Search

Background: Ghanaian female youth aged 15-24 years are especially vulnerable to sexually transmitted infections (STIs) compared to their male counterparts.Objectives: This study examined the association between educational attainment and risky sexual behavior among Ghanaian female youth. Method: A cross-sectional study was conducted using a nationally representative sample of youth from the 2014 Ghana Demographic and Health Survey (n=1702). The outcome of interest was risky sexual behavior, defined as having last intercourse with a non-marital partner without condoms. Descriptive and inferential statistical tests were utilized. Results: Overall, the prevalence of risky sexual behavior was 66.9%. In the bivariate analysis, risky sexual behavior differed by level of education. Compared to women with a college-level education, a significantly higher proportion of women with secondary education reported risky sexual behavior (72.9%), followed by those with primary education (65.7%) (p

Background: There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care. Research Aim: To describe the development, content validation, and interrater reliability of the LACT. Methods: This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants ( N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff’s alpha. Results: An acceptable degree of interrater reliability ( α = 0.70) among participants was detected for the 16 measures included in the instrument. Conclusion: This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding.

OBJECTIVE Female genital mutilation is a public health problem resulting in multiple health complications. In Ethiopia, female circumcision is widely practiced, with women taking center stage in the perpetuation of the practice. Using the Theory of Planned Behavior for variable selection, the following study assessed the association between maternal attitude towards female circumcision and daughter's circumcision status. METHODS From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 6948 women. The outcome variable assessed daughter's circumcision status; the main independent variable assessed participant's opinion towards female circumcision. We conducted univariate, bivariate, and multiple logistic regression analyses. RESULTS In the bivariate analysis, none of the variables, except for religion, showed any association with daughter's circumcision status. In the multivariable regression model, several variables showed a significant association with daughter's circumcision status. Older, rural, and circumcised women were more likely to have at least one daughter circumcised, but wanting female circumcision to stop, being a Muslim, and having at least a secondary education were negatively associated with daughter's circumcision status. CONCLUSION Our findings suggest that eliminating female circumcision may require changing maternal attitudes towards the practice by targeting rural, circumcised, and older women with no formal education.

The rise in caesarean deliveries constitutes a major public health concern in low- and middle-income countries (LMICs). Evidence on the influence of caesarean delivery on breastfeeding practices in LMICs is currently lacking.To examine the association between mode of delivery and breastfeeding initiation and prelacteal feeding practices in a nationally representative sample of Egyptian women.A cross-sectional study was carried out on 3773 women from the 2014 Egypt Demographic and Health Survey. The outcomes of interest were the timing of breastfeeding initiation and prelacteal feeding practices. Descriptive statistics and multivariable logistic regression models were performed.Overall, 25.1% of mothers initiated breastfeeding within 1 hour of birth and 63.5% practised prelacteal feeding within 3 days of birth. Mothers who had caesarean delivery had higher odds of delayed breastfeeding initiation [adjusted odds ratio (AOR) 2.25; 95% confidence interval (CI): 1.84-2.74] and were more likely to engage in prelacteal feeding (AOR: 1.44; 95% CI, 1.19-1.74). Moreover, the relationship between caesarean delivery and delayed breastfeeding initiation varied by parity with stronger association among multiparous (AOR: 2.57; 95% CI, 2.04-3.24) compared with primiparous mothers (AOR: 1.52; 95% CI, 1.03-2.25).Caesarean delivery significantly increased the likelihood of delayed breastfeeding initiation and increased prelacteal feeding practices. Breastfeeding support and guidance should target women considering caesarean delivery.الارتباط بين طريقة الولادة وممارسات الرضاعة الطبيعية في مصر: تحليل ثانوي للمسح السكاني والصحي لمصر.نهى فاضل، زيلاليم هالي.تُشكل زيادة عدد عمليات الولادة القيصرية مصدرًا رئيسيًا للقلق في مجال الصحة العامة في البلدان المنخفضة والمتوسطة الدخل. ولا تتوافر حاليًا براهين حول تأثير الولادة القيصرية على ممارسات الرضاعة الطبيعية في هذه البلدان.هدفت هذه الدراسة إلى دراسة الارتباط بين طريقة الولادة وبدء الرضاعة الطبيعية وممارسات التغذية السابقة للدَ ر (ظهور الأسنان اللبنية) في عينة تمثيلية وطنية من النساء المصريات.أُجريت دراسة مقطعية شملت 3773 امرأة من المسح السكاني والصحي لمصر. وتمثلت النتائج محل الاهتمام في توقيت بدء الرضاعة الطبيعية وممارسات التغذية السابقة للدَرّ. وقد أُجريت إحصاءات وصفية ونماذج انحدار لوجستي متعدد المتغيرات.بوجه عام، بلغت نسبة الأمهات اللاتي بدأن الرضاعة الطبيعية خلال ساعة من الولادة 25.1٪، بينما بلغت نسبة الأمهات اللاتي مارسن التغذية السابقة للدَرّ خلال 3 أيام من الولادة 63.5٪. وكانت نسبة الأرجحية لتأخر بدء الرضاعة الطبيعية أعلى بين الأمهات اللاتي ولدن ولادة قيصرية [نسبة الأرجحية المُصحّحة 2.25؛ بفاصل ثقة95٪: 1.84-2.74]، وازدادت احتمالية قيامهن بالتغذية السابقة للدَرّ (نسبة الأرجحية المُصحّحة: 1.44؛ بفاصل ثقة95٪، 1.19-1.74). وعلاوة على ذلك، تباينت العلاقة بين الولادة القيصرية وتأخر بدء الرضاعة الطبيعية من حيث التكافؤ مع وجود ارتباط أقوى بين الولادات المتعددة (نسبة الأرجحية المُصحّحة: 2.57؛ بفاصل ثقة95٪، 2.04-3.24) مقارنة بالأمهات اللاتي ولدن مرة واحدة فقط (نسبة الأرجحية المُصحّحة: 1.52؛ بفاصل ثقة95٪، 1.03-2.25).أدت الولادة القيصرية إلى زيادة احتمال تأخر بدء الرضاعة الطبيعية وممارسات التغذية السابقة للدَرّ زيادةً كبيرة. وينبغي أن يستهدف الدعم والتوجيه المتعلقان بالرضاعة الطبيعية النساء اللاتي يفكرن في الولادة القيصرية.Association entre le mode d’accouchement et les pratiques d’allaitement au sein en Égypte : analyse de l'enquête démographique et sanitaire égyptienne.L’ augmentation du nombre des césariennes constitue une préoccupation de santé publique majeure dans les pays à revenu faible et intermédiaire. Les données sur l'influence des césariennes sur les pratiques d'allaitement au sein dans ces pays font actuellement défaut.Étudier l'association entre le mode d'accouchement et la mise en route de l'allaitement au sein et les pratiques d'alimentation prélactée dans un échantillon de femmes égyptiennes représentatif au niveau national.Une étude transversale a été réalisée auprès de 3773 femmes dans le cadre de l’enquête démographique et sanitaire égyptienne de 2014. Les résultats d'intérêt étaient le moment de la mise en route de l'allaitement au sein et les pratiques d'alimentation prélactée. Des statistiques descriptives et des modèles de régression logistique multivariable ont été appliqués.Au total, 25,1 % des mères ont commencé à allaiter dans l’heure suivant l’accouchement et 63,5 % ont pratiqué l’alimentation prélactée dans les trois jours suivant l’accouchement. Les mères qui ont accouché par césarienne étaient plus susceptibles de retarder le début de l'allaitement au sein [odds ratio ajusté (ORa) : 2,25 ; intervalle de confiance (IC) à 95 % : 1,84-2,74] et de s'engager dans l'alimentation prélactée (ORa : 1,44 ; IC à 95 % : 1,19-1,74). En outre, la relation entre l'accouchement par césarienne et la mise en route tardive de l'allaitement au sein varie selon le nombre d’enfants, avec une association plus forte chez les multipares (ORa : 2,57 ; IC à 95 % : 2,04-3,24) par rapport aux mères primipares (ORa : 1,52 ; IC à 95 % : 1,03-2,25).L'accouchement par césarienne a considérablement augmenté la probabilité de retarder le début de l'allaitement au sein et les pratiques d'alimentation prélactée. L’ appui et l’orientation en matière d’allaitement au sein devraient cibler les femmes qui envisagent l’accouchement par césarienne.

