Tag Archives: Health Care Surveys

Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.

The relation of female circumcision to sexual behavior in Kenya and Nigeria

Women Health. 2016 Jun 29:1-18. [Epub ahead of print]

The relation of female circumcision to sexual behavior in Kenya and Nigeria.

Mpofu S, Odimegwu C, De Wet N, Adedini S, Akinyemi J

ABSTRACT

One of the reasons for the perpetuation of female circumcision is that it controls female sexuality. In this study, the authors examined the relationship between female circumcision and the sexual behavior of women in Kenya and Nigeria. Data on women who were aware of circumcision and were circumcised were extracted from the Kenya Demographic and Health Survey of 2008-09 as well as the Nigeria Demographic and Health Survey of 2008. The sample size was 7,344 for Kenya and 16,294 for Nigeria. The outcome variables were age at first intercourse and total lifetime number of sexual partners. The study hypothesis was that women who were circumcised were less likely to have initiated sex early and to have only one sex partner. Cox proportional hazards regression and Poisson regression were used to examine the relations of female circumcision and other selected variables to sexual behavior. No association was observed between female circumcision and the outcomes for sexual behavior of women in Kenya and Nigeria. The argument of sexual chastity is insufficient to sustain the perpetuation of female circumcision.

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Women’s position and attitudes towards female genital mutilation in Egypt: A secondary analysis of the Egypt demographic and health surveys, 1995-2014

BMC Public Health. 2015 Sep 10;15(1):874. doi: 10.1186/s12889-015-2203-6. FREE

Women’s position and attitudes towards female genital mutilation in Egypt: A secondary analysis of the Egypt demographic and health surveys, 1995-2014.

Van Rossem R, Meekers D, Gage AJ

ABSTRACT

BACKGROUND: Female genital mutilation (FGM) is still widespread in Egyptian society. It is strongly entrenched in local tradition and culture and has a strong link to the position of women. To eradicate the practice a major attitudinal change is a required for which an improvement in the social position of women is a prerequisite. This study examines the relationship between Egyptian women’s social positions and their attitudes towards FGM, and investigates whether the spread of anti-FGM attitudes is related to the observed improvements in the position of women over time.

METHODS: Changes in attitudes towards FGM are tracked using data from the Egypt Demographic and Health Surveys from 1995 to 2014. Multilevel logistic regressions are used to estimate 1) the effects of indicators of a woman’s social position on her attitude towards FGM, and 2) whether these effects change over time.

RESULTS: Literate, better educated and employed women are more likely to oppose FGM. Initially growing opposition to FGM was related to the expansion of women’s education, but lately opposition to FGM also seems to have spread to other segments of Egyptian society.

CONCLUSIONS: The improvement of women’s social position has certainly contributed to the spread of anti-FGM attitudes in Egyptian society. Better educated and less traditional women were at the heart of this change, and formed the basis from where anti-FGM sentiment has spread over wider segments of Egyptian society.

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Inconsistent reporting of female genital cutting status in Northern Ghana: Explanatory factors and analytical consequences

Stud Fam Plann. 2003 Sept 34(3): 200-210

Inconsistent reporting of female genital cutting status in Northern Ghana: Explanatory factors and analytical consequences

Jackson EF, Akweongo P, Sakeah EHodgson A, Asuru R, Phillips JF

ABSTRACT

Although many cross-sectional social surveys have included questions about female genital cutting status and correlated personal characteristics, no longitudinal studies have been launched that permit investigation of response biases associated with such surveys. This study draws upon the findings of a longitudinal study of women aged 15 to 49 in rural northern Ghana. The self-reported circumcision status of women interviewed in 1995 was compared with the status they reported when they were interviewed again in 2000 after the government began enforcing a law banning the practice and public information campaigns against it were launched. In all, 13 percent of respondents who reported in 1995 that they had been circumcised stated that they had not been circumcised in the 2000 reinterview; this inconsistency reached 50 percent for the youngest age group. Analysis shows that women who said they had not been circumcised are significantly younger, more likely to be educated, and less likely to practice traditional religion than are women who reported that they were circumcised. Factors that may explain these correlates of denial are discussed, and implications for research are reviewed.

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Egyptian ever-married women’s attitude toward discontinuation of female genital cutting.

Singapore Med J. 2010 Jan;51(1):15-20.

Egyptian ever-married women’s attitude toward discontinuation of female genital cutting.

Afifi M.

