Tag Archives: Cross-Sectional Studies

Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.

Labor, delivery and postpartum complications in nulliparous women with female genital mutilation admitted to Karamara Hospital

FREEEthiop Med J. 2017 Jan;55(1):11-7.

Labor, delivery and postpartum complications in nulliparous women with female genital mutilation admitted to Karamara Hospital.

Gudu W, Abdulahi M.


Objectives: To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM. Methods: A prospective hospital based study using structured questionnaire was conducted between January to March 2015 at Karamara hospital, Jijiga, Ethiopia. All nulliparous women admitted for labor and delivery were included. Data were collected regarding circumcision status, events of labor, delivery; postpartum and neonatal outcomes as well as attitude of mothers towards elimination of FGM/C. Results: Two hundred sixty four (92.0%) of the women had FGM/C with most (93.0%) undergoing Type III FGM. The mean age of the women was 22 yr. Failure to progress in 1st stage and prolonged 2nd stage of labor occurred in 165 (57.0%) and 189 (65.6%) of the cases respectively. Caesarean section was performed in 17.0% and instrumental delivery in 23.0%. 64.5% required episiotomies, 83.3% had an anterior episiotomy, 29 % had perineal tears, 25.7%% experienced post-partum hemorrhage and 24% postpartum infection. Among the newborns, there were 6.4% perinatal deaths; 18.8 % low birth weight and 1.5% birth injuries. Almost all complications were more frequently seen in circumcised compared to non-circumcised women. Conclusions: The prevalence of FGM is high and it substantially increases the risk of many maternal complications. Health professionals should be aware of these complications and support/care of women with FGM should be integrated at all levels of reproductive health care provision. Capacity building of responsible health professional should be initiated in the area with intensification of FGM eradication activities.

This article can be accessed in this LINK

Sexual Function, Mental Well-being and Quality of Life among Kurdish Circumcised Women in Iran.

FREEIran J Public Health. 2017 Sep;46(9):1265-1274.

Sexual Function, Mental Well-being and Quality of Life among Kurdish Circumcised Women in Iran.

Daneshkhah F, Allahverdipour H, Jahangiri L, Andreeva T


BACKGROUND: Female genital mutilation is an intentional inhumane procedure that threatens girls and women’s health. It is especially widespread in developing countries due to cultural, traditional and religious preferences. The aim of the current study was to investigate how circumcision affects women’s sexual function. METHODS: This cross-sectional study was conducted in the urban and rural area of Piranshahr County, Iran, in 2015 among convenience samples of 200 women, 15-49 yr old, who were applying to health care centers for receiving routine health care services. Data collection was conducted with the use of a self-administered written questionnaire to assess female sexual function, mental well-being, and quality of life. RESULTS: Significant differences were found between circumcised and non-circumcised women in total score of female sexual function index (FSFI) in domains of desire, arousal, vaginal moisture, orgasm, satisfaction, and pain [(P<0.001), MD(95%CI)=5.64(3.64 to 7.64)] and based on Hotelling’s T-square, significant differences were found in dimensions of quality of life and FSFI. CONCLUSION: The revealed sexual dysfunction among mutilated women gives ground to require that public health systems take actions aimed at implementing special sexual education program to improve sexual functions of mutilated women and changing beliefs and social norms in the community level.

This article can be accessed in this LINK

Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study.

Am J Obstet Gynecol. 2017 Jul;217(1):62.e1-62.e6. doi: 10.1016/j.ajog.2017.02.044. Epub 2017 Mar 3. Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study.

Rouzi AA, Berg RC, Sahly N, Alkafy S, Alzaban F, Abduljabbar H.


