RESUMO
Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls and women. In Kenya, national estimates show a steady decline in prevalence, although there is considerable variation at the sub-national level. There is a need to better understand female genital mutilation-related norms and meanings and whether there have been changes in these given long-term and diverse efforts to promote abandonment. Focusing on Narok and Kisii counties, we conducted a cross-sectional qualitative study to identify social norms surrounding the practice of female genital mutilation, as well as consensus or contestation with respect to these norms. Ten focus group discussions were held with men and women aged 18 years and older from the Maasai and Abagusii communities that have traditionally practised female genital mutilation. Study findings showed that norms associated with female genital mutilation such as sexuality and marriageability were actively contested by community members. This change may provide a useful starting point for programmes that seek to create dialogue and critical reflection on female genital mutilation to accelerate its abandonment.
Assuntos
Circuncisão Feminina , Estudos Transversais , Feminino , Grupos Focais , Humanos , Quênia/epidemiologia , Masculino , Normas SociaisRESUMO
BACKGROUND: To our knowledge, no studies exist on the influence of nomadic pastoralist women's networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). METHODS: Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. RESULTS: Women named 10-12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. CONCLUSIONS: Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women's networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women's wider networks.
Few studies have asked nomadic women in Kenya to name the important individuals in their lives when it comes to making reproductive and sexual health decisions, including their use of family planning. These important individuals are described as a woman's "network". We used a survey and open-ended interview format to identify the individuals in four nomadic women's networks ("social network analysis"). Data was analysed in R and we created a visual map of these networks. Women named 1012 individuals. Women's husbands made reproductive health decisions and did not approve of modern family planning use. Apart from their husbands, women did not know who in their network approved of their use of family planning. Female neighbors and mothers provided important support to women. Interventions to increase awareness of modern FP should engage with everyone in a woman's network.
Assuntos
Comportamento Contraceptivo , Tomada de Decisões , Saúde Reprodutiva , Análise de Rede Social , Idoso , Criança , Serviços de Planejamento Familiar , Feminino , Humanos , Quênia , Masculino , Saúde Sexual , Normas Sociais , MigrantesRESUMO
BACKGROUND: Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through combined efforts of international and non-governmental organizations, governments, and religious and civil society groups. One question asked by donors, program implementers and observers alike is whether there is any evidence that FGM/C is declining. In the last two decades, reliable data have been generated in numerous countries through major household surveys, including repeat cross-sectional surveys. What can we learn from these data? We explore this question by analyzing data on FGM/C obtained from women aged 15-49 in two successive household surveys in Senegal (2005 and 2010-11). The aggregate national-level statistics suggest that there has been no significant change in the prevalence of FGM/C among adult women. These figures are, however, unadjusted for potentially confounding factors, and potentially mask important variation in the practice. This paper aims to provide a deeper understanding of trends in FGM/C across regions, and possibly across generations, providing evidence as to when and where the practice of FGM/C is changing. We aim to answer the following questions: 1. What are the trends in FGM/C among women across Senegal and within regions? 2. Are individual characteristics, such as education, wealth and ethnicity, associated with a likelihood of FGM/C? 3. Are community-level factors, captured by covariate-adjusted geographic estimates, important predictors of a likelihood of FGM/C, as predicted by social convention theory?4. After adjusting for individual- and community-level factors, do we see a decrease in the prevalence of FGM/C across generations of women in Senegal? METHODS: Participants were 14,602 and 14,228 respondents from two consecutive Senegal Demographic and Health Surveys from 2005 to 2010 (FGM/C prevalence 30.1% in 2005 and 28.1% in 2010). A Bayesian geo-additive mixed model based on Markov Chain Monte Carlo techniques was used to map the change in the spatial distribution of FGM/C prevalence at the regional level during the five-year period, while simultaneously examining the effect of individual-level risk factors. RESULTS: Overall, the prevalence of FGM/C at that national level changed little over the 5-year period, but the fully-adjusted model and map of trends in residual spatial effects at the regional level reveal important spatial patterns. Across both survey periods, several high prevalence regions remained "hot spots," bearing a consistently high FGM/C prevalence. These include Kolda (along with the