Tag Archives: Prevalence

The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.

Female genital mutilation: implications for clinical practice

Br J Nurs. 2017 Oct 12;26(18):S22-S27. doi: 10.12968/bjon.2017.26.18.S22.

Female genital mutilation: implications for clinical practice

von Rège I, Campion D


Female genital mutilation (FGM) is an established cultural practice in over 30 countries. It has no health benefits, carries a high risk of physical and psychological harm, and is illegal in many countries including the UK. A sensitive approach is required, both in the management of complications and prevention of this practice. This article discusses the prevalence and classification of FGM, and offers practical advice to nurses and midwives involved in general and obstetric care. Legal aspects, including safeguarding responsibilities and the mandatory duty to report FGM in England and Wales, are outlined.

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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. .

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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.

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Trends and protective factors of female genital mutilation in Burkina Faso: 1999 to 2010

Int J Equity Health. 2015 May 8;14(1):42. doi: 10.1186/s12939-015-0171-1. FREE

Trends and protective factors of female genital mutilation in Burkina Faso: 1999 to 2010.

Chikhungu LC, Madise NJ


BACKGROUND: The practice of Female Genital Mutilation (FGM) is common in several African countries and some parts of Asia. This practice is not only a violation of human rights, but also puts women at risk of adverse health outcomes. This paper analysed the trends in the prevalence of FGM in Burkina Faso and investigated factors that are associated with this practice following the enactment of an FGM law in 1996.

METHODS: The study used the Burkina Faso Demographic and Health Survey (DHS) data sets from women aged 15 to 49 years undertaken in 1999, 2003 and 2010. Chi square tests were carried out to investigate whether there has been a change in the levels of FGM in Burkina Faso between 1999 and 2010 and multilevel logistic regression analysis were employed to identify factors that were significantly associated with undergoing FGM.

RESULTS: The levels of FGM in Burkina Faso declined significantly from 83.6% in 1999 to 76.1% in 2010. The percentage of women circumcised between the ages of 0 to 5 years increased from 34.2% in 1999 to 69% in 2010. Significantly more women in 2010 than in 1999 were of the opinion that FGM should stop (90.6% versus 75.1%, respectively). In 2010, the odds of getting circumcised were lowest amongst women that were born in the period 1990 to 1995 (immediately before the FGM law was enacted) compared to women born in the period 1960-1965 [OR 0.16 (0.13,0.20)]. There was significant variation of FGM across communities. Other factors that were significantly associated with being circumcised were education level, religion, ethnicity, urban residence and age at marriage.

CONCLUSIONS: Although the prevalence of FGM has declined in Burkina Faso, the levels are still high. In order to tackle the practice of FGM in Burkina Faso, the government of Burkina Faso and its development partners need to encourage girls’ participation in education and target its sensitization campaigns against FGM towards Muslim women, women residing in rural areas and women of Mossi ethnic background.

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Female genital mutilation in London and the UNICEF report; a local perspective on worldwide statistics

Arch Dis Child 2014;99:A73.

Female genital mutilation in London and the UNICEF report; a local perspective on worldwide statistics

Hodes D, Armitage A, Dykes A


Background In July 2013 the UNICEF report stated that 125 million women worldwide are affected by female genital mutilation (FGM). Despite an estimated 20,000 children at risk in the UK there is a complete absence of data on presentation in childhood and ignorance among many healthcare workers. Although, since 2003, it is illegal to take a child out of the country for FGM, there have been no prosecutions.

Aims To increase understanding of FGM by collecting and analysing details of all paediatric presentations of suspected FGM to a London clinic from 2006 onwards.

Methods Retrospective data collection on all suspected FGM cases referred to the tertiary safeguarding clinic in an inner London teaching hospital from 2006, including details of referral, history and examination findings.

Results Of 32 referrals 13 (41%) were since the start of 2013. 26 were Somali, 5 Ethiopian and 1 Malay. Common routes of referral included: healthcare workers (7), school concerns (7), siblings of cases (4) and family disputes (5). 22 (69%) were confirmed to have had FGM.

Of the 22 with FGM 15 were examined, of whom none had undergone WHO type 3 FGM (infundibulation). 10 girls (60%) had a normal or near normal examination (WHO type 4) with 5 (40%) having WHO types 1 and 2. Four children were taken from the UK after 2003 (i.e. illegally); unclear perpetrators and a lack of evidence have prevented prosecutions.

Conclusions Physical signs of FGM may be subtle and a normal examination does not exclude it. Our findings support the limited evidence from UNICEF that there is a trend toward less severe forms of FGM. WHO Type 4 without anatomical change was the commonest category in this small cohort and hence use of a revised classification (UNICEF) reflecting current practices could improve understanding of FGM and its implications for the child. Pursuing prosecution for neglect, as opposed to FGM, might be more successful in protecting children. The observed increase in referrals in 2013 supports the success of recent awareness campaigns and increases the chances of a criminal prosecution in this country.

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J Biosoc Sci. 2014 Jul 3:1-16. [Epub ahead of print]


Patra S, Singh RK.


