Tag Archives: Epidemiology

Field of medicine concerned with the determination of causes, incidence, and characteristic behavior of disease outbreaks affecting human populations. It includes the interrelationships of host, agent, and environment as related to the distribution and control of disease.

Female genital mutilation and efforts to achieve Millennium Development Goals 3, 4, and 5 in southeast Nigeria.

Int J Gynaecol Obstet. 2014 May;125(2):125-8. doi: 10.1016/j.ijgo.2013.11.008. Epub 2014 Feb 8.

Female genital mutilation and efforts to achieve Millennium Development Goals 3, 4, and 5 in southeast Nigeria.

Lawani LO, Onyebuchi AK, Iyoke CA, Okeke NE.


OBJECTIVE: To determine the prevalence of female genital mutilation (FGM), the common forms of FGM, reasons for the practice, associated obstetric outcomes, and how these have affected efforts to achieve Millennium Development Goals (MDGs) 3, 4, and 5 in southeast Nigeria.

METHODS: A prospective descriptive study of parturients in southeast Nigeria was conducted from January to December 2012. All primigravid women attending delivery services at 2 health institutions during the study period were recruited, examined, and classified using the 2008 WHO classification for FGM.

RESULTS: The mean age of the 516 participants was 27.24±4.80years and most (66.3%) had undergone FGM. Type II FGM was the most common form, accounting for 59.6% of cases. Most FGM procedures were performed in infancy (97.1%) and for cultural reasons (60.8%). Women who had undergone FGM had significantly higher risk for episiotomy, perineal tear, hemorrhage, cesarean delivery, neonatal resuscitation, fresh stillbirth/early neonatal death, and longer hospitalization, with higher risk ratios associated with higher degrees of FGM.

CONCLUSION: FGM is still a common practice in southeast Nigeria, where its association with adverse reproductive outcomes militates against efforts to achieve MDGs 3, 4, and 5.

This article can be accessed in this LINK.

Spatial modelling and mapping of female genital mutilation in Kenya.

BMC Public Health. 2014 Mar 25;14(1):276. doi: 10.1186/1471-2458-14-276.FREE

Spatial modelling and mapping of female genital mutilation in Kenya.

Achia TN.


BACKGROUND: Female genital mutilation/cutting (FGM/C) is still prevalent in several communities in Kenya and other areas in Africa, as well as being practiced by some migrants from African countries living in other parts of the world. This study aimed at detecting clustering of FGM/C in Kenya, and identifying those areas within the country where women still intend to continue the practice. A broader goal of the study was to identify geographical areas where the practice continues unabated and where broad intervention strategies need to be introduced.

METHODS: The prevalence of FGM/C was investigated using the 2008 Kenya Demographic and Health Survey (KDHS) data. The 2008 KDHS used a multistage stratified random sampling plan to select women of reproductive age (15-49 years) and asked questions concerning their FGM/C status and their support for the continuation of FGM/C. A spatial scan statistical analysis was carried out using SaTScan™ to test for statistically significant clustering of the practice of FGM/C in the country. The risk of FGM/C was also modelled and mapped using a hierarchical spatial model under the Integrated Nested Laplace approximation approach using the INLA library in R.

RESULTS: The prevalence of FGM/C stood at 28.2% and an estimated 10.3% of the women interviewed indicated that they supported the continuation of FGM. On the basis of the Deviance Information Criterion (DIC), hierarchical spatial models with spatially structured random effects were found to best fit the data for both response variables considered. Age, region, rural-urban classification, education, marital status, religion, socioeconomic status and media exposure were found to be significantly associated with FGM/C. The current FGM/C status of a woman was also a significant predictor of support for the continuation of FGM/C. Spatial scan statistics confirm FGM clusters in the North-Eastern and South-Western regions of Kenya (p < 0.001).

CONCLUSION: This suggests that the fight against FGM/C in Kenya is not yet over. There are still deep cultural and religious beliefs to be addressed in a bid to eradicate the practice. Interventions by government and other stakeholders must address these challenges and target the identified clusters.

This article can be accessed in this LINK

Estimates of female genital mutilation/cutting in 27 African countries and Yemen.

Stud Fam Plann. 2013 Jun;44(2):189-204. doi: 10.1111/j.1728-4465.2013.00352.x.

Estimates of female genital mutilation/cutting in 27 African countries and Yemen.

Yoder PS, Wang S, Johansen E.

ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA. Stan.Yoder@icfi.com


The practice of female genital mutilation/cutting (FGM/C) has been documented in many countries in Africa and in several countries in Asia and the Middle East, yet producing reliable data concerning its prevalence and the numbers of girls and women affected has proved a major challenge. This study provides estimates of the total number of women aged 15 years and older who have undergone FGM/C in 27 African countries and Yemen. Drawing on national population-based survey data regarding FGM/C prevalence and census data regarding the number of women in each country, we find that almost 87 million girls and women aged 15 and older have been cut in these 28 countries. Producing reliable figures for the number of women affected by FGM/C in these countries allows researchers and program directors to better comprehend the impact of the practice and to mobilize resources for advocacy against it.

This article can be accessed in this LINK

Female genital mutilation: potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention.