Department of Primary Health Care, Ministry of Health (Headquarters) Dubai, PO Box 1853, Dubai, United Arab Emirates. afifidr@gmail.com

INTRODUCTION: This study aimed to examine Egyptian ever-married women’s beliefs and attitude toward the discontinuation of female genital cutting (FGC). We also examined the significant sources of information which the women with positive attitude were exposed to the year prior to the survey. METHODS: In a national representative community-based sample of 15,573 ever-married Egyptian women, the intention to continue the practice of FGC and other sociodemographical variables were collected from the 2000 Egypt Demographic and Health Survey data. A secondary in-depth analysis was conducted on the data in order to investigate the women’s attitude and its associated factors. RESULTS: Only 12.4 percent of the sample intended to discontinue the practice. The logistic regression models showed that women with a positive attitude to discontinue the practice believed that FGC was not an important part of religious traditions, that husbands did not prefer a cut wife, and that FGC reduced sexual desire. The most significant sources of information related to a positive attitude to discontinue the practice were community discussions, the mosques or churches and the newspapers. CONCLUSION: The aforementioned sources of information are related to the social and religious aspects of women in the Egyptian community. In order to change women’s attitude toward the discontinuation of this unhealthy practice, communication rather than passive learning is needed.

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Female genital mutilation in the Sudan: survey of the attitude of Khartoum university students towards this practice.

Sex Transm Infect. 2003 Jun;79(3):220-3.

Female genital mutilation in the Sudan: survey of the attitude of Khartoum university students towards this practice.

Herieka E, Dhar J.

Bournemouth GU Clinic, Bournemouth, UK. elbushra.herieka@rbch.tr.swest.nhs.uk

BACKGROUND: Female genital mutilation (FGM) or female circumcision is the removal of variable amounts of tissue from the female external genitalia. It is practised all over the world on very young girls. This study was conducted in Sudan where FGM is a criminal offence and not a religious dictate. We assessed the knowledge, attitudes, and perceptions of this practice among Khartoum university students and compared the differences between male and female student responses.

METHODS: An anonymised detailed questionnaire was distributed among the university students. In addition to the participant’s age, marital status, course studying, details regarding their attitude, knowledge of the practice of FGM, and their own experiences were collected.

RESULTS: Of the 500 questionnaires distributed, 414 (82.8%) were returned from 192 (46%) females and 222 (54%) males. 109 (56.8%) of the female respondents were themselves circumcised.18.8% of the male students and 9.4% of the female students thought FGM was recommended by their religion. Only 90 (46.9%) female students compared with 133 (59.9%) male students thought FGM was illegal. Though 16 (8.3%) female respondents thought FGM would increase their chances of marriage, the majority, 166 (74.8%), of the male students would prefer a non-circumcised female.

CONCLUSIONS: This study shows that 109 (56.8%) female university students who responded were circumcised. Confusing religious messages and ambiguous laws seem to be responsible for the continuation of this practice. The study highlights the partnership that needs to be established between religious leaders and educationalists to end this medieval practice.

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Healthcare professionals more knowledgeable about female genital mutilation but still some way to go.

BMJ. 2012 Apr 18;344:e2744. doi: 10.1136/bmj.e2744.

Healthcare professionals more knowledgeable about female genital mutilation but still some way to go.

Relph S, Inamdar R, Singh H, Yoong W.

Clusters of cases of female genital mutilation have become increasingly common in the West owing to migration from countries where the practice is endemic The one UK study exploring healthcare professionals’ knowledge about the practice noted significant deficiencies among 45 respondents. We surveyed 79 healthcare professionals working in women and children’s health departments in north London boroughs with a high prevalence of female genital mutilation (6.3% v 1.48% nationally) to see whether knowledge had improved. They completed anonymous paper questionnaires based on the most recent guidelines from the Royal College of Obstetricians and Gynaecologists…

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No (wo)man is an island–the influence of physicians’ personal predisposition to labia minora appearance on their clinical decision making: a cross-sectional survey.

J Sex Med. 2011 Aug;8(8):2377-85. 2011 May 19.

No (wo)man is an island–the influence of physicians’ personal predisposition to labia minora appearance on their clinical decision making: a cross-sectional survey.

Reitsma W, Mourits MJ, Koning M, Pascal A, van der Lei B.

Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

INTRODUCTION: Physicians are increasingly presented with women requesting a labia minora reduction procedure.

AIM: To assess the influencing factor of personal predisposition in general practitioners, gynecologists, and plastic surgeons to labia minora appearance in relation to their willingness to refer for, or perform, a surgical labia minora reduction.

METHODS: Cross-sectional self-administered questionnaire survey. Between May 2009 and August 2009, 210 physicians were surveyed. Primary care: general practitioners working in the north of the Netherlands. Secondary care: gynecologists and plastic surgeons working in five hospitals in the north of the Netherlands.

MAIN OUTCOME MEASURES: A five-point Likert scale appraisal of four pictures showing a vulva, each displaying different sizes of labia minora, indicating a physician’s personal predisposition, manifesting as willingness to refer for, or perform, a labia minora reduction.

RESULTS: A total of 164/210 (78.1%) physicians completed the questionnaire, consisting of 80 general practitioners, 41 gynecologists, and 43 plastic surgeons (96 males, 68 females). Ninety percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society’s ideal (2-5 on the Likert scale). More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists (P < 0.01), and regarded such a woman as a candidate for a labia minora reduction procedure (P < 0.001). Irrespective of the woman’s labia minora size and the absence of physical complaints, plastic surgeons were significantly more open to performing a labia minora reduction procedure than gynecologists (P < 0.001). Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues (P < 0.01).