Background. The prevalence of undernutrition in low- and middle-income countries is still remarkably high. Undernutrition during adulthood is a greater risk factor for low productivity, poor health, and mortality. There is limited information on the prevalence and determinants of chronic energy deficiency in Ethiopia. Objective. To assess the prevalence and determinants of chronic energy deficiency among adults aged 18–59 years in Ethiopia. Method. A secondary data analysis was conducted using the data obtained from the 2016 Ethiopia Demographic and Health Survey. Data were collected using a multistage stratified cluster sampling technique, and the analytic sample consisted of 9,280 adults aged 18–59 years. The chi-square test and multivariable logistic regression analyses were used, and p value

Anaemia during pregnancy is associated with premature births, low birth weight and increased susceptibility to infection. Almost one-quarter (24.34%) of Ethiopian pregnant women suffer from anaemia. Nutritional counselling during antenatal care (ANC) visits may encourage pregnant women to take a more iron-rich diet and prevent anaemia. The present study examines the association between nutritional counselling during ANC and anaemia among Ethiopian women.This cross-sectional study uses the 2016 Ethiopia Demographic and Health Survey (EDHS) data (n = 4, 384). The outcome of interest was anaemia, measured objectively by blood haemoglobin level. The main independent variable was the receipt of nutritional counselling during ANC visits. Univariate, bivariate and multivariable analyses were performed using SAS, version 9.4 (SAS Institute Inc.).Overall, 25.8% of the participants were anaemic and 65.7% received nutritional counselling during ANC visits. Compared with women who received nutritional counselling during ANC visits, a significantly higher proportion of women who did not receive nutritional counselling were anaemic (23.1% vs. 30.8%; p 0.001). In the multivariable model, compared with women who received nutritional counselling during their ANC visits, the odds of being anaemic were higher among women who did not receive nutritional counselling during their ANC visits adjusted odds ratio = 1.34 (95% confidence interval = 1.07-1.67; p = 0.010).In a representative sample of Ethiopian women, exposure to nutritional counselling during ANC visits is associated with a lower likelihood of anaemia, independent of potential confounders. Focused ANC counselling that includes nutritional counselling programs during ANC visits can be an effective strategy to prevent and control anaemia.