newly subdivided region of Sédhiou in 2010), Tambacounda (along with the newly subdivided region of Kédougou in 2010), and Matam. At the same time, risk remained not significant in the high prevalence regions of Saint Louis and Zinguinchor and was attenuated between 2005 and 2010-11 in Kaolack (including the newly subdivided region of Kaffrine in 2010), shifting from not significant risk in 2005 to a very low FGM/C prevalence in 2010-11. In both surveys, unadjusted estimates of the effect of age show no significant difference in risk of FGM across age cohorts. However, non-parametric covariate-adjusted estimates show that in both surveys age is a significant risk factor for FGM/C, although not in the anticipated direction. The effect of age on prevalence of FGM/C is highest in women aged 15-20, and declines with increasing age. Other significant factors are socio-demographic variables, particularly ethnicity. CONCLUSIONS: Findings from two consecutive surveys reveal that while no significant changes in FGM/C prevalence are found at the national level, mixed changes are visible at the regional level, as well as at the individual level. The modelled covariate results confirmed that the patterns of FGM/C differ markedly with region of residence and age remaining significant risk factors in both surveys, suggesting that community factors (convention theory), above and beyond individual factors, play a crucial role in the perpetuation, spread or decline of the practice of FGM/C. There is a clear pattern of regions with higher prevalence of FGM/C, mostly the south-eastern region of Tambacounda, Kolda and Matam in 2005, including the eastern region of Kédougou and the southern region of Sédhiou in 2010, which were associated with a higher prevalence of FGM/C, while regions such as Louga, Thiès, Diourbel, Kaolack and Fatick in 2005 and Louga, Thiès, Diourbel, Fatick, Kaolack and Kaffrine in 2010 were associated with a lower prevalence of FGM/C. However, the total spatial residuals in both surveys also indicate that much of the variation in FGM/C likelihood remains to be explained. The spatial effects of the Kaolack region in 2005 was greatly attenuated after multiple adjustments of other risk factors indicating that perhaps the higher number of FGM/C affected women living in the region was inflated by other factors such as ethnicity, socio-economic status and education. Overall, the results indicate that across surveys, certain high prevalence regions remain "hot spots" regarding FGM/C prevalence. These novel findings fit with predictions of theory on social norms and conventions which suggest that the practice is upheld by interdependent expectations regarding the practice, and when such expectations are challenged within a community, the possibility for abandonment is opened.
Assuntos
Circuncisão Feminina/tendências , Adolescente , Adulto , Teorema de Bayes , Circuncisão Feminina/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Prevalência , Fatores de Risco , Senegal/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: For the last decades, the international community has emphasised the importance of a multisectoral approach to tackle female genital mutilation (FGM/C). While considerable improvement concerning legislations and community involvement is reported, little is known about the involvement of the health sector. METHOD: A mixed methods approach was employed to map the involvement of the health sector in the management of FGM/C both in countries where FGM/C is a traditional practice (countries of origin), and countries where FGM/C is practiced mainly by migrant populations (countries of migration). Data was collected in 2016 using a pilot-tested questionnaire from 30 countries (11 countries of origin and 19 countries of migration). In 2017, interviews were conducted to check for data accuracy and to request relevant explanations. Qualitative data was used to elucidate the quantitative data. RESULTS: A total of 24 countries had a policy on FGM/C, of which 19 had assigned coordination bodies and 20 had partially or fully implemented the plans. Nevertheless, allocation of funding and incorporation of monitoring and evaluation systems was lacking in 11 and 13 of these countries respectively. The level of the health sectors' involvement varied considerably across and within countries. Systematic training of healthcare providers (HCP) was more prevalent in countries of origin, whereas involvement of HCP in the prevention of FGM/C was more prevalent in countries of migration. Most countries reported to forbid HCP from conducting FGM/C on both minors and adults, but not consistently forbidding re-infibulation. Availability of healthcare services for girls and women with FGM/C related complications also varied between countries dependent on the type of services. Deinfibulation was available in almost all countries, while clitoral reconstruction and psychological and sexual counselling were available predominantly in countries of migration and then in less than half the countries. Finally, systematic recording of FGM/C in medical records was completely lacking in countries of origin and very limited in countries of migration. CONCLUSION: Substantial progress has been made in the involvement of the health sector in both the treatment and prevention of FGM/C. Still, there are several areas in need for improvement, particularly monitoring and evaluation.
