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1.
J Interpers Violence ; : 886260520916268, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370597

RESUMO

Evidence suggests an overlap between intimate partner violence (IPV) experience and perpetration. However, few studies in sub-Saharan Africa have investigated experience and perpetration of IPV among women and men within the same community. This study reports prevalence of past-year IPV experience and perpetration among women and men living in an informal settlement in Nairobi, Kenya, and factors associated with IPV. Data analyzed for this study involved a geographically distributed random sample of 273 women and 429 men who participated in a community survey. We approximated prevalence of IPV experience and perpetration and used logistic regression for estimating associations between individual-level factors and IPV. Women and men experienced similar levels of IPV, but a significantly higher proportion of men reported physical and sexual IPV perpetration. Witnessing violence between parents in childhood was associated with women's physical and sexual, and men's sexual IPV experience; and with women perpetrating emotional, and men perpetrating sexual IPV. Less equitable gender attitudes were associated with men's perpetration of physical IPV. More equitable gender knowledge was associated with women's experience of sexual IPV, and with men perpetrating IPV. Perceived skills to challenge gender inequitable practices were negatively associated with men perpetrating sexual IPV. In conclusion, we found IPV experience and perpetration were highly correlated, and that, contrary to commonly reported gender gaps, men and women experienced similar rates of IPV. We make suggestions for future research, including on IPV prevention interventions in areas with such IPV prevalence that would be beneficial for women and men and future generations.

3.
BMC Public Health ; 19(1): 1317, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638946

RESUMO

BACKGROUND: Adolescent girls in sub-Saharan Africa are disproportionally vulnerable to sexual and reproductive health (SRH) harms. In western Kenya, where unprotected transactional sex is common, young females face higher rates of school dropout, often due to pregnancy, and sexually transmitted infections (STIs), including HIV. Staying in school has shown to protect girls against early marriage, teen pregnancy, and HIV infection. This study evaluates the impact of menstrual cups and cash transfer interventions on a composite of deleterious outcomes (HIV, HSV-2, and school dropout) when given to secondary schoolgirls in western Kenya, with the aim to inform evidence-based policy to improve girls' health, school equity, and life-chances. METHODS: Single site, 4-arm, cluster randomised controlled superiority trial. Secondary schools are the unit of randomisation, with schoolgirls as the unit of measurement. Schools will be randomised into one of four intervention arms using a 1:1:1:1 ratio and block randomisation: (1) menstrual cup arm; (2) cash transfer arm, (3) cups and cash combined intervention arm, or (4) control arm. National and county agreement, and school level consent will be obtained prior to recruitment of schools, with parent consent and girls' assent obtained for participant enrolment. Participants will be trained on safe use of interventions, with all arms receiving puberty and hygiene education. Annually, the state of latrines, water availability, water treatment, handwashing units and soap in schools will be measured. The primary endpoint is a composite of incident HIV, HSV-2, and all-cause school dropout, after 3 years follow-up. School dropout will be monitored each term via school registers and confirmed through home visits. HIV and HSV-2 incident infections and risk factors will be measured at baseline, mid-line and end-line. Intention to treat analysis will be conducted among all enrolled participants. Focus group discussions will provide contextual information on uptake of interventions. Monitoring for safety will occur throughout. DISCUSSION: If proved safe and effective, the interventions offer a potential contribution toward girls' schooling, health, and equity in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT03051789 , 15th February 2017.


Assuntos
Redução do Dano , Produtos de Higiene Menstrual , Assistência Pública , Evasão Escolar/estatística & dados numéricos , Adolescente , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Herpes Genital/epidemiologia , Herpes Genital/prevenção & controle , Humanos , Quênia/epidemiologia , Projetos de Pesquisa
4.
Lancet Public Health ; 4(8): e376-e393, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31324419