Guided by the Anderson Behavioral Model, the researchers in this study examined the association between emotional violence and HIV testing uptake among women, using the 2016 Ethiopian Demographic and Health Survey. Only 3,637 women between the ages of 15 and 49 years were included. In the bivariate analysis, emotional violence, reported by 42.6% of respondents, was associated with prior HIV testing. In the multiple logistic regression model, emotional violence was not associated with HIV testing uptake among women (

Hypertension (HTN) is a major cardiovascular risk factor that affects 1.3 billion people and accounts for 17.9 million deaths annually worldwide. Seventy-five percent of global deaths due to HTN occur in low- and middle-income countries where HTN prevalence is higher, and HTN control and population awareness are lower, than in high-income countries. Approximately 26% of Egyptian adults meet criteria for HTN, but the prevalence of HTN unawareness is unknown in this population. The purpose of this study was to assess prevalence and predictors of HTN unawareness among Egyptian adults. Using data from the 2015 Egyptian Health Issues Survey (EHIS), we identified 2869 participants 18-59 years of age whose blood pressure met criteria for HTN at the time of data collection. Our outcome of interest, hypertension unawareness, was indicated when a participant reported that they had not been diagnosed with HTN (despite meeting criteria). Descriptive statistics and multivariable logistic regression were performed to determine prevalence of, and risk factors for, HTN unawareness. Fifty-six percent of the sample were unaware of their HTN status. The odds of HTN unawareness were highest among participants 18-39 years old compared to those 40-59 years old (OR 1.91; 95% CI 1.48-2.47); males compared to females (OR 2.59; 95% CI 1.85-3.62); and never married compared to currently married participants (OR 1.96; 95% CI 1.19-3.24). Compared to those who had a college level education, the odds of HTN unawareness were highest among participants who had no education (OR 2.21; 95% CI 1.45-3.38). In addition, the odds of HTN unawareness were higher for participants who had a normal body mass index compared to those who were obese (OR 1.82; 95% CI 1.26-2.65); and those considered healthy compared to those who had at least one chronic illness (OR 4.53; 95% CI 3.29-6.24). Our findings indicate that more than half of Egyptian adults who meet criteria for HTN are unaware of their blood pressure status. Younger, healthier, and normal weight people-who are typically at lowest risk for HTN-appear mostly likely to be unaware of their HTN status. Less educated people are least likely to know their hypertensive status. This suggests the need for a targeted health education campaign and regular blood pressure screening in Egypt.

Background In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country. Research Aim To determine the relationship between place of birth and early breastfeeding initiation in Indonesia. Method This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey ( N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders. Results The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively. Conclusions Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Objective: To explore the perceived experience of polycystic ovary syndrome (PCOS) among PCOS-diagnosed Bangladeshi women with examination of the influence of culture. Methods: This qualitative study included 25 Bangladeshi women who had been diagnosed with PCOS. The qualitative interviews were completed via Skype and/or phone between December 2017 to March 2018. Transcriptions of recorded, de-identified responses were analyzed using qualitative manual coding and thematic analysis. Results and discussion: Three overarching themes were identified from the narratives: PCOS diagnosis experience, PCOS knowledge, and role of religion and culture in relation to PCOS. The women expressed an unsatisfactory experience with their PCOS diagnosis including having to change healthcare professionals, inadequate access to resources, and concerns related to infertility and pregnancy complications. Lack of available evidence-based information was associated with limited knowledge of PCOS among the PCOS-diagnosed Bangladeshi women and their families. The respondents perceived that culture influenced refraining from sharing of information about PCOS thereby limiting knowledge, muting women’s health experience, and contributing to a negative perception on PCOS and related conditions. Participants felt that cultural expectations and emphasis on childbearing placed constant pressure on women and stigmatized PCOS. Conclusions: Bangladeshi women with PCOS perceive various challenges and limited access to information and resources. To minimize some of the challenges associated with PCOS, public health efforts should focus on increasing awareness, education, and resources for women and their families.

As the global population ages, there is increasing concern about the living arrangements of older adults, and in particular, whether they end up living on their own, in an institutional setting or in some other arrangement. In many low- and middle-income countries, there is a tradition of older persons living with their adult children, and very often in multigenerational households. However, as the number of older persons increases and populations become increasingly urbanized, it is likely that even in these countries more older persons are living alone. This raises a number of concerns regarding the well-being and care of the elderly. Following global trends, Egypt‟s population is also aging with 6.9 % over 60 in 2017 and a projected population of 60 of 9.2% by 2030 and 20.8% by 2050. Little is known about living arrangements of older persons in Egypt. Using Demographic Health Survey data, this study examines the changes in living arrangements in Egypt‟s governorates from 2000-2014. We find the proportion of older persons living alone is increasing in many governorates. For example, in 2000, the highest rate of living alone was in New Valley, with 11% households containing older persons living by 2014, Alexandria had the highest rate of households with only older persons (19% of all households). In 2000, the Red Sea governorate had the lowest rate of elder-only households, while Souhag, South Sinai, Behera and Fayoum had about 3% of their households containing elders living alone; all of these governorates experienced a tripling of the proportion of elder-only households by 2014. These demographic shifts correspond with migration patterns and changes in economic base within different governorates.

Objectives The aim of the study was to quantify the burden of premature mortality because of opioid overdose in Ohio, document the role of fentanyl poisoning in contribution to this evolving epidemic, examine geographic, demographic, and temporal patterns of mortality burden within Ohio, and measure the effect of opioid overdose on lifespan in the state. Methods A serial cross-sectional analysis was performed for all fatal opioid poisonings (N = 12,782) in the state of Ohio between January 1, 2010 and December 31, 2016. The burden of fatal opioid overdose was calculated in Years of Life Lost (YLL). YLL were mapped with respect to geographic and cultural region. The geographic spread of fentanyl poisoning was also mapped, and the shifting contribution of fentanyl poisoning to overall opioid mortality burden was assessed over time. Finally, the negative effect of opioid overdose on average lifespan was calculated. Results Opioid overdose resulted in 508,451 total YLL. In the year 2016 alone, there were 136,679 YLL attributable to opioid poisoning. Fentanyl-related YLL rose from 7.5% of all YLL because of opioid overdose in 2010 to 69.0% in 2016. In the same year, opioid overdose lowered the lifespan of an average Ohioan by 0.97 years. Conclusions Fatal opioid overdose accounted for over half a million YLL in Ohio during the 7-year study period. Opioid overdose mortality rose annually. Fentanyl involved overdoses accounted for a growing proportion of excess mortality. Burden was not equally distributed within the state. Two distinct geographical clusters of excess mortality were identified in the northeast and south.

