Tag Archives: Cohort Studies

Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.

Management of type III female genital mutilation in Birmingham, UK: A retrospective audit

Midwifery. 2014, 30(3):282–288 DOI: http://dx.doi.org/10.1016/j.midw.2013.04.008

Management of type III female genital mutilation in Birmingham, UK: A retrospective audit

Paliwal P, Ali S, Bradshaw S, Hughes A, Jolly K


Maternal infibulation and obstetrical outcome in Djibouti.

J Matern Fetal Neonatal Med. 2014 Sep 19:1-23. [Epub ahead of print]

Maternal infibulation and obstetrical outcome in Djibouti.

Minsart AF, N’guyen TS, Hadji RA, Caillet M.


The objective of the present study was to assess the relation between female genital mutilation and obstetric outcome in an East African urban clinic with a standardized care, taking into account medical and socioeconomic status. Methods This was a cohort study conducted in Djibouti between October 1, 2012 and April 30, 2014. Overall 643 mothers were interviewed and clinically assessed for the presence of female genital mutilation. The prevalence of obstetric complications by infibulation status was included in a multivariate stepwise regression model. Results Overall, 29 of 643 women did not have any form of mutilation (4.5%), as opposed to 238 of 643 women with infibulation (37.0%), 369 with type 2 (57.4%), and 7 with type 1 mutilation (1.1%).Women with a severe type of mutilation were more likely to have socio-economic and medical risk factors. After adjustment, the only outcome that was significantly related with infibulation was the presence of meconium-stained amniotic fluid with an odds ratio of 1.58 (1.10-2.27), p-value=0.014. Conclusions Infibulation was not related with excess perinatal morbidity in this setting with a very high prevalence of female genital mutilation, but future research should concentrate on the relation between infibulation and meconium.

This article can be accessed in this LINK

Trends in female circumcision between 1933 and 2003 in Osun and Ogun States, Nigeria (a cohort analysis).

Afr J Reprod Health. 2006 Aug;10(2):48-56.

Trends in female circumcision between 1933 and 2003 in Osun and Ogun States, Nigeria (a cohort analysis).

Adeokun LA, Oduwole M, Oronsaye F, Gbogboade AO, Aliyu N, Wumi A, Sadiq G, Sutton I, Taiwo M.

Association for Reproductive and Family Health, Ibadan, Oyo State. arfh@skannet.com.ng


The international movement against female circumcision gained momentum in the past two decades. Although recent studies report decline in the practice none has studied the cohort effect or provided plausible explanation for such decline. Changes in female circumcision occurring in two southwestern States of Nigeria between 1933 and 2003 were tracked in a cross-sectional survey using cohort analysis. 1174 female live births to 413 women were included in the analysis. About fifty-three percent of all females were circumcised. The prevalence dropped from 64.9% during the period 1933-60 to 25.7% for the period 2000-2003. For first order births, the corresponding rates were 58.8% and 25.0%. The decline for first-born females comes a decade before other birth orders. Age and education of mother are two main factors of the decline. Global consensus or legal enforcement plays secondary roles. Understanding how modernisation affects the decline in female circumcision should receive greater attention.

There is no LINK to view this article online.

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

BJOG. 2002 October; 109(10): 1089–1096

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

Okonofua FE, Larsen U, Oronsaye F, Snow RC, Slanger TE


Objective To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria.

Design Cross sectional study.

Setting Women attending family planning and antenatal clinics at three hospitals in Edo State, South–south Nigeria.

Population 1836 healthy premenopausal women.

Methods The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women’s socio-demographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models.

Main outcome measures Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections.

Results Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26–0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51–2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11–2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54–5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09–2.49) and genital ulcers (OR = 4.38, 95% CI = 1.13–17.00).

Conclusion Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

This article can be accessed in this LINK

Is there an association between female circumcision and perinatal death?

Bull World Health Organ vol.80 no.8 Genebra Aug. 2002

Is there an association between female circumcision and perinatal death?

Birgitta Essén, Birgit Bödker, N-O. Sjöberg, Saemundur Gudmundsson, P-O. Östergren, & Jens Langhoff-Roos


OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. 
METHODS: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990–96 to circumcised women. 
FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. 
CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women.

This article can be accessed in this LINK

Estimating the obstetric costs of female genital mutilation in six African countries

Bull World Health Organ vol.88 no.4 Genebra Apr. 2010

Estimating the obstetric costs of female genital mutilation in six African countries

Taghreed AdamI; Heli BathijaI; David BishaiII,*; Yung-Ting BonnenfantII; Manal DarwishIII; Dale HuntingtonI; Elise JohansenI for the FGM Cost Study Group of the World Health Organization

IWorld Health Organization, Geneva, Switzerland 
IIJohns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America 
IIIAssiut University, Assiut, Egypt


OBJECTIVE: To estimate the cost to the health system of obstetric complications due to female genital mutilation (FGM) in six African countries. 
METHODS: A multistate model depicted six cohorts of 100 000 15-year-old girls who survived until the age of 45 years. Cohort members were modelled to have various degrees of FGM, to undergo childbirth according to each country’s mortality and fertility statistics, and to have medically attended deliveries at the frequency observed in the relevant country. The risk of obstetric complications was estimated based on a 2006 study of 28 393 women. The costs of each complication were estimated in purchasing power parity dollars (I$) for 2008 and discounted at 3%. The model also tracked life years lost owing to fatal obstetric haemorrhage. Multivariate sensitivity analysis was used to estimate the uncertainty around the findings. 
FINDINGS: The annual costs of FGM-related obstetric complications in the six African countries studied amounted to I$ 3.7 million and ranged from 0.1 to 1% of government spending on health for women aged 15–45 years. In the current population of 2.8 million 15-year-old women in the six African countries, a loss of 130 000 life years is expected owing to FGM’s association with obstetric haemorrhage. This is equivalent to losing half a month from each lifespan. 
CONCLUSION: Beyond the immense psychological trauma it entails, FGM imposes large financial costs and loss of life. The cost of government efforts to prevent FGM will be offset by savings from preventing obstetric complications.

This article can be accessed in this LINK

Women’s sexual health and contraceptive needs after a severe obstetric complication (“near-miss”): a cohort study in Burkina Faso

Reproductive Health 2010, 7:22

Women’s sexual health and contraceptive needs after a severe obstetric complication (“near-miss”): a cohort study in Burkina Faso

Ganaba R, Marshall T, Sombié I, Baggaley RF, Ouédraogo TW, Filippi V.

Corresponding author: Rasmané Ganaba rganaba.muraz@fasonet.bf



Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum.


Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women’s reproductive intentions.

Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso.


Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group.


Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication.

The open access article can be found in this LINK