Assuntos
Genitália Feminina , Internacionalidade , Adulto , Circuncisão Feminina , Feminino , Pessoal de Saúde , Política de Saúde , Humanos , Prevalência , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: To investigate the hygiene (or "old friends") hypothesis in a high-infectious disease (ID) environment, rural Kilimanjaro, Tanzania. METHODS: Among a cross-sectional sample of 2- to 7-year-old children, we collected physician-diagnosed hay fever, asthma, and eczema, history of hospitalization, family size, and household environment information via questionnaire; performed active and passive surveillance for ID; and, evaluated total immunoglobulin E (IgE) and biomarkers of inflammation in dried blood spot specimens. We used regression models to describe patterns in allergic diseases. RESULTS: Complete information was available for 280 children: 12.5% had been diagnosed with hay fever; 18.9% with eczema; 2.1% with asthma. There was a positive association between hay fever and eczema diagnoses (π2 : 4.07; P = 0.044); total IgE was positively associated with eczema (ß: 0.24; P = 0.100) and allergic diseases together (ß: 0.26; P = 0.042). ID were common: the incidence of any ID diagnosis was 28 per 100 children per month. Hay fever was inversely associated with household animals (OR: 0.27; P = 0.006), and positively associated with earth housing materials (OR: 1.93; P = 0.079) and hospitalization in infancy with an ID (3.16; P = 0.066); patterns were similar when allergic disease outcomes were considered together. Few associations between these predictors and eczema or asthma alone were apparent. CONCLUSIONS: Allergic diseases were common among children in Kilimanjaro. The inverse association between household animals and allergy is consistent with the hygiene/old friends hypothesis; however, positive associations between allergic diseases and earth housing materials and early hospitalization with ID bear further explanation.
Assuntos
Asma/epidemiologia , Doenças Transmissíveis/epidemiologia , Eczema/epidemiologia , Higiene , Rinite Alérgica Sazonal/epidemiologia , Asma/etiologia , Criança , Pré-Escolar , Doenças Transmissíveis/etiologia , Estudos Transversais , Eczema/etiologia , Feminino , Humanos , Masculino , Prevalência , Rinite Alérgica Sazonal/etiologia , Tanzânia/epidemiologiaRESUMO
We sought to understand fertility intentions and HIV risk considerations among Kenyan HIV-serodiscordant couples who became pregnant during a prospective study. We conducted individual in-depth interviews (n = 36) and focus group discussions (n = 4) and performed qualitative data analysis and interpretation using an inductive approach. Although most of the couples were aware of the risk of horizontal and vertical HIV transmission, almost all couples reported that they had intended to become pregnant and that the desire for children superseded HIV risk considerations. Motivations for pregnancy were numerous and complex: satisfying desired family size, desire for biological children, maintaining stability of the union, and sociocultural pressures. Couples desired strategies to reduce HIV risk during conception, but expressed hesitation toward assisted reproductive technologies as unnatural. HIV prevention programs should therefore address conception desires and counsel about coordinated periconception risk-reduction strategies.