RESUMO

BACKGROUND: Girls and women need effective, safe, and affordable menstrual products. Single-use products are regularly selected by agencies for resource-poor settings; the menstrual cup is a less known alternative. We reviewed international studies on menstrual cup leakage, acceptability, and safety and explored menstrual cup availability to inform programmes. METHODS: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, Popline, Cinahl, Global Health database, Emerald, Google Scholar, Science.gov, and WorldWideScience from database inception to May 14, 2019, for quantitative or qualitative studies published in English on experiences and leakage associated with menstrual cups, and adverse event reports. We also screened the Manufacturer and User Facility Device Experience database from the US Food and Drug Administration for events related to menstrual cups. To be eligible for inclusion, the material needed to have information on leakage, acceptability, or safety of menstrual cups. The main outcome of interest was menstrual blood leakage when using a menstrual cup. Safety outcomes of interest included serious adverse events; vaginal abrasions and effects on vaginal microflora; effects on the reproductive, digestive, or urinary tract; and safety in poor sanitary conditions. Findings were tabulated or combined by use of forest plots (random-effects meta-analysis). We also did preliminary estimates on costs and environmental savings potentially associated with cups. This systematic review is registered on PROSPERO, number CRD42016047845. FINDINGS: Of 436 records identified, 43 studies were eligible for analysis (3319 participants). Most studies reported on vaginal cups (27 [63%] vaginal cups, five [12%] cervical cups, and 11 [25%] mixed types of cups or unknown) and 15 were from low-income and middle-income countries. 22 studies were included in qualitative or quantitative syntheses, of which only three were of moderate-to-high quality. Four studies made a direct comparison between menstrual cups and usual products for the main outcome of leakage and reported leakage was similar or lower for menstrual cups than for disposable pads or tampons (n=293). In all qualitative studies, the adoption of the menstrual cup required a familiarisation phase over several menstrual cycles and peer support improved uptake (two studies in developing countries). In 13 studies, 73% (pooled estimate: n=1144; 95% CI 59-84, I2=96%) of participants wished to continue use of the menstrual cup at study completion. Use of the menstrual cup showed no adverse effects on the vaginal flora (four studies, 507 women). We identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints (three with hydronephrosis), and five of toxic shock syndrome after use of the menstrual cup. Dislodgement of an intrauterine device was reported in 13 women who used the menstrual cup (eight in case reports, and five in one study) between 1 week and 13 months of insertion of the intrauterine device. Professional assistance to aid removal of menstrual cup was reported among 47 cervical cup users and two vaginal cup users. We identified 199 brands of menstrual cup, and availability in 99 countries with prices ranging US$0·72-46·72 (median $23·3, 145 brands). INTERPRETATION: Our review indicates that menstrual cups are a safe option for menstruation management and are being used internationally. Good quality studies in this field are needed. Further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products. FUNDING: UK Medical Research Council, Department for International Development, and Wellcome Trust.

5.
J Urban Health ; 96(4): 537-548, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30887375

RESUMO

Street-level environment characteristics influence the health behaviors and safety of urban residents, and may particularly threaten health within informal communities. However, available data on how such characteristics vary within and among informal communities is limited. We sought to adapt street audit strategies designed to characterize the physical environment for use in a large informal community, Rio das Pedras (RdP) located in Rio de Janeiro, Brazil. A smartphone-based systematic observation protocol was used to gather street-level information for a high-density convenience sample of street segments (N = 630, estimated as 86% of all street segments in the community). We adapted items related to physical disorder and physical deterioration. Measures selected to illustrate the approach include the presence of the following: (1) low-hanging or tangled wires, (2) litter, (3) structural evidence of sinking, and (4) an unpleasant odor. Intercept-only spatial generalized additive models (GAM) were used to evaluate and visualize spatial variation within the RdP community. We also examined how our estimates and conclusions about spatial variation might have been affected by lower-density sampling from random subsets street observations. Random subsets were selected to determine the robustness of study results in scenarios with sparser street sampling. Selected characteristics were estimated to be present for between 18% (unpleasant odor) to 59% (low-hanging or tangled wires) of the street segments in RdP; estimates remain similar (± 6%) when relying on a random subset created to simulate lower-density spatial sampling. Spatial patterns of variation based on predicted probabilities across RdP differed by indicator. Structural sinking and low-hanging or tangled wires demonstrated relatively consistent spatial distribution patterns across full and random subset sample sizes. Smartphone-based systematic observations represent an efficient and potentially feasible approach to systematically studying neighborhood environments within informal communities. Future deployment of such tools will benefit from incorporating data collection across multiple time points to explore reliability and quantify neighborhood change. These tools can prove useful means to assess street-level exposures that can be modifiable health determinants across a wide range of informal urban settings. Findings can contribute to improved urban planning and provide useful information for identifying potential locations for neighborhood-scaled interventions that can improve living conditions for residents in Rio das Pedras.