To evaluate whether there is an association between prenatal smoking and gestational diabetes mellitus (GDM).We conducted a secondary data analysis using data from the Pregnancy Risk Assessment Monitoring System from 2009 to 2015. Outcome measures included self-reported GDM and change in smoking status during pregnancy (nonsmoker, quit smoking, reduced the amount smoked, smoked the same or more). Multivariable logistic regression analyses were performed to estimate the association between prenatal smoking and GDM status, adjusted for maternal age, race-ethnicity, prepregnancy body mass index (BMI) categories (underweight, normal [referent group], overweight, and obese), and gestational weight gain (inadequate, normal [referent group], and excessive), overall and stratified by prepregnancy BMI and gestational weight gain subgroups.A total of 222,408 women were included; 5.3% (n=12,897) had GDM. Most (48.1%) women had normal prepregnancy BMI, and 43.1% had excessive gestational weight gain. Mothers who continued to smoke the same or greater number of cigarettes or reduced the number of cigarettes smoked had higher odds of GDM (adjusted odds ratio [OR] 1.46, 95% CI 1.25-1.71 and OR 1.22, 95% CI 1.08-1.38, respectively). Smoking the same or more cigarettes was associated with higher odds of GDM in all subgroups of prepregnancy BMI or gestational weight gain.Prenatal smoking is associated with higher odds of GDM, after adjusting for known risk factors, and stratifying by prepregnancy BMI and gestational weight gain. Reducing smoking during pregnancy might reduce the risk of GDM and could be an additional reason for promoting smoking cessation among pregnant women.

Background: Maternal high-risk fertility behaviors have been linked to negative maternal and child health outcomes that include anaemia, undernutrition, and child mortality. In this context, we examined the association between maternal high-risk fertility behavior and pregnancy intention among women of reproductive age in Rwanda.Methods: This cross-sectional study is based on secondary data from the 2014–15 Rwanda Demographic and Health Survey (n=5661). The outcome of interest was pregnancy intention of the last child defined as intended or unintended. Maternal high-risk fertility behaviors were measured using maternal age at delivery, birth order, and birth interval. Chi-square test and multivariable regression models were performed. Results: The prevalence of unintended pregnancy was 46.8% (n=2652). Overall, 35.8% (n=2017) of women experienced single high-risk fertility behavior, while 23.1% (n=1282) of women experienced multiple high-risk fertility behaviors. Compared to women who have not experienced high-risk fertility behavior, the multivariable odds ratio (95% CI) of unintended pregnancy among women in single-risk and multiple-risk fertility behaviors were 2.00 (1.75, 2.28; p Conclusion: Exposure to high-risk fertility behaviors is positively associated with unintended pregnancy among women in Rwanda. Therefore, reproductive and sexual health services should pay special attention to women who are 34 years old; who have more than three children already; or have children with less than 24 months’ interval between giving birth.

BackgroundHIV and mental disorders are predicted to be the leading causes of illness worldwide by the year 2030. HIV-infected patients are at increased risk of developing mental disorders which are significantly associated with negative clinical outcomes and propagation of new HIV infections. There is little evidence that links inflammation to development of mental disorders among HIV patients. Therefore, the main objective of this study was to evaluate if mental health symptoms were associated with biomarkers of inflammation in HIV infected subjects.MethodsA cross-sectional study was conducted in Dar es Salam, Tanzania from March to May 2018. Standardized tools were used to collect data based on the World Health Organisation's (WHO) stepwise approach for non-communicable diseases (NCD) surveillance. A total of 407 HIV+ patients on antiretroviral therapy were recruited. The WHO stepwise approach for NCD surveillance was used to collect data together with anthropometric measurements. Mental health symptoms were determined based on self-reported thoughts of helplessness, suicide ideation, depression, despair, discouragement, and feelings of isolation. Enzyme-linked immunosorbent assay was used to test for inflammatory markers:- C-reactive protein (CRP), Iinterleukin-6 (IL-6), interleukin-18 (IL-18), soluble tumour necrosis factor receptor-I (sTNFR-I), and soluble tumour necrosis factor receptor-II (sTNFR-II). Bivariate and multi-variate analysis was conducted to examine the association between biomarkers and mental health symptoms.ResultsThe prevalence of self-reported mental health symptoms was 42% (n = 169). Participants with self-reported symptoms of mental health had elevated CRP, were less likely to walk or use a bicycle for at least 10 minutes, were less likely to participate in moderate-intensity sports or fitness activities, and had poor adherence to HIV treatment (p ConclusionHigh CRP and sTNFR II were important contributors to the prevalence of mental health symptoms. This study is among the minimal studies that have examined mental health issues in HIV, and therefore, the findings may offer significant knowledge despite the potential reverse causality. Regardless of the nature of these associations, efforts should be directed toward screening, referral, and follow-up of HIV patients who are at-risk for mental health disorders.

