in their schools. About (44%) knew that menstruation is a physiological phenomenon while 60.2% knew that menstrual blood comes from the vagina. Nearly 40% of our study respondents missed their schools because of menarche. The use of absorbent material was frequent (90%) among the adolescent females and (68.7%) used commercially available sanitary napkins/pads. Although majority of the respondents (58.2%) were not taking baths during menstruation, 80.5% do cleaned their genitalia with water during menstruation. Female adolescents of our study had certain misconception regarding menstruation because of poor access to health-related education. Education can be provided at healthcare facilities, residential area as well as religious centers. Adolescent reproductive health should be included in the school curriculum; this will influence general reproductive health of females.

  • Prevalence of primary dysmenorrhea, its intensity, impact and associated factors among female students’ at Gondar town preparatory school, Northwest Ethiopia
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-06
    Abere Woretaw Azagew; Destaye Guadie Kassie; Tarkie Abebe Walle

    Primary dysmenorrhea is defined as a crampy pain in the lower abdomen before or during the menstrual period in the absence of any pelvic pathology. It is the leading motherhood problem worldwide but there is limited evidence on the prevalence of primary dysmenorrhea in the study area as well in Ethiopia. Researching primary dysmenorrhea helps to focus on the treatment plan. The study aimed to assess the prevalence, intensity, impact, and associated factors of primary dysmenorrhea among female students at Gondar town preparatory school. A cross-sectional study design conducted among female students at Gondar town Preparatory School from May 1–10/2017. A total of 459 study participants were used. A simple random sampling technique was used to select study participants. A self-administered structured questionnaire was employed. Epi Info version 7 and SPSS version 20 were used for data entry and analysis respectively. A binary logistic regression model was computed. Variables having a p-value < 0.05 in the multivariate logistic regression model were considered as statistically significant. A total of 459 female students participated in the study with a response rate of 96.29%. The prevalence of primary dysmenorrhea among female students was found to be 64.7% (95% CI; 60.2–69.2%). Around 61% reported moderate intensity of menstrual pain and 50.7% complain about lower abdominal pain. Sixty-five percent of study participants reported that absenteeism from school was the impact of menstrual pain. Having irregular monthly menstrual cycle (AOR = 1.70, 95% CI; 1.02, 2.84) and positive family history of dysmenorrhea (AOR = 5.19, 95% CI: 3.21, 8.37) were significantly associated with primary dysmenorrhea. The prevalence of primary dysmenorrhea was found to be high. Having an irregular monthly menstrual cycle and a positive family history of dysmenorrhea were determinants of primary dysmenorrhea.

  • Texas women’s decisions and experiences regarding self-managed abortion
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-06
    Liza Fuentes; Sarah Baum; Brianna Keefe-Oates; Kari White; Kristine Hopkins; Joseph Potter; Daniel Grossman

    Prior research has shown that a small proportion of U.S. women attempt to self-manage their abortion. The objective of this study is to describe Texas women’s motivations for and experiences with attempts to self-manage an abortion. The objective of this study is to describe Texas women’s motivations for and experiences with attempts to self-manage an abortion. We report results from two data sources: two waves of surveys with women seeking abortion services at Texas facilities in 2012 and 2014 and qualitative interviews with women who reported attempting to self-manage their abortion while living in Texas at some time between 2009 and 2014. We report the prevalence of attempted self-managed abortion for the current pregnancy among survey respondents, and describe interview participants’ decision-making and experiences with abortion self-management. 6.9% (95% CI 5.2–9.0%) of abortion clients (n = 721) reported they had tried to end their current pregnancy on their own before coming to the clinic for an abortion. Interview participants (n = 18) described multiple reasons for their decision to attempt to self-manage abortion. No single reason was enough for any participant to consider self-managing their abortion; however, poverty intersected with and layered upon other obstacles to leave them feeling they had no other option. Ten interview participants reported having a complete abortion after taking medications, most of which was identified as misoprostol. None of the six women who used home remedies alone reported having a successful abortion; many described using these methods for several days or weeks which ultimately did not work, resulting in delays for some, greater distress, and higher costs. These findings point to a need to ensure that women who may consider self-managed abortion have accurate information about effective methods, what to expect in the process, and where to go for questions and follow-up care. There is increasing evidence that given accurate information and access to clinical consultation, self-managed abortion is as safe as clinic-based abortion care and that many women find it acceptable, while others may prefer to use clinic-based abortion care.

  • Work-family balance and the subjective well-being of rural women in Sichuan, China
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-02
    Yue Shui; Dingde Xu; Yi Liu; Shaoquan Liu

    Due to the great burden of family and the conflicts among family, society and career roles resulting from migrant working, rural women suffer more conflicts between work and family and need more social attention. Previous studies of the conflicts between family and work mainly focus on the group of career women, and there is a lack of the research on the conflicts between work and family of rural women, which needs to be systematically and further studied. This study used a sample survey of 380 rural women in rural areas of Sichuan Province to measure rural women’s cognition of work-family, coordination and handling of conflicts, post-conflict choices, and subjective well-being; the study constructs an ordered multi-class logistic regression model to explore the impact of work-family conflict on the subjective well-being of rural women in rural regions. The study result shows that: (1) The level of subjective well-being of rural women is generally high, and 70% of women feel satisfied or very satisfied. (2) The factor which impacts the subjective well-being among rural women most is work-interfering-with-family conflict, followed by work-family balance and confidence in conflict coordination. This study can enhance our understanding of rural women in rural areas, and provide a reference for formulating policies to improve people’s life satisfaction.

  • A qualitative study on reasons for early removal of Implanon among users in Arba Minch town, Gamo Goffa zone, South Ethiopia: a phenomenological approach
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-02
    Mesfin Mamo Utaile; Mesfin Kote Debere; Etsehiwot Tilahun Nida; Dube Jara Boneya; Amsale Tekle Ergano

    Implanon is one of the cost - effective long acting reversible contraceptive methods used for spacing and limiting births in Ethiopia. Despite the scaling up initiative undertaken by the Ethiopian Government, Implanon uptake is very low compared to short acting contraceptive methods. There is low utilization of Implanon with high level of discontinuation in Ethiopia. Therefore, this study was conducted to explore the reasons for early removal of Implanon among users in Arba Minch town, South Ethiopia. A community-based qualitative exploratory study using phenomenological approach was conducted. In-depth and key informant interviews were used to collect data from April 20–27, 2018 in Arba Minch town. Convenient sampling was employed to recruit participants from the households of targeted villages. A total of 10 in-depth interviews with women who recently removed Implanon and 5 key informant interviews with health extension workers were conducted. The sample size was determined based on the concept of saturation. The collected data were analyzed using thematic content analysis technique. Data coding and analysis were facilitated by using Open code version 4.0 software. This study revealed that majority of participants were able to mention at least three types of contraceptive methods available in the nearby health facilities. The study underlined that side effect of the method, husband opposition, seeking more children, and method failure were the common reasons for early removal of Implanon, in which side effect of the method was the main reason. Among various forms of side effects of Implanon identified by users, heavy and irregular bleeding was mentioned as the most frequently occurring side effect. Our result indicated that heavy and irregular bleeding was the main reason for early removal of Implanon. Therefore it suggests improvement in the service delivery system. Improving client’s education and counseling service program could contribute much to avoid unreasonable and untimely removal of Implanon.

  • Is there a correlation between inflammatory markers and coagulation parameters in women with advanced ovarian endometriosis?
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-30
    Shaojie Ding; Qiao Lin; Tianhong Zhu; Tiantian Li; Libo Zhu; Jianzhang Wang; Xinmei Zhang

    Endometriosis is defined as a chronic inflammatory disease. Recent studies have shown that increased coagulation parameters including fibrinogen and platelets are associated with endometriosis. The objective of this study was to determine the levels of inflammatory markers and coagulation parameters and their correlations in women with endometriomas compared to those with benign ovarian cysts or normal pelvic anatomy. Between June 2015 and June 2017, a total of 548 women who underwent laparoscopic/laparotomic surgery for ovarian endometriomas (OMA group, n = 226), non-endometriosis benign ovarian cysts (Cyst group, n = 210) and tubal reanastomosis (Control group, n = 112) were recruited in this study. Inflammatory markers including c-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and coagulation parameters including platelet count, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time, and plasma fibrinogen as well as CA-125 were determined. Compared with Cyst group and Control group, TT and PT in OMA group were significantly shorter and plasma fibrinogen levels were significantly higher (P < 0.05). Moreover, the levels of plasma fibrinogen were positively correlated with CRP, NLR and PLR (P < 0.05). In addition, the confidence intervals for the area under the curve (AUC) for CA-125 × fibrinogen were significantly higher than those for CA-125 (0.904–0.952 vs. 0.899–0.949) in the diagnosis of endometrioma. These results indicate that women with endometriomas demonstrate a hypercoagulable status due to the inflammatory nature of endometriosis. The combined determination for CA-125 and fibrinogen demonstrate a higher area under the curve than the single detection of CA-125 in those with endometriomas compared to these with benign ovarian cysts. This study was approved by the Human Ethics Committee of the Women’s Hospital, School of Medicine, Zhejiang University (No.20170174) and all women provided written informed consent.

  • Unmet need for family planning and associated factors among currently married reproductive age women in Tiro Afeta District, South West Ethiopia, 2017: cross-sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-30
    Tesfaye Solomon; Mamo Nigatu; Tsegaye Tewelde Gebrehiwot; Biniam Getachew

    Unmet need for family planning in Oromia region was very high (28.9%) compared to other regions in Ethiopia. To address problems associated with unmet need for family planning locally available evidences are essential, however, there were no clear evidences on unmet need for family planning in Tiro Afeta district. This study aims to assess the magnitude and associated factors of unmet need for family planning among currently married women in Tiro Afeta district, South West Ethiopia, 2017. Community based cross sectional study was conducted in April, 2017. A total of 348 currently married women of reproductive age were enrolled from eight villages selected by simple random sampling and using proportional to size allocation. Data were entered using EpiData 3.1 and analyzed by SPSS version 22. Adjusted odds ratios at 95% confidence interval with p-value of < 0.05 were considered as significant variables. Unmet need for family planning among currently married women in Tiro Afeta was 26.1%. Factors significantly associated with unmet need for family planning were: never use of family planning before survey (AOR: 5.09, 95% CI: 2.73–9.50); multiparity (AOR: 3.02, 95% CI: 1.56–5.85); perceived husband’s attitude as disapproval (AOR: 2.75, 95% CI: 1.43–5.26); lack of counseling from health workers (AOR: 2.07, 95% CI: 1.11–3.85); and unavailability of Radio and/or Television in the house (AOR: 2.05, 95% CI: 1.15–3.66). Unmet need for family planning in Tiro Afeta was higher than national average but lower than Oromia region. Never use of family planning, women’s parity, husband’s attitude towards contraceptives, women counseling and unavailability of Radio and/or Television in the respondent’s home were significantly associated factors with unmet need for family planning. Therefore, the service providers and the district health office should strengthen counseling and partner involvement to reduce unmet need for family planning.