CONCLUSIONS: The personal predisposition of physicians (taking account of their specific gender and specialty) concerning labia minora size and appearance influences their clinical decision making regarding a labia minora reduction procedure. Heightened awareness of one’s personal predisposition vis-à-vis referral and willingness to operate is needed.

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Factors determining whether Ethiopian women support continuation of female genital mutilation

International Journal of Gynecology & Obstetrics. 2009 Dec; 107(3):232-235

Factors determining whether Ethiopian women support continuation of female genital mutilation

Masho SW, Matthews L

Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA

Abstract 

Objective To examine the factors influencing the opinions of women about whether female genital mutilation (FGM) should continue in Ethiopia.

Methods Data from questionnaire surveys of women (n=11375) collected during the Ethiopia Demographic and Health Survey were analyzed. Factors influencing the opinions of women concerning whether FGM should continue as a practice in Ethiopia were examined using multiple logistic regression.

Results Women who believed that FGM should continue were more likely to be aged 15–24years (adjusted odds ratio [OR] 1.21; 95% confidence interval [CI],1.05–1.41); rural residents (OR, 2.73; CI, 2.38–3.12); Muslim (OR, 1.98; CI,1.80–2.17); married (OR, 1.26; CI, 1.09–1.46); uneducated (OR, 2.85; CI, 2.51–3.23); circumcised (OR, 3.46 CI, 2.94–4.06); and to have had no exposure to mass media (OR,1.57; CI,1.41–1.75).

Conclusion To change the opinions of women regarding FGM, specific education and prevention programs should be designed to target these demographic groups of women.

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Impact of a communication programme on female genital cutting in eastern Nigeria

Trop Med Int Health. 2006 Oct; 11(10):1594-1603

Impact of a communication programme on female genital cutting in eastern Nigeria

Babalola S, Brasington A, Agbasimalo A, Helland A, Nwanguma E, Onah N

ABSTRACT

Objectives  This study describes a female genital cutting (FGC) elimination communication programme in Enugu State and assesses its impact in changing relevant knowledge, attitudes and behavioural intentions.

Methods  The FGC programme combined a community mobilization component with targeted advocacy and mass media activities. Data for assessing the impact of the programme derived from baseline and follow-up surveys in three intervention local government areas (LGA) in Enugu State and three comparison LGAs in Ebonyi State. An ideation model of behaviour change guided the analyses of the impact of the programme on personal advocacy for FGC, perceived self-efficacy to refuse pressure to perform FGC, perceived social support for FGC discontinuation, perceived benefits of FGC, perceived health complications of FGC and intention not to perform FGC on daughters. The analytical methods include comparing change in pertinent outcome variables from baseline to follow-up in the two study states and using logistic regression on follow-up data for the intervention state to assess the link between programme exposure and the relevant outcome indicators.

Results  The data show that while the pertinent ideational factors and the intention not to perform FGC either worsened or remained stagnant in Ebonyi State, they improved significantly in Enugu State. The logistic regression results show that programme exposure is associated with the expected improvements in all the pertinent indicators.

Conclusion  The multimedia communication programme has been effective in changing FGC-related attitudes and promoting the intention not to perform FGC.

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Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections.

Trop Med Int Health. 2005 Jan;10(1):105-15.

Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections.

Klouman E, Manongi R, Klepp KI.

Department of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. elise.klouman@medisin.uio.no

OBJECTIVES: To determine (i) the prevalence and type of female genital cutting (FGC) in a rural multi-ethnic village in Tanzania, (ii) its associated demographic factors, (iii) its possible associations with HIV, sexually transmitted infections (STIs) and infertility and (iv) to assess the consistency between self-reported and clinically observed FGC.

METHOD: The study was part of a larger community-based, cross-sectional survey with an eligible female population of 1993. All were human immunodeficiency virus (HIV)-tested and asked whether they were circumcised (n = 1678; 84.2%). Participants aged 15-44 years were interviewed (n = 636; 79.7%), and 399 (50.0%) were gynaecologically examined to screen for STIs and determine the FGC status.

RESULTS: At a mean age of 9.6 years, 45.2% reported being circumcised. In the age-group 15-44 years, 65.5% reported being cut, while FGC was observed in 72.5% and categorized as clitoridectomy or excision. The strongest predictors of FGC were ethnicity and religion, i.e. being a Protestant or a Muslim. FGC was not associated with HIV infection, other STIs or infertility. A positive, non-significant association between FGC and bacterial vaginosis was found with a crude odds ratio of 4.6. There was a significant decline of FGC over the last generation. An inconsistency between self-reported and clinically determined FGC status was observed in more than one-fifth of the women.

CONCLUSION: The data indicate that both women and clinicians might incorrectly report women’s circumcision status. This reveals methodological problems in determining women’s circumcision status in populations practising the most common type of FGC. The positive association between FGC and bacterial vaginosis warrants further investigation.

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