In the United States, the rates of cesarean delivery are well above the World Health Organization recommended target. Although obesity is a widely established risk factor for cesarean delivery, there is limited population-based research that examines the relationship between gestational weight gain and cesarean delivery.To determine the association between gestational weight gain and unplanned or emergency cesarean delivery.We examined 2107 mothers from the Infant Feeding Practices Study II 2005-2007. The Institute of Medicine's current guidelines were used to define categories of gestational weight gain: inadequate (less than the recommended guideline), adequate (within the recommended guideline) and excessive (above the recommended guideline).Approximately 49.3% and 13.6% of the participants had excessive weight gain and unplanned or emergency cesarean delivery, respectively. A Greater proportion of women with excessive weight gain had an unplanned or emergency cesarean delivery followed by women with adequate and inadequate weight gain, respectively (17.8%, 10.0%, 8.8%; p0.001). In the multivariable model, compared to women with adequate weight gain, the odds of unplanned or emergency cesarean delivery were higher among women with excessive weight gain (OR 1.56, 95% CI 1.07-2.27, p=0.020).Women with excessive gestational weight gain are more likely to experience an unplanned or emergency cesarean delivery, which increases the risk for poor maternal-infant health outcomes.It is critical to identify populations at increased risk of unplanned or emergency cesarean delivery and provide preconception and prenatal counseling to achieve and maintain the recommended weight gain for optimal maternal-infant health outcomes.

Female genital mutilation (FGM) is considered a human rights violation against women and girls causing serious short and long-term health complications. Despite being a criminal offence in Ethiopia since 2004, the practice continues. Minimal research has been published on factors associated with men's opinion about FGM in Ethiopia.The present cross-sectional study used secondary data to identify factors associated with men's opinions about the practice of FGM.Secondary data analysis was conducted using data from 8,718 men who responded to the 2016 Ethiopian Demographic and Health Surveys (EDHS). The dependent variable was men's opinion about FGM. Demographic, socioeconomic, and other characteristics were examined.Variables associated with men's support for FGM were lack of education (AOR = 2.91; 95% CI: 1.93, 4.40, p = 0.001), poor wealth index (AOR, 1.76; 95% CI 1.32, 2.35, p = 0.001), ethnically Afar (AOR = 2.50, 95% CI: 1.27, 4.95, p = 0.009) and Somali (AOR = 2.02, 95% CI: 1.15, 3.54, p = 0.015), Muslim religion (AOR = 1.58, 95% CI 1.13, 2.50, p = 0.007), and support for wife beating with at least one justification (AOR = 2.04, 95% CI: 1.66, 2.50, p = 0.001).Lack of education, poor household wealth index, being Muslim and being a member of the Afar or Somali ethnicity and having a tendency that it is appropriate for a husband to beat his wife, were positively associated support for FGM. These findings suggest that context-specific interventions are needed to eradicate the practice.

Background Serum zinc (Zn) levels have been shown to be associated with functional status; however, it is not clear whether this association differs by other sociodemographic characteristics. We examined the association between serum Zn levels and physical functioning difficulty in a representative sample of older adults in the US. Design and methods A cross-sectional study was conducted on participants 50 years and older from the 2011–12 and 2013–14 National Health and Nutrition Examination Surveys (n = 1136). Serum Zn levels were analyzed as tertiles. The main outcome of interest was physical functioning difficulty, defined as self-reported difficulty of basic physical functioning that included walking, transferring, dressing, and feeding. Results Mean Zn levels (SE) were 0.67(0.1), 0.81(0.1), and 0.98(0.1) μg/mL in the low, middle, and high Zn groups, respectively. Approximately 24.9% participants reported physical functioning difficulty. In the multivariable model, we found a significant multiplicative interaction between sex and serum Zn (P for interaction =0.028) and between education and serum Zn (P for interaction = 0.001) on basic physical functioning difficulty. The stratified analysis revealed that among men, compared to those with low serum Zn, the odds of having physical functioning difficulty were lower in men who had high serum Zn [aOR 0.43 (95% CI: 0.25–0.76)]. For women, compared to those with low serum Zn the odds of having physical functioning difficulty were higher in women who had middle serum Zn [aOR 2.67 (1.58–4.50)]. Among individuals with less than high school education, the odds of having physical functioning difficulty were lower in those who had middle serum Zn compared to those who had low serum Zn [aOR 0.48 (0.26–0.89)]. However, the odds of having physical functioning difficulty were higher in those who had middle serum Zn compared to those who had low serum Zn for individuals with high school [aOR 5.72 (1.92–17.00)] and beyond high school education [aOR 1.77 (1.05–2.97)], respectively. Conclusion Sex and educational attainment interact with serum Zn levels to influence basic physical functioning difficulty in older adults.

Objectives The aim of this study was to examine the association between maternal high-risk factors and anemia among reproductive-age women in Ethiopia. Methods A cross-sectional study was conducted using data from the 2016 Ethiopia Demographic and Health Survey (N = 5282). Hemoglobin levels were used to determine anemia status. Maternal high-risk factors were measured using maternal age at delivery, birth order, and birth interval. We performed χ2 test and multivariable regression models. Results There was a significant antagonistic interaction between maternal high-risk factors and place of residence on anemia (relative excess risk due to interaction, –1.79, synergy index, 0.48) with an attributable proportion due to interaction (AP) of –67% (AP = –0.67; 95% confidence interval [CI], –0.95 to –0.29). Multiplicative interaction was also significant (odds ratio for interaction, 0.38; P = 0.003). The odds of anemia were higher among women with any maternal high-risk factor than in those who did not experience any high-risk factors (adjusted odds ratio [AOR], 2.64; 95% CI, 1.24–5.63 for urban and AOR, 1.27; 95% CI, 1.01–1.61 for rural women). Exposure to a single maternal high-risk factor was significantly associated with increased odds of anemia among urban residents only (AOR, 2.61; 95% CI, 1.17–5.81). Exposure to multiple maternal high-risk factors significantly increased the odds of anemia (AOR, 2.82; 95% CI, 1.15–6.91) and (AOR, 1.55; 95% CI, 1.10–2.17) for urban and rural women, respectively. Conclusions Place of residence moderated the relationship between maternal high-risk factors and anemia. Context-specific strategies and interventions are needed to prevent anemia.