Assuntos
Características da Família , Fertilização , Infecções por HIV/prevenção & controle , Soronegatividade para HIV , Soropositividade para HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Intenção , Adulto , Feminino , Grupos Focais , Infecções por HIV/psicologia , Soropositividade para HIV/psicologia , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Pesquisa Qualitativa , Comportamento de Redução do Risco , Fatores Sexuais , Adulto JovemRESUMO
We evaluated sex, age, nutritional status, and infectious disease (ID) as predictors of two biomarkers of cell-mediated immunity (CMI), delayed-type hypersensitivity to Candida albicans (DTH-Candida), and anti-Epstein-Barr virus antibody (EBV Ab), among 200 children in Kilimanjaro, Tanzania. DTH-Candida, which decreases with compromised CMI, was positively associated with age (OR: 1.27; 95% CI: 1.02, 1.57) and triceps skinfold (TSF; OR: 1.16; 95% CI: 1.02, 1.26), and inversely associated with height-for-age Z score (HAZ; OR: 0.86; 95% CI: 0.68, 1.08) and diagnosed ID (OR: 0.48; 95% CI: 0.22, 1.08). There was significant interaction between TSF and ID: DTH-Candida exhibited a strong inverse association with ID among children with low TSF (OR: 0.16; 95% CI: 0.05, 0.50) and a strong positive association with TSF among children with ID (OR: 2.64; 95% CI: 1.29, 5.42). EBV Ab, which increases with compromised CMI, was inversely associated with male sex (ß: -0.47; 95% CI: -0.70, -0.24) and TSF (ß: -0.04; 95% CI: -0.08, 0.00), and positively associated with HAZ (ß: 0.06; 95% CI: -0.03, 0.15). Among males, EBV Ab was positively associated with anemia. Among normal HAZ children, EBV Ab was inversely associated with TSF. There was no association between DTH-Candida and EBV Ab. While DTH-Candida provides a direct measure of CMI, our results suggest that interpretation of EBV-Ab among Kilimanjaro children was complicated by its indirect relationship with CMI. Among our sample, CMI increased with age and adequate nutrition and was compromised during acute ID. The suggestive CMI-compromising effect of increasing height-for-age may bear further exploration.
Assuntos
Candida albicans/imunologia , Herpesvirus Humano 4/imunologia , Hipersensibilidade Tardia/imunologia , Análise de Variância , Anticorpos Antivirais/sangue , Biomarcadores/sangue , Criança , Pré-Escolar , Estudos de Coortes , Teste em Amostras de Sangue Seco , Feminino , Humanos , Hipersensibilidade Tardia/sangue , Hipersensibilidade Tardia/epidemiologia , Imunidade Celular , Modelos Lineares , Masculino , Desnutrição , Dobras Cutâneas , Tanzânia/epidemiologiaRESUMO
OBJECTIVE: The objective of the present study was to evaluate the effect of settlement on the nutrition and health status of pastoral women of reproductive age. DESIGN: A cross-sectional survey that included a 24 h dietary recall was administered to 224 randomly selected Gabra women. Height and weight were used to compute BMI. Whole capillary blood was used to measure Hb. Additional capillary blood was collected on filter paper and dried blood spots were analysed for transferritin receptor, C-reactive protein and a1-acid glycoprotein. Descriptive statistics were used to analyse population characteristics. The t test and the x2 test were used to determine population differences. Multiple criteria models were used to determine the prevalence of Fe deficiency, anaemia and inflammation. SETTING: Settled and semi-settled women in Kalacha Location in Marsabit County, Kenya. SUBJECT: Non-pregnant women aged 1549 years. RESULTS: Fe repletion was observed in 43% of settled and 40% of semi-settled women. Fe-deficiency erythropoiesis in was found in 18% of settled and 20% of semi-settled women, whereas 15% of settled compared with 25% of semi-settled women were suffering from Fe-deficiency anaemia. Anaemia due to chronic diseases was more prevalent in semi-settled women than in settled women, and more common than Fe-deficiency anaemia. CONCLUSIONS: Settled women were significantly less anaemic than semi-settled women, but had similarly high levels of chronic energy deficiency. While anaemia and Fe deficiency were more pronounced in semi-settled than settled women, anaemia of chronic disease and chronic infection were highly prevalent in both communities. Policies should be put in place to improve overall nutrition among pastoral women.