6.
J Glob Health ; 9(1): 010408, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30546869

RESUMO

Background: Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India. Methods: Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls' experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis. Findings: More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n = 492) than in regular schools (36%, n = 2072, P < 0.001). Girls reported menstruation affected school attendance (6% vs 11% in model vs regular schools respectively, P = 0.003) and concentration (40% vs 45%, P = 0.1) and was associated with pain (31% vs 38%, P = 0.004) and fear of stain or smell (11% vs 16%, P = 0.002). About 45% of girls reported using disposable pads in both model and regular schools, but only 55% and 29% of pad-users reported good disposal facilities, respectively (P < 0.001). In multivariate analysis, reported absenteeism during menstruation was significantly lower in Tamil Nadu (adjusted prevalence ratio (APR) 95% confidence interval (CI) = 0.24, 0.14-0.40) and Maharashtra (APR 0.56, CI = 0.40-0.77) compared to Chhattisgarh, and halved in model compared to regular schools (APR 0.50, CI = 0.34-0.73). Pain medication in school (APR 0.71, CI = 0.51-0.97) and use of disposable pads (APR 0.57, CI = 0.42-0.77) were associated with lower absenteeism and inadequate sanitary facilities with higher absenteeism during menstruation. Conclusions: Menstrual hygiene education, accessible sanitary products, pain relief, and adequate sanitary facilities at school would improve the schooling-experience of adolescent girls in India.


Assuntos
Higiene , Menstruação , Instituições Acadêmicas/organização & administração , Absenteísmo , Adolescente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Produtos de Higiene Menstrual/provisão & distribução , Setor Público , Inquéritos e Questionários
7.
Artigo em Inglês | MEDLINE | ID: mdl-30087298

RESUMO

Many females lack access to water, privacy and basic sanitation-felt acutely when menstruating. Water, sanitation and hygiene (WASH) conditions in schools, such as access to latrines, water, and soap, are essential for the comfort, equity, and dignity of menstruating girls. Our study was nested within a cluster randomized controlled pilot feasibility study where nurses provided menstrual items to schoolgirls. We observed the WASH conditions of 30 schools from June 2012⁻October 2013 to see if there were any changes in conditions, to compare differences between study arms and to examine agreement between observed and teacher-reported conditions. Data came from study staff observed, and school head teacher reported, WASH conditions. We developed scores for the condition of school facilities to report any changes in conditions and compare outcomes across study arms. Results demonstrated that soap availability for students increased significantly between baseline and follow-up while there was a significant decrease in the number of "acceptable" latrines. During the study follow-up period, individual WASH indicators supporting menstruating girls, such as locks on latrine doors or water availability in latrines did not significantly improve. Advances in WASH conditions for all students, and menstrual hygiene facilities for schoolgirls, needs further support, a defined budget, and regular monitoring of WASH facilities to maintain standards.


Assuntos
Higiene , Menstruação/psicologia , População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Sabões/provisão & distribução , Abastecimento de Água/estatística & dados numéricos , Adolescente , Estudos de Viabilidade , Feminino , Humanos , Quênia , Estudos Longitudinais , Instituições Acadêmicas , Estudantes/estatística & dados numéricos
8.
Health Place ; 53: 128-134, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30121010

RESUMO

We explored links between food environments, dietary intake biomarkers, and sudden cardiac arrest in a population-based longitudinal study using cases and controls accruing between 1990 and 2010 in King County, WA. Surprisingly, presence of more unhealthy food sources near home was associated with a lower 18:1 trans-fatty acid concentration (-0.05% per standard deviation higher count of unhealthy food sources, 95% Confidence Interval [CI]: 0.01, 0.09). However, presence of more unhealthy food sources was associated with higher odds of cardiac arrest (Odds Ratio [OR]: 2.29, 95% CI: 1.19, 4.41 per standard deviation in unhealthy food outlets). While unhealthy food outlets were associated with higher cardiac arrest risk, circulating 18:1 trans fats did not explain the association.