Background Despite significant public health intervention, maternal mortality remains high in low- and middle-income countries, including Ethiopia. Effective postnatal care is a critical service to reduce maternal mortality. In Ethiopia, only 17% of mothers received postnatal care services in 2016. Objective This study examined the association between antenatal care and timely postnatal care checkup among reproductive-age women in Ethiopia. Methods The study used the 2016 Ethiopian Demographic and Health Survey data. The current study included 4,081 women who give birth in the two years preceding the survey. Chi-square test and multivariable logistic regression analyses were used to examine the association between antenatal care and timely initiation of postnatal care. Results Postnatal care services within 2 days of delivery were received by 16.5% of women. Women who had at least four timely antenatal care visits had higher odds of timely postnatal checkups compared to women who had no antenatal care [adjusted Odds Ratio (aOR): 2.50; 95% CI 1.42–4.42]. Women who had at least four antennal care visits without timely initiation also had higher odds of postnatal check-up than their counterparts (aOR: 2.46; 95%CI: 1.22–4.97). Other factors significantly associated with timely initiation of PNC were secondary and above education (aOR: 1.64; 95%CI: 1.03–2.60), perceived distance to the nearby health facility as a significant barrier (aOR: 1.55; 95%CI: 1.15–2.09), primiparous (aOR: 0.34; 95%CI: 0.19–0.61) and institutional delivery (aOR: 14.55; 95%CI: 2.21–95.77). Conclusion The prevalence of timely initiation of postnatal care in Ethiopia is very low. Women who received recommended antenatal care services had higher odds of timely initiation of postnatal care. Thus, strengthening the existing maternal and child health programs to adhere to the recommended ANC care guidelines may improve the timely initiation of postnatal care.

Background: Exclusive breastfeeding is the optimal manner of early infant nutrition but women with gestational diabetes mellitus (GDM) often experience challenges with lactation in the early postpa...

Background Children’s physical fitness is an important predictor of metabolic health, physical function, and academic achievement. Although fitness is determined partially by heritable factors, it can be maintained and improved through regular physical activity. Because physical activity is known to vary by socioeconomic status, physical fitness may be expected to vary similarly. With this in mind, the purpose of this study was to examine disparities in physical fitness performance among a nationally-representative sample of 6–11 year-old children living in the United States. Methods We conducted secondary analysis of physical fitness data of children ages 6–11 years (n = 686) from the nationally representative National Health and Nutrition Survey (NHANES) Youth Fitness Survey (NNYFS) 2012. We estimated sex-stratified weighted means of four fitness performance tests: cardiorespiratory endurance, upper-, lower-, and core-muscular strength. The weighted mean for each fitness assessment was compared by income groups (federal income to poverty ratio – FIPR) accounting for complex sampling design and adjusting for age. Results Income disparities in physical fitness performance were evident among girls but not among boys. Girls from lower income groups ( Conclusion These findings highlight the need to support health-promoting physical activity among girls from disadvantaged backgrounds prior to the adolescent period.

Background The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the twenty-first century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field. However, several gaps remain in the knowledge of the burden of COVID-19 on patients with TB and HIV. This study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB, to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and clinical management. Methods We conducted an electronic search of potentially eligible studies published in English in the Cochrane Controlled Register of Trials, PubMed, Medrxiv, Google scholar and Clinical Trials Registry databases. We included case studies, case series and observational studies published between January, 2002 and July, 2020 in which SARS-CoV, MERS-CoV and COVID-19 co-infected to HIV/TB or TB in adults. We screened titles, abstracts and full articles for eligibility. Descriptive and meta-analysis were done and results have been presented in graphs and tables. Results After removing 95 duplicates, 58 out of 437 articles were assessed for eligibility, of which 14 studies were included for descriptive analysis and seven studies were included in the meta-analysis. Compared to the descriptive analysis, the meta-analysis showed strong evidence that current TB exposure was high-risk COVID-19 group (OR 1.67, 95% CI 1.06–2.65, P = 0.03). The pooled of COVID-19/TB severity rate increased from OR 4.50 (95% CI 1.12–18.10, P = 0.03), the recovery rate was high among COVID-19 compared to COVID-19/TB irrespective of HIV status (OR 2.23, 95% CI 1.83–2.74, P P Conclusion In summary, TB was a risk factor for COVID-19 both in terms of severity and mortality irrespective of HIV status. Structured diagnostic algorithms and clinical management are suggested to improve COVID-19/HIV/TB or COVID-19/TB co-infections outcomes.