  • Changes in body composition with a hypocaloric diet combined with sedentary, moderate and high-intense physical activity: a randomized controlled trial
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-27
    A. Hernández-Reyes; F. Cámara-Martos; R. Molina-Luque; M. Romero-Saldaña; G. Molina-Recio; R. Moreno-Rojas

    There is evidence showing the effectiveness of a hypocaloric diet and the increase in physical activity on weight loss. However, the combined role of these factors, not only on weight loss but also body composition, remains unclear. The purpose of this study was to investigate the effect of a hypocaloric diet on the body composition of obese adult women throughout different degrees of physical activity during a weight loss program. One hundred and seventeen healthy female volunteers were randomly assigned to one of the experimental groups: a control group with a low-level prescription of physical activity (1–4 METs), moderate physical activity group that performed 10.000 steps walking (5–8 METs) and intense physical activity group that trained exercises by at least 70% of VO2max three times a week (> 8 METs). All subjects followed a hypocaloric diet designed with a reduction of 500 kcal/day. Nutritional counseling was provided throughout the study period to help ensure dietary adherence. We found no differences in body weight compared to moderate and intense physical activity (ßstand. = − 0.138 vs. ßstand. = − 0.139). Body fat was lower in women following an intense activity (ßstand. = − 0.436) than those with moderate exercise (ßstand. = − 0.231). The high-intense activity also increased muscle mass at the end of the intervention, standing out above the moderate activity (ßstand. = 0.182 vs. ßstand. = 0.008). These findings indicate that a hypocaloric diet, without prescription of physical activity, is adequate to lose weight in the short term (12 weeks), but physical activity is vital to modify the body composition in women with obesity. Body fat was lower when women practiced a moderate exercise compared to hypocaloric diet only, but an intense physical activity was the most effective protocol to obtain a reduction of body fat and maintain muscle mass. The study protocol complied with the Declaration of Helsinki for medical studies, it was approved by the bioethical committee of Córdoba University, in the Department of Health at the Regional Government of Andalusia (Act n°284, ref.4156) and retrospectively registered in clinicaltrials.gov (NCT03833791). Registered 2 January 2019.

  • Shifts in FGM/C practice in Sudan: communities’ perspectives and drivers
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-30
    Nafisa Bedri; Huda Sherfi; Ghada Rudwan; Sara Elhadi; Caroline Kabiru; Wafaa Amin

    Although Sudan has one of the highest prevalence of female genital mutilation or cutting (FGM/C), there have been shifts in e practice. These shifts include a reduction in the prevalence among younger age cohorts, changes in the types of FGM/C, an increase in medicalization, and changes in age of the practice. The drivers of these shifts are not well understood. Qualitative data drawn from a larger study in Khartoum and Gedaref States, Family and Midwife individual interviews and focus group discussions. Analysis and categorization within a Social Norms theoretical framework. Major findings confirmed shifts in the type FGM/C (presumably from infibulation to non-infibulating types) and increasing medicalization in the studied communities. These shifts were reported to be driven by social, professional and religious norms. Changes in FGM practice in Sudan include drivers which will not facilitate abandonment of the practice instead lead to normalization of FGM/C. Yet professionalisation of Midwives including their oath to stop FGM/C has potential to facilitate abandonment rapidly if developed with other Sudan health professionals.

  • The psychometric properties of the Barkin index of maternal functioning (BIMF) for the Iranian population
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-21
    Mojgan Mirghafourvand; Jennifer L. Barkin; Mohammad Asghari Jafarabadi; Fatemeh Karami; Solmaz Ghanbari-Homayi

    Mothers’ capability for childcare and compatibility with the maternal role represent important challenges in postpartum care. Given the significance of evaluating maternal functioning, and the lack of adequate standard instruments in Iran for this purpose, the present study was aimed at translating and conducting a psychometric assessment of the Barkin Index of Maternal Functioning (BIMF) for Iranian women. The instrument was translated into Persian using the Backward Forward method. The study included 530 women in the postpartum period admitted to healthcare centers in Tabriz, Iran; they were selected through the cluster sampling method. Face, content, and construct (through exploratory and confirmatory analyses) validity were presently examined. Reliability of the questionnaire was determined using the internal consistency and test-retest reliability methods. Two factors (mom’s needs and competency), emerged based on exploratory factor analysis. The x2/df ratio was less than 5, and the values of the Root Mean Square Error of Approximation (RMSEA) and the Root Mean Square Residual (RMR) were less than 0.08 and 0.1, respectively, verifying the model validity. Cronbach’s alpha coefficient and Intra-class Correlation Coefficient (ICC) were calculated as 0.88 and 0.85, respectively, indicating reliability. The Persian version of the BIMF is a valid and reliable instrument for measuring the postpartum functioning of Iranian mothers.

  • Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-19
    Bettina Böttcher; Mysoon Abu-El-Noor; Nasser Abu-El-Noor

    Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives. A convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data. Women reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods. Women’s contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women’s choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.

  • A full Brazilian or all natural: understanding the influences on young women’s decision to remove their pubic hair
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-19
    Patricia Obst; Katherine White; Ebony Matthews

    Research indicates that young women are being exposed to increasing pressures to remove pubic hair from their bodies, which has the potential for both negative physical and psychological consequences. Women’s personal choice and reasoning for partaking in pubic hair removal is influenced by broader social influences; however, there is little theory-based research drawing from established decision-making models investigating the underlying processes that lead young women to engage in pubic hair removal practices. Based on the Theory of Planned Behaviour, it was hypothesised that 1) attitude, subjective norm, and perceived behavioural control would predict intention to remove pubic hair; 2) additional variables (prototype similarity and favourability) from the Prototype Willingness Model would significantly predict intention to remove pubic hair; 3) feminist values would significantly predict decreased intention to remove pubic hair; and 4) intention and perceived behavioural control would predict future self-reported removal of pubic hair. The current study included a sample of 270 young women (17–25 years old), who completed an online survey and a follow up survey 4 weeks later (N = 96). Attitudes, perceived behavioural control, and similarity to prototypical pubic hair removers were significant predictors of intention to remove pubic hair. Intention was significantly positively associated and feminist values were significantly negatively associated with actual pubic hair removal. These findings align with Theory of Planned Behaviour propositions. Furthermore, the expansion of the model highlights how broader social images impact on young women when deciding whether to engage in a behaviour that is intimately associated with their body image.

  • The effects of occupational pollutants on the reproductive health of female informal street traders in Warwick junction, Durban, South Africa – a cross-sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-18
    Sujatha Hariparsad; Rajen N. Naidoo

    Informal street traders are exposed on a daily basis to traffic emissions and biomass fuel smoke containing a variety of pollutants. These exposures are likely to place the female traders at increased risk for adverse reproductive outcomes. The aim of this study was to compare the reproductive outcomes among street traders exposed to pollutants from their work-related activities and traders without such exposure. A cross-sectional study was conducted among 305 female traders selected from exposed and non-exposed areas within the Warwick Junction trading hub, located in Durban, South Africa. Validated reproductive questionnaires and clinical assessments were conducted on all participants. Adverse reproductive outcomes such as low birth weight, spontaneous abortions and infertility were assessed. The mean age of the traders was 43.6 years (SD:12.1), mostly single (63%) and worked in trading hub for an average of 14 years. There were 876 pregnancies reported in the total sample. Traders pregnant while working in this location accounted for 120 pregnancies There was an increased risk of exposed traders having a low birth weight infant as compared to non-exposed traders (OR = 3.7; CI: 1.8, 7.6). Exposed traders were also almost 3 times more likely to be infertile as compared to non-exposed traders (OR = 2.6; CI: 1.6, 4.3). This study has demonstrated that female street traders working within a trading hub in KwaZulu-Natal, South Africa; exposed to occupational pollutants show an association with developing infertility and low birth weight infants. Recommendations to mitigate adverse exposures have been suggested which include short term safety interventions and better cooking practices and future long term policy interventions.

  • Do self-reported pregnancy complications add to risk evaluation in older women with established cardiovascular disease?
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-16
    Elin Täufer Cederlöf; Nina Johnston; Jerzy Leppert; Pär Hedberg; Bertil Lindahl; Christina Christersson

    In postmenopausal women with established cardiovascular disease (CVD), it is unknown whether a history of pregnancy complications are related to multisite artery disease (MSAD), defined as atherosclerotic lesions in at least two major vascular beds. Pregnancy complications are an established risk factor for CVD. This study aimed to investigate the frequency of pregnancy complications and their association to specific atherosclerotic manifestations and prediction of MSAD in older women with and without CVD. In total, 556 women were invited to participate in the study. Of these women 307 reported former pregnancy from a cohort of women with (n = 233) and without CVD (n = 74). The self-reported frequency of pregnancy complications were surveyed retrospectively by a questionnaire that included miscarriage, subfertility, gestational hypertension (GHT) and/or preeclampsia (PE), low birth weight, preterm birth, bleeding in late pregnancy, gestational diabetes mellitus and high birth weight. Three vascular beds were examined, the peripheral, carotid and coronary arteries. The mean age was 67.5 (SD 9.5) years. GHT and/or PE tended to be more common, but not significant, in women with CVD than in women without (20.3% vs 10.8%, p = 0.066). Among women with GHT and/or PE, hypertension later in life were more frequent than in women without (66.7% vs 47.4%, p = 0.010). GHT and/or PE were not associated with specific atherosclerotic manifestations or prediction of MSAD. In older women with established CVD, pregnancy complications was not associated to specific atherosclerotic manifestations and may not provide additional value to the risk evaluation for MSAD.

  • ‘Leaving no one behind’: a scoping review on the provision of sexual and reproductive health care to nomadic populations
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-16
    Moazzam Ali; Joanna Paula Cordero; Faria Khan; Rachel Folz

    Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.

  • Predictors of cervical cancer screening service utilization among commercial sex workers in Northwest Ethiopia: a case-control study
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-16
    Bekele Atinafu Muluneh; Desta Debalkie Atnafu; Belaynew Wassie

    Although an opportunistic approach of cervical cancer screening strategy had been implemented in Ethiopia, utilization of screening services among women is still low, accounted < 1%. We hypothesize that commercial sex women in Ethiopia faced a number of obstacles in order to access screening services. Identifying the predictors influencing utilizations of the screening services is an essential effort to tailor screening program towards increasing the utilization. An unmatched case-control study was implemented with a total sample size of 230 (46 cases and 184 controls). The study was conducted among commercial sex workers who attended confidential clinic opened for sex workers. Simple random sampling was employed. After the data were checked for completeness, consistency and accuracy, it was entered in to Epi nfo version 7 then exported to SPSS for further statistical analysis. Descriptive statistics were used to describe the profile of study participants. Logistic regression was employed to identify the predictors of cervical cancer screening uptake. P < 0.05 was computed to determine the level of statistical significance. Cervical cancer screening utilization was associated with providers’ recommendation (AOR = 6.8; 95% CI: 2.3, 9.7), history of sexually transmitted infection (AOR = 6.9; 95% CI: 1.29, 7.2), frequency of facility visit (AOR = 4.8; 95% CI: 1.97, 11.8) and history of vaginal examination (AOR = 0.21; 95% CI: 0.1, 0.68). The level of cervical cancer screening service utilization was higher among women with history of STI, frequency of facility visit and providers’ recommendation. The level of cervical cancer screening service utilization was lower in women with previous vaginal examination.