BACKGROUND: Female genital mutilation/cutting (FGM/C) is a cultural practice that involves several types of removal or other injury to the external female genitalia for nonmedical reasons. Although much international research has focused on the health consequences of the practice, little is known about sexual functioning among women with various types of FGM/C. OBJECTIVE: To assess the impact of FGM/C on the sexual functioning of Sudanese women. STUDY DESIGN: This is a cross-sectional study conducted at Doctor Erfan and Bagedo Hospital, Jeddah, Saudi Arabia. Eligible women completed a survey and a clinical examination, which documented and verified women’s type of FGM/C. The main outcome measure was female sexual function, as assessed by the Arabic Female Sexual Function Index. RESULTS: A total of 107 eligible women completed the survey and the gynecological examination, which revealed that 39% of the women had FGM/C Type I, 25% had Type II, and 36% had Type III. Reliability of self-report of the type of FGM/C was low, with underreporting of the extent of the procedure. The results showed that 92.5% of the women scored lower than the Arabic Female Sexual Function Index cut-off point for sexual dysfunction. The multivariable regression analyses showed that sexual dysfunction was significantly greater with more extensive type of FGM/C, across all sexual function domains (desire, arousal, lubrication,
orgasm, satisfaction, and pain) and overall. CONCLUSION: The study documents that a substantial proportion of women subjected to FGM/C experience sexual dysfunction. It shows that the anatomical extent of FGM/C is related to the severity of sexual dysfunction.

This article is available in this LINK

Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants – a cross-sectional study in Sweden

Reprod Health. 2017 Aug 8;14(1):92. doi: 10.1186/s12978-017-0351-0.FREE

Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants – a cross-sectional study in Sweden

Wahlberg A, Johnsdotter S, Ekholm Selling K, Källestål C, Essén B


BACKGROUND: Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden. METHODS: In a cross-sectional design, attitudes and knowledge regarding FGC, and measures of socioeconomic status, acculturation, and social capital, were assessed by a 49-item questionnaire in four municipalities in Sweden. Data were collected in 2015 from 648 Somali men and women, ≥ 18 years old, of which 113 supported the continuation of pricking. Logistic regression was used for the
analysis. RESULTS: Those more likely to support the continuation of pricking were older, originally from rural areas, and newly arrived in Sweden. Further, those who reported that they thought pricking was: acceptable, according to their religion (aOR: 10.59, 95% CI: 5.44-20.62); not a violation of children’s rights (aOR: 2.86, 95% CI: 1.46-5.61); and did not cause long-term health complications (aOR: 5.52, 95% CI: 2.25-13.52) had higher odds of supporting pricking. Religion was strongly associated with the support of pricking among both genders. However, for men, children’s rights and the definition of pricking as FGC or not were important aspects in how they viewed pricking, while, for women, health complications and respectability were important. CONCLUSIONS: Values known to be associated with FGC in general are also related to pricking. Hence, there seems to be a change in what types of FGC are supported rather than in their perceived values.

This article can be accessed in this LINK

Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study

The Journal of Sexual Medicine, 2016;13 (2):226–237

Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study

Abdulcadir J, Botsikas D, Bolmont M Bilancioni A, Djema DA, Demicheli FB, Yaron M, Petignat P


Introduction: Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations. Aim: To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image. Methods: A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d’Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index). Main Outcome Measures: Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores. Results: Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d’Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores. Conclusion: Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated.

This article can be accessed in this LINK

Determinants of Elongation of the Labia Minora in Tete Province, Central Mozambique Findings of a Household Survey

African Journal of Reproductive Health. 2016; 20(2): 111-121.LMEFREE

Determinants of elongation of the labia minora in Tete Province, Central Mozambique: Findings of a household survey

Martínez Pérez G, Bagnol B, Chersich M, Mariano E, Mbofana F, Hull T, Martin Hilber A


A WHO-supported provincial-level population-based survey was conducted in 2007 to understand the determinants and implications forhealth of vaginal practices. A total of 919 women aged 18-60 were selected randomly for enrolment. This is the first population-based study of females in Tete Province, Mozambique. At some time over their lives, 98.8% of women had practiced elongation of their labia minora and a quarter (24.0%) had done so in the past month. Currently practicing women were more likely to have engaged in sex recently, and used contraceptives and condoms at last sex than women who had stopped labial elongation. Younger age, residence in rural areas and having two or more male partners were also determinants of current practice. Women commonly reported they practiced for no specific reason (62.8%). Discomforting itchiness and lower abdominal pain were more frequent in women who had stopped labial elongation than in women who were currently practicing. Although women may not report current vaginal ill health, it is possible that prospective cohort studies could uncover alterations in genital vaginal flora or other indicators of impact on women’s health. The findings of this study do not suggest that labial elongation is linked with high-risk behaviors for HIV transmission. .