Hypertension (HTN) is a major cardiovascular risk factor that affects 1.3 billion people and accounts for 17.9 million deaths annually worldwide. Seventy-five percent of global deaths due to HTN occur in low- and middle-income countries where HTN prevalence is higher, and HTN control and population awareness are lower, than in high-income countries. Approximately 26% of Egyptian adults meet criteria for HTN, but the prevalence of HTN unawareness is unknown in this population. The purpose of this study was to assess prevalence and predictors of HTN unawareness among Egyptian adults. Using data from the 2015 Egyptian Health Issues Survey (EHIS), we identified 2869 participants 18-59 years of age whose blood pressure met criteria for HTN at the time of data collection. Our outcome of interest, hypertension unawareness, was indicated when a participant reported that they had not been diagnosed with HTN (despite meeting criteria). Descriptive statistics and multivariable logistic regression were performed to determine prevalence of, and risk factors for, HTN unawareness. Fifty-six percent of the sample were unaware of their HTN status. The odds of HTN unawareness were highest among participants 18-39 years old compared to those 40-59 years old (OR 1.91; 95% CI 1.48-2.47); males compared to females (OR 2.59; 95% CI 1.85-3.62); and never married compared to currently married participants (OR 1.96; 95% CI 1.19-3.24). Compared to those who had a college level education, the odds of HTN unawareness were highest among participants who had no education (OR 2.21; 95% CI 1.45-3.38). In addition, the odds of HTN unawareness were higher for participants who had a normal body mass index compared to those who were obese (OR 1.82; 95% CI 1.26-2.65); and those considered healthy compared to those who had at least one chronic illness (OR 4.53; 95% CI 3.29-6.24). Our findings indicate that more than half of Egyptian adults who meet criteria for HTN are unaware of their blood pressure status. Younger, healthier, and normal weight people-who are typically at lowest risk for HTN-appear mostly likely to be unaware of their HTN status. Less educated people are least likely to know their hypertensive status. This suggests the need for a targeted health education campaign and regular blood pressure screening in Egypt.

Background The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the 21st century and in the future. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field and play an important role in the present and future management of the co-infections. However, several gaps are remaining in the knowledge of the burden of COVID-19 on patients with TB and HIV, the diagnosis, and management of these patients. The study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB and to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and clinical management. Methods We conducted electronic search of potential eligible studies published in English in the Cochrane Controlled Register of Trials, PubMed, Medrxiv, Google scholar and Clinical Trials Registry databases. We included case studies, case series and observational studies published between January, 2002 and March, 2020 in which SARS-CoV, MERS-CoV and COVID-19 co-infected to HIV/TB or TB were managed in adult patients. We screened titles, abstracts and full articles for eligibility. As we anticipated heterogeneity in the literature, results were reported narratively. Results After removing 69 duplicates, 24 out of 246 articles were assessed for eligibility, of which 9 studies were included for qualitative analysis. Among them, we included two case reports, four case series, one case-control and two retrospective observational studies. The studies have shown that TB may occur during or after SARS-CoV. In terms of severity, the proportion of severe/critical SARS, MERS and COVID cases with TB co-infection was higher than in patients with mild/moderate stages (P = 0.0008). Conclusion SARS/MERS-CoV/COVID-19 associated to HIV/TB or TB subjects had a higher risk of developing severe/critical than mild/moderate SARS/MERS-CoV/COVID-19. Diagnostic algorithms and clinical management were suggested for efficiently improving COVID-19/HIV/TB co-infections outcomes.

Background Hypertension is a major risk factor for cardiovascular disease that affects 1·3 billion people and accounts for 17·9 million deaths worldwide annually. Most deaths from hypertension (around 75%) are in low-income and middle-income countries where hypertension prevalence is higher but control and population awareness of the condition are lower. Approximately 26% of Egyptian adults meet criteria for hypertension, but the prevalence of hypertension unawareness is unknown in this population. Here, we aim to assess prevalence and predictors of hypertension unawareness in Egyptian adults. Methods We undertook a cross-sectional study using data from the 2015 Egyptian Health Issues Survey (EHIS). We included data from respondents aged 18–59 years. The outcome of interest was hypertension unawareness, defined by objectively measured blood pressure done during the EHIS survey and a self-reported unawareness of hypertension status. We used descriptive statistics and multivariable logistic regression for analysis. Findings We analysed data from 2869 participants; 1915 of the respondents (65·5%) were in the 40–59 year age group, and 1639 respondents (56·5%) were women. More than half (56%) of EHIS respondents were unaware of their hypertension. The likelihood of hypertension unawareness was higher in participants aged 18–39 years than in those aged 40–59 years (odds ratio 1·91 [95% CI 1·48 −2·47]); men than in women (2·59 [1·85–3·62]; and never married compared with currently married participants (1·96 [1·19–3·24]). Compared with those who had college level education, hypertension unawareness was more likely in participants who had no education (2·21 [1·45–3·38], primary education (1·80 [1·20–2·70]), and secondary education (1·71 [1·21–2·40]). Additionally, hypertension unawareness was more likely in participants who had normal BMI than in those who were obese (1·82 [1·26–2·65]); and more likely in healthy participants than in those who had at least one chronic illness (4·53 [3·29–6·24]). Interpretation More than half of Egyptian adults with hypertension are unaware of their condition. Those typically at lowest risk for hypertension appear to be at highest risk for hypertension unawareness. Younger, healthier, and less educated men are least likely to know of their hypertension. Our findings suggest the need for a targeted health education campaign and regular blood pressure screening in Egypt. Funding None