  • Predictors of contraceptive use among adolescent girls and young women (AGYW) aged 15 to 24 years in South Africa: results from the 2012 national population-based household survey
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-12
    L. Makola; L. Mlangeni; M. Mabaso; B. Chibi; Z. Sokhela; Z. Silimfe; L. Seutlwadi; D. Naidoo; S. Khumalo; A. Mncadi; K. Zuma

    Despite a variety of contraceptives being available for women in South Africa, a considerable number of adolescent girls and young women still face challenges in using them. This paper examines socio-demographic and behavioral predictors of using contraceptives among adolescent girls and young women (AGYW) aged 15 to 24 years. A secondary data analysis was conducted based on the 2012 population-based nationally representative multi-stage stratified cluster randomised household survey. Multivariate backward stepwise logistic regression model was used to examine socio-demographic and behavioural factors independently associated with contraceptive use amongst AGYW aged 15 to 24 years in South Africa. Out of 1460 AGYW, 78% (CI: 73.9–81.7) reported using some form of contraceptives. In the model, contraceptive use was significantly associated with secondary education [OR = 1.8 (1.2–2.7), p = 0.005], having a sexual partner within 5 years of their age [OR = 1.8 (1.2–2.5), p = 0.002], and sexual debut at age 15 years and older [OR = 2.5 (1.3–4.6), p = 0.006]. The likelihood of association decreased with other race groups-White, Coloured, and Indians/Asians [OR = 0.5 (0.3–0.7), p = 0.001], being married [OR = 0.4 (0.2–0.7), p = 0.001], never given birth [OR = 0.7 (0.5–0.9), p = 0.045], coming from rural informal [OR = 0.5 (0.3–0.9), p = 0.010] and rural formal settlements [OR = 0.5 (0.3–0.9), p = 0.020]. Evidence suggest that interventions should be tailor-made to meet the needs of AGYW in order to, promote use and access to contraceptives. The results also suggest that family planning interventions should target those who had not given birth in order to reduce unplanned and or unintended pregnancies and associated risk factors. These findings contribute to public health discourse and reproductive health planning for these age groups in the country.

  • History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-12
    Fides Schückher; Tabita Sellin; Ingemar Engström; Kristina Berglund

    To examine the relationship between treatment outcome, as measured according to change in alcohol consumption, and a history of childhood abuse (emotional, physical, sexual) in socially stable women undergoing treatment for alcohol use disorder (AUD). Participants were assessed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview at the beginning of treatment (n = 75), end of treatment (n = 59) and 12 month follow-up after treatment (n = 57). Self-report data on alcohol consumption were obtained at all three time-points using the Alcohol Habits Inventory-Revised 2. Self-report data on childhood maltreatment were obtained at the beginning of treatment using the Childhood Trauma Questionnaire-short form. Study outcomes were changes in alcohol consumption (grams of pure alcohol per week), risk-drinking and reported abstinence. Of the 75 women enrolled, 38 (50.7%) reported a history of childhood abuse and the rest did not. Both groups showed a significant improvement in all three outcomes at the end of treatment and at 12-month follow-up. At the end of treatment, a significant inter-group difference was found for reported abstinence (non-abused group, 39.3% vs abused, 12.9%; p < 0.05). At 12-month follow-up, significant inter-group differences were observed for all treatment outcomes, with superior outcomes being found for the non-abused group, including a higher proportion of women with reported abstinence (55.6% vs 13.3%; p < 0.01). The present findings suggest that an evaluation of a possible history of childhood abuse is warranted in all women seeking treatment for AUD, irrespective of social stability. In terms of clinical practice, the results suggest that additional interventions may be warranted in this population.

  • Experience obtaining legal abortion in Uruguay: knowledge, attitudes, and stigma among abortion clients
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-09
    Shelly Makleff; Ana Labandera; Fernanda Chiribao; Jennifer Friedman; Roosbelinda Cardenas; Eleuthera Sa; Sarah E. Baum

    The abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. Implementation of the law in Uruguay has been lauded, but barriers to care, including abortion stigma, remain. This study aimed to assess women’s experiences seeking abortion services and related attitudes and knowledge following implementation of the law in Uruguay. We interviewed 207 eligible women seeking abortion services at a high-volume public hospital in Montevideo in 2014. We generated univariate frequencies to describe women’s experiences in care. We conducted regression analysis to examine variations in experiences of stigma by women’s age and number of abortions. Most of the women felt that abortion was a right, were satisfied with the services they received, and agreed with the abortion law. However, 70% found the five-day waiting period unnecessary. Women experienced greater self-judgement than worries about being judged by others. Younger women in the sample (ages 18–21) reported being more worried about judgment than women 22 years or older (1.02 vs. 0.71 on the ILAS sub-scale). One quarter of participants reported feeling judged while obtaining services. Women with more than one abortion had nearly three times the odds of reporting feeling judged. These findings highlight the need to address abortion stigma even after the law is changed. Some considerations from Uruguay that may be relevant to other jurisdictions reforming abortion laws include: the need for strategies to reduce judgmental behavior from staff and clinicians towards women seeking abortions, including training in counseling skills and empathic communication; addressing stigmatizing attitudes about abortion through community outreach or communications campaigns; mitigating the potential stigma that may be perpetuated through policies to prevent “repeat” abortions; ensuring that younger women and those with more than one abortion feel welcome and are not mistreated during care; and assessing the necessity of a waiting period. The rapid implementation of legal, voluntary abortion services in Uruguay can serve in many ways as an exemplar, and these findings may inform the process of abortion law reform in other countries.

  • How is patient-centred care conceptualized in women’s health: a scoping review
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-10
    Anna R. Gagliardi; Bryanna B. Nyhof; Sheila Dunn; Sherry L. Grace; Courtney Green; Donna E. Stewart; Frances C. Wright

    Gendered disparities in health care delivery and outcomes are an international problem. Patient-centred care (PCC) improves patient and health system outcomes, and is widely advocated to reduce inequities. The purpose of this study was to review published research for frameworks of patient-centred care for women (PCCW) that could serve as the basis for quality improvement. A scoping review was conducted by searching MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library, and Joanna Briggs index for English-language quantitative or qualitative studies published from 2008 to 2018 that included at least 50% women aged 18 years or greater and employed or generated a PCCW framework. Findings were analyzed using a 6-domain PCC framework, and reported using summary statistics and narrative descriptions. A total of 9267 studies were identified, 6670 were unique, 6610 titles were excluded upon title/abstract screening, and 11 were deemed eligible from among 60 full-text articles reviewed. None were based on or generated a PCCW framework, included solely women, or analyzed or reported findings by gender. All studies explored or described PCC components through qualitative research or surveys. None of the studies addressed all 6 domains of an established PCC framework; however, additional PCC elements emerged in 9 of 11 studies including timely responses, flexible scheduling, and humanized management, meaning tailoring communication and treatment to individual needs and preferences. There were no differences in PCC domains between studies comprised primarily of women and other studies. Given the paucity of research on PCCW, primary research is needed to generate knowledge about PCCW processes, facilitators, challenges, interventions and impacts, which may give rise to a PCCW framework that could be used to plan, deliver, evaluate and improve PCCW.

  • Determinant of time-to-first birth interval after marriage among Ethiopian women
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-10
    Ayele Gebeyehu Chernet; Dinberu Seyoum Shebeshi; Akalu Banbeta

    Time-to-first birth after marriage has a significant role in the future life of each individual woman and has a direct relationship with fertility. This study aimed to see the determinant of time-to-first birth interval after marriage among Ethiopian women. The data was obtained from 2011 Ethiopia Demographic and Health Survey which is the third survey. The sample was selected using a stratified; two-stage cluster sampling design and the data was analysed using parametric shared frailty model. A total of 7925 ever married women from the nine region of the country were included in this study. Of the total women, 5966 (75.3%) of them gave firstbirth. Age, residence area, employment status, contraceptive use and education of women were associated significantly to time-to-first birth. Women having younger age at first marriage, urban women, contraceptive users had prolonged time to first birth interval. There is a need of teaching family for contraceptive use and improving women education to increase the length of first birth interval in Ethiopia.

  • No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-05
    Grace Lucas; Ellinor K. Olander; Susan Ayers; Debra Salmon

    Young mothers face mental health challenges during and after pregnancy including increased rates of depression compared to older mothers. While the prevention of teenage pregnancy in countries such as the United States and the United Kingdom has been a focus for policy and research in recent decades, the need to understand young women’s own experiences has been highlighted. The aim of this meta-ethnography was to examine young women’s perceptions of their mental health and wellbeing during and after pregnancy to provide new understandings of those experiences. A systematic review and meta-ethnographic synthesis of qualitative research was conducted. Seven databases were systematically searched and forward and backward searching conducted. Papers were included if they were from Organisation for Economic Co-operation and Development countries and explored mental health and wellbeing experiences of young mothers (age under 20 in pregnancy; under 25 at time of research) as a primary research question – or where evidence about mental health and wellbeing from participants was foregrounded. Nineteen papers were identified and the Critical Appraisal Skills Programme checklist for qualitative research used to appraise the evidence. Following the seven-step process of meta-ethnography, key constructs were examined within each study and then translated into one another. Seven translated themes were identified forming a new line of argument wherein mental health and wellbeing was analysed as relating to individual bodily experiences; tied into past and present relationships; underpinned by economic insecurity and entangled with feelings of societal surveillance. There were ‘no straight lines’ in young women’s experiences, which were more complex than dominant narratives around overcoming adversity suggest. The synthesis concludes that health and social care professionals need to reflect on the operation of power and stigma in young women’s lives and its impact on wellbeing. It adds to understanding of young women’s mental health and wellbeing during and after pregnancy as located in physical and structural factors rather than individual capacities alone.

  • Preferred problem solving and decision-making role in fertility treatment among women following an unsuccessful in vitro fertilization cycle
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-05
    Celia Hoi Yan Chan; Bobo Hi Po Lau; Michelle Yi Jun Tam; Ernest Hung Yu Ng

    While the literature on healthcare decision-making has long focused on doctor-patient interaction, fertility treatment is an exception, characterized by a triangular interplay between the doctor, the woman and her partner. This study examined treatment decision-making preferences of women undergoing in vitro fertilization (IVF) treatment, following an unsuccessful IVF cycle, especially their preferred level of doctor and spousal involvement. A cross-sectional survey was conducted with 246 Chinese women undergoing IVF recruited from an assisted reproduction clinic of a university-affiliated hospital in Hong Kong. Data collection was conducted between January 2014 and August 2015. Most participants preferred sharing the decision-making tasks with their doctors (92%). In the doctor-patient relationship, passive roles were associated with higher marital satisfaction, presence of religious affiliation and secondary infertility, while autonomous roles were related to female-factor infertility. Fifty-two percent of participants anticipated sharing decision-making, while 46% preferred handing over the decision to their husbands. Preference for a passive rather than a shared role in the spousal relationship was related to a higher husband’s age, greater marital satisfaction and higher anxiety. In brief, women tended to prefer sharing decision-making tasks with their doctor as well as actively engaging their partner in making decisions about fertility treatment. This study adds to our understanding of women’s role preference and level of involvement in infertility treatment decision-making by providing quantitative evidence from women’s experience. It highlights the importance of healthcare professionals in facilitating shared decision-making among couples.