This article can be accessed in this LINK

Prevalence and associated factors of circumcision among daughters of reproductive aged women in the Hababo Guduru District, Western Ethiopia: a cross-sectional study. Gajaa M1, Wakgari N2, Kebede Y3, Derseh L3.

BMC Womens Health. 2016 Jul 22;16:42. doi: 10.1186/s12905-016-0322-6.

Prevalence and associated factors of circumcision among daughters of reproductive aged women in the Hababo Guduru District, Western Ethiopia: a cross-sectional study.

Gajaa M, Wakgari N, Kebede Y, Derseh L


BACKGROUND: Female genital mutilation is currently a public health problem which needs investigation and immediate action. Ethiopia is the second-ranked African country in terms of having higher numbers of circumcised girls. This study aimed to determine prevalence and associated factors of circumcision among daughters of reproductive aged women. METHODS: A community based cross-sectional study was conducted on 610 mothers. The total sample was allocated proportionally in three randomly selected kebeles based on the number of reproductive age mothers with at least one daughter under 15 years old. A systematic random sampling technique was used to draw the respondents. A structured and interviewer administered questionnaire was used to collect data. Logistic regression analyses were used to see the association of different variables. RESULTS: Out of 610 mothers, 293 (48 %) had at least one circumcised daughter. Having a good knowledge about genital mutilation (Adjusted Odds Ratio [AOR] =0. 14, 95 % CI: 0.09-0.23), positive attitude (AOR = 0. 26, 95 % CI: 0.16-0.43), being literate (AOR = 0.50, CI: 0.28-0.91) and living in urban area (AOR = 0.30, 95 % CI: 0.17-0.51) had a lower odds of female genital mutilation. In addition, not knowing genital mutilation as a crime (AOR = 5, 95 % CI: 3.07-8.19), and being in the age group of 40-49 (AOR = 2.56, 95 % CI: 1.40-4.69) had a higher odds of having circumcised daughter. Furthermore, fathers being traditional religion followers (AOR = 0.22, 95 % CI: 0.07-0.74) had less odds of having a circumcised daughter as compared to those who follow Ethiopian Orthodox Christian. CONCLUSIONS: In this study, about half of the mothers had at least one circumcised daughter. Mothers’ knowledge, attitude, age, residence, educational status and fathers’ religion were significantly associated with female genital mutilation. Hence, convincing mothers about the ill effects of circumcision and working with religious leaders is recommended.

This article can be accessed for free in this LINK

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

S Afr Med J. 2016 Jul 4;106(8):822-3. doi: 10.7196/SAMJ.2016.v106i8.10124.

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Adeniran AS, Ijaiya MA, Fawole AA, Balogun OR, Adesina KT, Olatinwo AW, Olarinoye AO, Adeniran PI


BACKGROUND: The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C). OBJECTIVE: To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it. METHODS: A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of &lt;0.05 was taken as significant. RESULTS: Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 – 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this. CONCLUSION: Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C.