Assuntos
Anemia Ferropriva/epidemiologia , Anemia/epidemiologia , Nível de Saúde , Deficiências de Ferro , Estado Nutricional , Características de Residência , Saúde da Mulher , Adolescente , Adulto , Agricultura , Anemia/sangue , Anemia Ferropriva/sangue , Doença Crônica , Estudos Transversais , Eritropoese , Feminino , Hemoglobinas/metabolismo , Humanos , Infecções/complicações , Quênia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
OBJECTIVES: To examine the circumstances and needs of older adults who were "kinless," defined as having no living spouse or children, when they developed dementia. METHODS: We conducted a secondary analysis of information from the Adult Changes in Thought study. Among 848 participants diagnosed with dementia between 1994 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants' medical records. RESULTS: In this community-dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one third lived with unrelated persons. Through inductive content analysis, we identified 4 themes that describe their circumstances and needs: (1) life trajectories, (2) caregiving resources, (3) care needs and gaps, and (4) turning points in caregiving arrangements. DISCUSSION: Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of nonfamily caregivers and participants' own roles as caregivers. Our findings suggest that clinicians and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.
Assuntos
Demência , Humanos , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Cônjuges , Vida Independente , Pesquisa QualitativaRESUMO
This study explored barriers to consistent condom use among heterosexual HIV-1 serodiscordant couples who were aware of the HIV-1 serodiscordant status and had been informed about condom use as a risk reduction strategy. We conducted 28 in-depth interviews and 9 focus group discussions among purposively selected heterosexual HIV-1 serodiscordant couples from Thika and Nairobi districts in Kenya. We analyzed the transcribed data with a grounded theory approach. The most common barriers to consistent condom use included male partners' reluctance to use condoms regardless of HIV-1 status coupled with female partners' inability to negotiate condom use, misconceptions about HIV-1 serodiscordance, and desire for children. Specific areas of focus should include development of skills for women to effectively negotiate condom use, ongoing information on HIV-1 serodiscordance and education on safer conception practices that minimize risk of HIV-1 transmission.
Assuntos
Preservativos , Infecções por HIV , Soronegatividade para HIV , Soropositividade para HIV , HIV-1 , Sexo Seguro/psicologia , Adulto , Barreiras de Comunicação , Preservativos/estatística & dados numéricos , Estudos Transversais , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/psicologia , Soropositividade para HIV/transmissão , Heterossexualidade , Humanos , Relações Interpessoais , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Pesquisa Qualitativa , Comportamento de Redução do Risco , Aconselhamento Sexual , Parceiros Sexuais/psicologiaRESUMO
Literature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common but conflicting views. On one side, FGM/C is seen as static and deeply entrenched, with parents lacking agency to interpret culture, evaluate options and adopt changes. An alternative perspective focuses on the fluidity of social norms, influencing whether and how FGM/C is practised. This study asks: in counties where FGM/C persists at high rates, Kisii and Narok, are there changes in the way that FGM/C is performed? and what drives these changes? In-depth interviews and focus group discussions were conducted to illuminate these questions. Data showed five ways that FGM/C practices have changed: (1) reduction in severity of cutting, (2) medicalised cutting, (3) performing FGM/C at younger ages, (4) cutting in secret, and (5) occasionally, abandonment of FGM/C. Messaging on health risks of FGM/C and fear of criminal punishment have motivated less severe cutting and medicalisation. Legislation has also driven the practice underground. Programmes aimed at ending FGM/C should create a critical dialogue on changes in norms with the intent of reducing stigmatisation of uncut girls and their families, and the ways cutting practices are shifting, thereby building on change that is already underway.