Afr J Reprod Health. 2007 Apr;11(1):33-42. FREE

Female genital mutilation: potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention.

Monjok E, Essien EJ, Holmes L Jr.

Institute of Community Health, University of Houston, Texas Medical center, Houston, TX 77030, USA


Female Genital Mutilation (FGM) which involves alteration of the female genitalia for non-medical grounds is prevalent in Sub-Saharan Africa, associated with long-term genitourinary complications, and possible HIV transmission. This mini-review aims to examine FGM and the possibility of HIV transmission through this procedure. We performed an electronic search using Medline for articles published between 1966 to 2006 for evidence of FGM practice, its complications, and the nexus between this procedure and HIV sero-positivity. The results indicate ongoing FGM practice, albeit prevalence reduction, due probably to the increasing knowledge of the consequences of FGM as a result of non-sterile techniques. Secondly, the complications of FGM are well established which include Genitourinary disorders. Further, while data is limited on HIV transmission via FGM, there is biologic plausibility in suggesting that FGM may be associated with increasing prevalence of HIV in sub-Saharan Africa. This paper recommends further studies in order to assess the association between FGM and HIV transmission.

This article can be accessed in this LINK.

The burden of reproductive-organ disease in rural women in The Gambia, West Africa.

Lancet. 2001 Apr 14;357(9263):1161-7.

The burden of reproductive-organ disease in rural women in The Gambia, West Africa.

Walraven G, Scherf C, West B, Ekpo G, Paine K, Coleman R, Bailey R, Morison L.

Medical Research Council Laboratories, Farafenni Field Station, PO Box 273, The, Banjul, Gambia. gwalraven@mrc.gm


BACKGROUND: Data on the epidemiology of reproductive-organ morbidity are needed to guide effective interventions, to set health-care priorities, and to target future research. This study aimed to find out the prevalence of reproductive-organ disease in a sample of rural Gambian women.

METHODS: A questionnaire on reproductive health was administered by fieldworkers to women aged 15-54 years living in a rural area under demographic surveillance. A female gynaecologist questioned and examined the women (including speculum and bimanual pelvic examinations). Vaginal swabs were taken to test for Trichomonas vaginalis, Candida albicans, and bacterial vaginosis, cervical smears for cytology, cervical swabs for Chlamydia trachomatis PCR and Neisseria gonorrhoeae culture, and venous blood for haemoglobin, HIV, herpes simplex virus 2, and syphilis serology.

FINDINGS: 1348 (72.0%) of 1871 eligible women took part. Reproductive-organ symptoms were more likely to be reported to the gynaecologist (52.7% of women) than to the fieldworker (26.5%). Menstrual problems, abnormal vaginal discharge, and vaginal itching were the most commonly reported symptoms. A minority of women said they had sought health care for their symptoms. The frequencies of reproductive-organ morbidity were high: menstrual dysfunction 34.1% (95% CI 29.6-39.1), infertility 9.8% (8.2-11.6), reproductive-tract infections 47.3% (43.7-51.0), pelvic tenderness 9.8% ((7.0-13.5), cervical dysplasia 6.7% (5.2-8.4), masses 15.9% (12.5-20.1), and childbirth-related damage to pelvic structures 46.1% (40.1-52.3). 948 (70.3%) women had at least one reproductive-organ disorder.

INTERPRETATION: For these rural women, whose lives depend heavily on their reproductive function, reproductive-organ disease is a large burden. In inadequately resourced rural areas, with poor education, heavy agricultural and domestic labour, and limited access to quality health care, many women are not able to attain and maintain reproductive health and wellbeing.

This article can be accessed in this LINK.

Female Genital Cutting: A Harmless Practice

Med Anthropol Q. 2003 June; 17 (2): 135-158

Female Genital Cutting: A Harmless Practice

Mackie G


A recent article in Medical Anthropology Quarterly (Obermeyer 1999) argues that the “facts ” about the “harmful effects ” of female genital cutting (FGC) are “not sufficiently supported by the evidence” (p. 79). The article suggests three further hypotheses, among others: (1) FGC may be of minimal harm because the more educated continue the practice just as much as the less educated; (2) FGC may be of minimal harm because it is so widespread and persistent; (3) FGC may be of minimal harm because the supposed link between the clitoris and female sexual pleasure is a social construction rather than a physiological reality. I challenge these hypotheses. I say that by appropriate standards of evaluation, FGC is harmful. Finally, I submit that most FGC is a proper matter of concern because it is the irreversible reduction of a human capacity in the absence of meaningful consent, [female genital cutting, harm evaluation, critical epidemiology, harmful traditional practices]

This article can be purchased in this LINK.

Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

Lancet. 2006 Jun 3;367(9525):1835-41.

Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

WHO study group on female genital mutilation and obstetric outcome, Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M.

National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia. FGMStudyGroup@who.int

Comment in Lancet. 2006 Jun 3;367(9525):1799-800.

Lancet. 2006 Aug 12;368(9535):579.

BACKGROUND: Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome.

METHODS: 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital.

FINDINGS: Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries.

INTERPRETATION: Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.

This article can be purchased in this LINK