  • Coital resumption after delivery among OASIS patients: differences between instrumental and spontaneous delivery
    BMC Womens Health (IF 1.592) Pub Date : 2019-12-06
    Sònia Anglès-Acedo; Cristina Ros-Cerro; Sílvia Escura-Sancho; Núria Elías-Santo-Domingo; M. José Palau-Pascual; Montserrat Espuña-Pons

    Obstetric anal sphincter injuries (OASIS) are associated with sexual dysfunction and a lower likelihood of sexual activity in the postpartum period. The aim of the present study was to compare coital resumption and the variables influencing this activity after delivery in women with and without a history of obstetric anal sphincter injury (OASIS) and according to the mode of delivery. A prospective, observational, case-control study was performed at 6 months postpartum in 318 women: 140 with a history of primary repaired OASIS and 178 women without OASIS. Demographic and obstetric data, breastfeeding, and symptoms of urinary and anal incontinence were collected. Patients were asked about coital resumption and completed the validated specific Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12). Continuous and non-continuous variables were compared using ANOVA and the Fisher exact tests, respectively. A multivariate logistic regression model and a multiple regression analysis were constructed to assess the impact of demographic and clinical variables on the percentage of coital resumption and on the PISQ-12 score, respectively. After a spontaneous delivery (SD), patients without OASIS showed a higher percentage of coital resumption than those with OASIS (98% vs. 77%; p = 0.003), and the PISQ-12 score was also higher (p < 0.001). PISQ-12 score was better in women with SD compared to those with operative vaginal delivery (OVD)(p < 0.001), independently of the history of OASIS. Current breastfeeding, a higher Wexner score and OVD negatively influenced the PISQ-12 score. After SD, women with OASIS resumed coital activity later than women without OASIS. Women with OVD resumed coital activity later, and had a lower PISQ-12 score than women with SD.

  • Nocturnal finger skin temperature in menstrual cycle tracking: ambulatory pilot study using a wearable Oura ring
    BMC Womens Health (IF 1.592) Pub Date : 2019-11-29
    Anna Maijala; Hannu Kinnunen; Heli Koskimäki; Timo Jämsä; Maarit Kangas

    Body temperature is a common method in menstrual cycle phase tracking because of its biphasic form. In ambulatory studies, different skin temperatures have proven to follow a similar pattern. The aim of this pilot study was to assess the applicability of nocturnal finger skin temperature based on a wearable Oura ring to monitor menstrual cycle and predict menstruations and ovulations in real life. Volunteer women (n = 22) wore the Oura ring, measured ovulation through urine tests, and kept diaries on menstruations at an average of 114.7 days (SD 20.6), of which oral temperature was measured immediately after wake-up at an average of 1.9 cycles (SD 1.2). Skin and oral temperatures were compared by assessing daily values using repeated measures correlation and phase mean values and differences between phases using dependent t-test. Developed algorithms using skin temperature were tested to predict the start of menstruation and ovulation. The performance of algorithms was assessed with sensitivity and positive predictive values (true positive defined with different windows around the reported day). Nocturnal skin temperatures and oral temperatures differed between follicular and luteal phases with higher temperatures in the luteal phase, with a difference of 0.30 °C (SD 0.12) for skin and 0.23 °C (SD 0.09) for oral temperature (p < 0.001). Correlation between skin and oral temperatures was found using daily temperatures (r = 0.563, p < 0.001) and differences between phases (r = 0.589, p = 0.004). Menstruations were detected with a sensitivity of 71.9–86.5% in window lengths of ±2 to ±4 days. Ovulations were detected with the best-performing algorithm with a sensitivity of 83.3% in fertile window from − 3 to + 2 days around the verified ovulation. Positive predictive values had similar percentages to those of sensitivities. The mean offset for estimations were 0.4 days (SD 1.8) for menstruations and 0.6 days (SD 1.5) for ovulations with the best-performing algorithm. Nocturnal skin temperature based on wearable ring showed potential for menstrual cycle monitoring in real life conditions.

  • Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey
    BMC Womens Health (IF 1.592) Pub Date : 2019-11-29
    Awol Seid Yimer; Lebitsi Maud Modiba

    Evidences from various parts of the world reveal that women with disabilities are facing widespread barriers in accessing public services. Service providers and program managers do not grasp the relevance of their work and interventions in addressing the sexual and reproductive health needs of women with disabilities. The present study therefore aimed to assess family planning knowledge and practice among women with sensory disabilities. A mixed method approach using quantitative and qualitative methods was employed to collect the data. The study included 326 blind and deaf women using respondent driven sampling technique and 29 purposely selected key informants. We carried out the study from August 2016–April 2017. The quantitative data were analyzed using SPSS and the qualitative analysis was done using Open code software version 4.02 and triangulated with the quantitative findings. The findings showed that nearly two third of the respondents of were sexually active. The majority (97.2%) of study respondents had heard about FP methods, however the level of comprehensive knowledge on modern contraceptive methods was 32.5%. The prevalence of unwanted pregnancy was 67.0% and abortion was 44%. Almost half of sexually active respondents ever used modern contraceptive methods, yet the contraceptive prevalence at the time of survey was 31.1%. Implants were the most commonly used (51%) contraceptive method among current users. The use of modern contraceptive methods among women with sensory disabilities was low. Thus, the government and concerned organizations need to address the attitudinal, social, and physical barriers women with sensory disabilities are facing while seeking, accessing to and using family planning services.

  • Growth pattern of uterine leiomyoma along pregnancy
    BMC Womens Health (IF 1.592) Pub Date : 2019-07-22
    Henry Hillel Chill; Gilad Karavani; Talya Rachmani; Uri Dior; Ofer Tadmor; Asher Shushan

    Uterine leiomyomas are often discovered during early pregnancy and in most cases will have no effect on pregnancy outcomes. However, in rare cases uterine leiomyomas may lead to obstetric complications. The aim of the study was to evaluate rate of uterine leiomyoma growth in the 3 trimesters of pregnancy. We conducted a retrospective cohort study. Included were women who were diagnosed with uterine leiomyoma during pregnancy and had at least two sonographic measurements in different trimesters. Data regarding leiomyoma growth, recorded by ultrasound examination, during 1st 2nd and 3rd trimesters were collected from electronic patient records. Two-hundred forty-eight uterine leiomyomas were included in the study. Leiomyoma area increased substantially in size between the 1st and 2nd trimesters (54.5% ± 75.9%, p = .007) and to a lesser degree between the 2nd and 3rd trimesters (17.9% ± 59.7%, NS). Evaluation of the change in size throughout the pregnancy – between 1st and 3rd trimesters revealed a significant increase of 95.9% ± 191.3% (p < .001). There was no significant growth of the leiomyomas between the 2nd and 3rd trimesters. Uterine leiomyomas tend to grow substantially during the 1st trimester of pregnancy. This trend is attenuated later with minimal growth towards the end of gestation.

  • Spontaneous regression of quiescent gestational trophoblastic disease after pregnancy: a case report
    BMC Womens Health (IF 1.592) Pub Date : 2019-07-23
    Yoshiyuki Okada; Shingo Miyamoto; Takashi Mimura; Tetsuya Ishikawa; Akihiko Sekizawa; Koji Matsumoto

    A persistent low-level elevation of serum human chorionic gonadotropin (hCG) without clinical or radiological evidence of pregnancy or tumors was recently defined as quiescent gestational trophoblastic disease (Q-GTD). Whether patients with Q-GTD should be treated or allowed to become pregnant remains unclear. We herein report a rare case of Q-GTD in which the hCG level spontaneously returned to normal after a successful pregnancy. The patient was a 37-year-old primigravida who presented with a persistent low-level elevation of hCG after uterine evacuation of a hydatidiform mole. There was no evidence of neoplasia in the uterus or distant metastasis. The low-level elevation of hCG persisted for at least 2 years but never exceeded 200 mIU/mL. The patient had a successful pregnancy at the age of 40 years. Interestingly, her hCG level subsequently normalized without chemotherapy. The present case may imply the safety and therapeutic effect of pregnancy in women with Q-GTD.

  • Childhood adversity and women’s cardiometabolic health in adulthood: associations with health behaviors, psychological distress, mood symptoms, and personality
    BMC Womens Health (IF 1.592) Pub Date : 2019-07-23
    Lotte van Dammen; Nicole R. Bush; Susanne R. de Rooij; Ben Willem J. Mol; Henk Groen; Annemieke Hoek; Tessa J. Roseboom

    We tested whether childhood adversity is associated with poor cardiometabolic health in adulthood among a sample of overweight or obese Dutch women of reproductive age. Health behaviors, psychological distress, mood symptoms, or personality traits were included as potential mediators. Data came from a follow-up visit (N = 115), carried out in 2016/2017, of a randomized controlled lifestyle intervention trial in 577 obese infertile women. The associations between total adversity exposure score and cardiometabolic health were tested with regression models. Sleep, smoking and eating behavior, symptoms of depression, anxiety and stress, and personality traits were potential mediators. Childhood adversity scores were not associated with cardiometabolic outcomes but were associated with poorer sleep quality score (M = 7.2 (SD = 3.5) for those with ≥2 types of events versus 4.8 (2.9) for those with no events; p = 0.022), higher external eating score (26.4 (8.7) versus 21.8 (10.3); p = 0.038), higher perceived stress score (17.1 (6.8) versus 12.3 (4.5); p = 0.016), post-traumatic stress score (1.9 (1.5) versus 0.6 (1.1); p < 0.001), and lower agreeableness score (28.2 (4.2) versus 30.3 (3.1); p = 0.035). Childhood adversity was associated with poorer health behaviors including sleep and eating behavior, and more stress-related symptoms, but not with women’s cardiometabolic health.

  • The influence of probiotics on genital high-risk human papilloma virus clearance and quality of cervical smear: a randomized placebo-controlled trial
    BMC Womens Health (IF 1.592) Pub Date : 2019-07-24
    Yu-Che Ou; Hung-Chun Fu; Chih-Wen Tseng; Chen-Hsuan Wu; Ching-Chou Tsai; Hao Lin

    Probiotics has been shown to be effective in reducing vaginal colonization of pathogenic organisms. The aim of this study was to investigate the influence of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on genital high-risk human papilloma virus (HR-HPV) clearance and quality of cervical smear. This was a randomized, double-blinded, placebo-controlled trial. Women with genital HR-HPV infection were randomized into study and control groups. A probiotic or placebo preparation was administered orally (one capsule daily) until negative HR-HPV testing. A cervical smear and HR-HPV tests were performed at the beginning of the study and every 3 months thereafter until a negative result was obtained. A total of 121 women with genital HR-HPV infection were enrolled (62 in the study group and 59 in the control group). There was no significant difference in HR-HPV clearance rate between the two groups (58.1% vs. 54.2%). The only factor predicting HR-HPV clearance was a lower initial viral load (HR 3.214; 95% CI: 1.398, 7.392; p = 0.006). Twenty-two women had a mildly abnormal initial cervical smear and nine had an unsatisfactory smear. At 6 months follow-up, both mildly abnormal cervical smear and unsatisfactory smear rates had decreased significantly in the study group compared to the control group (p = 0.017 and 0.027). The application of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 did not influence genital HR-HPV clearance, but may have decreased the rates of mildly abnormal and unsatisfactory cervical smears. Clinicaltrials.gov NCT01599416 , May, 2012. Retrospectively registered.

