Knowledge, attitudes, and practices of female health care service providers on female genital mutilation in Somalia: A cross-sectional study.

BACKGROUND: Despite a strong international standpoint against female genital mutilation, the prevalence of female genital mutilation in Somalia is extremely high. OBJECTIVES: This study assessed the knowledge, attitude, and practice of female genital mutilation among female health care service providers in order to formulate appropriate policies and programs to eliminate this harmful practice. DESIGN: Facility-based cross-sectional survey conducted in 2019 among female doctors and nurses working in Banadir Hospital, Mogadishu, Somalia. METHODS: A total of 144 female health care service providers were randomly selected, and data were collected through a pre-tested, semi-structured questionnaire. Quantitative data were analyzed by using the statistical software SPSS (Version 21), and qualitative data were analyzed thematically in accordance with the objectives of the study. RESULTS: The study found that about three-fifths of the respondents had undergone some forms of female genital mutilation during their life. An overwhelming majority believed that female genital mutilation practices were medically harmful, and a majority of them expressed their opinion against the medicalization of the practice of female genital mutilation. The study also observed a significant association between participants' age and their negative attitudes regarding the legalization of female genital mutilation. CONCLUSION: Health care service providers' effort is critical to eliminating this harmful practice from the Somalian society. Strong policy commitment and a comprehensive health-promotion effort targeting the parents and community leaders are essential to avert the negative impact of female genital mutilation.

Prevalence of and factors associated with tobacco smoking in the Gambia: a national cross-sectional study.

OBJECTIVES: To examine the prevalence of and risk factors associated with tobacco smoking in the Gambia. DESIGN: A nationwide cross-sectional study. SETTING: The Gambia. PARTICIPANTS: The study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis. DATA ANALYSIS: We analysed data from the Gambia Demographic and Health Survey (DHS), 2019-2020. DHS collected nationally stratified data from local government areas and rural-urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking. RESULTS: The response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019-2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40-49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40-49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia. CONCLUSIONS: Men, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.

Holistic Approach to Tuberculosis Detection, Treatment and Prevention: Emerging Evidence and Strategies from the Field.

The global fight against tuberculosis (TB) has gained momentum since the adoption of the 'End TB Strategy' in 2014 [...].

Familial and socio-cultural barriers in maintaining tobacco-free homes in Bangladesh: a comparative cross-sectional study.

OBJECTIVES: Children, pregnant women and the elderly at a global level are all being dangerously exposed to tobacco use in the household (HH). However, there is no understanding of the familial and socio-cultural factors that provide barriers to ensuring tobacco-free homes in Bangladesh either in urban or rural areas (U&RAs). This study therefore investigates those barriers to help enable a move towards tobacco-free homes in Bangladesh. DESIGN: Comparative cross-sectional study. SETTINGS: Data were collected from both urban and rural settings in Bangladesh. PARTICIPANTS: A probability proportional sampling procedure was used to select 808 participants in U&RAs out of a total of 3715 tobacco users. Semi-structured interviews through the use of a questionnaire were conducted with the participants followed by a multivariate logistic regression analysis of the data in order to explore the familial and socio-cultural factors associated with tobacco use at home. RESULTS: The prevalence of tobacco use at home was 25.7% in urban areas and 47.6% in rural areas. In urban areas: marital status (adjusted OR (AOR)=3.23, 95% CI 1.37 to 6.61), education (AOR=2.14, 95% CI 1.15 to 3.99), the smoking habits of elderly family members (AOR=1.81, 95% CI 0.91 to 2.89), offering tobacco as a traditional form of leisure activity at home (AOR=1.85, 95% CI 0.94 to 2.95) and lack of religious practices (AOR=2.39, 95% CI 1.27 to 4.54) were identified as significant socio-cultural predictors associated with tobacco use at home. In rural areas: age (AOR=5.11, 95% CI 2.03 to 12.83), extended family (AOR=3.08, 95% CI 1.28 to 7.38), lack of religious practices (AOR=4.23, 95% CI 2.32 to 7.72), using children to buy or carry tobacco (AOR=3.33, 95% CI 1.11 to 9.99), lack of family guidance (AOR=4.27, 95% CI 2.45 to 7.42) and offering tobacco as a traditional form of leisure activity at home (AOR=3.81, 95% CI 2.23 to 6.47) were identified as significant determinants for tobacco use at home. CONCLUSION: This study concludes that socio-cultural traditions and familial norms in Bangladesh provide significant barriers for enabling tobacco-free homes. The identification of these barriers can aid policymakers and programme planners in Bangladesh in devising appropriate measures to mitigate the deadly consequences of tobacco use in the home. The consequences also include the dangers involved in family members being exposed to secondhand smoke.

Determinants of stunting during the first 1,000 days of life in Bangladesh: A review.