Assuntos
Circuncisão Feminina , Feminino , Humanos , Quênia , Grupos Focais , Medicalização , Normas SociaisRESUMO
Anthropogenic carbon emissions have the potential to trigger changes in climate and ecosystems that would be catastrophic for the well-being of humans and other species. Widespread shifts in production and consumption patterns are urgently needed to address climate change. Although transnational agreements and national policy are necessary for a transition to a fully decarbonized global economy, fluctuating political priorities and lobbying by vested interests have slowed these efforts. Against this backdrop, bottom-up pressure from social movements and shifting social norms may offer a complementary path to a more sustainable economy. Furthermore, norm change may be an important component of decarbonization policies by accelerating or strengthening the impacts of other demand-side measures. Individual actions and policy support are social processes-they are intimately linked to expectations about the actions and beliefs of others. Although prevailing social norms often reinforce the status quo and unsustainable development pathways, social dynamics can also create widespread and rapid shifts in cultural values and practices, including increasing pressure on politicians to enact ambitious policy. We synthesize literature on social-norm influence, measurement, and change from the perspectives of psychology, anthropology, sociology, and economics. We discuss the opportunities and challenges for the use of social-norm and social-tipping interventions to promote climate action. Social-norm interventions aimed at addressing climate change or other social dilemmas are promising but no panacea. They require in-depth contextual knowledge, ethical consideration, and situation-specific tailoring and testing to understand whether they can be effectively implemented at scale. Our review aims to provide practitioners with insights and tools to reflect on the promises and pitfalls of such interventions in diverse contexts.
Assuntos
Ecossistema , Normas Sociais , Carbono , Mudança Climática , Humanos , PolíticasRESUMO
OBJECTIVES: Newborns are dependent on breastmilk vitamin A for building hepatic stores of vitamin A that will become critical for survival after weaning. It has been documented that vitamin A concentrations in breastmilk decline across the first year postpartum in both well-nourished and malnourished populations. The reason for this decline has been assumed to be a sign of concurrently depleting maternal hepatic stores. This study investigates this assumption to clarify why the decline occurs, drawing on life history theory. METHODS: A cross sectional survey was conducted among lactating mothers in Kenya in 2006. Data were used to examine (1) the relationship between liver vitamin A and time, (2) if the relationship between milk and liver vitamin A varies by time, and (3) by maternal parity. RESULTS: The relationship between liver vitamin A and time fits the quadratic pattern with marginal significance (P = 0.071, n = 192); the liver vitamin A declined during early postpartum then recovered in late postpartum time, controlling covariates. The milk-liver vitamin A relationship varied by postpartum time periods (P = 0.03) and by maternal parity (P = 0.005). Mothers in earlier postpartum or higher parity had a stronger positive relationship between milk and liver vitamin A than mothers in later postpartum or lower parity. CONCLUSIONS: Our observations are consistent with life history tradeoffs and negate the assumption that maternal hepatic and milk vitamin A decline together. Rather, maternal liver vitamin A has a dynamic relationship with milk vitamin A, particularly depending on postpartum time and maternal parity.
Assuntos
Fígado/química , Leite Humano/química , Vitamina A/análise , Adulto , Estudos Transversais , Feminino , Humanos , Quênia , Modelos Biológicos , Paridade , Período Pós-Parto , Gravidez , Fatores de Tempo , Vitamina A/sangueRESUMO
There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as 'women's business'. These two perspectives lead to divergent predictions: if FGM/C underpins patriarchal structures, men should be expected to be ardent supporters of FGM/C as it bolsters their power and status; if FGM/C is a women's affair, men should have little involvement. We test these predictions using data from a mixed-method study of norms and social networks in two regions of Senegal. Data show that men comprise 50% of core network members, although they exert influence in different ways in each study site. In South Senegal excision is upheld by men, as well as older women, through a constellation of norms that define FGM/C as prerequisite to marriage and social inclusion. In Central Senegal these gender norms have eroded, opening possibilities for abandonment of FGM/C, and men, particularly fathers, at times successfully advocate this change. This suggests that men can play an important role in ending FGM/C, and should be involved in intervention efforts.