Assuntos
Biomarcadores/sangue , Abastecimento de Alimentos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Idoso , Ácidos Graxos/análise , Ácidos Graxos/metabolismo , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/prevenção & controle , Características de Residência , Fatores de Risco , Washington/epidemiologia
9.
Resuscitation ; 130: 118-123, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30057353

RESUMO

BACKGROUND: Medical establishments in the neighborhood, such as pharmacies and primary care clinics, may play a role in improving access to preventive care and treatment and could explain previously reported neighborhood variations in sudden cardiac arrest (SCA) incidence and survival. METHODS: The Cardiac Arrest Blood Study Repository is a population-based repository of data from adult cardiac arrest patients and population-based controls residing in King County, Washington. We examined the association between the availability of medical facilities near home with SCA risk, using adult (age 18-80) Seattle residents experiencing cardiac arrest (n = 446) and matched controls (n = 208) without a history of heart disease. We also analyzed the association of major medical centers near the event location with emergency medical service (EMS) response time and survival among adult cases (age 18+) presenting with ventricular fibrillation from throughout King County (n = 1537). The number of medical facilities per census tract was determined by geocoding business locations from the National Establishment Time-Series longitudinal database 1990-2010. RESULTS: More pharmacies in the home census tract was unexpectedly associated with higher odds of SCA (OR:1.28, 95% CI: 1.03, 1.59), and similar associations were observed for other medical facility types. The presence of a major medical center in the event census tract was associated with a faster EMS response time (-53 s, 95% CI: -84, -22), but not with short-term survival. CONCLUSIONS: We did not observe a protective association between medical facilities in the home census tract and SCA risk, orbetween major medical centers in the event census tract and survival.


Assuntos
Reanimação Cardiopulmonar , Centros Comunitários de Saúde , Morte Súbita Cardíaca/prevenção & controle , Farmácias/estatística & dados numéricos , Serviços Preventivos de Saúde , Fibrilação Ventricular/terapia , Adulto , Idoso , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/organização & administração , Socorristas/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Estados Unidos
10.
Glob Health Action ; 9: 33032, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27938648

RESUMO

BACKGROUND: A lack of adequate guidance on menstrual management; water, disposal, and private changing facilities; and sanitary hygiene materials in low- and middle-income countries leaves schoolgirls with limited options for healthy personal hygiene during monthly menses. While a plethora of observational studies have described how menstrual hygiene management (MHM) barriers in school impact girls' dignity, well-being, and engagement in school activities, studies have yet to confirm if inadequate information and facilities for MHM significantly affects quantifiable school and health outcomes influencing girls' life chances. Evidence on these hard outcomes will take time to accrue; however, a current lack of standardized methods, tools, and research funding is hampering progress and must be addressed. OBJECTIVES: Compile research priorities for MHM and types of research methods that can be used. RESULTS: In this article, we highlight the current knowledge gaps in school-aged girls' MHM research, and identify opportunities for addressing the dearth of hard evidence limiting the ability of governments, donors, and other agencies to appropriately target resources. We outline a series of research priorities and methodologies that were drawn from an expert panel to address global priorities for MHM in schools for the next 10 years. CONCLUSIONS: A strong evidence base for different settings, standardized definitions regarding MHM outcomes, improved study designs and methodologies, and the creation of an MHM research consortia to focus attention on this neglected global issue.

11.
Am J Public Health ; 106(4): 651-3, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26890178

RESUMO

OBJECTIVES: To investigate accuracy of distance measures computed from Global Positioning System (GPS) points in New York City. METHODS: We performed structured walks along urban streets carrying Globalsat DG-100 GPS Data Logger devices in highest and lowest quartiles of building height and tree canopy cover. We used ArcGIS version 10.1 to select walks and compute the straight-line distance (Geographic Information System-measured) and sum of distances between consecutive GPS waypoints (GPS-measured) for each walk. RESULTS: GPS distance overestimates were associated with building height (median overestimate = 97% for high vs 14% for low building height) and to a lesser extent tree canopy (43% for high vs 28% for low tree canopy). CONCLUSIONS: Algorithms using distances between successive GPS points to infer speed or travel mode may misclassify trips differentially by context. Researchers studying urban spaces may prefer alternative mode identification techniques.


Assuntos
Precisão da Medição Dimensional , Meio Ambiente , Sistemas de Informação Geográfica/instrumentação , Caminhada , Humanos , Cidade de Nova Iorque , Viagem , População Urbana
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