  • Successful programmatic approaches to facilitating IUD uptake: CARE’s experience in DRC
    BMC Womens Health (IF 1.592) Pub Date : 2019-07-24
    Sarah Castle; Heidi Schroffel; Jean Jose Nzau Mvuezolo; Bavon Mupenda; Justin Mumbere; Rachel Shapiro

    Achieving the unfinished agenda towards sexual and reproductive health and rights requires overcoming remaining barriers to contraceptive uptake, which can be method-specific. Women’s uptake of the IUD is poor across sub-Saharan Africa. The objective of this paper is to identify the reasons for comparatively high IUD use observed in a CARE project in DRC, together with the programmatic characteristics which facilitated uptake. Qualitative data were collected in 2015 as part of a reproductive health project in the DRC. Using purposive sampling, 15 focus group discussions took place with IUD users, users of other methods and non-users of modern contraception as well as their male partners. Eighteen in-depth interviews were conducted with health providers, project staff, community health workers and local stakeholders to capture a range of experiences. Data were analyzed using content theory approach and contextualized through a review of routine monitoring data. In an area with practically no previous IUD use, 38,662 new FP clients were served during the first 5 years of the project and 82% (31,569) chose long-acting or permanent methods. Over 10,000 clients chose an IUD, representing 30% of the total FP clients. Key informants expressed mainly positive views about the IUD and quality of service. Concerns related to method insertion, which some perceived as too intimate or shameful. Findings indicate that this uptake reflects effective supply chains, good provider training and supervision and multiple communication strategies including those which target men. Community engagement was enhanced by local stakeholders’ participation in sensitization and quality assurance as well in analysis of data for decision-making. The findings of the paper showed that by involving local stakeholders in addressing structural and socio-cultural barriers to women’s free access to FP, programs can positively influence quality of service and method mix as well as knowledge and attitudes surrounding FP use and thus improve the uptake of FP in general and IUDs in particular, even in conflict-affected settings. A Theory of Change for enhancing IUD provision within family planning programs is suggested.

  • Reliability and validity of Japanese versions of the UCLA loneliness scale version 3 for use among mothers with infants and toddlers: a cross-sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2019-07-26
    Azusa Arimoto; Etsuko Tadaka

    Mothers with infants and toddlers are a potential target population for the prevention or alleviation of feelings of loneliness. However, the theory and methods for measuring loneliness among mothers with infants and toddlers have yet to be standardized worldwide, including in Japan. Our goal was to evaluate the reliability and validity of the Japanese version of the UCLA Loneliness Scale Version 3 (UCLA-LS3-J), as well as two short-form versions—the 10-item UCLA-LS3 (SF-10) and the 3-item UCLA-LS3 (SF-3)—for the measurement of loneliness in mothers with infants and toddlers in Japan. This cross-sectional study was conducted using a self-report questionnaire. The target population was 430 mothers with infants and toddlers who visited a community health center in Yokohama City in Japan. Questionnaire items encompassed the UCLA-LS3-J, as well as demographic data, the feeling for childrearing scale, and measures of social networks and subjective health status. The reliability and validity of the UCLA-LS3-J and its two short-form versions (SF-3 and SF-10) were determined via IBM SPSS Amos and SPSS Statistics 22. Questionnaires were returned by 248 mothers (valid response rate: 57.7%) aged 32.7 ± 4.6 (mean ± SD) years. The mean score on the UCLA-LS3-J was 38.4 ± 9.7 (range 20.0–73.0), with a normal distribution. When confirmatory factor analysis was carried out (for a single factor model), the goodness of fit of the model was almost identical to that of the original UCLA-LS3 version for the UCLA-LS3-J: (GFI = 0.882, AGFI = 0.840, CFI = 0.932, RMSEA = 0.066) and SF-10: (GFI = 0.942, AGFI = 0.900, CFI = 0.956, RMSEA = 0.081). The SF-3 model also showed an acceptable fit. The UCLA-LS3-J total score was significantly correlated with the total score on the SF-10 (r = 0.965) and SF-3 (r = 0.868). The Cronbach’s α coefficient of the UCLA-LS3-J was 0.926, while those of the SF-10 and SF-3 were 0.888 and 0.790, respectively. The score on the UCLA-LS3-J was positively correlated with childcare burden (r = .319, p < 0.001) and negatively correlated with social networks (r = −.438, p < 0.001). This study indicated that the reliability and validity of the UCLA-LS3-J as well as its two short-form versions were adequate for assessing loneliness in mothers with infants and toddlers in Japan.

  • A qualitative exploration of ‘thrivership’ among women who have experienced domestic violence and abuse: Development of a new model
    BMC Womens Health (IF 1.592) Pub Date : 2019-08-06
    Isobel Heywood; Dana Sammut; Caroline Bradbury-Jones

    Domestic violence and abuse (DVA) is a serious public health issue, threatening the health of individuals the world over. Whilst DVA can be experienced by both men and women, the majority is still experienced by women; around 30% of women worldwide who have been in a relationship report that they have experienced violence at the hands of their partner, and every week in England and Wales two women are killed by their current or ex-partner. The purpose of this study was to explore the concept of thrivership with women who have experienced DVA, to contribute to our understandings of what constitutes ‘thriving’ post-abuse, and how women affected can move from surviving to thriving. Thirty-seven women took part in this qualitative study which consisted of six focus groups and four in-depth interviews undertaken in one region of the UK in 2018. Data were analysed using a thematic analysis approach. Initial findings were reported back to a group of participants to invite respondent validation and ensure co-production of data. The process of ‘thrivership’ – moving from surviving to thriving after DVA - is a fluid, non-linear journey of self-discovery featuring three ‘stages’ of victim, survivor, and thriver. Thriving after DVA is characterised by a positive outlook and looking to the future, improved health and well-being, a reclamation of the self, and a new social network. Crucial to ensuring ‘thrivership’ are three key components that we propose as the ‘Thrivership Model’, all of which are underpinned by education and awareness building at different levels: (1) Provision of Safety, (2) Sharing the Story, (3) Social Response. The study findings provide a new view of thriving post-abuse by women who have lived through it. The proposed Thrivership Model has been developed to illustrate what is required from DVA-services and public health practitioners for the thrivership process to take place, so that more women may be supported towards ‘thriving’ after abuse.

  • Female perspectives on male involvement in a human-papillomavirus-based cervical cancer-screening program in western Kenya
    BMC Womens Health (IF 1.592) Pub Date : 2019-08-08
    Konyin Adewumi; Sandra Y. Oketch; Yujung Choi; Megan J. Huchko

    To be effective, population-based cervical cancer prevention programs must be tailored to meet the needs of the target population. One important factor in cervical cancer screening may include male involvement. To iteratively improve a screening program employing self-collected vaginal swabs for human-papillomavirus (HPV) testing in western Kenya, we examined the role of male partners and community leaders in decision-making and accessing screening services. We carried out 604 semi-structured, in-depth interviews (IDIs) with women and community health volunteers who took part in a multiphase trial of implementation strategies for HPV-based cervical cancer screening. IDIs were coded and themes related to decision-making, screening and treatment barriers, and influence of male partners and community leaders were identified and analyzed. Women experienced both support and opposition from their male partners. Partner support took the form of financial support for transportation and emotional support and encouragement, while opposition ranged from anticipated negative reactions to lack of permission, isolation, and abandonment. Though most women described their own partners as supportive, many felt that other male partners would not be supportive. Most participants believed that increased HPV and cervical cancer knowledge would increase partner support. Women reported a general acceptance of involvement of community leaders in education and screening campaigns, in a setting where such leaders may hold influence over men in the community. There was a clear interest in involving male partners in the cervical cancer prevention process, specifically in increasing knowledge and awareness. Future research should explore the feasibility and effectiveness of engaging male partners in cervical cancer screening and prevention programs.

  • Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review
    BMC Womens Health (IF 1.592) Pub Date : 2019-08-09
    Eleanor Black; Fran Hyslop; Robyn Richmond

    Uganda has one of the highest age-standardized incidence rates of cervical cancer in the world. The proportion of Ugandan women screened for cervical cancer is low. To evaluate barriers and facilitators to accessing cervical cancer screening, we performed a systematic review of reported views of Ugandan women and healthcare workers. The aim of this review is to inform development of cervical cancer screening promotional and educational programs to increase screening uptake and improve timely diagnosis for women with symptoms of cervical cancer. Fourteen studies that included the views of 4386 women and 350 healthcare workers published between 2006 and 2019 were included. Data were abstracted by two reviewers and findings collated by study characteristics, study quality, and barriers and facilitators. Nineteen barriers and twenty-one facilitators were identified. Study settings included all districts of Uganda, and the quality of included studies was variable. The most frequently reported barriers were embarrassment, fear of the screening procedure or outcome, residing in a remote or rural area, and limited resources / health infrastructure. The most frequent facilitator was having a recommendation to attend screening. Understanding the barriers and facilitators to cervical cancer screening encountered by Ugandan women can guide efforts to increase screening rates in this population. Additional studies with improved validity and reliability are needed to produce reliable data so that efforts to remove barriers and enhance facilitators are well informed.

  • Difference in vaginal microecology, local immunity and HPV infection among childbearing-age women with different degrees of cervical lesions in Inner Mongolia
    BMC Womens Health (IF 1.592) Pub Date : 2019-08-12
    Jing-Jing Zheng; Jing-Hui Song; Cong-Xiang Yu; Fei Wang; Peng-Cheng Wang; Jing-Wei Meng

    This study aims to investigate the difference in vaginal microecology, local immunity and HPV infection among childbearing-age women with different degrees of cervical lesions. A total of 432 patients were included in this study. Among these patients, 136 patients had LSIL, 263 patients had HSIL and 33 patients had CSCC. These patients were assigned as the research groups. In addition, 100 healthy females were enrolled and assigned as the control group. The microbiological indexes of vaginal secretions were evaluated. Furthermore, the concentrations of SIgA, IgG, IL-2 and IL-10 in vaginal lavage fluid, as well as the presence of HPV, mycoplasma and Chlamydia in cervical secretions, were detected. The results is that: (1) Differences in evaluation indexes of vaginal microecology among all research groups and the control group were statistically significant (P < 0.0001). As the degree of cervical lesions increased, the number of Lactobacillus decreased, and there was an increase in prevalence of bacterial imbalance, and the diversity, density and normal proportion of bacteria was reduced. Furthermore, the incidence of HPV, trichomonads, clue cell and Chlamydia infection increased. Moreover, the positive rate of H2O2 decreased, while the positive rates of SNa and GADP increased. (2) Differences in the ratio of IL-2 and IL-10 in the female genital tract among all research groups and the control group were statistically significant (P < 0.0001). As the degree of cervical lesions increased, IL-2 decreased, IL-10 increased and IL-2/IL-10 decreased, while SIgA and IgG were elevated. The reduction of dominant Lactobacillus in the vagina, impairment of H2O2 function, flora ratio imbalance, pathogen infections, reduction in IL-2/IL-10 ratio, and changes in SIgA and IgG levels could all be potential factors that influenced the pathogenicity of HPV infection and the occurrence and development of cervical lesions.