Objectives Anemia constitutes a major public health problem in low- and middle-income countries. The purpose of this study was to examine the individual and combined influence of high-risk fertility behavior on anemia among reproductive age women in Ethiopia.Methods Secondary data analysis was conducted using a nationally representative sample of women aged 15-49 years from the 2016 Ethiopia Demographic and Health Survey (n=5799). Anemia status was the outcome of interest. Maternal high-risk fertility behaviors were measured using maternal age at delivery, birth order and birth interval. Descriptive statistics and multivariable regression models were performed.Results Overall, 28.7% of women had anemia and 71.4% experienced at least one high-risk fertility behavior. In the multivariable model, there was a significant interaction between high-risk fertility behavior and place of residence on anemia. Women with any high-risk fertility behavior were more likely to have anemia than women without any high-risk fertility behavior. However, the strength of association differed by place of residence (AOR: 2.68; 95% CI, 1.26-5.67 for urban and AOR: 1.27; 95% CI, 1.01-1.61 for rural residents). Single high-risk fertility behavior was significantly associated with anemia only among urban residents (AOR: 2.65; 95% CI, 1.20-5.83). Multiple high-risk fertility behavior significantly increased the odds of anemia, with stronger association among urban residents (AOR: 2.82; 95% CI, 1.14-6.95) than rural residents (AOR: 1.56; 95% CI, 1.11-2.19).Conclusions Place of residence moderated the relationship between high-risk fertility behaviors and anemia. Our findings suggest the need for context-specific strategies and interventions to prevent anemia.

Background: Studies from high-income countries have reported that even after receiving antiretroviral treatment (ART), HIV-infected adults may not achieve normal levels of certain inflammatory markers that are known to be associated with the onset and development of non-communicable diseases. Objective: To examine the relationship between ART and markers of systemic inflammation in HIV/AIDS patients at an urban antiretroviral clinic in Ghana. Methods: We examined serum levels of high sensitivity CRP (hsCRP), interleukin-6 (IL-6), interleukin-18(IL-18), and tumor necrosis factor-α (sTNFR1 and sTNFR2) from 40 HIV infected patients. Kruskal-Wallis Test was used to examine the differences in markers of systemic inflammation according to the types of ART medication taken. We then utilized generalized additive models (GAM) with non-linear function to examine the association between ART and markers of systemic inflammation after adjusting for potential confounders. Results: Overall, 30 (75.0%) of the participants received ART and 35 (85%) were female. Kruskal-Wallis Test revealed no significant differences in the markers of systemic inflammation among the three categories of ART (none, AZT, 3TC, EFV/NVP, and TDF, 3TC/FTC, EFV/NVP). In the multivariable-adjusted GAM model, we found a significant but nonlinear association between time since diagnosis and CRP levels (p=0.006). Conclusion: Although the relatively small sample size limits the scope of the study's findings, these results suggest that individuals on ART need to be screened periodically for the development of chronic conditions. This line of investigation has the potential to influence treatment and clinical guidelines that will improve the quality of care for HIV-infected patients.

OBJECTIVES Electronic cigarette (e-cigarette) use has recently increased among adults in the United States. Previous studies have identified physical health outcomes associated with e-cigarettes. Few studies have examined the relationship between e-cigarette use and mental health outcomes. This study aimed to investigate the relationship between e-cigarette use and depression. METHODS The present cross-sectional study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) in the United States (n = 11918). RESULTS Overall, 3.7% and 11.2% of the participants were current and former e-cigarette users, respectively. A significantly higher proportion of current e-cigarette users reported having depression (32.4%) than former users (27.3%) and non-users (16.0%). In the multivariable model, we found significant interactions between marital status, employment status, marijuana use and e-cigarette use on depression. Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among unemployed current e-cigarette users (OR = 2.85, 95% CI = 1.63, 4.97) and unemployed former e-cigarette users (OR = 1.89, 95% CI = 1.26, 2.84). Compared to people who do not use marijuana, the odds of self-reported depression were higher among marijuana users who were also current e-cigarette users (OR = 1.68, 95% CI = 1.08, 2.61) and former e-cigarette users (OR = 1.35, 95% CI = 1.07, 1.71). Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among widowed/divorced/separated participants who were current e-cigarette users (OR = 3.42, 95% CI = 1.60, 7.29) and former e-cigarette users (OR = 1.55, 95% CI = 1.03, 2.34). CONCLUSION In a representative sample of adults in the United States e-cigarette use is associated with depression, predominantly in widowed/divorced/separated, unemployed and people who use marijuana. This association was independent of potential cofounders.

Additional file 1: Table 1. Quality assessment of included studies

OBJECTIVE To evaluate associations between insurance status and HPV vaccination. METHODS The present cross-sectional study analyzed data from women aged 18-26 years who participated in the National Health and Nutritional Examination Surveys 2009-2012 in the USA. RESULTS The study included 621 women; 424 (68.3%) had some type of insurance and 198 (30.6%) had received the HPV vaccine. In the multivariable model, we found significant interactions between race/ethnicity and insurance status on receiving HPV vaccination. Compared with individuals with no insurance, non-Hispanic black women with any type of insurance demonstrated increased likelihood of HPV vaccination (adjusted odds ratio [aOR] 3.63, 95% confidence interval [CI] 1.60-8.21; P=0.002). Among Mexican Americans, there was a negative association between having some insurance and HPV vaccination (aOR 0.35, 95% CI 0.15-0.81; P=0.007). For non-Hispanic black women, the association remained significant across all insurance types (private [aOR 4.29, 95% CI 1.67-11.00; P=0.003], Medicaid [aOR 2.86, 95% CI 1.15-7.13; P=0.025], and other [aOR 4.74, 95% CI 1.06-21.15; P=0.042]). Non-Hispanic white women with insurance other than private or Medicaid had a higher likelihood of HPV vaccination compared with uninsured individuals (aOR 8.36, 95% CI 2.79-25.05; P