Assuntos
Circuncisão Feminina , Idoso , Feminino , Identidade de Gênero , Humanos , Masculino , Casamento , Senegal , Rede SocialRESUMO
OBJECTIVES: We used community-based ethnography and public health risk assessment to assess beliefs about pesticide exposure risks among farmworkers in the Lower Yakima Valley of Washington State. METHODS: We used unstructured and semistructured interviews, work-site observation, and detailed field notes to gather data on pesticide exposure risks from 99 farmworkers. RESULTS: Farmworkers' pesticide-relevant beliefs and attitudes could be grouped into 5 major themes: (1) dry pesticides are often perceived as a virtually harmless powder, (2) farmworkers who identify themselves as allergic to pesticides are more acutely affected by exposure, (3) the effect of pesticide exposure is more severe for those perceived as physically weak, (4) protective equipment is used selectively in response to financial pressure to work rapidly, and (5) some farmworkers delay decontamination until they find water deemed an appropriate temperature for handwashing. CONCLUSIONS: We elucidated farmworkers' pesticide-relevant beliefs regarding perceived danger and susceptibility to pesticides, the need to put safety second to financial considerations, and reasons for delaying decontamination. Researchers and policymakers should incorporate these data in study designs and legislation concerned with farmworker exposure to pesticides.
Assuntos
Agricultura , Antropologia Cultural , Exposição Ocupacional , Praguicidas/efeitos adversos , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Observação , Medição de Risco , Washington , Adulto JovemRESUMO
An evolutionary perspective suggests that iron deficiency may have opposing effects on infectious disease risk, decreasing susceptibility by restricting iron availability to pathogens, and increasing susceptibility by compromising cellular immunocompetence. In some environments, the trade-off between these effects may result in optimal iron intake that is inadequate to fully meet body iron needs. Thus, it has been suggested that moderate iron deficiency may protect against acute infection, and may represent a nutritional adaptation to endemic infectious disease stress. To test this assertion, we examined the association between infection, reflected by C-reactive protein, a biomarker of inflammation, and iron status, reflected by transferrin receptor (TfR) and zinc protoporphyrin to heme ratio (ZPP:H), among school-age Kenyan children, and evaluated the hypothesis that moderate iron deficiency is associated with lower odds of infectious disease. TfR > 5.0 mg/l, with sensitivity and specificity for iron deficiency (ZPP:H > 80 micromol/mol) of 0.807 and 0.815, was selected as the TfR definition of iron deficiency. Controlling for age and triceps skinfold thickness (TSF), the odds ratio (OR) for acute viral or bacterial infection associated with iron deficiency (compared to normal/replete) was 0.50 (P = 0.11). Controlling for age and TSF, the OR for infection associated with an unequivocally iron replete state (compared to all others) was 2.9 (P = 0.01). We conclude that iron deficiency may protect against acute infection in children.
Assuntos
Adaptação Fisiológica , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/fisiopatologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/fisiopatologia , Evolução Biológica , Biomarcadores/análise , Criança , Feminino , Humanos , Quênia/epidemiologia , Modelos Logísticos , MasculinoRESUMO
This study explores the effect of women's autonomy on children's health. Research was conducted among the Rendille, a traditionally nomadic pastoralist population living in northern Kenya. Using data collected from 435 women and 934 of their children, we tested the hypothesis that women with higher levels of autonomy would have children with better nutrition. Results of our study indicated that while women's autonomy had no effect on younger-ages 0-35 months-children's nutrition as measured by WHZ scores, greater levels of women's autonomy were significantly associated with improved nutrition among older-ages 3-10 years-children. These results suggest that women's autonomy is an important factor in relation to children's health in some circumstances. In addition to exploring the applied aspects of our findings, we also suggest how considering the concept of women's autonomy may add to the existing literature on parental investment.