Epidemiology, Regional Characteristics, Knowledge, and Attitude Toward Female Genital Mutilation/Cutting in Southern Iran

J Sex Med. 2015 Jul;12(7):1577-83. doi: 10.1111/jsm.12938. Epub 2015 Jul 2.
Epidemiology, Regional Characteristics, Knowledge, and Attitude Toward Female Genital Mutilation/Cutting in Southern Iran
Dehghankhalili M, Fallahi S, Mahmudi F, Ghaffarpasand F, Shahrzad ME, Taghavi M, Fereydooni Asl M
INTRODUCTION: Female genital mutilation/cutting (FGM/C), also known as female circumcision, is an ancient traditional procedure that involves partial or total removal of the female external genitalia for nonmedical reasons. Although it is well described in African and some Arabic countries, data from Iran are scarce. AIM: To describe the epidemiology, regional characteristics, knowledge, and attitude toward FGM/C in Southern Iran. METHODS: This cross-sectional study was conducted during a 36-month period from 2010 to 2013 in Hormozgan, a southern province of Iran near the Persian Gulf. We included 780 women in six major rural areas of the province who referred to healthcare centers for vaccination, midwifery, or family planning services. All participants underwent complete pelvic examination to determine the type of FGM. The questionnaire consisted of several sections such as demographic and baseline characteristics, and two self-report sections addressing the knowledge and attitude toward FGM/C and its complications. Baseline sociodemographic characteristics including age, educational level, marital status, religion, and nationality were the independent variables. RESULTS: Among the participants, 535 (68.5%) had undergone FGM/C. FGM/C was associated with higher age (P = 0.002), Afghan nationality (P = 0.003), Sunni Islam as religion (P = 0.019), illiteracy (P < 0.001), and family history of FGM/C in mother (P < 0.001), sister (P < 0.001), and grandmother (P < 0.001). Ancient traditions in the area (57.1%) were mentioned as the most important factor leading to FMG/C. Urinary tract infection was the most common reported complication (60.4%). CONCLUSION: FGM/C is a common practice in rural areas of Southern Iran. It is associated with increased age, illiteracy, Sunni Islam religion, Afghan nationality, and positive family history. Lack of knowledge toward FGM/C is the main cause of its high prevalence and continuation in the area. Dehghankhalili M, Fallahi S, Mahmudi F, Ghaffarpasand F, Shahrzad ME, Taghavi M, and Fereydooni Asl M. Epidemiology, regional characteristics, knowledge, and attitude toward female genital mutilation/cutting in Southern Iran.

Intention toward the continuation of female genital mutilation in Bale Zone, Ethiopia

Int J Womens Health. 2015 Jan 9;7:85-93. doi: 10.2147/IJWH.S74832. eCollection 2015.

Intention toward the continuation of female genital mutilation in Bale Zone, Ethiopia

Bogale D, Markos D, Kaso M


BACKGROUND: Female genital mutilation (FGM) is a harmful traditional practice that is deeply rooted in Africa. It is associated with health complications and human rights violations. Research on intention for the continuation of FGM and the social determinants underpinning this practice are scarce. Therefore, this study intended to assess the intention of women toward the continuation of FGM among Bale Zone reproductive-age women.

METHODS: A community-based cross-sectional study design supplemented by qualitative methods was conducted in 2014. A total of 634 reproductive-age women were involved in the quantitative part of the study. The respondents were drawn from five randomly selected districts of Bale Zone. The total sample was allocated proportionally to each district based on the number of reproductive-age women it has. Purposive sampling method was used for qualitative study. Then, data were collected using a pretested and structured questionnaire. The collected data were analyzed by Statistical Package for Social Sciences for Windows version 16.0. Multiple logistic regressions were carried out to examine the existence of a relationship between intentions for the continuation of FGM and selected determinant factors.

RESULTS: This study revealed that 26.7% of the respondents had intention for the continuation of FGM. Religion, safeguarding virginity, tradition, and social values were the major reasons for the perpetuation of this practice. Circumcised respondents and those who were not able to read and write were ~3 (adjusted odds ratio = 2.89, 95% confidence interval = [1.33, 6.20]) and 7.58 (adjusted odds ratio = 7.58, 95% confidence interval = [3.47, 16.54]) times more likely intending the continuation of FGM than uncircumcised and those who attended secondary-level education and above, respectively.

CONCLUSION: The study shows that the intention toward the persistence of the practice is high in Bale Zone. Rural residents, those who were not able to read and write, and circumcised respondents were more likely to continue the practice.

This article can be accessed in this LINK