Stunting is a major problem in Bangladesh, with a prevalence of 31% in 2017. The prevalence of stunting in children aged under two has reduced by only 6% since 2004. After children reach 2 years of age, the consequences of stunting become almost irreversible. This paper seeks to examine and analyze the determinants associated with stunting during the first 1,000 days of life in Bangladesh to assist in developing evidence-based interventions in Bangladesh. A literature review was conducted comprehensively on all relevant peer-reviewed and gray literature of studies conducted in Bangladesh. The existing literature was searched and examined using the World Health Organization (WHO) conceptual framework for stunting. Evidence indicates that low maternal weight, lack of maternal education, severe food insecurity, lack of access to suitable nutrition, nonexclusive breastfeeding, pathogen-specific diarrhea, and low weight and height at birth are associated with early childhood stunting in Bangladesh. The relation of the quality of drinking water with stunting is not clear in Bangladesh. Literature about the association between stunting and determinants such as the political economy, education systems, and agriculture and food systems is not found. This synthesis shows that the factors of stunting are multifaceted. As such, a multi-sectoral approach is essential in Bangladesh, employing evidence-based interventions to address the determinants that contribute to the risk of stunting to achieve the global nutrition target by 2025.

Children's exposure to second-hand smoke at home in Bangladesh: a community survey.

OBJECTIVES: In Bangladesh, second-hand smoke (SHS) is recognised as a principal source of indoor air pollution and a major public health problem. However, we know little about the extent to which people are aware of the risks of second-hand smoking, or restrict smoking indoors or in the presence of children. We report findings of a community survey exploring these questions. DESIGN AND SETTING: A total of 722 households were surveyed in urban and rural settings, using a multistage cluster random sampling approach and a semistructured questionnaire. In addition, we used qualitative methods to further explore the determinants of smoking-related behaviours inside homes. FINDINGS: 55% of households in our sample had at least one regular smoker. Smoking indoors was common. In 30% of households, smoking occurred in the presence of children, exposing nearly 40% of children to SHS. Overall, we found a lack of awareness about the harms associated with second-hand smoking. CONCLUSIONS: Our study highlights that a sizeable proportion of children and non-smokers are exposed to SHS at homes in Bangladesh, posing a significant and grave public health problem. In the absence of any impetus to legislate against smoking in private places, an educational approach is recommended to change smoking practices at home. Such a shift toward voluntary smoking restrictions at home would require behaviour change among smokers and support from non-smoking family members.

Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods.

OBJECTIVES: In Bangladesh, private healthcare is common and popular, regardless of income or area of residence, making the private sector an important player in health service provision. Although the private sector offers a good range of health services, tuberculosis (TB) care in the private sector is poor. We conducted research in Dhaka, between 2004 and 2008, to develop and evaluate a public-private partnership (PPP) model to involve private medical practitioners (PMPs) within the National TB Control Programme (NTP)'s activities. Since 2008, this PPP model has been scaled up in two other big cities, Chittagong and Sylhet. This paper reports the results of this development, evaluation and scale-up. DESIGN: Mixed method, observational study design. We used NTP service statistics to compare the TB control outcomes between intervention and control areas. To capture detailed insights of PMPs and TB managers about the process and outcomes of the study, we conducted in-depth interviews, focus group discussions and workshops. SETTING: Urban setting, piloted in four areas in Dhaka city; later scaled up in other areas of Dhaka and in two major cities. FINDINGS: The partnership with PMPs yielded significantly increased case finding of sputum smear-positive TB cases. Between 2004 and 2010, 703 participating PMPs referred 3959 sputum smear-positive TB cases to the designated Directly Observed Treatment, Short-course (DOTS) centres, contributing about 36% of all TB cases in the project areas. There was a steady increase in case notification rates in the project areas following implementation of the partnership. CONCLUSIONS: The PPP model was highly effective in improving access and quality of TB care in urban settings.

Determinants of oral contraceptive pill use and its discontinuation among rural women in Bangladesh.

Oral contraceptive pills (OCP) contribute a major share in the current method-mix in Bangladesh. However, multiple studies show high discontinuation rates of OCP. The present study examines the behavior and attitude towards OCP use, and investigates the determinants of its discontinuation among the rural married women of Bangladesh. The present study is based on critical analyses of the data from 24 focus group discussions and 135 in-depth-interviews with women, their husbands and key informants conducted over the period of 1 year. The present study shows that more than two-thirds of married women have at one time or another used OCP as a method of family planning. However, many women did not take the pills regularly and about one-quarter of ever users had taken, at one stage or another, a 'short break' from OCP use. Although nearly half of them took a break because of side effects, interestingly, 16% took a break as the result of fear of health problems that were related to 'folk stories' and other misconceptions. The individual assessment by users of the national family planning service delivery, perceived side effects, misconceptions about continuous use of pills, quality of counseling and information, and contraceptive behavior of the OCP users considerably influenced the decisions on contraceptive use or non-use. (Reprod Med Biol 2006; 5: 111-121).