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Tomada de Decisões , Mães , Autonomia Pessoal , Adolescente , Adulto , Análise de Variância , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Quênia , Modelos Lineares , Masculino , Fatores de Risco , População Rural/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Female genital mutilation/cutting (FGM/C), also known as female circumcision, is a global public health and human rights problem affecting women and girls. Several concerted efforts to eliminate the practice are underway in several sub-Saharan African countries where the practice is most prevalent. Studies have reported variations in the practice with some countries experiencing relatively slow decline in prevalence. This study investigates the roles of normative influences and related risk factors (e.g., geographic location) on the persistence of FGM/C among 0-14 years old girls in Kenya. The key objective is to identify and map hotspots (high risk regions). We fitted spatial and spatio-temporal models in a Bayesian hierarchical regression framework on two datasets extracted from successive Kenya Demographic and Health Surveys (KDHS) from 1998 to 2014. The models were implemented in R statistical software using Markov Chain Monte Carlo (MCMC) techniques for parameters estimation, while model fit and assessment employed deviance information criterion (DIC) and effective sample size (ESS). Results showed that daughters of cut women were highly likely to be cut. Also, the likelihood of a girl being cut increased with the proportion of women in the community (1) who were cut (2) who supported FGM/C continuation, and (3) who believed FGM/C was a religious obligation. Other key risk factors included living in the northeastern region; belonging to the Kisii or Somali ethnic groups and being of Muslim background. These findings offered a clearer picture of the dynamics of FGM/C in Kenya and will aid targeted interventions through bespoke policymaking and implementations.
Assuntos
Circuncisão Feminina/etnologia , Análise Espacial , Adolescente , Teorema de Bayes , Criança , Pré-Escolar , Etnicidade/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Cadeias de Markov , Prevalência , Fatores de Risco , Análise Espaço-TemporalRESUMO
PURPOSE OF REVIEW: Female genital cutting/mutilation (FGM/C) performed by health care professionals (medicalization) and reduced severity of cutting have been advanced as strategies for minimizing health risks, sparking acrimonious ongoing debates. This study summarizes key debates and critically assesses supporting evidence. RECENT FINDINGS: While medicalization is concentrated in Africa, health professionals worldwide have faced requests to perform FGM/C. Whether medicalization is hindering the decline of FGM/C is unclear. Factors motivating medicalization include, but are not limited to, safety concerns. Involvement of health professionals in advocacy to end FGM/C can address both the supply and demand side of medicalization, but raises ethical concerns regarding dual loyalty. Ongoing debates need to address competing rights claims. SUMMARY: Polarizing debates have brought little resolution. We call for a focus on common goals of protecting the health and welfare of girls living in communities where FGM/C is upheld and encourage more informed and open dialog.
RESUMO
Social norms theory has become prominent framework for understanding the perpetuation of female genital mutilation/cutting (FGM/C), and has influenced the design of interventions aimed at stopping the practice. Theoretical advances draw attention to the fact that FGM/C is often upheld by multiple interconnected norms that may vary and shift over time, offering a potential resource for social transformation. Analyzing focus group data from Senegambian women, the questions we explore are: What are the constellation of norms associated with FGM/C? When are existing practices and norms being contested, and how does this reflect prevailing structures of power and authority? Our research identifies four overarching themes: 1) pressure to conform with FGM/C arising from sanctions such as ostracization, and moral norms linked to the embodiment of virtue; 2) upholding tradition as a means of venerating ancestors; 3) upholding social hierarchy by displaying respect for elders; and 4) shifting beliefs about the healthful vs. harmful nature of FGM/C. While strong value is placed on upholding tradition, there is also an appreciation that elements of tradition must be revised to meet fluctuating realities, including the novel threat of HIV infection. Moreover, older women are uniquely positioned to realize the dual goal of honoring tradition while negotiating change. Rather than resisting change, we find that some older women express an openness to reassessing norms and practices as they seek solutions to maintaining the physical well-being, moral integrity and cultural identity of girls in their families. Moreover, given the authority of older women over younger women, they also have power to negotiate change. By recognizing older women as potential change leaders, and drawing on variability and fluidity in social norms, it may be increasingly possible to design interventions that will shape possibilities for action and accelerate abandonment of FGM/C without undermining the cultural value of tradition.