  • Association of breastfeeding and postmenopausal osteoporosis in Chinese women: a community-based retrospective study
    BMC Womens Health (IF 1.592) Pub Date : 2019-08-13
    Guiming Yan; Yaqi Huang; Hong Cao; Jie Wu; Nan Jiang; Xiaona Cao

    Postmenopausal osteoporosis (PMOP) has long been a pervasive public health concern. With the aging Chinese population, the prevention, assessment and management of postmenopausal osteoporosis were particularly important. During the breastfeeding, a large amount of Calcium loss from maternal bone for infants’ growth. However, whether this loss is completely reversible remains controversial. As the relationship between breastfeeding and postmenopausal osteoporosis is different from society to society and is not clear from the literature, the purpose of this study was to determine whether breastfeeding was an independent factor for the development of PMOP based on Chinese postmenopausal population. A retrospective cross-sectional investigation was conducted at Tianjin Xiaobailou health Community Healthcare Center between December 2017 and June 2018. Postmenopausal women over the age of 50 who underwent the annual health examination or visited the center to perform bone densitometry as a part of routine screening for disease were recruited. A trained community nurse administered a questionnaire to all participants by face-to-face interview. Participants were questioned about age, BMI, Vitamin D and calcium intake, the history of smoking, drinking and fracture, age of menarche, age of menopause, the number of pregnancy, parity, feeding pattern (breastfeeding, artificial feeding and mixed feeding) and overall breastfeeding duration. BMD measurements were carried out using quantitative ultrasound (QUS) at the bilateral radius. A total of 202 women who met the inclusive and exclusive criteria were enrolled. Univariate analysis revealed that overall breastfeeding more than 24 months increased the risk of osteoporosis (OR 39.00, 95%CI 2.40–634.65, p = 0.010). However, multivariate estimate of the risk of osteoporosis by overall breastfeeding duration suggested that when controlling for age, BMI, the number of pregnancy and parity, the overall breastfeeding duration was not an independent risk factor for postmenopausal osteoporosis (OR 5.22, 95%CI 0.18–147.76, p = 0.333). Additionally, age (OR 1.16, 95%CI 1.05–1.29, p = 0.003), BMI (OR 1.26, 95%CI 1.04–1.54, p = 0.021) and the number of pregnancy (OR 1.80, 95%CI 1.08–2.98, p = 0.024) were significant associated with postmenopausal osteoporosis. Breastfeeding was not associated with postmenopausal osteoporosis, while age, BMI and the number of pregnancy may contribute to increasing risk of postmenopausal osteoporosis in Chinese women.

  • A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial
    BMC Womens Health (IF 1.592) Pub Date : 2019-08-17
    Fred M. Ssewamala; Ozge Sensoy Bahar; Yesim Tozan; Proscovia Nabunya; Larissa Jennings Mayo-Wilson; Joshua Kiyingi; Joseph Kagaayi; Scarlett Bellamy; Mary M. McKay; Susan S. Witte

    Sub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found that they had increased odds of HIV infection relative to the general female population. Social structural factors, such as the sex work environment, violence, stigma, cultural issues, and criminalization of sex work are critical in shaping sexually transmitted infection (STI)/HIV risks among WESW and their clients in Uganda. Poverty is the most commonly cited reason for involvement in sex work in SSA. Against this backdrop, this study protocol describes a randomized controlled trial (RCT) that tests the impact of adding economic empowerment to traditional HIV risk reduction (HIVRR) to reduce new incidence of STIs and HIV among WESW in Rakai and the greater Masaka regions in Uganda. This three-arm RCT will evaluate the efficacy of adding savings, financial literacy and vocational training/mentorship to traditional HIVRR on reducing new incidence of STI infections among 990 WESW across 33 hotspots. The three arms (n = 330 each) are: 1) Control group: only HIVRR versus 2) Treatment group 1: HIVRR plus Savings plus Financial Literacy (HIVRR + S + FL); and 3) Treatment group 2: HIVRR plus S plus FL plus Vocational Skills Training and Mentorship (V) (HIVRR + S + FL + V). Data will be collected at baseline (pre-test), 6, 12, 18 and 24-months post-intervention initiation. This study will use an embedded experimental mixed methods design where qualitative data will be collected post-intervention across all conditions to explore participant experiences. When WESW have access to more capital and/or alternative forms of employment and start earning formal income outside of sex work, they may be better able to improve their skills and employability for professional advancement, thereby reducing their STI/HIV risk. The study findings may advance our understanding of how best to implement gender-specific HIV prevention globally, engaging women across the HIV treatment cascade. Further, results will provide evidence for the intervention’s efficacy to reduce STIs and inform implementation sustainability, including costs and cost-effectiveness. ClinicalTrials.gov , ID: NCT03583541 .

  • Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: a qualitative study
    BMC Womens Health (IF 1.592) Pub Date : 2019-09-02
    Carla Freijomil-Vázquez; Denise Gastaldo; Carmen Coronado; María-Jesús Movilla-Fernández

    Internationally, women with cervical intraepithelial neoplasia (CIN) lack knowledge about their disease, which limits their ability to take responsibility for self-care and creates negative psychosocial effects, including marital problems. Normally, screening is performed in primary care, and in case of abnormal results, the patient is referred to specialized care for follow-up and treatment. Given the lack of international literature regarding patients’ experiences in primary and specialized healthcare, our study aims to: (a) investigate how women with CIN perceive the communication and management of information by healthcare providers at different moments of their healthcare and (b) identify these women’s informational needs. A qualitative exploratory study was carried out in a gynecology unit of a public hospital of the Galician Health Care Service (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women aged 21 to 52 years old with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed. A thematic analysis was carried out, including triangulation of researchers for analysis verification. Two analytical themes were identified. The first was communication gaps in the diagnosis and management of information in primary and specialized healthcare. These gaps occurred in the following moments of the healthcare process: (a) cervical cancer screening in primary care, (b) waiting time until referral to specialized care, (c) first consultation in specialized care, and (d) after consultation in specialized care. The second theme was participants’ unmatched informational needs. The doubts and informational needs of women during their healthcare process related to the following subthemes: (a) HPV transmission, (b) HPV infection symptoms and consequences, and (c) CIN treatment and follow-up. This study shows that women who have a diagnosis of CIN experience important healthcare informational challenges when accessing primary and specialized care that have several implications for their wellbeing. The information given is limited, which makes it difficult for women to understand and participate in the decision making regarding the prevention and treatment of CIN. Service coordination among different levels of care and the availability of educational materials at any given time would improve the patients’ healthcare experience.

  • Reducing underreporting of stigmatized pregnancy outcomes: results from a mixed-methods study of self-managed abortion in Texas using the list-experiment method
    BMC Womens Health (IF 1.592) Pub Date : 2019-09-03
    Heidi Moseson; Sofia Filippa; Sarah E. Baum; Caitlin Gerdts; Daniel Grossman

    Accurately measuring stigmatized experiences is a challenge across reproductive health research. In this study, we tested a novel method – the list experiment – that aims to reduce underreporting of sensitive events by asking participants to report how many of a list of experiences they have had, not which ones. We applied the list experiment to measure “self-managed abortion” - any attempt by a person to end a pregnancy on one’s own, outside of a clinical setting – a phenomenon that may be underreported in surveys due to a desire to avoid judgement. We administered a double list experiment on self-managed abortion to a Texas-wide representative sample of 790 women of reproductive age in 2015. Participants were asked how many of a list of health experiences they had experienced; self-managed abortion was randomly added as an item to half of the lists. A difference in the average number of items reported by participants between lists with and without self-managed abortion provided a population level estimate of self-managed abortion. In 2017, we conducted cognitive interviews with women of reproductive age in four states to understand how women (1) interpreted the list experiment question format, and (2) interpreted the list item on prior experiences attempting to self-manage an abortion. Results from this list experiment estimated that 8% of women of reproductive age in Texas have ever self-managed an abortion. This number was higher than expected, thus, the researchers conducted cognitive interviews to better understand how people interpreted the list experiment on self-managed abortion. Some women interpreted “on your own” to mean “without the knowledge of friends or family”, as opposed to “without medical assistance”, as intended. The list experiment may have reduced under-reporting of self-managed abortion; however, the specific phrasing of the list item may also have unintentionally increased reporting of abortion experiences not considered “self-managed.” High participation in and comprehension of the list experiment, however, suggests that this method is worthy of further exploration as tool for measuring stigmatized experiences.

  • An investigation of the effects of infertility on Women’s quality of life: a case-control study
    BMC Womens Health (IF 1.592) Pub Date : 2019-09-04
    Katayoun Bakhtiyar; Ramin Beiranvand; Arash Ardalan; Farahnaz Changaee; Mohammad Almasian; Afsaneh Badrizadeh; Fatemeh Bastami; Farzad Ebrahimzadeh

    Human instinctively desire to have offspring. Infertility can cause painful emotional experiences throughout the life mainly known as quality of life impairment. This study aimed to investigate the impact of infertility on a woman’s quality of life. A number of 180 infertile and 540 fertile women participated in this matched case-control study. The cases were selected through a combination of multistage stratified and cluster sampling methods. For each infertile woman three fertile women were randomly selected. The data gathering instrument consisted of demographic variables and the WHOQOL-BREF questionnaire. Data collection was conducted through interview with participants. The multivariate marginal model and SPSS software 21 were used for data analyses with a significance level of 0.05. The results of the multivariate modeling show infertility can potentially affect various aspects of women’s quality of life such as physical health (p < 0.001), mental health (p < 0.001), social health (p < 0.001) and the total score of quality of life (p < 0.001) significantly. An infertile woman practice a relatively lower scores in QOL sub-scales of mental, physical and environmental health; while they experience a higher social health score than a fertile woman.

  • Risk factors of induced abortion among preparatory school student in Guraghe zone, Southern region, Ethiopia: a cross-sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2019-09-11
    Kifle Lentiro; Teklemichael Gebru; Abdusemed Worku; Agizie Asfaw; Tigist Gebremariam; Addisu Tesfaye

    Induced abortion is a common undergo in many societies of the world. Every year, around 20 million unsafe abortions are done worldwide. From fragmented studies conducted in Ethiopia, the prevalence of induced abortion and its adverse effects are increasing over time. The aim of this study was to assess factors associated with induced abortion among female preparatory school students in Guraghe zone. A cross-sectional study was conducted among female students of preparatory schools in April 2017. Systematic random sampling technique was employed to select 404 students from the total of 3960 female preparatory school students in the study area. Data was collected through self-administered questionnaires. Descriptive summary, binary and multivariate analyses were underwent to identify factors associated with induced abortion. The study was ethically approved by institutional review board of Wolkite University. The response rate of this study was 98.3%. The lifetime prevalence of induced abortion among young preparatory schools students whose age range from 15 to 22 years was 13.6% [95% CI (10.4, 17.1)]. The odds of induced abortion undergo was 2.3 times more likely in rural family residents [AOR = 2.3, 95% CI (1.1, 4.8)] as compared to that of urban family residents. Students without sexual health education were 6.4 times more likely to undergo induced abortion as compared to those who got sexual health education at sc0000hool [AOR = 6.4, 95% CI (3.1, 13.1)]. Furthermore, students who drank alcohol often were 4 times [AOR = 4.0, 95% CI (1.1, 14.2)] more likely to undergo induced abortion and students who consumed alcohol sometimes had 3.3 times [AOR: 3.3, 95%CI (1.4, 8.1)] the risk of induced abortion compared with girls with no history of alcohol consumption. A high lifetime prevalence of induced abortion among young adolescent was observed. Being rural residence, not having reproductive health education, and alcohol consumption were found to be independent predictors of induced abortion undergo. Therefore, IEC/BCC programs with special emphasis on youth friendly sexual and reproductive health services should be strengthened to reduce induced abortion.

  • Fatalism in breast cancer and performing mammography on women with or without a family history of breast cancer
    BMC Womens Health (IF 1.592) Pub Date : 2019-09-13
    Maryam Molaei-Zardanjani; Mitra Savabi-Esfahani; Fariba Taleghani

    Breast cancer is the most prevalent cancer in women, and in those with a positive family history, it is important to perform mammography. One of the probable barriers in doing mammography is fatalism. This is a descriptive/cross-sectional study conducted on 400 women residing in Isfahan, Iran, randomly selected in 2017. Sampling was done randomly among the enrolled women in Health Integrity System. The data collection tool was a questionnaire regarding the demographic-fertility information and fatalism. The data analysis was done by SPSS software. A P-value < 0.05 was considered statistically significant. The results showed that the mean rate of fatalism was 59.5 ± 23.2 in women with the experience of mammography, and 65.9±18.7 in women without the experience. Moreover, the mean rate of fatalism was 73.1±15.2 in subjects with a family history of breast cancer, and 59.3 ± 22.5 in those no family history related to this condition. Accordingly, fatalism was statistically significant associated (P < 0.001) with a family history of breast cancer and experience of mammography. There was no significant relationship between demographic information and fatalism (P > 0.05). The results indicated that fatalism in women with no experience of mammography was higher than in those with a positive history. Regarding the necessity of mammography in women with a family history of breast cancer, the required interventions seem to be essential to changing the viewpoints of women regarding the importance and effect of mammography as a screening method for breast cancer.