Female genital cutting (FGC) is widely practised in Kenya. However, its prevalence has declined over the last two decades (38.0% in 1998 KDHS, 32.2% in 2003 KDHS and 27.1% in 2008-09 KDHS), implying changes in behaviours and attitudes of Kenyans towards FGC. This study provides an overview of changing attitudes of women towards FGC in Kenya. An extensive literature review was undertaken and 2008-09 Kenya Demographic and Health Survey data were used to focus on the present scenario. Analyses were based on a national sample of 2284 circumcised women. About 68% of these women wanted to discontinue FGC, and attitudes towards discontinuation were found to vary with women’s background characteristics. Surprisingly, 92.5% of circumcised women of the North-Eastern province still wished to continue FGC, and for Muslims the percentage was 72.2%. About 36% of circumcised women responded that their daughters were already circumcised. Only 13% of circumcised mothers intended their daughters to be circumcised in the future. The study shows that the attitude of Kenyan women, irrespective of their circumcision status, has been changing gradually towards the discontinuation of circumcision of their daughters.

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Female Genital Mutilation/Cutting: Will It Continue?

J Sex Med. 2014 Aug 14. doi: 10.1111/jsm.12655. [Epub ahead of print]

Female Genital Mutilation/Cutting: Will It Continue?

Mohammed GF, Hassan MM, Eyada MM.


INTRODUCTION: Female genital mutilation/cutting (FGM/C) is a prevalent, deeply rooted traditional practice in Egypt. AIMS: Specification of the motives behind the continuation of FGM/C in Egyptian community and evaluation of the sexual function in women with FGM/C.

METHODS: This cross-sectional study, involved 2,106 sexually active female participants with FGM/C. Full history-taking and general examination to evaluate the type of FGM/C were conducted. Sexual function was assessed by using the Female Sexual Function Index (FSFI) questionnaire.

MAIN OUTCOME MEASURES: Enumerate and specify the motivational factors and its percent among the participants. The correlation between FGM/C and FSFI domain scores was done with Pearson’s correlation.

RESULTS: Tradition, cleanliness, and virginity were the most common motives empowering the continuation of FGM/C (100%), followed by men’s wish, esthetic factors, marriage, and religion factors (45.2-100%). Type I FGM/C was the most common, followed by type II. There was only negative correlation between the type II FGM/C and sexual satisfaction. No statistically significant difference between type I and non-FGM/C was found.

CONCLUSIONS: FGM/C remains high. A variety of socio-cultural myths, religious misbelievers, and hygienic and esthetic concerns were behind the FGM/C. Overall, a large proportion of the participants supported the continuation of FGM/C in spite of adverse effect and sexual dysfunction associated with FGM/C.

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Collecting data on female genital mutilation

BMJ. 2014 May 13;348:g3222. doi: 10.1136/bmj.g3222.

Collecting data on female genital mutilation.

Erskine K.


Female genital mutilation is defined by the World Health Organization as “all procedures that involve partial or total removal of the external female genitalia or other injury to the female genitalia for non-medical reasons.” A horrendous form of child abuse, in its most extreme form (type 3) it involves removing the clitoris and labia and narrowing the vaginal introitus. More than 100 million women worldwide are affected.

The procedure has many complications including dyspareunia, sepsis, and death—procedure related mortality was estimated at 2.3% in one country.1 It is done for many reasons—there is no single religious basis. In some cultures a woman who has not undergone the procedure may be thought unmarriageable. In women with type 3 mutilation, the introitus may be too narrow for childbirth, and the tissues that have sealed together need to be separated; this is termed deinfibulation. Female genital mutilation was made an offence in 1985 in the United Kingdom, with a penalty of up to 14 years in prison.

A government declaration to end the practice …

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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.

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Perception and attitude of pregnant women in a rural community north-west Nigeria to female genital mutilation

Arch Gynecol Obstet. 2014 Sep 21. [Epub ahead of print]

Perception and attitude of pregnant women in a rural community north-west Nigeria to female genital mutilation.

Ashimi AO, Amole TG.


PURPOSE: Nigeria has the highest absolute number of residents who have undergone female genital mutilation (FGM) and most are carried out during infancy; however most reports on FGM are from urban based facilities hence we sought to know the perception and attitude of pregnant women residing in a rural community in northern Nigeria to FGM.

METHODS: A descriptive cross sectional study utilized a pretested structured interviewer administered questionnaire to assess the types of FGM known, reasons for performing it and willingness to support or perform FGM among 323 pregnant women attending antenatal care in two different health facilities.

RESULTS: Of the 323 respondents, 256 (79.3 %) were aware of the practice and the common varieties of FGM known to them were Gishiri cut in 137 (53.5 %) and Angurya cut 113 (44.1). The notable reasons for carrying out FGM in the community were tradition 88 (34.4 %), to ease difficulty in childbirth 69 (26.9 %) and better marriage prospect in 55 (21.5 %). Of the respondents that were aware of FGM; 100 (39.1 %) have experienced it and 55 (21.5 %) of those aware of it would subject their daughters to the procedure. There was statistically significant association between willingness to mutilate daughters by the respondents type of education (p = 0.014) and the type of facility they were receiving antenatal care (p = 0.001).

CONCLUSION: FGM is prevalent in this community with Gishiri cut being the commonest variety. It is often associated with difficult childbirth and many women would subject their daughters to this practice. Female education and empowerment is crucial to discontinuation of this practice.

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