  • Number of parity is associated with low-grade albuminuria in middle-aged and elderly Chinese women
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-07
    Kan Sun; Diaozhu Lin; Feng Qiling; Feng Li; Yiqin Qi; Wanting Feng; Meng Ren; Li Yan; Dan Liu

    Women with a higher number of pregnancies have a higher risk of developing cardiovascular diseases. Subtle fluctuations in albumin excretion could be related to pathophysiologic changes in the vascular system. We aimed to investigate the possible association of parity with low-grade albuminuria. We conducted a community-based study in 6495 women aged 40 years or older. Low-grade albuminuria was defined according to the highest quartile of urine albumin-to-creatinine ratio in participants free of micro- or macro-albuminuria. Parous women with a higher number of pregnancies had increased age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), fasting plasma glucose (FPG), and fasting insulin, as well as decreased high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR) levels, and proportion of menopause. The prevalence of low-grade albuminuria in parous women gradually increased with parity number. Compared with women with one childbirth, those with more than two childbirths were independently associated with a higher prevalent low-grade albuminuria (odds ratios [ORs] 1.41, 95% confidence interval [CI], 1.09–1.81) after multiple adjustments. In subgroup analysis after multiple adjustments, significant relation between parity number and prevalent low-grade albuminuria was detected in subjects age 55 years or older. Number of parity is associated with prevalent low-grade albuminuria in middle-aged and elderly Chinese women without micro- or macro-albuminuria.

  • Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-15
    Daniel Grossman; Sarah Raifman; Tshegofatso Bessenaar; Lan Dung Duong; Anand Tamang; Monica V. Dragoman

    Medical abortion (MA) has become an increasingly popular choice for women even where surgical abortion services are available. Pain is often cited by women as one of the worst aspects of the MA experience, yet we know little about women’s experience with pain management during the process, particularly in low resource settings. The aim of this study is to better understand women’s experiences of pain with MA and strategies for improving quality of care. This qualitative study was conducted as part of a three-arm randomized, controlled trial in Nepal, Vietnam, and South Africa to investigate the effect of prophylactic pain management on pain during MA through 63 days’ gestation. We purposively sampled seven parous and seven nulliparous women with a range of reported maximum pain levels from each country, totaling 42 participants. Thematic content analysis focused on MA pain experiences and management of pain compared to menstruation, labor, and previous abortions. MA is relatively less painful compared to giving birth and relatively more painful than menstruation, based on four factors: pain intensity, duration, associated symptoms and side effects, and response to pain medications. We identified four types of pain trajectories: minimal overall pain, brief intense pain, intermittent pain, and constant pain. Compared to previous abortion experiences, MA pain was less extreme (but sometimes longer in duration), more private, and less frightening. There were no distinct trends in pain trajectories by treatment group, parity, or country. Methods of coping with pain in MA and menstruation are similar in each respective country context, and use of analgesics was relatively uncommon. The majority of respondents reported that counseling about pain management before the abortion and support during the abortion process helped ease their pain and emotional stress. Pain management during MA is increasingly essential to ensuring quality abortion care in light of the growing proportion of abortions completed with medication around the world. Incorporating a discussion about pain expectations and pain management strategies into pre-MA counseling and providing access to information and support during the MA process could improve the quality of care and experiences of MA patients. Australian New Zealand Clinical Trials Registry ACTRN12613000017729 , registered January 8, 2013.

  • Fit for fight – self-reported health in military women: a cross-sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-17
    Elin Anita Fadum; Leif Åge Strand; Monica Martinussen; Laila Breidvik; Nina Isaksen; Einar Borud

    Substantial research has found that women assess their health as poor relative to men, but the reasons for this are not fully understood. Military women are characterised by good health and the ability to work in an archetypically male culture. Thus, studies on the gender pattern of self-reported health in military personnel could generate hypotheses for future research on the possible associations between gender and health. However, such studies are rare and limited to a few countries. The aim of this study was to examine self-reported physical and mental health in Norwegian military women. We compared responses on self-reported health of 1068 active duty military women in Norway to those of active duty military men (n = 8100). Further, we compared the military women to civilian women working in the Norwegian Armed Forces (n = 1081). Participants were stratified into three age groups: 20–29; 30–39; and 40–60 years. We used Pearson Chi-square tests, Students t-tests and regression models to assess differences between the groups. The military women in our study reported physical illness and injuries equal to those of military men, but more military women used pain relieving and psychotropic drugs. More military women aged 20–29 and 30–39 years reported mental health issues than military men of the same age. In the age group 30–39 years, twice as many military women assessed their health as poor compared to military men. In the age group 40–60 years, more military women than men reported musculoskeletal pain. Military women used less smokeless tobacco than military men, but there were few differences in alcohol consumption and smoking. Military women appeared to be more physically healthy than civilian women, but we found few differences in mental health between these two groups. Most military women reported physical symptoms equal to those of military men, but there were differences between the genders in mental health and drug use. More favourable health compared to civilian women was most evident in the youngest age group and did not apply to mental health.

  • Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-18
    Sabina Ulbricht; Angelika Beyer; Ulrich John

    To determine whether use of intrauterine device (IUD) is influenced by a history of induced abortion and the type of contraceptives used until costs are covered. We analyzed data from 301 female residents in Mecklenburg-West Pomerania, an economically challenged community. The women, aged between 20 and 35 years, were entitled to receive unemployment benefits, and had access to free-of-charge oral contraceptives, ring or IUD. Cross-sectional data were analyzed using logistic regression. There were 112 (37.2%) women with a history of induced abortion, and 46 (15.3%) reported exclusively using less effective contraceptives (e.g. condoms). In a univariate logistic regression, use of an IUD was associated with a history of having had an induced abortion. Furthermore, uptake of an IUD was associated with women who had, until costs were covered, exclusively choice to use less effective contraceptives (OR = 3.281, 95% CI: 1.717; 6.273). Both associations remained significant in a multivariate model. Free contraceptives provided to women receiving unemployment benefits may increase the use of IUDs, especially among those with a history of an induced abortion and those using less effective contraceptives.

  • Secnidazole for treatment of bacterial vaginosis: a systematic review
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-21
    Mohamed A. Abd El Aziz; Foruzan Sharifipour; Parvin Abedi; Shayesteh Jahanfar; Helen Marie Judge

    Bacterial vaginosis (BV) is one of the common vaginal infections among childbearing women. The usual treatment for BV is metronidazole; hence 30% of women have recurrence within 60 to 90 days after treatment. There are some studies which assessed the effect of secnidazole on BV. The aim of this systematic review was to investigate the effectiveness of secnidazole for treatment of BV. The Cochrane Library, MEDLINE (PubMed), Scopus, and Web of Science (all databases from inception till October 28, 2018) were searched. Primary outcomes were clinical cure rate and microbiologic cure rate and the secondary outcomes were adverse events. Data was extracted from eligible studies by two review authors individually and analyzed by RevMan 5.3. Our search found six trials involving 1528 participants. Treatment with 2 g secnidazole could significantly reduce the risk of BV in patients with three or less episodes of BV in the last year by OR: 7.54 (95% CI, 3.89–14.60, p < 0.00001) and in patients with four or more episodes of BV in the last year (OR: 4.74, 95% CI: 1.51–14.84, p = 0.0.008). Secnidazole (2 g) could significantly increase the microbiologic cure rate in women with 3 or less episodes of BV in the last year (OR: 7.63, 95% CI: 2.30–25.33, p = 0.0009) but not in the women with 4 or more episodes of BV in the last year (OR: 20.17, 95% CI: 1.06–382.45, p = 0.05). The clinical cure rate, microbiological effect and the therapeutic cure rate of 2 g secnidazole was significantly more than that of 1 g secnidazole. The results showed that the clinical cure rate of 2 g secnidazole was not different from the following medications: metronidazole (500 mg bid for 5 days), secnidazole plus vaginal metronidazole, 2 g single dose of oral metronidazole and 2 g secnidazole plus vaginal ornidazole. This review showed that 2 g and 1 g secnidazole were better than placebo, however, 2 g secnidazole was more effective than 1 g. Secnidazole 2 g was not different from metronidazole (500 mg bid for 5 days), or from secnidazole plus vaginal metronidazole, or 2 g single dose of oral metronidazole or from 2 g secnidazole plus vaginal ornidazole.

  • Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-22
    Humariya Heena; Sajid Durrani; Muhammad Riaz; Isamme AlFayyad; Rabeena Tabasim; Gazi Parvez; Amani Abu-Shaheen

    Incidence of breast cancer in the Kingdom of Saudi Arabia (KSA) has increased in recent years. Screening helps in early detection of cancer and early diagnosis and timely treatment of breast cancer lead to a better prognosis. Women in the healthcare profession can have a positive impact on the attitudes, beliefs, and practices of general public. Therefore, it is important that the healthcare workers themselves have adequate knowledge and positive attitudes. We conducted a study to assess the knowledge, attitudes, and practices related to breast cancer screening among female healthcare professionals. A cross-sectional study was conducted on female health professional of KFMC (King Fahad Medical City). Data was collected using a pre-designed, tested, self-administered questionnaire. The questionnaire included specific sections to test the participants’ knowledge, attitude, and practices related to cervical cancer and its screening. Data analysis was done using descriptive statistics. A total of 395 health care workers participated in this study. The mean age of the participants was 34.7 years. Participants included physicians (n = 63, 16.0%), nurses (n = 261, 66.1%), and allied health workers (n = 71, 18.0%). Only 6 (1.5%) participants had a good level of knowledge of breast cancer and 104 (26.8%) participants demonstrated a fair level of knowledge. Overall, 370 (93.7%), 339 (85.8%), and 368 (93.2%) participants had heard of breast self-examination, clinical breast examination, and mammography, respectively. A total of 295 (74.7%) participants reported practicing breast self-examination, 95 (24.1%) had undergone clinical breast examination, and 74 (18.7%) had ever undergone mammography. The knowledge, attitudes, and practices related to breast cancer screening were found to be lower than expected. Active steps are required to develop educational programs for the health care staff, which might empower them to spread the knowledge and positively influence the attitudes of female patients in the hospital.

  • Knowledge and experience of a cohort of HIV-positive and HIV-negative Ghanaian women after undergoing human papillomavirus and cervical cancer screening
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-23
    Arabella Stuart; Dorcas Obiri-Yeboah; Yaw Adu-Sarkodie; Anna Hayfron-Benjamin; Angela D. Akorsu; Philippe Mayaud

    Cervical cancer is the most common cancer in women in Ghana, but knowledge and experience of women who have had cervical screening is under-evaluated. This study examined knowledge and understanding of HPV and cervical cancer and evaluated experiences of screening in a cohort of women of mixed HIV status. This was a mixed methods study using questionnaires and focus group discussions, with a knowledge score constructed from the questionnaire. HIV-positive and HIV-negative women were recruited from a larger cervical screening study in Ghana and were interviewed 6 months after receiving screening. Quantitative data was analyzed and triangulated with qualitative data following thematic analysis using the framework approach. A total of 131 women were included (HIV-positive, n = 60). Over 80% of participants had a knowledge score deemed adequate. There was no difference between HIV-status groups in overall knowledge scores (p = 0.1), but variation was seen in individual knowledge items. HIV-positive women were more likely to correctly identify HPV as being sexually-transmitted (p = 0.05), and HIV negative women to correctly identify the stages in developing cervical cancer (p = < 0.0001). HIV-positive women mostly described acquisition of HPV in stigmatising terms. The early asymptomatic phase of cervical cancer made it difficult for women to define “what” cancer was versus “what” HPV infection was. All women expressed that they found it difficult waiting for their screening results but that receiving information and counselling from health workers alleviated anxiety. Knowledge of women who had participated in a cervical screening study was good, but specific misconceptions existed. HIV-positive women had similar levels of knowledge to HIV-negative, but different misconceptions. Women expressed generally positive views about screening, but did experience distress. A standardized education tool explaining cervical screening and relevance specifically of HPV-DNA results in Ghana should be developed, taking into consideration the different needs of HIV-positive women.

  • Diagnostic challenges: low-grade adenosarcoma on deep endometriosis
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-26
    Jose Carlos Vilches Jimenez; Emilia Villegas Muñoz; Iván González Poveda; David Santos Lorente; Belinda Sanchez Pérez; Jesús S. Jimenez Lopez

    Müllerian adenosarcoma is a rare malignancy. These tumors occur mainly in the uterus, but also in extrauterine locations, usually related to endometriosis. Because of their rarity, there is limited data on optimal management strategies. We present a 44-year-old woman with a history of endometriosis who consults for chronic pelvic pain. In the imaging tests, a heterogeneous mass is observed that impresses endometriosis, encompassing the uterus and left appendage. Surgery is performed by finding an extrauterine adenosarcoma that affected the uterus, ovary and bladder wall. This is a rare case but should be considered in a patient with atypical clinical characteristics or preoperative pathology, so we show the diagnostic and therapeutic strategies carried out for the resolution of the case.

  • The myth of menstruation: how menstrual regulation and suppression impact contraceptive choice
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-28
    Andrea L. DeMaria; Beth Sundstrom; Stephanie Meier; Abigail Wiseley

    Women in the US have access to various hormonal contraceptive methods that can regulate menstruation. This study examined the attitudes and perceptions of reproductive-aged women toward contraceptive methods, including how menstrual regulation and suppression preferences influenced contraceptive choice. Data collection used a mixed-methods approach, including 6 focus groups (n = 61), individual interviews (n = 18), and a web-based survey (n = 547). Participants described contraceptive method preferences that allowed monthly bleeding and daily control, expressing concerns about long-acting reversible contraception (LARC) because of decreased user involvement. Some participants noted LARC improved their menstrual control. Many participants felt menstruation was healthy, whereas suppression was abnormal and resulted in negative health outcomes. Though participants indicated LARC as beneficial (M = 4.99 ± 1.66), convenient (M = 5.43 ± 1.68), and healthy (M = 4.62 ± 1.69), they chose combined oral contraceptives due to convenience. Findings suggest women need more information about menstrual regulation and suppression before selecting a contraceptive method, specifically in relation to LARC versus combined oral contraception. Framing menstrual suppression as healthy and natural may improve perceptions of long-term health consequences related to LARC. Providers should discuss menstrual suppression safety to ensure selection of contraceptive options aligning with women’s preferences and needs.

  • Cervical cancer screening service utilization and associated factors among age-eligible women in Jimma town using health belief model, South West Ethiopia
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-28
    Tadesse Nigussie; Bitiya Admassu; Aderajew Nigussie

    Cervical cancer is the second most common gynecologic cancer affecting the lives of women. It causes hundreds of thousands of death among women annually worldwide. When a woman is screened for cervical cancer at least once in her life between the ages of 30 and 40, the risk of getting cervical cancer can be decreased by 25–36%. Despite this advantage, the coverage of cervical cancer screening is limited in low and middle-income countries including Ethiopia. To assess cervical cancer screening service utilization and associated factors among age-eligible women in Jimma town, South West Ethiopia, 2017. Community based cross-sectional study was used. Seven hundred thirty-seven women were selected using systematic random sampling. Data were collected using a structured interview administered questionnaire. Data were collected on socio-demographic, reproductive factors, knowledge of cervical cancer as well as constructs of Health belief model and practice related variables. Logistic regression analysis was performed, and variables with a p-value of less than 0.05 in the multivariable analysis were taken as statistically significant predictors of cervical cancer screening service utilization. Of the 737 women, only 15.5% were screened for cervical cancer. The independent predictors of cervical cancer screening utilization were: being government employee [AOR = 3.00, 95% CI: 1.49–6.01], knowing someone who has ever screened [AOR = 3.61, 95% CI: 2.07–6.29], having history of gynecologic examination for any reason (having previous examination that expose women genitalia for physician like examination during child birth, abortion procedure and examination for STI) [AOR =2.84, 95% CI: 1.48–5.45], not preferring gender of physician for gynecological examination [AOR = 3.57, 95% CI: 1.98–6.45], getting advice from health care providers [AOR = 4.45, 95% CI: 2.57–7.70], having good knowledge of cervical cancer screening [AOR = 3.46, 95% CI: 1.47–8.21] and having perceived susceptible for cervical cancer [AOR = 3.03, 95% CI: 1.64–5.56]. The utilization of cervical cancer screening services was low in Jimma town. Strengthening the screening service is important through raising the awareness of the community towards cervical cancer and screening services.

  • Spanish validation of female condom attitude scale and female condom use in Colombian young women
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-28
    Vallejo-Medina Pablo; Ramírez Carlos Eduardo; Saavedra-Roa Diego Alejandro; Gómez-Lugo Mayra; Pérez-Durán Claudia

    Infection by HIV and other STIs and unplanned pregnancies are among the most serious problems associated with sexuality. Male and female condoms are the only dual-purpose devices to control both unplanned pregnancies and STIs, and studying people’s attitudes toward the use of these devices are excellent ways to predict their use. Therefore, the purpose of the present study was to adapt and validate the Female Condom Attitude Scale for Spanish language and to evaluate the use of female condoms in Colombian population. For that purpose, a total of 387 Colombian women aged 23.68 years in average were asked to respond to the Female Condom Attitude Scale, the Sexual Opinion Survey, and the UCLA Multidimensional Condom Attitudes Scale. The use of female condom in Colombia is very low; only 5.10% of the surveyed women had used it at least once. On the other hand, results revealed a five-factor dimensionality (Sexual pleasure enhancement, Inconvenience, Improved prophylaxis, Sexual pleasure inhibition, and Insertion reluctance) with alphas between .81 and .96. The scale also showed adequate psychometric properties and criterion validity. No relationship was found between attitudes toward female condom and attitudes toward male condom. The Spanish adaptation of the Female Condom Attitude Scale was found to be reliable and valid in a sample of young women.

  • Online reported women’s experiences of symptomatic pelvic organ prolapse after vaginal birth
    BMC Womens Health (IF 1.592) Pub Date : 2019-10-29
    Maria Mirskaya; Eva-Carin Lindgren; Ing-Marie Carlsson

    Pelvic organ prolapse (POP) is a major public health problem with a relative high lifetime risk of surgery. The main risk factor for developing POP is vaginal birth. Many women become symptomatic later in life and most of the existing research on symptomatic pelvic organ prolapse (sPOP) predominantly concentrates on the effects of the condition on postmenopausal women. However bothersome symptoms of POP can be reported as early as in women’s 20s and may occur shortly after vaginal birth. Limited studies provide an insight into daily life of fertile women with sPOP. Thus, we aimed to explore fertile women’s experiences of symptomatic pelvic organ (sPOP) after vaginal birth. An inductive, text-driven approach was taken by selecting thread posts from an internet forum written by 33 Swedish fertile women who had experienced sPOP after vaginal birth. The overarching theme “being irreparably damaged” was identified as representing an experience of being disabled by sPOP after vaginal birth. The fertile women experienced that their lives were ruined because of physical and psychological limitations caused by this unexpected, unfamiliar and unexplained condition. Living with sPOP impinged on sexual health, restricted daily and sports activities and affected the women’s ability to fulfill everyday parental duties. This in turn compromised women’s psychological health. In addition, the negligence of healthcare professionals who tended to trivialize and normalize the symptoms led to the belief that there were no sustainable treatments and that women would have to live with bothersome symptoms of POP for rest of their lives. This study found that sPOP had a significant negative impact on fertile women’s lives. The women indicated that they had not had the opportunity to voice their concerns and had not been taken seriously by healthcare professionals. It is of the utmost importance to acknowledge this problem and develop guidelines for prevention and management of sPOP to improve the quality of life for women.

  • Intimate partner violence among HIV positive women in care - results from a national survey, Uganda 2016
    BMC Womens Health (IF 1.592) Pub Date : 2019-11-01
    Steven Ndugwa Kabwama; Justine Bukenya; Joseph K. B. Matovu; Violet Gwokyalya; Fredrick Makumbi; Jolly Beyeza-Kashesya; Shaban Mugerwa; John Baptist Bwanika; Rhoda K. Wanyenze

    Women remain disproportionally affected by the HIV/ AIDS epidemic because of sociocultural factors including violence perpetrated by intimate partners. Among HIVpositive (HIV+) women, intimate partner violence (IPV) affects engagement in care and reproductive health outcomes. We analyzed data from a national survey to estimate the prevalence of IPV among HIV+ women in care and associated factors. The study was conducted among 5198 HIV+ women in care. Data were collected on socio-demographic characteristics, self-reported couple HIV status, mutual HIV status disclosure and IPV. IPV was assessed by asking participants whether their current husband or partner ever hit, slapped, kicked or did anything to hurt them physically, and whether their current husband or partner ever physically forced them to have intercourse or perform any sexual acts against their will. Women who responded “yes” were classified as having ever experienced IPV. Modified Poisson regression was used to identify factors associated with experiencing IPV. Of 5198 HIV+ women, 1664 (32.1%) had ever experienced physical violence, 1466 (28.3%) had ever experienced sexual violence and 2290 (44.2%) had ever experienced any IPV. Compared with women in relationships where the woman and their male partner were of the same age, women in relationships where the partner was ≥1 year younger were more likely to ever experience IPV (Prevalence risk ratio [PRR] = 1.43, 95% Confidence Interval [95%CI]: 1.10–1.71), as were women in relationships where the partner was < 10 years older (PRR = 1.20, 95%CI: 1.00–1.43) or ≥ 10 years older (PRR = 1.31, 95%CI: 1.05–1.64). Compared with women who did not have biological children, women with 3–4 biological children were more likely to have ever experienced IPV (PRR = 1.27 95%CI: 1.00–1.59) as were those with ≥5 biological children (PRR = 1.34, 95%CI: 1.06–1.71). Compared with women in sero-concordant relationships, women in sero-discordant relationships were less likely to ever experience IPV (PRR = 0.87 95%CI: 0.78–0.98). In Uganda, a high proportion of HIV+ women have ever experienced IPV. Experiencing IPV was associated with circumstances related to the intimate relationship between the woman and her male partner. Health care workers should screen HIV+ women in care for IPV and offer appropriate psychosocial assistance.

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上海纽约大学William Glover